Week of Monday, May 17, 2021 | Issue 14
Hayden Cribbon, PACOM Team
People following social distancing norms in India
Date: May 17, 2021
Parties involved: Indian Government, Indian healthcare system, Indian general public
The event: On May 17, India recorded 4,529 deaths, the single highest COVID-19 daily death toll in any country so far. Despite the record-breaking number of deaths, experts believe that the actual numbers are considerably higher, with many Indians in rural and poverty-stricken areas likely dying from COVID-19 but not being officially recorded. India is currently in the grip of one of the worst waves of the pandemic experienced anywhere in the world, with the country recording over 25 million cases and over 280,000 deaths. The pandemic has not only had a devastating impact on India’s healthcare system but the implications for the nation’s economy, domestic security and geo-poltical situation will also be severe and far-reaching.
India is the fifth largest economy in the world and contributes significantly to world economic growth. Certain industries and even the economies of entire nations have grown dependent on India. India’s impact on the world’s economy was evidenced even before the pandemic, with the IMF citing India’s middingly output as the main reason for sluggish world growth figures in 2018 and 2019. Clearly, India’s 2020 and 2021’s economic performance is also going to be greatly diminished, and while many other of the world’s major economies continue to face COVID related issues, the hope that 2021 would be a year for economic recovery is all but gone.
Across the world, anti-establishment groups have propagated conspiracy theories related to the origin and governmental handling of the virus. These conspiracy theories are promoted by organizations such as terrorist, revolutionary and criminal networks that have a vested interest in advancing the distrust and disharmony between the population and the government. A common conspiracy promoted by such groups relates to the Chinese Government artificially manufacturing the COVID virus in order to disrupt and damage its competitors/enemies. Given the discontent towards China already present within India’s population due to northern border conflicts, anti-establishment groups may have a dangerous opportunity to effectively spread this message towards susceptible individuals and start to sow seeds of hatred which may actualise with attacks on Chinese individuals and communities within India.
However, the current desperation in India may be capitalized on by the US to help further cement a strategic partnership between the two countries. The Biden administration has already pledged to send USD 100 million worth of medical supplies, including oxygen, vaccine materials, and therapeutics to India. In 2020, the US and its regional allies (Australia, Canada and Japan) signalled their interest in securing India as an ally or close partner through the Quadrilateral Security Dialogue (QUAD) so as to counter China’s growing threat. Historically, India has remained neutral in US affairs in Asia. However, the country’s sovereignty could be threatened by China’s assertiveness. The COVID crisis gives the US the opportunity to show India that they are fully committed and loyal to the partnership and in turn increase the trust between the two countries.
COVID-19 has proven to be a very challenging time for law enforcement and policy-makers in India. This is because while COVID brings up issues relating to workplace displacement, the vast majority of Indian authorities are also singularly focused on fighting the pandemic. Adversary groups could take advantage of this vulnerable situation and increase nefarious activities in volume and severity. This could be particularly relevant to technical infrastructure like cyber networks and computer systems made vulnerable by the disruption of normal practices in both government and private organizations. Therefore, the COVID-19 crisis could also bring an exponential hike in cybercrimes. The recent hacking on Air India seems to confirm this hypothesis.
Date: May 21, 2021
Parties involved: Indian Government, Indian healthcare system, Indian COVID-19 patients
The event: On May 20, India declared a “black fungus” epidemic in five states. Healthcare professionals have witnessed a spike in a normally rare deadly disease known medically as Mucormycosis. The disease has a 50% mortality rate and it usually infects people whose immune system has been compromised, causing blackening or discoloration over the nose, blurred or double vision, chest pain, breathing difficulties and coughing blood. This normally rare disease is able to actively spread through hospitals and clinics housing COVID patients. Doctors believe that the use of steroids to treat severe COVID-19 could be causing the surge in cases, as steroids commonly reduce the immunity levels of patients. Furthermore, drugs that would be usually used to treat black fungus are in short supply due to the demands on the healthcare system and the disruption to supply chains.
In a matter of weeks the black fungus has spread in many parts of India, with five states (Tamil Nadu, Odisha, Gujarat, Rajasthan and Telangana) declaring an epidemic and more states are expected to follow. Many medical experts believe that infection can occur if clean masks are not worn and the rooms are poorly ventilated. Therefore, nations and populations with ill-equipped healthcare systems are more likely to suffer from the disease. Given India’s proximity to developing nations in South-East Asia, the disease may have an increased chance of spreading throughout the region. Given the steep rise in COVID cases in neighboring Nepal, the country may also be at an increased risk of the black fungus disease as the nation’s healthcare system and resources may be possibly stretched to breaking point.
The emergence and inability of Indian healthcare professionals to treat the black fungus disease is symptomatic of the potential issues that could arise due to the stalling of medicine supply chains of Indian pharmaceutical companies. India has a large pharmaceutical industry and the Serum Institute of India is the main single supplier to the Covax scheme. However, India still relies on other countries, notably China, to supply active pharmaceutical ingredients (APIs). China is the largest supplier of APIs to India, accounting for over 70% of India’s imports in 2019. When the company responsible for cargo flights exporting APIs from China to India announced they were suspending their service due to COVID fears, there were grave concerns about how this would affect the global pharmaceutical supply chain. In the short term this has driven up the cost of basic medical supplies for a healthcare system already crippled by the COVID-19 pandemic. In the medium term, this has the potential to turn normally banal medical conditions into life-threatening situations.
The Covax vaccine scheme is 140 million doses short because of India's continuing COVID crisis. The Covax scheme is an initiative led by the World Health Organization to ensure equality and equity in the distribution of COVID vaccines. The scheme aims at vaccinating at least 20% of the population in all countries worldwide. The Serum Institute of India (SII), the largest single supplier to the Covax scheme who was meant to supply half of the vaccines, has made none of its planned shipments since exports were suspended in March. This disruption to an integral part of the Covax scheme will endanger populations in developing countries. As witnessed in India, COVID-19 is able to ravage societies with overwhelmed public health systems. Therefore, if Covax is unable to protect vulnerable regions in South America, Africa and Asia the damage may be severe and long lasting.
 The Strategic Consequences of India’s COVID-19 Crisis, Council on Foreign Relations, April 2021, https://www.cfr.org/blog/strategic-consequences-indias-covid-19-crisis
 India’s pharma industry reevaluating reliance on China APIs, BioWorld, March 2021, https://www.bioworld.com/articles/504236-indias-pharma-industry-reevaluating-reliance-on-china-apis
 Covax, World Health Organisation, 2021, https://www.who.int/initiatives/act-accelerator/covax