WHO warns of rising coronavirus deaths, but India is safer as vaccination works wonders.

New waves of coronavirus (COVID-19) infections are underscoring that the pandemic is nowhere near over yet. It is marked by a worrisome upward trend in deaths that could morph into new crises.

Increasing COVID-19 cases are not only putting further pressure on already stretched health systems and workers but also triggering an “increasing trend of deaths”, said World Health Organization (WHO) chief Tedros Adhanom Ghebreyesus.

The WHO’s Emergency Committee on COVID-19 concluded last week that the pandemic remains a “Public Health Emergency of International Concern” partly because sub-variants of Omicron, like BA.4 and BA.5, continue to drive waves of cases, hospitalization and deaths.

“The virus is running freely and countries are not effectively managing the disease burden based on their capacity, in terms of both hospitalization for acute cases and the expanding number of people with post COVID-19 condition – often referred to as long-covid,” Tedros warned.

Importantly, diagnostics, treatments and vaccines are not being deployed effectively and there is a major disconnect in COVID-19 risk perception between scientific communities, political leaders and the general public, especially in the US.

Against this risk-laden backdrop, India, the country that suffered most grievously in the pandemic’s early stages, is now reaping the benefits of massive nation-wide vaccination campaigns.

Unlike China, the Indian government did not block people’s lives through draconian lockdowns except at the pandemic’s start when there were no vaccines. It got through subsequent crises using only vaccines manufactured in India.

About 80% of vaccinations were with AstraZeneca (called Covishield in India), which was designed at Oxford University but manufactured in India. The others, Covaxin and Corbevax, were entirely Indian developed and made. Russia’s Sputnik V was also used.

On 17 July, India celebrated 2 billion vaccinations including booster doses and is continuing the momentum. WHO has recognized some of the India-made vaccines as being effective but has still not approved Sputnik V for use outside Russia.

Instead, it has put its significant international influence behind the messenger RNA (mRNA) vaccines made by Pfizer and Moderna, which are also being recommended by the US and European medical authorities.

The Indian experience suggests that mRNA vaccines are not the only ways to move forward. Other vaccines, which are much cheaper and do not require complex cold storage protocols, are also effective. There is evidence now that mRNA vaccines lose efficacy quickly and patients need at least two booster shots after the original two shots.

Perhaps a new generation of mRNA shots under development will be able to fight all variants of the original coronavirus strain and have longer lasting effects. Meanwhile, the Indian experience may be worth emulating both for vaccines that are easier to use and for running mass vaccination campaigns in very difficult conditions.

The Indian experience also offers an alternative to China’s draconian zero-covid lockdowns that have stymied its economy and may accelerate economic recession in Europe and around the world.

Some 260 million people across 41 cities are affected by lockdowns or local controls in China currently, the Japanese bank Nomura estimated. The damage wrought by China’s zero-covid policy is evidenced by the 0.4% rise in GDP in the second quarter compared with a year earlier.

India, with 1.35 billion people, has lifted most Covid-related restrictions, international travel is recovering robustly and its economy is reported to be fastest growing in the world, according to several experts including the World Bank.

WHO’s Tedros emphasized risk factors for coronavirus resurgence noting that surveillance has reduced significantly, including testing and sequencing. That makes it increasingly difficult to assess the impact of variants on transmission, disease characteristics, and the effectiveness of counter-measures.

There is a dual challenge of communicating risk and building community trust in health tools and public health social measures like masking, distancing and ventilation. India seems to have overcome some of these hurdles, especially by persuading people to accept vaccination.

Reluctance to be vaccinated is still a major obstacle in the US. The coronavirus is surging again across the US as BA.5, the most transmissible coronavirus variant yet. Fortunately, the wave of new cases is cause for caution, not alarm, because hospitalizations have increased by only 20% in the past two weeks and deaths are increasing very modestly.

However, risks are rising because most Americans are meeting warnings with a collective shrug. That would matter less if more of them accepted vaccination. The BA.5 strain is four times more resistant to mRNA vaccines, including Pfizer and Moderna, according to a new study cited by the Mayo Clinic’s Vaccine Research Group.

Unvaccinated people have about a five times higher chance of contracting the virus than those who are vaccinated and boosted. Chances of hospitalization are 7.5 times higher, and chances of death are 14 to 15 times higher, the Group’s chief Gregory Poland said.