If South Asia’s pandemic isn’t addressed as a whole, India’s COVID-19 crisis could be just the beginning

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Veena Sriram is an assistant professor at the University of British Columbia. Sara Shneiderman is an associate professor at the University of British Columbia. Drona Rasali is an adjunct professor at the University of British Columbia. Md Zabir Hasan is a postdoctoral research fellow at the University of British Columbia. Shashika Bandara is a global health policy doctoral student at McGill University.

We are living through a critical turning point in the COVID-19 pandemic. While rich countries celebrate newly gained freedoms due to vaccinations, South Asia and South America are experiencing some of the worst health crises in recent memory. South Asia, a region with a combined population of nearly 2 billion people, is intensely vulnerable, as the crisis in India has exposed. The country has pushed past 250,000 officially reported deaths this week, and cases continue to spread in both urban and rural areas of the country. The images of funeral pyres and desperate pleas for oxygen do not fully capture the severity of the moment.

The media spotlight on India masks an even more troubling picture when we consider South Asia as a whole. Nepal and Sri Lanka are reporting their highest daily case rates since the beginning of the pandemic, with Nepal facing its own calamitous shortage of beds and oxygen. Authorities in Pakistan are bracing for a potential increase in the near future, after holiday gatherings. Bangladesh had reported steady declines after a second nationwide lockdown, but there has been a recent and worrisome uptick in cases. The exception in the region is Bhutan, which has immunized 93 per cent of its adult population as of mid-April – but the continuation of trade as well as deep-rooted socio-economic connections between people across the region maintains risks of exposure unabated, despite official border closings

Countries across the region face manifold challenges in accessing vaccines, therapeutics, and other public health measures. Bangladesh, for example, is set to run out of its AstraZeneca stock due to a halt in Indian exports. Nepali civil society groups have started petitions to the U.S. government to share its vaccine supply urgently, in addition to the US$10-million that it has already pledged – requests considered at Wednesday’s Senate Foreign Relations Committee Hearing. Pakistan is grappling with high price points for vaccines, putting them out of reach for the majority of the country’s population.

This is not the time for siloed, fragmented approaches. A coordinated, regional approach to combating the COVID-19 pandemic is urgently required in South Asia. Lives in one country are no more precious than lives in another, and the regional spread of COVID has major repercussions for all countries, in Asia and beyond. Canada, for its part, has announced an aid package in response to the crisis in India, and building on this, we urge Canada, and South Asian diaspora organizations within it, to act quickly to adopt a broader regional focus. That will require a coordinated response that focuses on supplies and management, and on learning from response coordination, channelling technical assistance and other resources, and collectively pressuring regional governments to prioritize public health.

While a huge amount of vaccine supply is being appropriately targeted to India, the need is no less desperate in Nepal. The country now has one of the world’s highest test positivity rates, at nearly 50% and hospital beds and oxygen have run out in many parts of the country. Pakistan, Bangladesh, and Sri Lanka must also have enough stock for current or potential surges. We are optimistic about the Canadian government’s recent decision to consider a TRIPS waiver for intellectual property related to the COVID-19 vaccine, and strongly urge active support for the waiver during negotiations. Vaccine equity in the region and globally is the only way to truly end this pandemic, and the Canadian government can and must embrace a proactive strategy on vaccine equity through all possible mechanisms.

Many South Asian countries have large, vibrant diasporas in North America, some of which are working to support rapid response networks in their countries of origin. As one example, Nepali and Indian diaspora organizations have recently sent open letters to the Canadian government requesting stronger, more coordinated responses to the crisis. We believe there is major scope between these groups for learning, support and solidarity, and the Canadian government can take direction from these organizations to develop their own coordinated responses.

Academic and research institutions in Canada and the U.S. – many of which have developed large health research, development, and humanitarian infrastructures in each of these countries - also can and should support colleagues on the ground. Engaging in response efforts within these countries is imperative if we do not want to see this crisis further escalate to other parts of Asia and beyond, as some fear it might have already. Technical assistance to increase COVID-19 diagnostic testing, provide relevant machines to collaborators, and deploy institutional channels as megaphones to bring attention to the crisis in South Asia are all important.

As in previous epicentres of the pandemic, political determinants and a lack of meaningful proactive government measures have had dire consequences in South Asia. The insistence of particular groups in India in holding large religious gatherings and election rallies, the Sri Lankan government’s policies to reduce testing and ease public health restrictions during the April New Year season, the Nepali government allowing weddings to continue, and a lack of transparency in vaccine procurement highlights the policy incoherence that has resulted in the current situation. South Asian diaspora members with influence in their home countries should collectively pressure their governments to prioritize public health at this time of crisis, and communicate effectively to the public to minimize misinformation.

The escalating crisis in South Asia demands that Canada and its South Asian community build on existing efforts to present a united fight against the pandemic. These countries have the capacity to overcome this challenge, and collectively, our chances are much stronger. The crisis gets worse every single day, and we have no time to waste.

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