Black Fungus Adds to India's Woes
As India continues to battle COVID-19, it now gears up to battle with another disease - Black Fungus.
Hi there, I’m Aman Thakker. Welcome to Indialogue, a newsletter analyzing the biggest policy developments in India. The aim of this newsletter is to provide you with quality analysis every week on what’s going on in India.
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India Deals with a New Epidemic - Black Fungus
As India continues to battle its second wave of COVID-19 infections, a new disease has recently come to the forefront that is adding a new dimension of stress to India’s health systems. That disease is black fungus.
So what is black fungus? What do we know about what is causing it? And what does it mean for India’s ongoing battle against COVID-19.
Black fungus, or mucormycosis, is an extremely rare infection. The cause of the disease is mold found in damp environments like soil or compost. This mold is not usually harmful for most people. In fact, one Mumbai-based doctor said “It is ubiquitous and found in soil and air and even in the nose and mucus of healthy people.”
However, the mold can cause serious infection for people with underlying health conditions, such as those who are immunocompromised, diabetes patients, HIV/AIDS patients, and cancer patients. The infection then attacks the respiratory tract, the brain, and the lungs, potentially causing life-threatening health issues.
So far, from what we know, there have been more than 7,200 reported cases of black fungus from across India. Half of these cases have been reported in Maharashtra and Gujarat, with additional states like Madhya Pradesh, Haryana, and Telangana reported cases as well.
Several states have so far declared as an epidemic, and the central government has not only asked all of India’s 28 states to declare the disease as an epidemic, but also report all cases of the disease to the center’s Ministry of Health and Family Welfare. Moreover, this past Friday, on May 21, Prime Minister Modi discussed the disease in a public interaction, saying “In recent days we have a new challenge of Black Fungus. It is important to prepare systems to tackle it… We should focus on precautions against black fungus and step up efforts to deal with the challenge.”
Initial information about the cause of the disease shows that there is a link to COVID-19 infections. Doctors have said that recovered and recovering COVID-19 patients, and particularly those that were on steroids, were at risk to get the disease because steroids and other COVID-19 treatment drugs “suppress [the patients’] immune response.” Dr. Hemant Thacker of Breach Candy Hospital in Mumbai said “The fungus takes the window of opportunity, invades the body… This body has a small opening because of Covid, because of the sugars (high glucose levels), because of the antibiotics -- because of so many other things, (black fungus) gets a foothold.”
Others have also suggested that use of ventilators and humidifiers in COVID-19 and intensive care wards in hospitals could be creating the conditions for the fungus to grow and spread. COVID-19 patients undergoing oxygen therapy may be getting exposed to humidity and moisture, making them more prone to fungal infection, said the ministry.
However, it should be noted that this information is still preliminary, and the medical community insists that not every patient being treated for COVID-19 will be at risk for black fungus. The disease remains quite uncommon among those who do not have diabetes. However, in India, which has the second-highest levels of diabetes in the world, doctors are concerned that still means many are at risk.
A recent study by Indian microbiologists published in the Microorganisms medical journal in March 2021 found that India continued to struggle with a rate of “uncontrolled diabetes,” and that many of the patients of black fungus they studied (which do include the recent spike infections) did not even know they had diabetes until they were diagnosed with black fungus.
So how can it be treated? In cases where the infection is caught early, doctors can prescribe injections of Amphotericin-B or “ampho-B,” which must be administered every day for up to eight weeks. However, in more serious cases, surgery is required to cut away dead and infected tissue, leading to patients losing their jaw or their eye.
However, what’s become clear is that India is now running short of medication to deal with black fungus. News reports suggest that Delhi and Maharashtra are already facing shortages of Amphotericin-B. The cost of treatment is also expensive, for both injections as well as for surgery if either injections are not procured in time or if the infection is detected late. States such as Maharashtra, however, are taking steps to reduce the cost, making injections of Ampho-B and other treatments free for patients.
The Delhi High Court, on May 20, instructed the central government to procure Amphotericin-B from “wherever it is available in the world … time is at a premium and so are human lives.” The government is already taking steps to provide licenses to additional domestic manufacturers to scale up production of the injection.
It is important to reiterate that there is not yet cause for panic regarding black fungus. Cases remain rare for healthy individuals, and the declaration of an epidemic at this stage is geared towards ensuring greater awareness of the disease, its causes, its treatments, and its prevention among India’s medical community. However, what is clear that the emergence of thousands of cases of a new disease is only going to add additional stress to India’s already-strained public health care system.
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Understanding India’s Vaccine Procurement Pipeline
The Government of India announced its procurement pipeline for COVID-19 vaccines from August - December 2021 to boost confidence that India would be able to vaccine its population.
Per the government, India will procure a total of 2 billion doses in a period of five months (you can see the data yourself from the Government’s press conference here, beginning at the 29:46 mark). The breakdown by vaccine is as follows:
Approved Vaccines
Covishield: 750 million doses (avg. 150 million doses per month)
Covaxin: 550 million doses (avg. 110 million doses per month)
Sputnik: 156 million doses (avg. 31.2 million doses per month)
Likely to be approved vaccines:
NOVAVAX: 200 million doses (avg. 40 million doses per month)
Bio E Sub Unit Vaccine: 300 million doses (avg. 60 million doses per month)
Zydus Cadilla: 5 million doses (avg. 1 million doses per month)
Bharat Biotech Nasal Vaccine: 100 million (avg. 20 million doses per month)
Gennova mRNA Vaccine: 6 million doses (avg. 1.2 million doses per month)
However, ensuring this kind of pipeline of vaccines will require a significant boost in production capacity from where things stand today.
Covishield production capacity is currently at 65 million doses per month, and is expected to rise to 100 million per month by July.
However, that is still 2/3rds of the 150 million doses per month expected under the procurement pipeline outlined above.
Covaxin production capacity is currently at 20 million doses per month, and is expected to rise to 55 million per month by July.
However, that is only 1/2 the 110 million doses per month expected under the procurement pipeline outlined above.
News Roundup
Vijaita Singh of The Hindu reports that “There was a minor face-off between Indian and Chinese troops in the no-patrolling zone at Galwan Valley in Eastern Ladakh in the first week of May.” The incident, however, did not lead to a clash and both sides were able to disengage quickly. However, official statements from the Indian Army say that no such “minor face-off” took place.
The Ministry of Home Affairs announced it has relaxed some restrictions for Indian non-governmental and non-profit organizations under the Foreign Contribution (Regulation) Act, 2010 (FCRA), in two public notices issued on May 18, 2021. In the first notice, the government announced that non-profits with registration certificates expiring on or after September 29, 2020 up to September 30, 2021. In the second notice, the government announced it would extend the deadline for non-profits to open accounts with the New Delhi Main Branch of the State Bank of India to receive funds from outside of India under the FCRA to June 30, 2021. After that date, however, NGOs and non-profits will not be able to accept overseas funds in any account except the SBI account.
The Ministry of External Affairs announced that External Affairs Minister Dr. S. Jaishankar will visit the United States from May 24-28, 2021. During his visit, the Minister will meet with the United Nations Secretary General Antonio Guterres in New York, as well as Secretary of State Blinken and other senior Biden administration officials in Washington, D.C.
The Reserve Bank of India announced it has appointed Rajesh Bansal, an expert in electronic cash transfers and digital financial services, as the Chief Executive Officer of the Reserve Bank Innovation Hub. The function of the Reserve Bank Innovation Hub is to “test potential new capabilities, opportunities in technology and leverage on the same to create viable products or services and enable their adoption for wider reach and greater impact across the country.”
The Government of India and the Sultanate of Oman have renewed the Memoranda of Understanding (MoUs) signed between the two countries on military cooperation as well as on maritime issues on May 20, 2021.
Three to Read
From cogent analysis to potentially big news that you should keep an eye on, here are a few commentaries and other pieces of writing that I found particularly enlightening:
Dr. Sumit Ganguly, distinguished professor of political science and the Rabindranath Tagore chair in Indian cultures and civilizations at Indiana University, Bloomington, and Dr. Nicolas Blarel, associate professor of international relations at the Institute of Political Science at Leiden University, write: “In a tweet last week, T.S. Tirumurti, India’s permanent representative to the United Nations, said that India condemned “all acts of violence, especially rocket attacks from #Gaza.” On the face of it, the statement may have seemed like relatively banal comment coming after days of violence in Israel and the Gaza Strip. But for close watchers of the India-Israel relationship, it was nothing short of intriguing, underscoring how the Indo-Israeli partnership has evolved since the Cold War’s end. Throughout the Cold War, India had almost unequivocally supported the Palestinian cause and had kept Israel at a studied distance. But in this statement, it went out of its way to single out the rocket attacks from the Palestinian side. In turn, it underscored the difficulty that Indian diplomacy is faced with in striking a balance.”
Dr. Manjari Chatterjee Miller, associate professor at the Pardee School at Boston University, argues: “There is no question, India should have first supplied its own population before exporting doses. But, in principle, the idea of India deepening its footprint in Africa through a vaccine strategy was forward-thinking, and were India not struggling domestically today to vaccinate its own population, could have paid dividends. Although India has immense social capital among African nations, it has not matched this in material ties, and China’s economic and investment presence in Africa has been outstripping India’s for many years.”
Tauseef Shahidi and Pramit Bhattacharya, data journalists at Livemint, write: “For the second month in a row, India has outperformed other large emerging markets, the latest update to Mint’s emerging markets tracker shows. China follows close behind India on the rankings. Chart-busting export growth, high levels of manufacturing activity, and relatively moderate retail inflation in April pushed up India’s ranks in the league tables despite a selloff by foreign equity investors that pulled down both stock market capitalization and the rupee… For now, the Indian economy remains a one-trick pony, relying largely on the rebound in global demand to stay afloat.”
Thanks for reading this latest edition of Indialogue. Please let me know if you have any thoughts or feedback by emailing me at aman@amanthakker.com.