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An analysis of six-weekly (official) covid deaths since the pandemic began around March 2020 indicates that mortality is declining, albeit at a varying pace, almost across the board after having peaked in April-June 2021. The inference is that the pandemic is either petering out, or the expected third wave is still to materialize. The third wave hypothesis has its origins in the pattern of the Spanish Flu a century ago that covid has broadly tracked. It is possible that a third wave might be averted, or at least moderated, on account of the global vaccination drive, the spread of the virus’s Delta variant notwithstanding.

This is the big picture, based on aggregated data from 32 major countries in Europe, the Americas and Asia that together account for about 70% of the global population and 87% of covid deaths (see table). Regional patterns differ, and some countries have bucked the regional trend.

Declining mortality
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Declining mortality

The six-weekly data ending 21 July 2021 shows that the decline is more marked in Europe (Russia and Ukraine excepted) and North America than in South America and Asia. The second wave also peaked earlier in Europe (between October 2020 and February 2021) and North America (December-February 2021).

South America by and large continues to show high and rising mortality. In Asia, Indonesia and Bangladesh have bucked the regional trend of falling mortality.

These differences possibly lie in the highly skewed coverage of covid vaccinations. While about half the population in most high-income countries has been fully vaccinated, low coverage in the more populous poorer countries of the world, including India (below 7%), has kept the global average under 15%.

The official global death count now exceeds 4 million. The Americas and Europe, which account for just 22% of the global population, have had 73% of all covid deaths so far. The Asian trend (Central and West Asia is aggregated with Europe on account of both proximity and similarity in trends) is dominated by India, which accounts for about three-quarters of all covid deaths in the region. At over 400,000, the third highest after the US and Brazil, it is the only country in Asia and Africa with more than 100,000 deaths. The other 10 countries are in Europe (four) and the Americas (six).

Deaths per million in India (304) are significantly lower than the global average (536), and much lower than both Europe (1,388) and the Americas (2,178). However, if India’s covid deaths in the six-week period between 21 April and 6 June 2021 are taken at around 10 times higher than the recorded figure, as a number of studies suggest, the death toll rises to around 2 million. Covid mortality, in terms of deaths per million, would then be comparable to Europe, although lower than the Americas. There may be similar undercounting in other countries with poor governance systems.

Going forward, the covid pandemic has underscored three critical issues requiring the attention of policymakers, as similar epidemics will occur in the future as well. The first issue arises out of the North-South divide. Richer countries cannot escape the negative externalities arising from poorer countries’ inability to access vaccines. A fully-funded mechanism needs to be put in place that makes vaccines available globally in an equitable and timely manner. Also, do we need differentiated strategies for poorer countries with weaker public health infrastructure and finances? If so, what might these be? The efficacy of stringent lockdowns in such countries, which cannot afford adequate fiscal support to protect livelihoods and where shutdowns often result in more overcrowding than less, needs to be revisited.

The second issue has to do with the aetiology of viral pandemics. Viruses are optimized for transmission and mutate rapidly. Therefore, they are not easy to target through vaccines. Viruses that are highly infectious are usually not very deadly, and those that are deadly, not highly infectious. But every now and then, there will be the perfect storm of a deadly highly infectious virus, like a century ago and presently. Handling such a viral pandemic has proven to be a major challenge even in rich countries with advanced public health systems. Modern science still has some way to go in learning how to deal with such viral epidemics.

The third issue has to do with mobility and pandemics. Until very recently, we humans were relatively immobile, with most people spending their entire life without venturing beyond a few kilometres of their homes. Human disease and immune systems also tended to be local phenomena. Epidemics were contained locally. This changed with the maritime and later even more dramatically with the industrial revolution that increasingly gave humans geographic mobility.

The first pandemics, the Justinian plague of the ancient world and Black Death of the medieval period, were spread through ports by ships and then reached the interiors rather slowly, if at all. New diseases carried by Europeans to the New World, against which local populations had no immunity, resulted in high mortality there. And in early industrial Britain, mortality actually rose because of heightened mobility, till public health interventions led to a decline.

The colonial era saw increased human mobility that carried diseases far into interior regions through motorized road and rail transport. The very high mortality of the Spanish Flu was not entirely on account of limitations of extant public health and infrastructure at the time, but also on account of large-scale troop movements arising from the First World War. With the increasing density of air transport across the globe, pathogens can spread globally within days. Governments across the world scrambled to close borders in a disruptive manner that had a devastating impact on economies and livelihoods. What kind of mobility protocols need to be adopted in handling pandemics that will prove least disruptive for the global economy?

Alok Sheel is RBI chair professor of macroeconomics, Indian Council for Research on International Economic Relations

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