This time a year ago, as Indian American physicians, we watched helplessly as the United States, our home, succumbed to the first wave of Covid-19. This past week, we watched our ancestral home, India, succumb to a catastrophic surge of the virus with no end in sight. As hospital beds fill, so do our WhatsApp messages with pleas from family and friends abroad who are suffering -- and dying -- amid a medical apocalypse. Our social media feeds are filled with horrifying images of Indians gasping for air rejected by hospitals devoid of oxygen and beds, mass cremations and burials and people dying in the streets

India, the world's second-most populous nation, is setting world records for the highest number of new infections, with over 400,000 new cases now being reported daily -- a number that most health experts estimate is a gross undercount. The worst is yet to come -- and the US needs to play a leading role in supporting the world's largest democracy. Given that Covid-19 is a global pandemic, the consequences for the US and the rest of the world will be devastating if we fail to immediately control India's Covid-19 crisis.

Why does the Covid-19 crisis in India affect the world?

First, as long as there is unmitigated spread in India, we enable more dangerous variants to arise, hampering our own progress in containing the pandemic. In addition to the B.1.1.7 variant that has already spread worldwide, the B.1.617 and B.1.618 variants are also now disseminating across India rapidly. These newer variants are suspected to be more transmissible and possibly able to evade prior immunity from either vaccination or prior infection. B.1.617 has already spread to over 20 countries outside of India, including the US. Each new variant threatens economic recovery and the drive toward herd immunity.

Second, India is a major supplier of vaccines and medications worldwide. India agreed to supply vaccines to low- and middle- income countries (LMICs) through Covid-19 Vaccines Global Access (COVAX). It is also a manufacturer of remdesivir, a medication routinely used to lower the morbidity of severe Covid-19. India's crisis will weaken the world's ability to fight the pandemic as multiple countries will lose a critical lifeline of vaccines and medications.

Third, America is a direct beneficiary of India's health and economic welfare. The country is a key regional economic and security ally and physicians of Indian origin have been instrumental in filling critical workforce gaps in the US and in helping to provide lifesaving care during the pandemic. India is the largest exporter of doctors to the world, providing tens of thousands of nurses and physicians to the US Investing in India is thus synonymous with investing in our own healthcare infrastructure.

How can the United States help India?

As Dr. Anthony Fauci, President Joe Biden's chief medical adviser, recently stated about India, "We really do need to do more." In addition to the recent announcement of aid by the Biden administration, the US should lead in long-term health diplomacy and planning.

As a first step, the United States should transfer all surplus vaccine doses to India and other countries in need. While we applaud the release of unused stockpile of AstraZeneca vaccine, this is just a start. The AstraZeneca vaccine is not authorized for use in the US, yet millions of doses were 'on hold.' It is not in the US' interest to hoard vaccines but instead to ensure that vaccines are equitably distributed to those countries that need them most. Global vaccine equity is egregious, with only 0.3% of global Covid-19 vaccine supply currently allocated to low-income countries.

The US should also help India and other countries manufacture vaccines, medications and supplies to beat the pandemic. The world's largest vaccine manufacturer, Serum Institute of India, tweeted a plea to lift US controls on exports of key raw materials for vaccine production. The recent US commitment to send raw materials and aid to India is a necessary start to address some of India's immediate Covid-19 needs. Far more is needed, however, beyond supplies of PPE, critical oxygen, and monetary donations during this unprecedented crisis. To help end the global pandemic, the US must also back a patent waiver, allowing India and other LMICs to produce their own Covid-19 vaccines via enhanced collaboration with other countries, increased funding from pooled resources, and technology transfer and assistance from existing suppliers. In addition, aid is needed for these countries to have tools for rapid and diagnostic RT-PCR testing and genomic sequencing for emerging variants.

Lastly, US political leaders must call on Prime Minister Narendra Modi to institute stricter mitigation measures to curb the spread of Covid-19 and call for greater transparency in reporting cases and deaths. We are too familiar with the devastating effects from a former administration that suppressed critical information, minimized pandemic severity and overlooked the scientific community's advice. Without further mitigation, India's projections for cumulative Covid-19 death totals will surpass the US total very soon. While the US has begun to restrict travel from India, we must remember that a travel ban cannot end a global pandemic.

As the world hits its highest numbers of Covid-19 cases, with one-third from India, the US must lead in global health diplomacy to end the pandemic.

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