India, big vaccine exporter, now vaccine exporter as COVID-19 cases soar

By Alasdair Pal and Krishna N. Das

NEW DELHI (Reuters) -India on Tuesday said it will fast-track emergency approvals for COVID-19 vaccines authorized by Western countries and Japan, paving the way for possible imports of Pfizer, Johnson & Johnson, and Moderna shots.

The move, which will exempt companies from carrying out local safety trials for their vaccines, follows the world’s biggest surge in cases in the country this month.

Since April 2, India has reported the highest daily tallies of infections. It reported 161,736 cases on Tuesday, taking the total to 13.7 million, while deaths rose by 879 to 171,058.

On Tuesday, India’s richest state Maharashtra, which accounts for about a quarter of the country’s cases, said it would impose stringent restrictions from Wednesday to try to contain the spread.

India has the biggest global vaccine manufacturing capacity and had exported tens of millions of doses before its own demand skyrocketed and led to a shortage in some states.

Dozens of poor countries have relied on Indian exports to run their inoculation drives.

The health ministry said vaccines authorized by the World Health Organization or authorities in the United States, Europe, Britain and Japan could be granted emergency use approval in India.

“If any of these regulators have approved a vaccine, the vaccine is now ready to be brought into the country for use, manufacture and fill-and-finish,” Vinod Kumar Paul, a senior government health official, told a news conference.

“We hope and we invite the vaccine makers such as Pfizer, Moderna, Johnson & Johnson and others … to be ready to come to India as early as possible.”

Pfizer said it would work towards bringing its vaccine to India after withdrawing its application in February.

U.S. federal health agencies on Tuesday recommended pausing use of the J&J shot after six women under age 50 developed rare blood clots after receiving it.

India has administered more than 108 million vaccine doses, sold more than 54.6 million vaccine doses abroad and gifted more than 10 million to partner countries.

It is currently using the AstraZeneca shot and a homegrown vaccine for its own immunization drive, and this week approved Russia’s Sputnik V shot for emergency use.

RALLIES, RELIGIOUS GATHERINGS

The jump in India’s infections, for which Health Minister Harsh Vardhan acknowledged widespread failure to heed curbs on movement and social interaction, has prompted calls for the government to cancel huge public events.

Still, hundreds of thousands of devout Hindus are set to bathe in the Ganges river on Wednesday, the third key day of the weeks-long Kumbh Mela – or pitcher festival.

Nearly a million bathed in the Ganges on Monday in the belief that its waters would wash away their sins. More than 100 tested positive for COVID-19 in random testing of around 18,000 attendees, media said.

Similar concerns of a spike in cases were sparked by mass election rallies by Prime Minister Narendra Modi’s party and opposition groups during polls in four states and one federally run region.

At one rally in the eastern state of West Bengal, a key political prize, Home Minister Amit Shah posted Twitter pictures of meetings with crowds of supporters while unmasked.

DEADLY SPREAD

The second wave of infections, which began in India’s major cities, is increasingly spreading into the hinterland, where healthcare facilities are often rudimentary.

In Raipur, the capital of Chhattisgarh state known for its large tribal population, the main government hospital’s morgue was struggling to keep up, said joint director Dr Vineet Jain.

“All oxygenated and ICU beds are full in our set-up,” he told Reuters.

“Around 50 dead bodies are laying, we have a shortage of space. Some private hospitals do not have space to keep the dead bodies so they also send the bodies to us.”

India is currently reporting around double the daily cases of the United States and Brazil, the two other worst affected countries, though its daily death toll is lower.

India’s total infections rank after only the United States, having overtaken Brazil on Monday.

(Reporting by Krishna N. Das and Alasdair Pal in New Delhi and Jatindra Dash in Bhubaneswar; Editing by Nick Macfie, Ana Nicolaci da Costa and John Stonestreet)

India approves Russia’s Sputnik V COVID-19 vaccine

By Nigam Prusty and Krishna N. Das

NEW DELHI/MOSCOW (Reuters) -India has approved the use of Russian Sputnik V COVID-19 vaccine, the Russian Direct Investment Fund (RDIF) said on Monday, confirming earlier reports of its imminent endorsement.

India overtook Brazil to become the nation with the second highest number of infections worldwide after the United States, as it battles a second wave, having given about 105 million doses among a population of 1.4 billion.

The RDIF, which is responsible for marketing the vaccine abroad, said the Drug Controller General of India (DCGI) had approved the use of Sputnik V.

“India, the world’s 2nd most populous nation, became the 60th country to register #SputnikV after positive results of local Phase 3 clinical study. Sputnik V is now authorized in 60 countries with population of over 3 bln people,” a post on the Sputnik V official Twitter account said.

Earlier on Monday, two people familiar with the matter said the panel of the Central Drugs Standard Control Organization (CDSCO) had recommended the authorization.

The RDIF has signed deals to produce more than 750 million doses of Sputnik V in India with six domestic firms.

India has so far used two vaccines, one developed by AstraZeneca and Oxford University, and the other by domestic firm Bharat Biotech.

Sputnik V, developed by Moscow’s Gamaleya Institute, has proved 91.6% effective against COVID-19 and has been approved for use in more than 50 countries.

The Indian drugs regulator did not respond to a request for comment on the expert panel’s approval of the Russian vaccine.

Indian pharmaceutical firm Dr. Reddy’s, which is marketing the vaccine in India, said it was awaiting formal word from the authorities.

“Dr. Reddy’s and RDIF are working diligently with the Indian regulatory authorities to obtain the approval for Sputnik V. We are fully committed to playing our part in India’s fight against COVID,” the company said.

Shares of Dr. Reddy’s ended up 5% after the Economic Times newspaper first reported the news.

The firm has helped run a small domestic trial to test the vaccine’s safety and ability to generate an immune response.

(Additional reporting by Rama Venkat and Shivani Singh in Bengaluru, Polina Ivanova and Vladimir Soldatkin in Moscow; Writing by Sachin Ravikumar; Editing by William Maclean and Angus MacSwan)

Global COVID-19 death toll surpasses 3 million amid new infections resurgence

By Roshan Abraham and Anurag Maan

(Reuters) – Coronavirus-related deaths worldwide crossed 3 million on Tuesday, according to a Reuters tally, as the latest global resurgence of COVID-19 infections is challenging vaccination efforts across the globe.

Worldwide COVID-19 deaths are rising once again, especially in Brazil and India. Health officials blame more infectious variants that were first detected in the United Kingdom and South Africa, along with public fatigue with lockdowns and other restrictions.

According to a Reuters tally, it took more than a year for the global coronavirus death toll to reach 2 million. The next 1 million deaths were added in about three months.

Brazil is leading the world in the daily average number of new deaths reported and accounts for one in every four deaths worldwide each day, according to a Reuters analysis.

The World Health Organization acknowledged the nation’s dire condition due to coronavirus, saying the country is in a very critical condition with an overwhelmed healthcare system.

“Indeed there is a very serious situation going on in Brazil right now, where we have a number of states in critical condition,” WHO epidemiologist Maria Van Kerkhove told a briefing last Thursday, adding that many hospital intensive care units are more than 90% full.

India reported a record rise in COVID-19 infections on Monday, becoming the second nation after the United States to post more than 100,000 new cases in a day.

India’s worst-affected state, Maharashtra on Monday began shutting shopping malls, cinemas, bars, restaurants, and places of worship, as hospitals are being overrun by patients.

The European region, which includes 51 countries, has the highest total number of deaths at nearly 1.1 million.

Five European countries including the United Kingdom, Russia, France, Italy and Germany constitute about 60% of Europe’s total coronavirus-related deaths.

The United States has the highest number of deaths of any country at the world at 555,000 and accounts for about 19% of all deaths due to COVID-19 in the world. Cases have risen for the last three weeks but health officials believe the nation’s rapid vaccination campaign may prevent a rise in deaths. A third of the population has received at least one dose of a vaccine.

At least 370.3 million people or nearly 4.75% of the global population have received a single dose of COVID-19 vaccine by Sunday, according to latest figures from research and data provider firm Our World in Data.

However, the World Health Organization is urging countries to donate more doses of approved COVID-19 vaccines to help meet vaccination targets for the most vulnerable in poorer countries.

 

India’s daily virus cases breach 100,000; mutants, behavior blamed

By Neha Arora and Rama Venkat

NEW DELHI (Reuters) -India reported a record rise in COVID-19 infections on Monday, becoming the second country after the United States to post more than 100,000 new cases in a day, as politicians stage massive election rallies raising fears of further spreading the virus.

Hospitals in the worst affected state, Maharashtra, are being overrun by patients. India’s richest state, home to its commercial capital Mumbai and numerous industries, reported a record 57,074 new cases overnight.

The country’s daily infections have risen about 12 fold since hitting a multi-month low in early February, when authorities eased most restrictions and people largely stopped wearing masks and following social distancing.

With 103,558 new infections, India has now reported 12.6 million cases, the highest after the United States and Brazil, data from the health ministry showed. Deaths jumped by 478, still one of the lowest fatality rates in the world, raising the total to 165,101.

India has recorded the most number of infections in the past week anywhere in the world. More infectious variants of the virus may have played a role in the second surge, some epidemiologists say.

“The new variant, or variants of concern, probably explains a lot of it, rather than simplistic explanation of behavior,” said Rajib Dasgupta, head of the Center of Social Medicine & Community Health in New Delhi’s Jawaharlal Nehru University.

India has found hundreds of cases of the virus variants first detected in the United Kingdom, South Africa and Brazil.

Subhash Salunke, a former WHO official who advises Maharashtra on its COVID-19 strategy, said cases in the state would continue to rise for another couple of weeks. He said a way out was vaccinating all adults in its hardest-hit cities such as Mumbai, Pune and Nashik.

“If we start doing this, by the end of April we will see a downward trend,” he said.

VACCINE RAMP-UP

India, the world’s biggest maker of vaccines, has injected 77 million doses at home since starting its campaign in the middle of January – the third highest after the United States and China.

India’s per capita COVID-19 vaccinations, however, are lower than many other countries, including that of more populated China that started giving shots to its citizens much earlier.

India is currently vaccinating only people above the age of 45, having covered health and front-line workers first with the AstraZeneca shot and a government-backed one.

In a meeting held by Indian Prime Minister Narendra Modi on Sunday, officials discussed raising the country’s vaccine output further. The government has in recent weeks slowed vaccine exports, after shipping more than 65 million doses.

“It was highlighted that all efforts are underway to secure adequate quantities of vaccines to meet the rising domestic requirements as well as to meet the genuine needs of other countries,” his office said in a statement.

Though cases have risen exponentially in nearly a dozen states, politicians and ministers are still addressing election rallies attended by tens of thousands of mask-less people jostling for space.

The health minister in the northeastern state of Assam, currently voting to elect a new government, was ridiculed on social media on the weekend after saying there was no need for masks in his state and that wearing one hurts businesses like beauty parlors.

Maharashtra will start shutting shopping malls, cinemas, bars, restaurants and places of worship from Monday evening. Authorities will also impose a complete lockdown at weekends, as experts worried about a shortage of critical-care beds in hospitals, especially in its smaller cities.

The rise in cases has pulled down the stock market.

(Reporting by Rama Venkat Bengaluru and Neha Arora in New Delhi; Writing by Krishna N. Das; Editing by Himani Sarkar and Michael Perry)

India AstraZeneca shot delay could be ‘catastrophic’ for Africa: health official

ADDIS ABABA (Reuters) – India’s temporary hold on major exports of AstraZeneca’s COVID-19 shot will undermine Africa’s vaccination plans, and could have a “catastrophic” impact if extended, the head of the continent’s disease control body said on Thursday.

India decided to delay big exports of the shots made in its territory by the Serum Institute of India (SII) to make sure it could meet local demand, two sources told Reuters last week.

The hold “will definitely impact our ability to continuously vaccinate people,” the director of the Africa Centers for Disease Control and Prevention, John Nkengasong, told a news conference in Addis Ababa.

The African Union had planned to vaccinate 30-35% of the continent’s population by the end of the year he said. “If the vaccines are delayed we are unlikely to meet our target,” he added.

That AU target primarily relies on supplies from the global COVAX vaccine-sharing facility, through which 64 poorer countries including many in Africa are supposed to get doses from the SII. COVAX aims to provide enough shots for African countries to inoculate at least 20% of their populations.

“If the delay continues, I hope it’s a delay and not a ban, that would be catastrophic for meeting our vaccinations schedule,” Nkengasong said.

African countries have reported 4.25 million coronavirus infections and 112,000 related deaths, though experts have said the actual numbers could be higher.

The AU has also been negotiating with manufacturers to help member states secure the additional doses they will need to achieve 60% coverage.

On Monday, Johnson & Johnson announced it would supply the AU with up to 400 million doses of its COVID-19 vaccine. Delivery of those doses is due to begin in the third quarter of this year and will continue through 2022.

Those doses are separate from the GAVI/WHO-backed global COVAX facility.

Nkengasong said on Thursday the AU has “pivoted” towards the J&J shot in part as a result of the delay in the delivery of AstraZeneca shots, and also because it is a single-dose shot.

The J&J doses will begin to arrive in June or July, which will ease any shortage caused by the delay in the AstraZeneca doses, Nkengasong said. The gap until the arrival of the J&J doses is a concern, he added.

(Reporting by Addis Ababa newsroom; Writing by Maggie Fick; Editing by Andrew Heavens)

India backs AstraZeneca shot as COVID-19 cases hit three-month high

By Neha Arora and Rama Venkat

NEW DELHI (Reuters) – India said on Wednesday its coronavirus immunization campaign would continue with “full rigor” despite some concerns in Europe about the safety of the AstraZeneca vaccine it relies heavily upon as infections hit a three month high.

The European Medicines Agency is investigating reports of 30 cases of unusual blood disorders out of 5 million recipients of the vaccine in the region.

Since starting the drive in mid-January, India has administered 36 million vaccine doses, which are mostly the AstraZeneca shots developed with Oxford University and locally known as Covishield.

“We have no signal of concern in this regard,” Vinod Kumar Paul, who heads a government committee on vaccines, told a news conference, adding that experts in India had looked into the issue.

“Covishield vaccination in the country will go on with full rigor.”

The World Health Organization has said it is assessing whether medical events such as blood clots are related to the vaccination and urged anyone offered a vaccine to take one. AstraZeneca has said a review of safety data has shown no evidence of an increased risk of blood clots.

Paul said as infections had risen in the country since early February, hitting a three-month high on Wednesday, the government was looking at accelerating the vaccination drive that also uses a homegrown shot created by Bharat Biotech and the state-run Indian Council of Medical Research.

The federal health ministry has so far distributed to states 75.4 million vaccine doses, less than half of which have been given to frontline workers, the elderly and people above 45 with health conditions.

Prime Minister Narendra Modi said quick action was needed to contain the surge, as the country’s infections tally hit 11.44 million, the third behind the United States and Brazil.

“We need to soon stop the emerging second peak of corona,” he said in a virtual meeting with state leaders, urging them to increase testing and strictly monitor mask-wearing. “We need to take quick, decisive steps.”

India’s cases jumped by 28,903 on Wednesday, the highest increase since Dec. 13. Deaths increased by 188, the highest in two months, to stand at 159,044.

Modi said states needed to proactively ensure infections did not increase in the countryside, where healthcare facilities would fall short. Rural India is home to two-thirds of the country’s 1.35 billion people.

The federal government has blamed crowding and a reluctance to wear masks for the spike, ruling out the virus mutations that have been a factor in Western countries.

The recent increase has been led by the western state of Maharashtra, home to India’s commercial capital of Mumbai.

Nearly 62% of infections in the past 24 hours and 46% of the deaths were reported by Maharashtra, which has ordered a lockdown in some districts and put curbs on cinemas, hotels and restaurants until end of the month.

(Reporting by Neha Arora in NEW DELHI and Rama Venkat in Bengaluru; Additional reporting by Sethuraman N R, Sachin Ravikumar, Chandini Monnappa, Nigam Prusty and Nidhi Verma; Editing by Shri Navaratnam, Krishna N. Das)

U.S., India, Japan and Australia agree to provide a billion vaccine doses in Asia

By David Brunnstrom, Michael Martina and Jeff Mason

WASHINGTON (Reuters) – U.S. President Joe Biden and the leaders of Australia, India and Japan agreed in a summit on Friday to cooperate in providing up to a billion coronavirus vaccine doses to developing countries in the Indo-Pacific by the end of 2022, a move to counter China’s widening vaccine diplomacy.

Biden, hosting the first leader-level meeting of a group central to his efforts to counter China’s growing military and economic power, said a free and open Indo-Pacific region was “essential” to all four countries.

“The United States is committed to working with you, our partners, and all our allies in the region, to achieve stability,” he said.

Biden’s national security adviser, Jake Sullivan, said the leaders addressed key regional issues at the virtual meeting, “including freedom of navigation and freedom from coercion” in the South and East China Sea, the North Korean nuclear issue, and the coup and violent repression in Myanmar.

Sullivan told a news briefing the meeting discussed the challenges posed by China, although this was not the focus. He said that among the issues discussed were recent cyberattacks and semi-conductor supply-chain issues.

The Quad leaders committed to delivering up to one billion doses of COVID-19 vaccines to Southeast Asia by the end of 2022, Sullivan said .

Japanese Prime Minister Yoshihide Suga said he wanted the four “to forge strongly ahead toward the realization of a free and open Indo-Pacific” and that Japan had agreed to cooperate in providing vaccine-related support to developing countries.

He also told reporters he had expressed strong opposition to attempts by China to change the status quo in the region and that the four leaders had agreed to cooperate on the issue.

India and Australia also emphasized the importance of regional security cooperation, which has been enhanced by previous lower-level Quad meetings.

India Foreign Secretary Harsh Vardhan Shringla said the meeting had agreed U.S. vaccines would be manufactured in India, something New Delhi has called for to counter Beijing’s widening vaccine diplomacy.

In a joint statement the leaders pledged to work closely on COVID-19 vaccine distribution, climate issues and security.

“We strive for a region that is free, open, inclusive, healthy, anchored by democratic  values, and unconstrained by coercion,” they added, without mentioning China by name.

The meeting also agreed to set up a group of experts to help distribute vaccines, as well as working groups for cooperation on climate change, technology standards, and joint development of emerging technologies.

The leaders agreed to hold an in-person meeting later this year.

India, Australia and Japan have all faced security challenges from China, strengthening their interest in the Quad. Quad cooperation dates back to their joint response to the Indian Ocean earthquake and tsunami in 2004.

The Quad was revived under the Trump administration, which saw it as a vehicle to push back against China. The United States hosted a foreign ministers’ meeting in 2019, which was followed by another in Japan last year and a virtual session in February.

Friday’s meeting coincided with a major U.S. diplomatic drive to solidify alliances in Asia and Europe to counter China, including visits next week by Secretary of State Antony Blinken and Defense Secretary Lloyd Austin to Japan and South Korea.

Blinken will also meet in Alaska with China’s top diplomat, Yang Jiechi, and State Councillor Wang Yi – the first high-level in-person contact between the world’s two largest economies under the Biden administration.

Washington has said it will not hold back in its criticism of Beijing over issues ranging from Taiwan to Hong Kong and the genocide it says China is committing against minority Muslims.

Modi told the session the Quad had “come of age” and would “now remain an important pillar of stability in the region.” Australian Prime Minister Scott Morrison called the meeting “a whole new level of cooperation to create a new anchor for peace and stability in the Indo-Pacific.”

A fact sheet issued after the meeting said the United States, through its International Development Finance Corp, would work to finance Indian drugmaker Biological E Ltd to produce at least 1 billion COVID-19 vaccine doses by end of 2022.

It also said Japan was in discussions to provide concessional yen loans for India to expand manufacturing of COVID-19 vaccines for export.

The Biden administration told Reuters on Tuesday the United States and Japan would help fund Indian firms manufacturing vaccines for U.S. drugmakers Novavax Inc and J&J.

However, Indian government sources say U.S. curbs on exports of critical materials could hamper that effort and those to start large-scale distribution to Southeast Asia.

(Reporting by David Brunnstrom, Michael Martina, Jeff Mason and Doina Chiacu; additonal reporting by Kiyoshi Takenaka in Tokyo; Editing by Gareth Jones and Alistair Bell)

New WTO chief calls for tripling of vaccine production

By Emma Farge and Philip Blenkinsop

GENEVA (Reuters) – The new chief of the World Trade Organization (WTO) urged its member states on Monday to work with pharmaceutical companies to license more COVID-19 vaccine manufacturing in developing countries in order to triple global production.

“People are dying in poor countries,” Ngozi Okonjo-Iweala said on her first day in office. “The world has a normal capacity of production of 3.5 billion doses of vaccines and we now seek to manufacture 10 billion doses.”

Her call comes as a group of developing countries led by South Africa and India seek to waive intellectual property rights for COVID-19 drugs and vaccines, a move opposed by the United States, the European Union and other wealthy nations.

Okonjo-Iweala, the WTO’s first female and first African director-general, said that, while this debate continued, companies must be encouraged to open up and license more viable manufacturing sites now in developing countries.

In a speech to the WTO’s 164 member states, she said there was an upcoming world manufacturing convention and urged the start of dialogue with manufacturers associations.

After a long campaign that was derailed in the latter stages by a Trump administration veto, the 66-year-old Nigerian was confirmed as boss last month, pledging to “forget business as usual” at the WTO, which is struggling to strike new deals and whose arbitration functions are paralyzed.

“READY TO GO”

“It feels great. I am coming into one of the most important institutions in the world and we have a lot of work to do. I feel ready to go,” Okonjo-Iweala told a reporter on arrival at the WTO’s lakeside Geneva headquarters where she donned a mask and elbow-bumped officials.

The former Nigerian finance and foreign minister aims to revive the global trade watchdog ahead of a major year-end meeting, saying she feared the world was leaving the WTO behind.

WTO delegates agreed to hold the next major ministerial conference in Geneva from Nov. 29.

The meeting was originally due to be held in Kazakhstan in 2020 but was delayed due to the pandemic. Okonjo-Iweala has said she hopes ministers at the year-end meeting can finalize deals on ending fisheries subsidies and reforms for the WTO’s top appeals body.

Since the WTO director-general holds few executive powers, some analysts question her ability to revive the body in the face of so many challenges, including persistent U.S.-China trade tensions and growing protectionism heightened by the pandemic.

(Reporting by Emma Farge and Philip Blenkinsop in Brussels; editing by Ed Osmond and Gareth Jones)

Kashmir villagers hopeful but wary after India and Pakistan agree to ceasefire

By Fayaz Bukhari and Abu Arqam Naqash

SRINAGAR, India/MUZAFFARABAD, Pakistan (Reuters) – Villagers living on both sides of the Line of Control dividing the Himalayan region of Kashmir welcomed an agreement between long-time foes India and Pakistan to stop shelling from each side, but some were skeptical it would hold.

The nuclear-armed neighbors signed a ceasefire agreement along the Line of Control (LoC) in 2003, but that has frayed in recent years and there have been mounting casualties.

In a joint statement on Thursday, India and Pakistan said they would observe a ceasefire.

“It has given a new lease of life to us. We were living in constant fear of being hit,” said Laldin Khatana, the headman of Churnada village on the Indian side of the border.

Khatana said that two people had been killed last year by shelling in the hillside village, home to 1,600 people, many of whom gathered at a mausoleum to celebrate the new agreement.

“It was affecting our farming and grazing,” he told Reuters via telephone. “And children were scared to go to school.”

Kashmir has long been a flashpoint between India and Pakistan, which claim the region in full but rule only in part. Tensions reignited after New Delhi withdrew the autonomy of Jammu and Kashmir state in August 2019 and split it into two federally administered territories.

Since 2018, Indian data shows that 70 civilians and 72 soldiers have been killed in cross-border firing.

On the Pakistani side, nearly 300 civilians have been killed since 2014, when ceasefire violations began rising, according to a Pakistan military source.

“The fresh announcement is welcome and can help us live a life free of fear, only if implemented in letter and in spirit,” said Danish Shaikh, a resident of Ban Chattar village in Pakistan-controlled Kashmir’s Neelum valley.

“Who knows how seriously and how long they will stick to the fresh understanding?”

The picturesque Neelum valley saw hundreds of hotels and guesthouses sprout up when the ceasefire held, with tourists visiting year round.

But with skirmishes and firing increasing, tourism went into a tailspin and guesthouse operators like Khawaja Owais were forced to dig into their savings.

“This is good news indeed. Not just for us who are running businesses in the valley but for everyone who has faced death and destruction during heavy shelling,” Owais said of the agreement.

“Let’s hope and pray it remains intact.”

(Writing by Devjyot Ghoshal; Editing by Nick Macfie)

India warns of worsening COVID-19 situation, vaccinations to expand

By Krishna N. Das and Neha Arora

NEW DELHI (Reuters) – India announced an expansion of its COVID-19 vaccination program on Wednesday but warned that breaches of coronavirus protocols could worsen an infection surge in many states.

Nearly a month after the health minister declared that COVID-19 had been contained, states such as Maharashtra in the west and Kerala in the south have reported a spike in cases amid growing reluctance to wear masks and maintain social distancing.

India’s infections are the second highest in the world at 11.03 million, swelled by a further 13,742 in the past 24 hours, health ministry data showed. Deaths rose by a two-week high of 104 to 156,567.

“Any laxity in implementing stringent measures to curb the spread, especially in view of new strains of virus…, could compound the situation,” the ministry said in a statement singling out nine states and a federal territory.

India has confirmed the long-time presence of two mutant variants – N440K and E484Q – in addition to those first detected in Brazil, Britain and South Africa.

TESTS FALLING

The health ministry said that while cases in the states of Chhattisgarh, Gujarat, Kerala, Maharashtra, Madhya Pradesh and Punjab, as well as the federal territory of Jammu and Kashmir, were rising, the proportion of high-accuracy RT-PCR tests in those places was falling because many states prefer antigen tests, which are cheaper and quicker but less accurate.

The federal government is worried excessive reliance on rapid antigen tests could undercount cases, leading to real infections going unchecked and spreading the disease.

Cases have also risen in Karnataka, Tamil Nadu and West Bengal.

In the past week, a third of India’s 36 states and union territories have reported an average of more than 100 new cases each day, with Kerala and Maharashtra both registering more than 4,000, in a trend experts link to the reopening of schools and suburban train services.

Maharashtra reported 8,807 new COVID-19 cases on Wednesday, the highest in nearly five months. Of those, 1,167 were in Mumbai, India’s financial capital.

The government has also asked states to speed up vaccinations for healthcare and frontline workers. Just about 11 million people have received one or two doses in a campaign that began on Jan. 16. The target is 300 million by August.

From March 1, India will start vaccinating people above 60 and those older than 45 with health conditions free of charge in about 10,000 government hospitals and for a fee in more than 20,000 private facilities, the government said.

Earlier on Wednesday, a regulatory panel sought more data from drugmaker Dr. Reddy’s Laboratories for emergency authorization of Russia’s Sputnik V COVID-19 vaccine, a senior official with direct knowledge of the discussions said.

The Central Drugs Standard Control Organization did not immediately reply to a Reuters request for confirmation.

(Reporting by Krishna N. Das and Neha Arora; Additional reporting by Rajendra Jadhav; Editing by Mark Heinrich)