Health experts have warned low testing and antigen tests often giving false negatives were concealing the scale of the pandemic in India © REUTERS

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The doctor behind India’s coronavirus strategy defended the government’s response to the pandemic despite the country recording the highest number of Covid-19 infections after the US.

In an interview with the Financial Times, Balram Bhargava, director-general of the Indian Council of Medical Research, the country’s leading clinical research institution, said the country’s health authorities had “shown the world how to fight emerging diseases” despite limited resources.

“India has done exceedingly well in comparison to other developed countries until now, considering the vast and diverse population of the country,” said Dr Bhargava, who advises the Narendra Modi government on the pandemic.

“Cost-effective diagnostic capabilities” were now helping authorities control the spread of the disease, he added. “Now [that] we are able to detect cases at the early stage, the situation is bound to improve in coming days.”

New infections in India are showing little sign of slowing. Chart showing daily new confirmed cases (seven-day rolling average, log scale)

Dr Bhargava’s comments clash with health experts’ assessment of India’s handling of the pandemic. With 5.6m cumulative infections, the country is fast approaching the US’s 6.9m cases by adding nearly 90,000 new cases a day on average over the past seven days.

After running through big cities, the virus is spreading through rural areas where the majority of the country’s 1.4bn people live.

India’s official coronavirus death toll per one million population is 66, ranking it 78th in the world. This is better than the US and UK but worse than Pakistan, Vietnam and China.

Health experts have warned, however, that low testing in India combined with increasing numbers of rapid antigen tests that often give false negatives are concealing the scale of the pandemic and that deaths are being undercounted.

As of September 21, India had conducted 726 daily tests per million people, compared with 2,620 in the US and 1,277 in Turkey. It has recorded more than 90,000 Covid-19-related deaths, compared with more than 200,000 in the US and 4,737 in China.

Ramanan Laxminarayan, founder of the Center for Disease Dynamics, Economics & Policy, criticised Dr Bhargava’s comments as “not grounded”.

“India is lagging the world on testing, therefore you have not captured the full extent of the epidemic, and it is unclear if there is lower mortality after adjusting for the younger population, lower testing and incomplete death reporting,” said Mr Laxminarayan.

“The disease is ripping through India right now. It is uncontrolled. Now much of the epidemic is going to stay hidden because it’s going to be in rural areas, where there is no testing and healthcare facilities are poor.”

K. Srinath Reddy, president of the Public Health Foundation of India, said comparing India with other countries was “cold comfort” and that it would take months before case numbers and deaths started declining. “Coronavirus in India is not one peak, it is a mountain range,” he said.

New Delhi has struggled to keep the pandemic in check after encouraging people to return to work after one of the world’s harshest lockdowns was imposed in March. Forced out of work with no help from the state, millions of migrant workers trekked home from cities to their villages in one of the biggest human migrations seen in the country since partition.

The Indian economy has been hit hard by the pandemic: the Asian Development Bank recently predicted India’s economy would contract 9 per cent this year.

Indian authorities had hoped a fast-tracked vaccine would help ease the crisis. The ICMR initially said its “indigenous” coronavirus vaccine candidate, Covaxin, would be ready by August 15, but has since backtracked.

In response to concerns that India might not be able to conduct a Covid-19 mass vaccination, Dr Bhargava said: “We are confident of putting in place an efficient vaccine delivery infrastructure in India.”

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