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For many in the health care field, India’s tragic coronavirus surge — fueling a world-record 352,991 reported cases on Monday alone — is a painful flashback to the darkest days of 2020 when the virus rampaged through Massachusetts and the rest of the United States.

But it’s also a reminder that, while more than 42 percent of the American population has had at least one vaccine shot, immunization has barely begun in many parts of the world — fewer than 10 percent of Indians have received a shot.

It’s also a stark warning that new waves of COVID-19 or a vaccine-eluding variant could emerge in unvaccinated regions and threaten the United States until most of the global population is inoculated.

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“You’re seeing a case of the virus overwhelming the Indian health care system, and these new [virus] strains are driving the lethality,” said Dr. Atul Gawande, the Boston surgeon, writer, and public health researcher, who has been advocating for US aid to India.

“It’s like experiencing what Boston went through in March and especially April of last year,” Gawande said, though in a nation four times more populous and with a far less robust health care system. “It’s critical for us to increase [vaccine] supplies and release supplies to the rest of the world.”

Massachusetts doctors and public health leaders — some of whom, like Gawande, have relatives stricken by the virus in India — have called on the Biden administration to send India personal protective equipment, oxygen tubes for hospitals, and raw materials key to making vaccines, such as adjuvants that boost the body’s immune response to injections.

Federal officials said Monday that the United States will share doses of AstraZeneca’s vaccine — about 10 million doses have been stockpiled here but not yet authorized for domestic use — with India and other countries once the vaccine has cleared federal safety reviews. That followed a White House announcement on Sunday that it was “working around the clock” to deploy COVID-19 therapeutics and testing kits, as well as ventilators, protective gear, and other supplies.

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Many health care professionals in Massachusetts have signed an open letter to President Biden urging the US government to waive patent protection for vaccine makers, require them to share know-how with developing countries to speed mass production of vaccines, and help finance overseas manufacturing plants.

“Because India is so enormous and has such an impact on the global economy, it’s waking people up in a way that a surge in Sierra Leone would not,” said Dr. Joia Mukherjee, chief medical officer at Partners in Health in Boston, who works with clinical teams around the world. “As well as we’re doing [with vaccines] in the US, it’s going to be meaningless if the virus is still spreading and the global economy is still stuck in the mud.”

India reported 2,812 deaths Monday, bringing the official death toll now over 195,000. Experts say the surge won’t peak for several weeks — Monday was the fifth day in a row India has broken the record for most cases in one country. The closely watched model from the University of Washington forecasts a staggering toll of nearly 1 million deaths in India by Aug. 1.

“We need to urgently slow transmission in India, and we need to prevent as many deaths as possible,” said Dr. Abraar Karan, a global health physician at Brigham and Women’s Hospital in Boston, who has worked as a public health researcher in Indian villages and has family members there who have been hospitalized with COVID-19. “With exponential spread, every day there is worse than the last day.”

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Karan said India’s actual toll is almost certainly much higher than its official toll. “People die in homes, people die in villages, people die in places that can not be detected,” he said.

While the situation in India is the world’s most dire, global health advocates say it’s also a cautionary tale.

“There’s a humanitarian concern right now in India, and a warning of what might happen in other places,” said Dr. Louise Ivers, executive director of the Center for Global Health at Massachusetts General Hospital. “We are not safe until everyone is safe.”

Only a handful of countries have reported substantial shares of their population vaccinated. Fewer than 1 percent of people have gotten a COVID-19 shot in Africa, fewer than 4 percent in Asia, and just over 11 percent in South America, according to Oxford University data.

India is one of the world’s biggest producers of vaccines, but the explosion of cases linked to variants has overwhelmed the nation’s capacity to produce vaccines. Both the B.1.1.7 variant first identified in the United Kingdom and the B.1.617 variant first seen in India itself are spreading rapidly there.

Also driving the Indian outbreak have been relaxed restrictions that led people to mingle at political rallies and religious events, and low vaccine coverage. Just 1.6 percent of people in India are fully vaccinated, according to a New York Times database.

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Dr. Peter Hotez, dean of the National School of Tropical Medicine at Baylor College of Medicine, welcomed the news that the United States will share its stock of AstraZeneca vaccines with India and raw materials to make doses there. However, he warned, “It’s still a drop in the bucket, given the task at hand.”

COVID-19 patients received oxygen in Delhi on Sunday.
COVID-19 patients received oxygen in Delhi on Sunday. Atul Loke/NYT

A vaccine that Hotez helped develop at the Baylor and Texas Children’s Hospital Center for Vaccine Development recently received approval to enter a late-stage trial in India. If the vaccine proves safe and effective, he said, the Indian company that licensed it, vaccine-maker, Biological E. Ltd., has the capacity to produce 1 billion doses for worldwide distribution, including in India.

Earlier this year, numerous countries were counting on the Serum Institute of India, which makes 60 percent of the world’s vaccines each year, to provide COVID-19 doses. But now the institute is having difficulty meeting demands at home.

Serum had promised to supply 1.1 billion doses of an Indian-made version of the AstraZeneca vaccine called Covishield by May to a group called COVAX for distribution. But the institute had only exported 19.6 million vaccine doses to COVAX, the government said earlier this month.

None of the companies that make the COVID-19 vaccines cleared for use in the United States — Pfizer and its German partner BioNTech, Moderna, and Johnson & Johnson — have deals to sell doses to India. But Pfizer said last Thursday that it had offered India a not-for-profit price for its vaccine and was in talks with the Indian government about distributing it.

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Dr. Ingrid Katz, an associate physician at Brigham and Women’s, wrote recently in the New England Journal of Medicine that it will take more than four and a half years to inject enough people globally to suppress the virus at the current rate of vaccinations.

“Vaccine distribution remains nonexistent in many of the poorest countries, and experts anticipate that 80 percent of the population in low-resource settings will not receive a vaccine this year,” Katz and a trio of colleagues wrote.

Katz, in an interview, said the flare-up in India underscores the need for the United States and other wealthy nations to shift quickly from “vaccine nationalism” to “vaccine equity,” and recognize the global dimension of the coronavirus pandemic.

“This virus came to us from halfway around the world, and there’s no reason to think it won’t come around again,” she said. “If we can’t come together as a globe to assure our most vulnerable are protected now, I don’t know when we can.”

Ryan Huddle of the Globe staff contributed to this story.



Robert Weisman can be reached at robert.weisman@globe.com. Follow him on Twitter @GlobeRobW. Jonathan Saltzman can be reached at jonathan.saltzman@globe.com. Martin Finucane can be reached at martin.finucane@globe.com.