US has accumulated a stockpile of AstraZeneca vaccine of more than 20 million doses. It should ship these stockpiles to India instead of leaving them in the warehouses

India has become the terrifying new epicentre of the Covid-19 pandemic. New cases have topped 300,000 daily and are still rising; the official death toll of over 2,000 per day is almost certainly an underestimate. Every hour brings horrifying new stories of mass cremations, overwhelmed testing centres, people dying while waiting for a hospital bed. The country desperately needs help — and the U.S. should provide it.

To this point, the Biden administration has rebuffed pleas to share the huge U.S. supply of vaccine doses with the rest of the world, making a slight exception only for neighbours Mexico and Canada. And India is hardly the only nation buffeted by a new wave of cases. Brazil’s official death toll is far higher. Many African countries are struggling to procure vaccines, whereas India boasts a homegrown pharmaceutical industry that can churn out tens of millions of doses.

Still, there are several reasons why the Biden administration should view the crisis in India with particular alarm. The first is the sheer scale of the problem. Just one Indian state — Uttar Pradesh — has nearly as many people as Brazil; Maharashtra, home to the country’s financial capital Mumbai, has nearly twice the population of South Africa. Now that migrant workers are once again fleeing cities for the countryside, and worshipers have returned home after attending the massive Kumbh Mela religious festival on the banks of the Ganges, there are fears that the virus could take hold in the countryside where most of the country’s 1.3 billion citizens live.

If it does, India’s tottering healthcare system risks a breakdown. Per capita, Brazil spends about 40 times as much on healthcare as Uttar Pradesh. Brazil has 214 doctors per 100,000 people, compared to Uttar Pradesh’s 39. The northern Indian state has less than half as many hospital beds per capita. And yet, even Brazil’s richest state Sao Paolo has warned its healthcare system is verging on collapse. If the surge in cases continues, India’s poorest states won’t be able to cope.

This could have massive repercussions for the U.S. and other nations. The variant that seems to be driving India’s new wave of cases has already been found elsewhere, including in the U.S. The longer the pandemic rages in India, the greater the chances that more dangerous mutations will emerge and spread around the world.

Finally, India’s role in the global pandemic is unique. The developing world is counting on affordable Indian vaccine-makers such as Serum Institute of India Pvt Ltd. for their supplies. With India now reserving virtually all its doses for domestic use, those countries will have to wait even longer to be vaccinated. And if the pandemic disrupts production at Indian pharmaceutical companies, it could affect crucial non-Covid medications as well. Half the world’s children have been vaccinated by Serum Institute.

The Biden administration can do two things to help. The first is to ease restrictions on critical exports, imposed under the Defence Production Act to prioritize the needs of U.S. companies.

Vaccine production requires very specific, medically approved inputs, which are difficult to substitute quickly in the middle of a pandemic. Currently, U.S. producers must secure permission before exporting such things as special sterile filters, disposable bags for cell cultures, cell culture media and single-use tubing. The embargo has led to major bottlenecks. Serum Institute says that without those inputs, it may not be able to deliver the 160 million vaccine doses it had planned to produce next month.

Second, the U.S. should immediately share doses from its own supply of Oxford-AstraZeneca and Johnson & Johnson vaccines. Even though regulators have yet to approve the AstraZeneca vaccine for use in the U.S., the country has accumulated a stockpile of more than 20 million doses and has a purchase agreement for 300 million more. It also has a purchase agreement for 100 million J&J doses, which U.S. officials fear some Americans will be reluctant to take because of potential side effects.

The Biden administration should ship these stockpiles to India instead of leaving them in U.S. warehouses. The move wouldn’t slow down the current U.S. vaccination drive, which is proceeding without either vaccine. Serum Institute is already producing AstraZeneca doses and another Indian company, Biological E Ltd., is making the J&J vaccine. India could thus refill U.S. coffers, if needed, once the current crisis is under control.

The Biden administration, which says it’s consulting with India on its surge, has recognized the need to vaccinate the world. It has increased funding to the World Health Organization’s COVAX facility, which aims to distribute vaccines to low-income countries, and rallied its fellow “Quad” nations behind an effort to produce doses for Southeast Asia.

But both initiatives will take time to bear fruit — and both depend crucially on Indian vaccine-makers. If the U.S. wants either effort to succeed, it needs to come to India’s aid now.