Why India and Brazil Have Different COVID-19 Death Rates

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Despite rising COVID-19 vaccination rates, Brazil and India have registered spikes in daily infection and death rates.
Despite rising COVID-19 vaccination rates, Brazil and India have registered spikes in daily infection and death rates. (Image: SamuelFrancisJohnson via Pixabay CC0 1.0)

In March, the rates of daily new Coronavirus Disease 2019 (COVID-19) infections and deaths ramped up significantly in India and Brazil. Researchers have attempted to figure out why the surges occurred despite widespread vaccination efforts, and why Brazil’s cumulative deaths per million of over 2,000 is so much higher than India’s rate of about 200.

As of May 14, at least 16.65 percent of Brazil’s population has received at least one jab, and over 7.5 percent have been fully vaccinated. Around 52 million vaccines have been distributed in total. In contrast, around 10.13 percent of India’s population has received at least one shot as of May 14, and about 3 percent have been fully vaccinated. A total of around 180 million shots have been distributed.

Between Jan. 15 and May 14, the number of daily COVID-19 cases per million in Brazil rose by around 15 percent from 255.25 to 293.75. During the same period, daily COVID-19 deaths per million nearly doubled from 4.56 to 9.08.

For the same time period in India, the number of daily COVID-19 cases per million surged from 13.40 to 256.75, and daily COVID-19 deaths per million rose from 0.16 to 2.89. However, the daily case rate is starting to fall in India, down to 231.52 on May 17.

Healthcare professionals recommend ivermectin use in India

On April 28, the Indian government’s Ministry of Health & Family Welfare released revised COVID-19 guidelines. The agency recommended that asymptomatic patients “consider Tab Ivermectin (200 mcg/kg once a day, to be taken empty stomach) for 3 to 5 days.” Some medical professionals believe that ivermectin has helped to drive the recent reduction in daily case rates, and will continue to do so if promoted more widely.

A joint statement published on May 3 from the British Ivermectin Recommendation Development (BiRD) group and the Frontline Covid Critical Care Alliance (FLCCC) Alliance recommended that ivermectin use be expanded to include prevention and early treatment of COVID-19 in India. The BiRD group consists of several researchers and doctors worldwide, and FLCCC is a US-based nonprofit organization with world-renowned clinician-researchers.

The statement reads, “Indeed, at least one of India’s states, Uttar Pradesh, has already been using this drug to great effect. We are now even more encouraged that the All India Institute of Medical Sciences and Indian Council of Medical Research have urgently responded with a recommendation to use ivermectin in mild outpatient illness.”

“We also recommend that Ivermectin be used as covid-19 prophylaxis on a large scale through mass distribution of ivermectin in the dose of 0.2mg/kg (12mg for a 60 kg person) weekly to adults to decrease transmission amongst the general population in the current crisis. We believe this will save thousands of lives and reduces the suffering of millions,” it continues.

“Stories of Ivermectin’s ability to beat covid-19 can be found in many parts of the world, including the Dominican Republic, Peru, Zimbabwe and South Africa, as well as in other African countries where mass administration of ivermectin against parasitic infections is practiced. More than 3.7 billion people have been treated with Ivermectin for parasitic infections and it has been found to be extremely safe.”

Vaccine distribution and adverse events

In terms of cumulative COVID-19 infections, India and Brazil are ranked in the top three. India has registered 25,495,144 total cases as of May 18, and Brazil has 15,661,106 cases. However, India has a population of 1,392 million compared to around 213 million in Brazil. Despite having only 15 percent of India’s population, Brazil has nearly two-thirds of India’s number of total cases.

Almost 80 percent of Brazil’s immunizations have been with the Chinese-made Sinovac vaccine, according to Reuters. In April, The Epoch Times reported that 14 people in Hong Kong had died after being vaccinated with Sinovac, and 13 people had developed facial paralysis. Also, despite being the world’s most vaccinated country using China’s Sinopharm vaccine and the AstraZeneca vaccine, Seychelles also had a recent surge in infection rates.

In addition, Brazil recently suspended the AstraZeneca vaccine in pregnant women following the death of an expectant mother. Denmark, Cameroon, and Norway have stopped using AstraZeneca vaccines because of concerns about lethal cases of blood clots. 

The Indonesian government recently suspended a batch of the AstraZeneca vaccine, and in Canada, the province of Ontario decided not to give AstraZeneca as a first dose after eight cases of blood clots came to light.

Divergence hypotheses

The difference in daily death rates between India and Brazil has puzzled many experts. In an interview with Bloomberg, Shekhar Mande, the head of India’s Council of Scientific and Industrial Research, suggested that hygiene may be one reason why India’s deaths per million is considerably lower.

“Our hypothesis, and this is strictly a hypothesis, is that because our populations are continuously exposed to many kinds of pathogens, including viruses, our immune system does not hyper-react to any new variation that comes in,” Mande said in the interview.

With regard to Brazil, a study published in Science from researchers in the UK, US, Brazil, Belgium, and Denmark found that the P.1 coronavirus variant was a driving factor behind the rapid spread of the virus in the region of Manaus in Brazil during the second wave of COVID-19 infections.

“We found that the P.1 variant has notable differences compared to the previously circulating strains in Manaus. We estimate a 1.4 to 2.2 times increase in transmissibility, and an ability to evade between 25 and 61% of natural immunity generated from infection with earlier strains,” Dr. Thomas Mellan, one of the authors of the study, said in a statement.

Lockdowns and mandatory vaccinations

In India, Prime Minister Narendra Modi has not acquiesced to demands from opposition parties for a full national lockdown. However, several state governments such as in Uttar Pradesh, Assam, Tamil Nadu, Bihar, Kerala, and Bengal have either imposed lockdowns or are considering new restrictions.

In Brazil, President Jair Bolsonaro has refused to impose lockdown measures. However, he recently announced that he would deploy the army into the streets if the absence of a lockdown resulted in chaos.

COVID-19 vaccinations have not been mandated by the Indian national government. In January, health workers at the All India Institute of Medical Sciences (AIIMS) in Delhi opted out of the vaccine experiment.

“I am not yet ready to take a vaccine for which the trials have not even been completed. A majority of us do not want to be guinea pigs,” a health worker at AIIMS told the National Herald. Nevertheless, New Delhi made vaccinations compulsory for healthcare workers back in February.

Brazil’s Supreme Court has ruled that local governments can “impose legal measures for making vaccination mandatory, even though they cannot force citizens to take the vaccine,” according to Agencia Brasil. Restrictions could include “not being allowed to file for a benefit, or being banned from entering a place or enrolling at a public school.”

With reporting by Arvind Datta.

  • Steven Li is a medical professional with a passion for lifelong learning and spreading positivity and truth to the world. He has a Doctor of Medicine (MD) degree and a passion for business and marketing, cultivated through healthcare and technology-related consulting projects. He also has a love for music and the performing arts.