Mass religious gatherings such as the Kumbh Mela, attracting millions of Hindu pilgrims, and political rallies were allowed to continue even when cases numbers began rising sharply in late March.

In April alone, India recorded around 7 million new infections. On a per-capita basis however India’s caseload remains low compared to many other countries.

The hard-hit capital New Delhi, meanwhile, extended its shutdown for another week while top US pandemic adviser Anthony Fauci said that India should go into a national lockdown for “a few weeks”.

Less than two months after the health minister said India was in the “end game” of the pandemic and New Delhi sent millions of vaccines abroad, the surge has sent worried Indians rushing for the jabs still in the country.

On Saturday the inoculation programme was expanded to all Indians over 18, equating to around 600 million people, even though many states said they have insufficient stocks to do so.

Millions of younger people terrified by the current situation and desperate to get inoculated registered on the government’s digital platform. But very few of them have been given appointments and only half a dozen of India’s 28 states began vaccinating people under 45, and in many cases only a token scale.

Further confusion has been created by New Delhi’s decision to ask states and private hospitals to order vaccine supplies on their own, creating a three-tier pricing system that requires them to pay more per dose than the central government.

This has led to squabbles between the central government, run by Prime Minister Narendra Modi’s Bharatiya Janata Party, and states governed by opposition parties.

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Anecdotal evidence suggests that some private clinics have been told they won’t receive any vials for months.

“The whole thing looks like a confused elephant to me right now,” said T Jacob John, a retired clinical virology professor at the Christian Medical College Vellore.

“Do you want to control the epidemic, save lives or both? If you want both you’ll require a huge amount of vaccines. And we don’t have it.”

He and other experts say that given the shortages, and its colossal population, India should have a much more targeted policy, concentrating vaccinations in hotspots.

Gujarat is among the few states to have said they would do so, with chief minister Vijay Rupani saying on Friday that vaccinations for over-18s would happen only in the 10 worst-hit districts.

The Serum Institute of India is making 60-70 million AstraZeneca doses per month, and is aiming for 100 million by July. Bharat is aiming to produce 10 million a month and targets 60-70 million.

Indian firms also have deals to produce other shots including Russia’s Sputnik V – some 150,000 doses of which were delivered on Saturday – and Johnson & Johnson’s single-dose vaccine, but it could be months until these are deployed.

DEADLY FIRE

Meanwhile, at least 16 Covid-19 patients and two nurses died on Saturday in the latest in a series of hospital fires in India, officials said.

There were around 50 other patients at the four-storey hospital in Bharuch in the western state of Gujarat when the blaze began at 1am. It has since been put out.

“Primary investigation revealed that the fire started due to a short-circuit in the ICU of the hospital,” said local police official Rajendrasinh Chudasama.

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On April 23 a fire on the outskirts of Mumbai killed 13 Covid-19 patients, a few days after another blaze left 22 people dead at another clinic, also in Maharashtra state.

India’s health care system has long suffered from underfunding, and the new virus outbreak has seen critical shortages in oxygen, drugs and hospital beds, with patients dying outside hospitals in some areas.

In New Delhi’s Batra Hospital, local media reported that eight people including a doctor died on Saturday after the facility ran out of oxygen.

Additional reporting by Reuters