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What worries me is that we may not even be able to measure the peak cases accurately. Data show that testing is increasing at a far slower rate than cases. In this scenario, numbers will reach a plateau — not because case numbers have stopped rising but because testing capacity will be tapped out. The national average test positivity rate is over 22 percent, but several states have rates that are, alarmingly, even higher — including Goa at 46.3 percent and Uttarakhand, which hosted the Kumbh festival, at 36.5 percent. “India will have a manufactured peak of about 500,000 daily cases by mid-May,” argued Rijo M. John, a health economist.

Vaccines remain one of the most effective public health tools, and vaccination with speed is shown to significantly reduce the spread of the coronavirus. India started its vaccination drive in mid-January with a sensible plan to vaccinate 300 million people in phases — health care workers, frontline workers and then people above 60 years of age or above 45 years with comorbidities. And as a leading supplier of vaccines worldwide — India supplies about 40 percent of all the world’s vaccines — two Indian companies, Serum Institute of India and Bharat Biotech, were well positioned to execute.

But by mid-March only 15 million doses had been delivered, covering a mere 1 percent of India’s population. The vaccination drive was hobbled by messages from Indian leadership that the country had conquered the virus and by news from Europe associating fatal blood clots with the AstraZeneca vaccine, which remains the mainstay of India’s vaccination rollout.

When the second wave arrived, only 33 million people, about 2.4 percent of the population, had received one dose and seven million people had received both doses. On May 1, vaccination opened for everyone older than 18 years, but many states have reported shortages and the pace of vaccination has slowed down. Local supplies are expected to stabilize by July, but their low penetration cannot reverse the current wave of infection and death in India.

Covid-19 vaccines mitigate disease, but they may not prevent infection, especially when transmission rates are as high as they are now. Though good data is lacking, variant viruses with evasion potential may also have a role in “breakthrough” infections in vaccinated people.

The immediate need is to reduce spread by increased testing and isolation of people who test positive. Several Indian states are under lockdown. This would “flatten the curve,” allowing health care facilities and supplies to regroup. Rapidly enhancing the health care infrastructure will also save lives. India should increase available hospital beds by setting up temporary facilities, mobilize retired doctors and nurses, and strengthen the supply chain for critical medicines and oxygen.

At the same time, India cannot allow the pace of vaccinations to slow. It must vaccinate at scale now, aiming to deliver 7.5 million to 10 million doses every day. This will require enhancing vaccine supplies and doubling delivery points. There are only about 50,000 sites where Indians can get vaccines right now; we need many more. Since only 3 percent of these delivery points are in the private sector, this is where capacity can be added.