One Village Quelled the Virus. The Next Was Overrun. It’s a Bad Sign for India.

GARH MUKTESHWAR, India — When a devastating second wave of Covid-19 infections reached India’s countryside this spring, the village of Khilwai took immediate action. Two testing centers were set up, and 30 positive cases were isolated. The outbreak was contained with just three deaths.

It was a different story in the two villages on either side of Khilwai. Testing remained limited. The local health center in one village had been closed, its staff sent away to a larger hospital. The coronavirus spread, and at least 30 people in each village died with Covid-19 symptoms.

But even as the three villages in India’s most populous state, Uttar Pradesh, diverged in their handling of the coronavirus, they have been united in another way: a vaccine hesitancy that is prevalent throughout India and threatens to prolong the country’s crisis.

The combination of an uneven virus response — a reflection of huge inequality in resources and the vagaries of local attitudes — and a struggling vaccination campaign has left officials warning of a third wave of infections when the second has at best only leveled off. Any sense of rapid relief like the one now prevailing in the United States is unlikely anytime soon.

Just 5 percent of India’s 1.4 billion people are fully vaccinated, while about 20 percent have had a first dose. That gives the country insufficient protection against the highly contagious Delta variant of the virus, which first surfaced in India.

At the same time, the country continues to report tens of thousands of new infections and close to 1,000 deaths each day, numbers that are almost certainly an undercounting. Resigned talk of a third wave is indicative of how virus fatigue, and the catastrophic toll of hundreds of thousands of people in the last wave, have resulted in a new definition of acceptable loss.

“Last year, if you had told somebody that we have over 1,000 deaths a day — and the real number might be five times that — they would have said that is completely unacceptable,” said Ramanan Laxminarayan, director of the Center for Disease Dynamics, Economics and Policy, a public health research organization based in Washington and New Delhi. “This year, people are as if ‘It’s just 1,000 deaths a day. It’s fine. We can manage with that.’”

Dr. Laxminarayan said the vast unvaccinated population and the persistent circulation of the virus meant there would still be flare-ups large and small.

“It is not going anywhere; it is going to be an endemic disease that will stay with us,” he said. “The thing is — can we keep it at a low-level intensity, rather than high intensity, with vaccinations and other measures?”

Vaccinating a population of more than one billion was always going to be a daunting task.

India’s upper hand as the world’s largest vaccine manufacturer was wasted because of mismanagement. After the first wave, the authorities acted as if India had defeated the virus for good, sending vaccines abroad as part of its “vaccine diplomacy.” In a move seen as an admission of the problems, Prime Minister Narendra Modi on Wednesday replaced his health minister as part of a sweeping cabinet reshuffle.

Now, as the government finally seems to have some of the supply issues sorted out, vaccine hesitancy is so widespread that Mr. Modi himself has stepped in to address it.

“I’ve myself been vaccinated with both doses,” he told one villager who joined his monthly radio call-in last week to report that people were afraid. “And my mother is close to a hundred years of age; she too has taken both doses.”

In the countryside, the aggressive vaccination push by a state machinery that is absent in other times of need is seen by residents in a conspiratorial light. Urban elites question the vaccines because of their rushed development and a lack of transparency about a domestically developed shot.

Misinformation, particularly spread through WhatsApp groups, has led some to believe that the vaccines have side effects like sterility or magnetism. Opposition figures trying to score political points against the government have amplified the concerns.

In some corners, cow dung, lemon juice, oils and herbs have been promoted as remedies. Business-minded religious gurus have pushed their own products as Covid cures, once even with help from Mr. Modi’s health minister. In a video clip, Baba Ramdev, a religious entrepreneur, mocks modern science and falsely claims that 1,000 doctors have died after taking the vaccine.

The three villages in Uttar Pradesh reflect the problem. A health official said that teams had set up vaccination clinics across the villages with a daily capacity of 100 to 200 doses. But each day, the supplies are barely touched. The official read from the ledger for one of the villages: 10 doses one day, five the next, two the day after.

In one of the villages, Dautai, the doctor at the local clinic, Ahmad Arsalan, went door to door with local elders to answer questions. Ishrat Ali, the principal of the local school, said one of his friends had read that anyone who took the vaccine would die within two years.

“I told him, ‘OK, the doctors got the vaccine, the police got the vaccine, everyone got the vaccine. If they all die, what are you going to do living on your own here?’” Mr. Ali said, recalling his convincing argument with a chuckle.

Rajveer Singh Tyagi, a village leader in Khilwai who had helped rally testing resources to contain the spread, said that persuading people to respond similarly to the vaccination drive had been difficult.

“We had vaccination camps, at least four times, but still they are not coming forward,” Mr. Tyagi said. “They say that corona has not affected any of them, so why should they take the vaccine?”

In the absence of blanket vaccinations, Uttar Pradesh, like the rest of India, is left to hope that any third wave of infections is not a repeat of the second.

Understand the Covid Crisis in India

    • What to Know: Shortages of oxygen and hospital beds, along with low vaccination rates, have added to the surge in illness and deaths in India.
    • Case Counts: Experts say the true death count far exceeds official figures. This chart illustrates how known Covid cases have grown over the last few months across the country.
    • Travel Bans: The U.S. has begun to restrict travel from India, and Australia has banned all incoming travel from the country, including among its own citizens.
    • How to Help: Donors around the world are giving money for meals, medical expenses, P.P.E. and oxygen tanks, among other essential supplies.

    The state is run by a Modi protégé, Yogi Adityanath, who is up for re-election next year. Critics accuse him of playing down the devastation, even as hospital officials cried out for oxygen and bodies surfaced in the Ganges River.

    The crematories on one stretch of the river near Garh Mukteshwar, which includes the three adjacent villages, had an eightfold increase in the number of bodies from late April to early May, reaching 160 a day.

    Khilwai, the village that fared well, was spared in part because of happenstance. The second person to die was a relative of the village chief. Her leverage was used to pressure the district government to set up the testing camps, one at her home and the other at a temple.

    While local elders counted more than 30 deaths in each of the other two villages, teams sent by the district health office to “survey” the claims would officially register Covid-19 deaths only if there was a positive test certificate. A column listing the cause of other deaths read: “Unknown fever. Unknown fever. Asthma. Chest infection. Unknown fever.”

    “All the elders are gone,” said Ram Nath, a resident of one of the villages, Janupura. “But there was no testing. How do we know it was corona?”

    The health facilities across all three villages were largely similar. In Khilwai, the government clinic amounted to one nurse in a sweltering room that has not had electricity for nearly a decade. In Janupura, Dr. Rajendra Prasad’s private practice was pretty much the last hope.

    Dr. Prasad said he had a degree in traditional medicine known as Ayurveda, though local villagers doubted he had any degree at all. As he treated patients, he was recovering from his own Covid-19 infection, which required him to be put on a ventilator.

    Now, he was on oxygen, under a fan in his first-floor office-cum-medicine-shop. His son, a physiotherapist, was helping to parcel out medicines.

    “He’s better than all the doctors with degrees — at least he checks from up close,” a villager, Mohit Tyagi, said of Dr. Prasad. “The other doctors just take the fee and don’t even come close to check.”

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