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This article previously appeared on News@Northeastern. It was written by Molly Callahan.

The pace of vaccinations in India continues to drop as cases of COVID-19 in the country soar—a humanitarian crisis that makes the country vulnerable to counterfeit medicines and could also have wide-reaching supply-chain consequences around the world, say Northeastern scholars of supply chain management and criminology. 

India, the second-most populous country in the world, is home to the Serum Institute, the world’s largest vaccine manufacturing site responsible for supplying COVID-19 vaccines to a number of other countries around the world. The country is also the leading supplier in several other critical industries, including information technology support and generic drug manufacturing.

If SARS-CoV-2, the coronavirus that causes COVID-19, continues to surge, it could hobble businesses—and indeed economies—around the world, says Nada Sanders, university distinguished professor of supply chain management at Northeastern.

“The global economy, and the U.S. economy could see the ripple effects of this crisis as quickly as a month or two,” Sanders says.

Some of the negative consequences have already begun playing out in countries such as Kenya and South Africa, in which government and public health officials were depending upon vaccines manufactured at the Serum Institute to inoculate their residents against the deadly virus.

Additionally, Sanders says, businesses in the United States employ millions of Indian workers to run back-office operations—companies including American Express, Microsoft, CISCO, Ford, GE, Oracle, Dell, IBM, and others all rely on Indian workers to run customer support call centers, IT support, and more.

“If India’s economy falters, it can have huge global economic impacts, and certainly in the U.S.,” she says.

To compound the situation, the imbalance between the huge demand for vaccines and the limited supply makes India fertile ground for criminals looking to make some money by selling counterfeit vaccines—medicines that, at best, are useless against COVID-19, and at worst, can be harmful to those receiving them, says Nikos Passas, professor of criminology and criminal justice at Northeastern.

“This is an explosive mix, and it makes for a criminogenic environment when you have such demand and supply mismatches,” says Passas, who is also co-director of the Institute for Security and Public Policy at the university. “There’s been an illegal trade from the minute these products came on the market.”

At the end of April, Pfizer identified the first confirmed instances of the COVID-19 counterfeit vaccine in Poland and Mexico, according to The Wall Street Journal. The vials recovered in Mexico also had fraudulent labeling, while a substance inside vials in Poland was likely an anti-wrinkle treatment. In Mexico, some people were charged as much as $1,000 for the fake vaccine.  

“We’re seeing multiple types of crime, and multiple layers of opportunity for people to make illicit gain,” Passas says. “When people are stressed out financially and their guard is lowered, the opportunity for criminal enterprises to make a lot of money and cause a lot of harm is huge.”

Last week, U.S. President Joe Biden threw his support behind waiving intellectual property rights for COVID-19 vaccines. If it’s adopted, the plan would enable more companies around the world to produce the vaccines currently made in the U.S.—potentially reducing the discrepancy between supply and demand.

“We’re in a race with the virus,” Sanders says. “We know enough that we can’t seal our borders, and when we look at what’s happening around the world—the impact we’re seeing for countries in Africa and states in India—the whole global economy will be impacted. Worse, as long as the virus keeps spreading, it’s seeding mutations that might evade vaccinations. We really are in this together.”

Read more on News@Northeastern.