The conventional forum of global diplomacy tends to be dominated by the issues of trade and security. However, the COVID-19 pandemic has brought to the light the importance of health diplomacy. Health security cannot be limited to the engagement at national level. Today, global level engagement is needed more than ever, as the world grapples with the issues of newly emerging communicable diseases, climate change, pandemics, anti-microbial resistance, and threat of bioterrorism. One might think that it is only now, since the pandemic started, that India has started to engage at global level on matters related to health. However, India has had a long history of health diplomacy which is driven by its ever-growing pharmaceutical, health, and IT industries.
Since the time of independence, India has been providing development assistance to lower income countries, in whatever capacity it can. Given India’s economic situation back then, it used to receive more funds than it would donate to other countries. However, in recent years, India has been focusing more on moving from being a recipient of aid to being a provider of foreign assistance. In the early 2000s, India’s foreign development assistance was seen more as an “expression of soft power centred on South-South solidarity”. However, since 2014, China’s growing assertion in India’s neighbouring countries and Indian Ocean has pushed India to provide foreign assistance to strategically important countries, besides the immediate neighbourhood, such as Seychelles and Mauritius. In 2016-17, India’s financial assistance in health sector accounted for 5.27% of the total foreign assistance budget.
India has played a critical role in making medicines and vaccines available at low prices, to people of low income countries. As of 2019, India supplies nearly two-third of the world’s AIDS treatment drugs. In 1993, when anti-retroviral drugs costed thousands of dollars per patient, Mumbai-based pharmaceutical company Cipla began producing the same drugs at a cost of USD 350. A few years later, Cipla also started producing fixed-dose combinations of ARV drugs – a combination of three drugs which were manufactured by three separate pharmaceutical companies. This drove down the global prices of ARV drugs. Moreover, Cipla also played an instrumental role in fighting the Big Pharma against the intellectual property rules, which prevented access to ARV drugs.
According to WHO’s 2020 Global Vaccine Market report, five major vaccine manufacturers produce 60% of the global volume and three out of those five manufacturers are Indian companies – Serum Institute of India, Bharat Biotech, and Haffkine. During 1990s, when recombinant hepatitis B vaccines were available for USD 23 per dose, Hyderabad based Shantha Biotech developed a novel process for producing the same vaccine and the price today is less than USD 4. MenAfriVac which was developed specifically for Africa to treat Meningitis A, was a result of collaboration among SII, PATH, and WHO with funding from Bill and Melinda Gates Foundation.
India has a major role to play in providing telemedicine services in Africa. The Pan African e-network was envisioned by the then President APJ Abdul Kalam, when he addressed the inauguration of Pan African Parliament in 2004. The Government of India and the African Union work collaboratively on this project, with the Ministry of External Affairs being the designated nodal ministry. India’s super specialty hospitals are connected to 48 patient end locations/hospitals in Africa, which facilitates the provision of quality diagnostic and treatment services. Considering the progress in health outcomes and towards Sustainable Development Goals, the Government of India, in 2018, proposed to extend technical and financial assistance for five more years.
When the COVID-19 pandemic started, the Government of India sought to engage at regional and multilateral levels. It reinvigorated dialogue with SAARC countries and set up an emergency fund with an initial contribution of USD 10 million. India also pushed for a meeting with leaders of G20 countries. It provided technical assistance to countries like Kuwait and Maldives, by sending Rapid Response Teams. Even though India’s vaccination drive against COVID-19 has just began, it has already supplied 15.6 million doses of vaccine to 17 countries. These include Myanmar, Bangladesh, Sri Lanka, Nepal, Afghanistan. Vaccines will soon be sent to Cambodia, Mongolia, and Pacific Island states.
The pandemic has presented an opportunity to India to earn goodwill of strategically important countries. India is on a higher footing as it is producing the vaccine which is already approved in the US and UK, and more importantly, its vaccine industry has already gained credibility in the past 40 years. It is in the best interests of India to identify countries that are strategically important and engage in a dialogue with them through providing aid or technical assistance as needed. For instance, Bangladesh was supposed to conduct clinical trials for vaccine developed by China-based Sinovac. However, Sinovac later asked Bangladesh to fund the trials which it was not ready to do. India stepped in and has already delivered 30 million doses under the tripartite agreement signed with the country. Africa-China relations have suffered in the recent times with China not delivering on its promise of supplying vaccines and Africans facing discrimination in China.
Although China has an edge over India, when it comes to producing Active Pharmaceutical Ingredients, this is the time India can start developing domestic capabilities. It already has plans of setting up bulk drug parks. Besides APIs, India also needs to focus on getting more investment in R&D so that it encourages innovation in the pharmaceutical industry. The global engagement has to occur simultaneously with the improvement of India’s public health system. Improvement in health indicators will cement India’s credibility at international level.
Post pandemic, it is inevitable that health will take a key position in matters of international relations. It is the time that India maintains the momentum it has gained in health diplomacy. India has all the means to become the leader of health diplomacy in the global South, with its pharmaceutical and health industries that have the ability to provide drugs and medical treatments at lower prices and its IT industry which can facilitate health innovations.