India's Rising Role in Global Health Governance | 01 Aug 2024

The recent World Health Assembly marked a significant step forward in global health governance with amendments to the International Health Regulations and the extension of negotiations for a Pandemic Treaty. However, the treaty's adoption remains uncertain. The central point of contention lies in the sharing of pathogens and related benefits, with developing countries demanding equitable access to vaccines and diagnostics produced using their genetic resources. Also, while the One Health approach gains traction, its implementation faces challenges due to resource constraints in developing countries.

India, as a major player in global health, must actively engage in these negotiations to protect its interests. It should advocate for a strong Pathogen Access and Benefit Sharing mechanism, push for technology transfer and intellectual property waivers, and ensure that the One Health approach is implemented in the country.

What are the Major Health Challenges Currently Affecting the Globe?

• Cardiovascular Diseases: Cardiovascular diseases (CVDs) are the leading cause of mortality globally.
  • Low- and middle-income countries are disproportionately affected. Of the 20.5 million CVD-related deaths in 2021, approximately 80% occurred in low- and middle-income countries.
  • In India, cardiovascular diseases account for more than 26% of all deaths.
• Infectious Diseases: While Covid-19 dominated headlines, other infectious diseases continue to pose significant challenges.
  • Malaria affects over 200 million people annually, with 94% of cases in Africa.
  • HIV/AIDS, though better managed, still affects 39.9 million people globally.
  • Tuberculosis remains a major concern, causing 1.3 million deaths in 2022.
  • India faces challenges with emerging infections and antimicrobial resistance, with over 58,000 newborn deaths attributed to drug-resistant infections annually.
    • Also, Tripura state of India registers 1,500 new HIV/AIDS cases annually.
• Mental Health Disorders: Mental health disorders affect 1 in 8 people globally, with depression and anxiety being the most common.
  • Economic costs of mental health conditions are projected to reach USD 6 trillion by 2030.
  • Despite the scale of the problem, there's a significant treatment gap, with over 75% of people in low- and middle-income countries receiving no treatment.
  • In India, an estimated 150 million people need mental health interventions.
• Malnutrition and Obesity: Paradoxically, the world faces simultaneous challenges of undernutrition and obesity.
  • In 2022, 2.5 billion adults were overweight, including 890 million who were living with obesity, while 390 million were underweight.
  • Childhood malnutrition causes 3.1 million under-five child deaths annually, while childhood obesity has increased tenfold in four decades.
  • This double burden strains healthcare systems, particularly in developing countries.
• Non-Communicable Diseases (NCDs): NCDs, including cancer, diabetes, and chronic respiratory diseases, cause 71% of global deaths annually.
  • The burden is rising rapidly in low- and middle-income countries, where 85% of premature NCD deaths occur.
  • Modifiable risk factors like tobacco use, physical inactivity, and unhealthy diet contribute significantly.
  • India is home to 77 million diabetics, second highest in the world.
    • A World Economic Study estimates that India stands to lose up to USD 4.58 trillion between 2012-2030 due to NCDs
• Climate Change and Health: Climate change is increasingly recognized as a major threat to global health.
  • Rising temperatures and extreme weather events contribute to heat-related illnesses, respiratory diseases, and the spread of vector-borne diseases.
  • The World Health Organization estimates that climate change will cause approximately 250,000 additional deaths per year between 2030 and 2050.
  • Air pollution, closely linked to climate change, causes 7 million premature deaths annually.
    • It caused nearly 1.67 million deaths in India in 2019.
• Water, Sanitation, and Hygiene (WASH): Inadequate access to clean water, sanitation, and hygiene facilities poses a significant health risk globally.
  • 2.2 billion people lack access to safely managed drinking water, while 4.2 billion lack safely managed sanitation services.
  • This contributes to the spread of waterborne diseases, with diarrheal diseases alone causing 829,000 deaths annually.
  • Poor WASH conditions also exacerbate malnutrition and impede economic development.
• Aging Population and Healthcare: The global population is aging rapidly, with profound implications for healthcare systems.
  • By 2050, one in six people worldwide will be over 65, up from one in 11 in 2019.
  • This demographic shift increases the prevalence of age-related conditions like dementia.
  • By 2050, the elderly population in India is projected to rise to 319 million (19.5% of the total population).

These major global health challenges highlight the need for coordinated international action and cooperation. However, achieving such coordination is not straightforward, as evidenced by the current lack of global consensus on the Pandemic Treaty.

Why is there a Lack of Global Consensus on the Pandemic Treaty?

• Equity and Access to Medical Countermeasures: At the heart of the disagreement is the issue of equitable access to vaccines, treatments, and diagnostics during pandemics.
  • Low- and middle-income countries (LMICs) are pushing for guaranteed access to a significant portion (at least 20%) of these resources, while high-income countries are reluctant to commit to such binding agreements.
  • This reflects the stark inequities seen during the Covid-19 pandemic, where wealthy nations secured the majority of vaccine supplies early on.
• Intellectual Property Rights and Technology Transfer: Another major point of contention is the governance of intellectual property (IP) rights and technology transfer.
  • LMICs are advocating for provisions that would facilitate the transfer of technology and know-how to enable local production of vaccines and treatments.
    • This includes calls for IP waivers during health emergencies.
  • High-income countries and pharmaceutical companies argue that strong IP protections are necessary to incentivize innovation and investment in research and development.
  • They prefer voluntary mechanisms for technology transfer rather than mandatory ones.
  • The disagreement extends to the interpretation and use of TRIPS (Trade-Related Aspects of Intellectual Property Rights) flexibilities, with LMICs pushing for explicit support of these flexibilities in the treaty.
• Financing and Resource Allocation: There's significant debate over how to finance pandemic preparedness and response, especially in resource-limited settings.
  • LMICs argue for substantial, predictable funding commitments from wealthy nations to build and maintain robust health systems.
  • High-income countries, while acknowledging the need for support, are cautious about open-ended financial commitments.
  • The proposed creation of a Pandemic Fund has been met with mixed reactions.
• Sovereignty and National Autonomy: Many countries are concerned about potential infringements on national sovereignty.
  • This is particularly evident in discussions about the World Health Organization's (WHO) authority during health emergencies.
  • Some nations are reluctant to cede decision-making power to an international body, fearing it could override national policies or interests.
• One Health Approach and Multisectoral Coordination: The incorporation of the One Health approach, which recognizes the interconnection between human, animal, and environmental health, has met with mixed reactions.
  • While many high-income countries strongly support this holistic approach, some LMICs view it as an additional burden on their already strained resources.
  • The challenge lies in operationalizing this approach across different sectors and ensuring that it doesn't divert resources from immediate health needs in resource-limited settings.
• Geopolitical Tensions and Trust Deficit: Underlying these technical issues are broader geopolitical tensions and a trust deficit between nations.
  • Historical inequities in global health governance, rise of Bioterrorism, combined with recent experiences during the Covid-19 pandemic, have heightened suspicions and reinforced north-south divisions.
  • Rebuilding trust and fostering genuine collaboration in this context is a significant challenge.

What Role can India Assume in Leading Global Healthcare Efforts?

• Pharmaceutical Manufacturing and Supply Chain: India should focus on expanding and modernizing its pharmaceutical manufacturing capabilities, aiming to ensure a stable global supply of affordable medicines and vaccines.
  • Investing in research and development will be crucial to move up the value chain from generics to novel drug discovery.
  • The country can lead initiatives to strengthen global pharmaceutical supply chains, reducing dependence on any single nation.
  • Leveraging schemes like the Production Linked Incentive (PLI) for pharmaceuticals will enhance India's manufacturing prowess.
  • Balancing domestic needs with global commitments while addressing quality concerns will be key to establishing India as the undisputed "pharmacy of the world."
• Digital Health and Telemedicine: India should capitalize on its digital health initiatives, particularly the National Digital Health Mission, to position itself as a leader in health technology.
  • Sharing expertise in developing and implementing large-scale digital health systems with other developing countries can solidify this leadership.
  • The success of India's CoWIN platform for Covid-19 vaccine management led to its adoption by several countries in 2022-2023, showcasing India's digital health leadership.
• Traditional Medicine and Integrative Healthcare: India should promote evidence-based research in traditional medicine systems like Ayurveda and their integration with modern healthcare.
  • Leading global efforts in standardizing and regulating traditional medicine practices can establish India as an authority in this field.
  • Leveraging the WHO Global Centre for Traditional Medicine in Gujarat can boost these efforts.
• Affordable Healthcare Models: India should actively share best practices from implementing large-scale health insurance schemes like Ayushman Bharat with the global community.
  • Promoting innovative, low-cost medical devices and healthcare delivery models can position India as a leader in affordable healthcare.
  • The country can spearhead initiatives for affordable management of non-communicable diseases in resource-limited settings.
• Global Health Security and Pandemic Preparedness: India should leverage its vaccine manufacturing capabilities and experience in managing infectious diseases to play a central role in global health security.
  • Contributing to global disease surveillance networks and early warning systems will be crucial.
  • India can share expertise in managing diseases like tuberculosis and HIV/AIDS with other nations.
  • Building on initiatives like the Quad Vaccine Partnership will strengthen India's position.
• Medical Education and Healthcare Workforce: India should take the lead in developing global standards for medical education and training, leveraging its experience in producing a large healthcare workforce.
  • Initiating global programs for ethical recruitment and brain circulation rather than brain drain will be crucial.
  • Building on recent reforms like the establishment of the National Medical Commission will be important.
• Promoting Research and Clinical Trials: India should promote ethical and inclusive clinical trial practices, leveraging its large and diverse population.
  • Leading research on diseases prevalent in the Global South can establish India as a key player in global health research.
  • Facilitating global collaborations in medical research, particularly in genomics and personalized medicine, will be crucial.