Health Diplomacy: a strategic armament in Indian Foreign Policy

Hans Morgenthau viewed diplomacy as a tool to promote the national interest by peaceful means. In the era of “New diplomacy”, “Medical diplomacy” was first coined by Peter Bourne (special assistant to US President Jimmy Carter) who wanted to explore the role of health and medicine in bettering international relations.

Consequently, in the post-cold war era, Joseph Nye spearheaded the concept of “soft power” which is defined as “an ability of a state to realize foreign policy objectives through attraction or co-option”. Moreover, human dignity formed the bedrock of inter-state cooperation. Hence, health diplomacy gained traction in foreign policy architecture.

However, the emergence of 21st century warrants the review of health diplomacy since the nature of the health crisis has changed fundamentally. First, globalization has propelled communicable infections beyond borders (SARS, H1N1, MERS, Ebola, Nipah and now COVID-19). Second, ecological disequilibrium viz. due to deforestation, wet market trade, biodiversity loss has exposed new pathogens to humans. Third, rising inequality and poverty have led to the marginalization of more than 60% of the global population making them more vulnerable to health crisis (The Inequality virus report). Fourth, rapid and unplanned urbanization has created problems of sanitation and hygiene. Fifth, lifestyle alterations have increased incidents of non-communicable diseases. Finally, emerging multipolar world order sans multilateralism has jeopardized global cooperation. COVID-19 pandemic, akin to X-ray, has only revealed the deep fractures in global health diplomacy.

India is not immune to these challenges. Thus, there is a dire need to inoculate health diplomacy in the mainstream strategic matrix. Interestingly, the origins of Indian health diplomacy can be traced back to ancient times when the subcontinent acted as a “Vishwaguru” (Knowledge epicentre: Sushruta and Charaka Samhitas, Universities like Taxila and Nalanda) and illuminated the world. Today’s comatose world is again yearning for a lifeline and India appears to be well equipped to meet the needs of humanity.

India’s “Vaccine Maitri” initiative has infused a sense of relief across the world. India currently contributes 62% of global vaccine production and is committed to participating in equitable vaccine distribution as reflected by its contribution to WHO’s COVAX facility and cooperation with UNICEF, CEPI and GAVI alliance. Moreover, India is among the top five (V5) vaccine powerhouses.

Furthermore, India is the largest provider of generic medicines and a major contributor to Biosimilars globally. Assured and timely supply of Hydroxychloroquine (HCQ), paracetamol, antivirals against HIV-AIDS, biosimilars like recombinant insulin, adalimumab, trastuzumab etc has reposed faith in India as the “Reliable Pharmacy of the world”.

Indian R&D and start-up sector has risen to the occasion and delivered astounding results within a short duration. Within few months, Indian industry and academia ensured the transition from a net importer to self-reliant India with respect to PPE kits, N-95 respirators, mechanical ventilators, diagnostic kits like RT-PCR, key drugs like remdesevir, favipiravir etc. This has created a suitable groundwork for The Make in India and Make for the World campaign.

India’s prowess in health diplomacy can thus be leveraged to secure its national interest in the following ways. Recently, the term “Bio-war” has been in vogue. COVID-19 has demonstrated its catastrophic potential as a bioweapon to dismantle India’s national security. Thus, robust biosurveillance and bio deterrence infrastructure can be ensured by strengthening India’s health infrastructure. Additionally, the possibility of a bio-war opens up a window of opportunity for India to engage multilaterally and hold rogue actors accountable (Biological Weapons Convention and Cartagena Protocol on Biosafety).

More fundamentally, COVID crisis has created strategic opportunities for India to counter Chinese belligerence by diversifying supply chains and by cultivating technology partners like the US, Australia, Japan, Israel and the UK. Also, it has facilitated India to provide transparent health care support (eg Vaccine Maitri) to the world vis a vis China’s opaque Health Silk route.

Recent IMF’s WEO report projects India’s growth to be at 11.5% in 2021. Economic security can thus be enhanced by developing health sector. This will attract investments, create the necessary infrastructure, generate employment and boost trade, making India truly Atmanirbhar.

At the core of Indian foreign policy lies the “Neighbourhood First” approach. This has been galvanised through initiatives like SAARC emergency fund, Vaccine diplomacy, BIMSTEC Public health cooperation, IBSA fund, Medical tourism etc.

Moreover, South-South health cooperation (Africa, Latin America and Indo-Pacific island countries) has been a conventional strategy for India viz. medical aid in peacekeeping missions, capital investments in health infrastructure, skill development programs for health professionals through ITEC platform and pharmaceutical diplomacy.

Global governance and reformed multilateralism based on equity and sustainability are sine qua non for India’s national interest. Health diplomacy provides a gateway for India to play a pivotal role in steering UNSC reforms, WHO reforms, WTO reforms and environmental reforms (Paris agreement).

Notwithstanding opportunities, there are certain challenges to face. As per Kautilyan statecraft, Rajniti (Internal governance) forms an indispensable limb of any state. In order to translate global aspirations, India has to speed up the wheels of change. Proactive execution of goals enshrined in Atmanirbhar Bharat vision can be a starting point.

Indian health care has systemic issues. Public spending in health care (1% of GDP) and R&D (0.65% of GDP) is abysmal. Seventy per cent of APIs and KSMs are dependent on one country. IPR ecosystem is underdeveloped. These factors are inhibiting India from unleashing its reserve potential.

Multilateralism is under stress when it is required the most. Geopolitical contestations between major powers are rendering global institutions and mechanisms ineffective. It is important to note that 21st-century problems are planetary in nature and requires the adoption of “geo civic sense”.

To navigate stormy waters, India can act as a lighthouse by building consensus around the need for global health diplomacy and cooperation. Aurobindo envisioned India as the universal spirit with a divine mission to serve humanity. This is precisely what Indian actions speak- Be it COVID crisis, climate change or fight against terrorism.

Indian health diplomacy as a determinant of foreign policy has a bivalent utility. Besides soft power (International Yoga day, Global Centre for Traditional Medicine, Pharmacy of the world), it has the potential to transform into hard power. If harnessed appropriately, it can generate strong undercurrents in the geopolitical, geostrategic and geoeconomic spheres. Thus, acting as a keystone in foreign policy calculus.

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