Health sector cooperation between our two nations has a rich history which successive administrations have taken forward. This engagement has only strengthened over the past decade and a half with the deepening of strategic initiatives like the global disease detection network, pandemic preparedness, joint research initiatives, the India-US Health dialogue etc. Given the indicative directions by way of statements by President Trump and his appointees, five areas mandate a focus: trade and market access for pharmaceuticals, devices and products; vaccine development and production; pandemic preparedness; digital health, cybersecurity and AI; and climate resilience for the health sector.
Trade, especially pharmaceutical exports to the US will be a keystone issue that needs deft handling and deep engagement. The US accounts for over 31% of India’s total pharmaceutical exports, the total value of which is USD 27.9bn in 2023-24. By some estimates, India supplies about 40% of generic formulations in the US and many pharmaceutical companies have set up substantial manufacturing operations in the country. Along with this, medical devices are another important element in the medical trade basket, with export of medical devices products standing at USD 3.8bn in 2023-24 with the US as the primary market as per EY.
As it expands its exports, India continues to remain heavily import-dependent, with USD 8.2 bn in imports, and 80% to 85% of medical devices sourced internationally. The global medical devices sector is slated to worth USD 433 bn by 2025, with the United States dominating this market with 40% market share. At the same time, India is seeing a rising trend of imports of medical devices which stand at USD 8539.50 mn in FY 2021-22 as per a study commissioned by the Ministry of Chemical and Fertilizers Department of Pharmaceuticals.
With the incoming US President nominee obviating free trade and preferential treatment of even established trade treaty partners while using tariffs as a negotiating tool, India will have its task cut out to ensure the continuity of its exports of pharmaceuticals and medical devices. A negotiating tool available for India would be the strident stand that nominee Trump took at the pulpit during the election campaign. Trump railed against rising costs of healthcare and prescription drugs, calling out the powerful pharmaceutical sector for its profiteering. Cost of care being a hot-button issue, could be an area where India offers to help lower the cost of medications through its expansive generics portfolio which could be allotted preferential treatment by the government mandated programs like Medicare and Medicaid. In effect, the Indian pharmaceutical sector needs to be projected as an ally for the incoming administration in helping it keep an important campaign commitment in office. Vaccine development and supply portends to become contentious with the new US administration. With the tapping of Robert Kennedy Jr. as the head of the Department of Health and Human Services (HHS), the hitherto area of traditional cooperation may get upended. Kennedy Jr., a strident anti-vaxxer, will oversee priority areas for health policy and diplomacy for the US, and the co-development and access to vaccines may become an early victim. This has implications for India. India accounts for 60 per cent of global vaccine production making it the largest vaccine producer in the world in a global vaccine market estimated to be around 5.5 bn doses, with a market value of USD 33 bn in 2019. India is also the eighth in the list of highest exporters of vaccines. The US and India have a history of vaccine cooperation, with the bilateral Indo-US Vaccine Action Programme (VAP) under implementation since 1987. This programme aims to support novel vaccine research, human immunology, vaccine related technologies, translational research and other activities of shared scientific interest supported jointly by both sides. The VAP is recognized internationally and considered as a model bilateral programme in biomedical research and has had notable successes including collaborative research. Further the US supported India’s Covid-19 vaccination program with the government providing USD 25mn through the U.S. Agency for International Development (USAID) and another USD 50mn for the development of a paediatric hexavalent vaccine through the Development Finance Corporation. The continuing success of cooperation in this domain and the development of vaccines for existing and novel diseases will depend on India keeping this high on the health engagement agenda. Pandemic preparedness is an area of global concern. The felt need post the pandemic for a comprehensive global Pandemic Fund is yet to see the light of day. Key reasons include a de-prioritisation of this issue amongst competing geopolitical, economic and ideological priorities for governments across the world. But the devastating impact of the Covid-19 pandemic showed the major inequities and capacity constraints of countries and the global health system. India has a major stake in the prevention, containment and response to future pandemics. This area being one of the global commons, the need for leadership by the US and more broadly the G20 group of countries will be vital. The tapping of Dr. Jay Bhattacharya as head of the National Institutes of Health (NIH) has been met with concern for people working on pandemic preparedness. Known for his critical views on the population level response to Covid-19 including on lockdowns, vaccination and masking, how this shapes US policy on pandemics will be an area to keenly watch. Here again, given the devastating pandemics can have on the economic vitality of a country may be an effective tool for India to get the US to be more alive to the issue. Other than funding and continuing focus on joint initiative like the Bio-5 alliance and India-US Health Dialogue – joint research on future potential pandemics should remain a priority area.
Artificial Intelligence (AI) and cybersecurity have emerged as areas of opportunities and threats respectively for all countries. They now straddle the geopolitical and national security domains which require global cooperation. AI, digital health solutions and cybersecurity will play an increasingly important role in global health diplomacy. India has much to offer through its digital public goods infrastructure and technologies like the health stack and e-health solutions. At the same time, the risks to an ever-digitising health system from malign actors threatens the progress that has been made. Given the ear-space that tech-entrepreneurs currently enjoy with the incoming president. India should tap on to these themes for an early harvest set of areas for joint work and expansion of trade in services and technologies.
Finally, the need to build resilient and adaptive health systems in the face of climate change will remain critical. The position of the incoming administration on climate change notwithstanding, the US system does need to get on a credible path to decarbonising and building resilience within its health system like the NHS. At the same time, the Indian health system needs to grow “green” to both help India meet its climate commitments and also to ensure a responsive health system that continues to deliver in the face of climate calamities and climate induced diseases. It is high time that the climate and health agenda be put up the issue matrix both within the country and in its dealings with the world, most importantly with the US.
The highlighted issues are not by any means comprehensive – the impact on a new visa regime on the inflow of medical talent is another issue that may emerge with the new administration amongst others. With such a weighty health cooperation agenda and an ideologically, America First driven new US administration, India needs to set up a joint task force to stocktake and plan a way forward on its health engagement with the US. The continuity of existing areas of work and including emerging ones needs prioritisation and consensus within the government prior to it being negotiated bilaterally. The health of nations is the real wealth of nations, and India is well placed to use its health sector as a soft-hard power in its engagement and deepening cooperation with the US.
Dr. Karan Thakur is a healthcare administrator at Apollo Hospitals. Views expressed are personal
