India and G20: Expectations from a Public Health Perspective

India’s overarching goals as the G20 president included promoting inclusive and resilient global growth, accelerating progress on the United Nations’ Sustainable Development Goals, and providing equitable global benefits from and access to technological innovation and digital transformation. All these elements were reflected in tangible ways in India’s leadership of the G20 health workstream. Especially in the wake of Covid-19, India’s overarching goals as president were to build on earlier G20 work and encourage cooperation to prevent and prepare for future pandemics, with a strong focus on equitable healthcare access for low- and medium-income countries.

India’s specific goals in the health area were for the G20 countries to adopt measures and encourage cooperation to mitigate the likelihood of another pandemic and its risks, and to better coordinate pandemic response. As part of this effort, India encouraged a strong G20 message regarding the development, manufacturing, and delivery of medical pandemic preparedness countermeasures, such as vaccines and medicines. This included promoting manufacturing and supply chain integration. Another goal was for members to build the capacity to strengthen the “One Health” initiative and address antimicrobial resistance. India also stressed the goal of equitable access to healthcare and the elimination of ongoing health threats, both as essential elements of pandemic preparedness and to ensure robust and equitable economic and social development. To further this objective, India prioritized G20 endorsement of strengthened access to universal care, including through equitable access to innovations. Building on its own public health priorities, India also stressed the important role of digital health applications such as artificial intelligence (AI) and telemedicine and pushed for data sharing and health data interoperability across G20 countries. India similarly prioritized the need to eradicate tuberculosis (TB) and mitigate noncommunicable diseases. Additionally, India aimed for the G20 to establish a role for integrative (traditional) medicine in global health systems, including Ayurvedic medicine.

Q1: What were the key outcomes of the G20 Health Ministers’ Meeting?

A1: The robust, 25-paragraph Outcome Document and Chair’s Summary issued following the G20 Health Ministers’ Meeting in August covered all of the Indian presidency’s priority areas, building on prior G20 work. In the case of pandemic preparedness, the ministers aligned key definitions and prioritized goals across all G20 members. Given the vast differences in medical systems, economies, and societies across G20 membership, agreement in these areas could provide a critical basis to improve responses at both national and international levels if Covid-19 or other pandemics reemerge as threats. While the document’s language concerning the development and distribution of medical countermeasures is somewhat aspirational, it lays down important markers on the importance of international cooperation between governments and the pharmaceutical industry as well as other components of successful dialogue. The ministers also highlighted specific areas of pandemic preparedness cooperation underway between members both within and outside the G20, such as the establishment of a Pandemic Fund and other work under the G20 Joint Finance and Health Task Force. In reiterating a pledge to eliminate AIDS, TB, malaria, and polio, the ministers highlighted the need for governments to refocus on persistent health threats of particular concern, especially in less economically developed economies. This reinforces the message that equitable global health access will play an important role in ensuring sustainable global development and in preventing future pandemics and other outbreaks. The ministers additionally highlighted the importance of digital health and health data modernization in strengthening healthcare systems and providing more equitable access to a range of preventive services and care.

Importantly, the outcome document sends a clear message that the work of the G20 should reinforce and not duplicate existing international healthcare architecture, stressing members’ support for the role of several global and regional organizations while highlighting which issues covered are of primary concern to all G20 economies. This includes repeated reference to the important role that the World Health Organization (WHO) continues to play in pandemic preparedness and in enabling lower and middle-income countries to reach the UN Sustainable Development Goals as well as universal health coverage. The WHO’s role was also cited in several other areas throughout the document, such as addressing climate change-related health threats and the development of medical countermeasures. While recognizing the need for reform in the WHO, the document also signals an important vote of confidence for the organization at a critical time after a few tumultuous years. It also makes clear the primary importance of international cooperation via a wide number of organizations and initiatives in the post-Covid-19 era, highlighting organizations as diverse as the United Nations and the International Civil Aviation Organization.

In addition to the ministers’ meeting, the Indian presidency addressed some of its key areas of focus through additional initiatives and meetings. These included working-level discussions on TB, climate change and health, hypertension and diabetes, food safety and nutrition, and adolescent and youth wellbeing. These efforts were recognized by the health ministers in their statement. During the ministerial, the WHO and the G20 India presidency additionally jointly announced a new Global Initiative on Digital Health (GIDH). India also hosted a first-ever global summit with the WHO on the margins of the ministerial that discussed the role of traditional medicine in modern healthcare.

Q2: Were there any surprises?

A2: The outcome document included a chair’s summary that referred to the negative health implications of the Ukraine war. While this was the only paragraph in the document not signed off on by all G20 members, reflecting their disagreement, it was far more expansive than the brief reference of the issue made in the Chair’s Summary of the 2022 Health Ministerial.

The outcome document’s repeated reference to the health risks inherent in climate change, including a standalone paragraph, was a bit of a surprise given that the issue had not been as emphasized by Indian officials in the run-up to the meeting. It is nevertheless in line with India’s overall areas of emphasis in its international affairs generally and under the G20 presidency specifically. References to issues such as Ukraine and climate change also underline the recognition by members that health risks cannot be considered in a vacuum.

Q3: What are potential areas for U.S.-India cooperation in health?

A3: The United States and India enjoy a robust partnership on many health-related issues. There are more agencies under the U.S. Health and Human Services Department represented in India than in any other country overseas and bilateral cooperation includes topics of focus in both countries. This close partnership moved front and center in discussions and workshops in the lead-up to the August G20 Health Ministerial. The G20 Health Agenda under the Indian presidency also covered several bilateral U.S.-India priorities, such as TB eradication and the fight against diabetes, hypertension, and other noncommunicable diseases. As part of President Biden’s Cancer Moonshot initiative, a U.S.-India Cancer Dialogue will follow on from outcomes discussed in the G20, increasing bilateral collaboration in this area.

In addition to the ministerial meeting, U.S. health and human services secretary Xavier Becerra conducted bilateral meetings with Indian counterparts, building on the research and health cooperation outcomes from Prime Minister Modi’s June visit to Washington, These commitments include cooperation on topics as varied as pharmaceutical supply chains, AI-enabled cancer diagnostic research programs, and health and climate. The secretary highlighted U.S.-India pharmaceutical cooperation during his visit, including to address cancer drug shortages.

Covid-19 highlighted weaknesses in the global vaccine supply chain. One of the G20’s health working groups addressed the Global Vaccine Research Collaborative, emphasizing that collaboration between governments, research organizations, and pharmaceutical companies is essential to strengthen health systems against Covid and other pandemics. Building off of the G20, the United States and India will keep the Indo-U.S. Vaccine Action Program alive until at least 2027, and continue work toward the development of a resilient supply chain ecosystem. Other aspects of the G20’s Digital Health agenda may provide additional impetus for research collaboration and knowledge exchange between the two countries and strengthen coordination of technical health knowledge and resources.

Q4: What will Brazil pick up on healthcare in its G20 year?

A4: This year, the G20 troika was composed of Indonesia (the previous chair), India (the current chair), and Brazil (the successor)—all Global South countries. When Brazil takes the mantle for 2024, it will be charged with taking forward priority health issues that members discussed under the Indian G20 presidency. This includes pandemic preparedness as well as digital health and its role in primary care—a priority under Brazil’s own digital health strategy. Brazil is also likely to build on the India’s work towards mitigating the role of climate change on One Health and other health-related risks. Lastly, Brazil will likely maintain efforts to reach G20 consensus on health systems strengthening, particularly to ensure less economically developed economies gain equitable access to health innovations.

Katherine B. Hadda is a visiting fellow at the Chair in U.S.-India Policy Studies at the Center for Strategic and International Studies (CSIS) in Washington, D.C. Yatin Jain is a program coordinator and research assistant for the Chair in U.S.-India Policy Studies at CSIS.

Yatin Jain
Program Manager and Research Associate, Chair in U.S.-India Policy Studies