The effects of India's health diplomacy on the world


India's vaccine donation programme offers a case study of sharing too much at the cost of their domestic population

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Image by Lisa Ferdinando

By Krishnan Srinivas

The Coivd-19 pandemic has offered states the unexpected opportunity to expand their geopolitical influence, including India who have been able to dominate using its well established pharmaceutical industry, known for supplying affordable vaccines and medicines. As the sixth largest and fastest growing economy in the world, it needed to expand its soft power. Being known as the “pharmacy of the world”, India donated masks, PPE kits and certain medicines such as paracetamol and hydroxychloroquine early on in the pandemic to many developing and developed countries.

In January 2021, India started exporting vaccines starting with its South Asian neighbours such as Maldives, Nepal, Bhutan and Sri Lanka, before expanding to Africa, South East Asia, and Latin America. Along with exports, the Indian government had also gifted vaccines as part of their own “Vaccine Maitri” (Vaccine Friendship) initiative as well as the COVAX initiative as a way to expand their soft power. Arguably, India was using their large vaccine manufacturing capability of cheap and affordable vaccines to act as a leader to fellow developing countries during this time and therefore was expanding influence across the world, which could become valuable given the increasing importance of rising states in international discussions and agreements.

India’s growing influence in the sphere of vaccine diplomacy had ripple effects, so much so that even China joined the race in competing for vaccine soft power, donating homemade Sinopharm and Sinovac vaccines to developing countries. Ultimately, this provided some relief to the developing world with supplies, especially when many Western developed nations were being accused of vaccine hoarding, with some even halting vaccine exports and related raw materials for vaccine manufacturing. Many people in India’s ruling party and its supporters patted themselves on the back, through government advertisements and on social media as a proud moment for the country being able to share vaccines and medicines to other countries.

As April 2021 arrived, India’s Covid cases exploded, meaning international support was required to cushion the shortage of equipment and the government was pushed to delay vaccine exports. As of 14 April 2021, the day when India reported a record of over 200,000 daily cases, only 1 percent of its 1.3 billion people had been fully vaccinated and only 7 percent of the population had received a first dose. At that point, neither the central nor state governments anticipated an explosion of cases. There were many reports then of herd immunity, since India’s cases had declined and election rallies, weddings, religious festivals and other crowded gatherings were going on in full swing, and in complete violation of Covid norms.

The slow vaccination rate also resulted in high numbers of hospitalisations, with many people frantically looking for beds and some sections turning to social media to see if a bed was spare, leading to criticism of Indian attempts to vaccinate internationally before achieving domestic goals. The catastrophic situation had resulted in the government’s policy turning inward and focusing more on curbing the domestic outbreak. This included transporting oxygen to states, adding more hospital capacity, using medical school students to help in the staff shortage and opening up vaccination to over-18s, despite a lack of vaccines. Part of this decision was likely an image makeover as until April there was also no incentive to scale up the healthcare system and rather they focused on an economic recovery.

While India’s delay in exporting vaccines eventually gave China a larger share of power in the vaccine soft power race, a more real consequence was that there was a significant delay in vaccines that many developing countries had signed contracts for. Though the US had decided to share vaccines around the end of April to many developing nations which could make up the shortfall, it was not as much as India’s manufacturing and eventual donating capability.

India reached a peak on May 4 2021 with around 414,000 daily cases, a world record at that time. While cases had then reduced in India, most Indian states during the entirety of May were still in strict lockdowns. The vaccination pace then started gathering a lot more steam and the situation started to stabilise, albeit small outbreaks in different parts of the country.

India had resumed bilateral ex-ports of vaccines in October 2021, with the Serum Institute resuming supply to the COVAX scheme in November. This is also the time in which the WHO had approved one of India’s indigenous Covaxin vaccines, after months of delays. At this time, many Western nations were administering booster shots (or third doses) for their adult populations, and many developing nations in South East Asia and South America were ramping up vaccination numbers. However, African countries were and are still left out with a majority of them with fully vaccinated populations not having reached even 30 percent.

India, being a manufacturer of a large share of affordable vaccines around the world, with high safety standards, planned on using this as a means to expand diplomatic soft power and help developing countries. However, its second wave casted criticisms and questions as to the reason behind this at the cost of its domestic population. As a result, India is now balancing its act between sharing vaccines and preventing its domestic population from facing a shortfall. Meanwhile many developed countries have been accused and criticised of vaccine hoarding, as a means of prioritising their domestic population. This scenario offers a case study of sharing too much at the cost of their domestic population and how one must balance between sharing with others as well as taking care of its own population.