“Our G20 priorities will be shaped in consultation with not just our G20 partners, but also our fellow-travellers in the Global South,” said Union health minister Dr Mansukh Mandaviya. Addressing the Health Ministers’ meeting during the Voice of Global South Summit organised by the Ministry of External Affairs in January this year, Mandaviya apparently chanted what Prime Minister Narendra Modi had already said. “It is the need of the hour to focus on long-term measures to build stronger, more resilient health systems that can prevent, prepare for, and respond to future health-related challenges, while maintaining essential health services.”
The primary goal of the summit was to “ensure that valuable inputs generated from partner countries in the Voice of Global South Summit deliberations receive due cognisance globally. India’s ongoing presidency of the G20 provides India a special and strong opportunity to channelise these inputs into the deliberation and discourse of the G20.”
Disturbingly, as the days progress towards the Health Working Group Ministers’ meeting, which is to be held in Gandhi Nagar on 17-18 August, it has become clear that India’s health agenda in the G20 is likely to serve the interests of the developed countries and philanthropic foundations such as the Bill & Melinda Gates Foundation (BMGF), say representatives of several developing countries in Geneva.
India has set three health priorities as part of its G-20 presidency. First, health emergency prevention, preparedness and response with a focus on antimicrobial resistance (AMR) and the One Health framework.
Second, strengthening cooperation in the pharmaceutical sector with a focus on access and availability to safe, effective, quality and affordable medical countermeasures (vaccines, therapeutics and diagnostics).
And third, digital health innovations and solutions to aid universal health coverage and improve healthcare service delivery.
The first two priorities allegedly serve the purposes of the developed countries. On the third priority, the European Union (EU) has apparently pushed back India’s request to make digital health tools a “Digital Public Good”.
Health emergency prevention, preparedness and response
The main thrust of this priority is health and extending the idea of health emergency to AMR. “One Health” is a jargon to describe that human health depends on the health of plants, animals and the environment. Therefore, it is important to surveil pathogens causing infection among plants and animals to identify those of human pandemic potential and thus prevent the next pandemic.
This surveillance also requires collecting pathogen samples from plants and animals along with human pathogens and sharing them with the developed countries. This is very clear from the WHO Bureau’s text of a pandemic instrument that proposes that countries “implement One Health surveillance mechanisms using data collected from and shared across human, animal, and environmental sources for the purpose of preventing and controlling the spillover of pathogens with pandemic potential between humans and animal populations, as well as between different animal species”.
This sharing of samples or their genetic sequences fully compromises the access and benefit- sharing provisions under India’s Biological Diversity Act 2002 and the UN Convention on Biological Diversity (CBD).
Under the CBD, any research benefits emerging out of any genetic materials including pathogens should be shared with the respective country of origin.India’s Biological Diversity Act 2002 implements the access and benefit-sharing provisions at the national level.
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The One Health agenda demands the transfer of genetic materials from the South to the North without any legal commitment to return any potential benefits emanating from such sharing to the South, says a Geneva-based health analyst.
Pathogen samples or their genetic sequencing data are important to develop vaccines, diagnostics or medicines against infections from these pathogens.
The developed countries want to access pathogens or their genetic sequence data to develop the above-mentioned medical products but are not ready to share the technology or know-how related to those products. Often such medical products are protected through patents and trade secrets.
Thus, the One Health agenda serves the purposes of the pharmaceutical industries of the developed countries.
In 2022, four international organisations viz. The Food and Agriculture Organisation of the United Nations (FAO), the United Nations Environment Programme (UNEP), the (WHO), and the World Organisation for Animal Health (WOAH, formerly, the Office International des Epizooties), adopted the One Health Joint Plan of Action (2022-26).
The draft G-20 Health Ministerial Declaration contains language to endorse this joint action plan. This joint action plan requires a range of norms and standard settings and information sharing without clearly mentioning the governance of this shared information and the benefit emanating from that.
Many trade experts in Geneva are worried about the One Health agenda that is being pushed because information on plants and animal pathogens could be used as a tool to prevent agricultural imports from developing countries, including India, by raising the requirements to prove the absence of such pathogens in agriculture and meat products.
Though the joint action plan mentions access to quality vaccines, there are no details in the plan on how to achieve that target. Interestingly, the joint action plan was developed without any effective participation from countries except through an online consultation.
The endorsement of the joint action plan is akin to giving a seal of approval to the plan, which many G20 developing country members have no informed understanding of and neither did they participate in its development.
It is interesting to note that many developed countries inserted the One Health agenda in the ongoing negotiations on the UN General Assembly Political Declaration on Pandemic Prevention, Preparedness and Response (PPPR).
The inclusion of AMR into health emergency surveillance is an overlapping item under the One Health agenda. However, the most important implication is the extension of surveillance on AMR-related areas and thus converting health emergency surveillance into AMR surveillance.
The EU has already presented extensive proposals for inclusion as part of the new pandemic instrument currently under negotiations at WHO. Thus, it is clear that it is an EU agenda.
Access to medical countermeasures
Under this agenda item, India is pushing other G20 developing country counterparts to agree to the establishment of a platform on medical countermeasures to facilitate access to vaccines, therapeutics (medicines) and diagnostics.
This is not a new idea but is an institutionalisation of a failed experiment known as Access to COVID-19 Tools Accelerator (ACT-A), which was established in April 2020 to respond to the COVID-19 pandemic based on a white paper developed by BMGF.
ACT-A was envisaged as a multi-stakeholder platform without any effective say for the WHO member states. The Strategic Review of ACT-A points out the member states’ lack of participation as a serious shortcoming.
In January 2023, the WHO had already envisaged a plan to give a new lease of life to ACT-A under a new name and mooted the idea of establishing a Platform for Medical Counter-Measures (MCM). The WHO delegation attended the 1st G20 Health Working Group meeting in Trivandrum where it sold this idea, and the Indian G20 presidency apparently bought this idea without a second thought.
In February 2023, Africa and Norway hosted a joint-meeting in Johannesburg to discuss the new lease of life to ACT-A through the Platform for MCM. This was envisaged as a mechanism to carry out research and development (R&D) on vaccines, therapeutics and diagnostics and then licence these for production and supply in low- and middle-income countries, thus excluding many developing countries like Argentina, Brazil and even African countries like Namibia. This has created opposition among many developing countries including Brazil.
Another reason for opposition is that the Platform for MCM is envisaged as a multi-stakeholder mechanism including donors as part of its governance, thus accommodating BMGF.
Many developing countries, especially African nations, view this WHO move as scuttling the creation of a mechanism for production and supply as part of the new pandemic instrument currently under negotiation. Many delegates in Geneva believe that the mechanism under the new pandemic instrument would create accountability and shared ownership.
Realising the resistance, WHO is now saying that it is establishing only an interim platform and further progress is subject to the negotiations on the pandemic instrument.
It is also worth noting that the endorsement of such a platform has already come from industrialised countries grouped under the G7. Further, many developed countries proposed language for the endorsement. The G7 Leaders Communique from the Hiroshima Summit in May 2023 states: “We announce the G7 Hiroshima Vision for Equitable Access to MCMs and launch the MCM Delivery Partnership for equitable access (MCDP) to contribute to more equitable access to and delivery of MCMs based on the principles of equity, inclusivity, efficiency, affordability, quality, accountability, agility and speed”.
The developed countries are trying to obtain an endorsement for the establishment of the interim platform.
Last week in New York, during the negotiations on UN General Assembly Political Declaration on PPPR, developed countries made the following proposal: “Urge sustainable, affordable, fair, equitable, effective, efficient and timely access to medical countermeasures, including vaccines, therapeutics, diagnostics and other health products and call on the WHO to coordinate this with relevant partners to ensure its ability for interim mechanism, ensuring coherence with the mindful of the/without prejudice of the ongoing discussions of the Intergovernmental Negotiating Body and the Working Group on Amendments to the International Health Regulations (2005) in Geneva.”
Sources revealed that the G20 draft Health Ministers’ Declaration also contains more or less the same text, thus giving an endorsement for the WHO to establish the interim platform on MCM.
Implications on credibility
Currently, India is engaged in hectic diplomatic efforts, through its missions abroad, including the UN Mission in Geneva, to bring about a consensus on the G20 Health Ministers’ Declaration. India’s apparent desperation to showcase the success of its G20 presidency has also allegedly forced it to support the developed country agenda of One Health and Platform for MCM in WHO and the UN General Assembly.
This creates an image of being an alleged “satellite country” of the North and severely dents India’s credibility as an independent development arbitrator in various international forums. The immediate consequences of such erosion of credibility would be India’s efforts to build a coalition in forums like the WTO. The health agenda also once again proves that forums like the G20 are being used by the G7 to obtain endorsement and legitimacy for their agenda from developing countries like India.
Under the vacuous Modi Administration, whether it is in finance, trade, and now health, India seems to have become a champion of that proverbial saying: Run with hares and hunt with hounds.
Ravi Kanth Devarakonda is a senior journalist based in Geneva.
