When German Chancellor Angela Merkel selected Hamburg as the venue of the Group of 20 summit, I imagine she hoped to showcase the place of her birth and her country. But the best-laid plans sometimes take unexpected turns. Many of the images and sound bites seared in the minds of those following the summit from thousands of miles away were that of protests and sudden twists like Ivanka Trump representing her father, US President Donald Trump, during at least one working session of the summit.
That — and the predicted climate change rift that set the US against the other G-20 members — were seen as defining moments of the Hamburg meet. But all said and done, the two-day summit did manage to get everyone to agree on a whole range of development issues, from investment in Africa to preparedness for pandemics. Global conferences typically don’t solve the problems of the world. But they emit powerful signals. India won plaudits for promoting ease of doing business, startup funding and labour reforms at this gathering of the world’s 20 largest economies.
But there is something else which should have created more of a buzz. For the first time, global health was discussed at a G-20 summit, alongside economic and political issues. This was largely at Germany’s behest. The Lancet, the prestigious medical journal, pointed out: “In recent years, under Angela Merkel’s leadership, Germany has shown a growing financial and political interest and involvement in global health, rooted in human rights, multilateralism, and the Bismarck model of social protection.”
Infectious diseases are not just health problems but present a growing economic and security threat across borders. One major emerging threat is antimicrobial resistance or AMR, as more and more bugs develop immunity to medicines and turn into superbugs. The arrival of global health on the G-20 agenda must be seen in this context. The G-20 nations have pledged to strengthen health systems and combat antimicrobial resistance, a “growing threat” to public health and economic growth. In a world that has already experienced Zika, Ebola, severe acute respiratory syndrome (SARS), attention to these issues are vital, and the G-20 leaders have sent a welcome signal. Dr Tedros Adhanom Ghebreyesus, the new director-general of the World Health Organisation, led the WHO delegation at the summit and used the opportunity to link pandemic preparedness to universal health coverage. Prime Minister Narendra Modi spoke about India’s new health policy and flagged the Swachh Bharat Mission. One hopes more toilets are not only built but also used.
In another development important to this country, tuberculosis was discussed at the G-20 summit. India has the world’s highest TB burden. In 2015, some 2.8 million Indians were diagnosed with TB and 480,000 died of the disease. India has taken initiatives to address the problem but a massive diagnostic gap persists. As does drug-resistance. In 2012, India started a Web-based reporting system — Nikshay — to implement a policy of mandatory TB notification. But despite the progress, India still needs to track one million missing cases of TB every year, specially from the private sector.
In this context, the G-20 declaration identifying TB as a priority area for research and development is good news indeed. Hopefully, it will help tackle the enormous challenge of TB in this country. It helped that G-20 health ministers had gathered in Berlin this May and finalised a set of common goals and practices to promote health under the Berlin Declaration. India’s health minister J.P. Nadda took an active part. Clearly, global health is on the international political agenda again and India is very much part of the discussions.
But if India wants to be perceived as a development icon, it must take the lead in the global health discourse as well as in best practices. Health experts such as Anant Bhan point out that India has come up with policies, successfully conveyed its intent to make significant changes in the healthscape of the country but “leadership” would mean translating that into action on the ground. India has several health feats to its credit. In the past decade, the most celebrated one is its success in the battle against polio. Last year, the WHO declared this country free of yaws and maternal and neonatal tetanus.
But the country’s public health system remains patchy. For instance, whether a woman lives or dies at childbirth depends to a great extent on where she is. Those who have money can buy their way out of the mess; the vast majority cannot, and suffer. Last week, India’s civil society came out with a report on the Sustainable Development Goals: Agenda 2030. The chapter on health is revealing. The National Health Policy 2017 calls for the strengthening of primary care in the form of developing “health and wellness centers”. But the “poor financial outlays for health in the last budget seem inconsistent with this vision” the report points out.
In a country where medicines continue to account for almost half of total treatment costs, it is heartening that the government has flagged free medicines and diagnostics for all in public health facilities. The experiences of Rajasthan and Tamil Nadu show that if free generic medicines are dispensed to the public, it can sharply cut down out-of-pocket medical expenditures. However, as the report points out: “This is achievable if Central government funding is available instead of being left entirely to states.”
The Narendra Modi government has taken steps like price control of medicines, but in what appears to be a case of mixed messages, the powerful Niti Aayog has also recommended disinvestment of government-owned pharmaceutical companies. It is one thing to offload Air India, but this suggestion, if followed, could potentially rob the government of a vital tool to promote affordable access to medicines. Many countries in the developing world and elsewhere already look to India for low-cost life-saving medicines and frugal innovations. Now India needs to step up with fresh ideas, resources and action on the ground if it wants to wear the mantle of a leader in global healthcare.
