Strengthening Health Diplomacy in the Global South: The Role of Think Tanks

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Countries often engage in adversarial terms, but their health systems remain interdependent, even through long periods of hostility. Earlier this year, the United States unleashed new tariff measures on Indian imports. However, generic medicines were kept outside the scope of the new tariffs, possibly because Indian firms supply a large share of the low-cost generics used in the United States, which helps contain public health expenditure. Generics make up close to 90 percent of all prescriptions dispensed in the United States. Analysts warn that tariffs on these imports could raise costs for public payers and trigger severe shortages in critical drugs in the US, and this factor possibly contributed to the Trump administration’s decision — in its self-interest — to shield generic pharmaceutical products for now, even as other sectors were slapped with heavy tariffs. 

The lesson for the Global South is clear: political rivalry does not end interdependence in health supply chains. Just as the US cannot easily delink from Indian generics, India cannot sustain those exports without Chinese inputs. This creates a constant requirement for negotiation, even when other channels narrow.

India’s relationship with China is also marked by simultaneous confrontation and dependence. Intermittent clashes at the border and a tense security situation for most of the last decade have not significantly impacted trade between the countries. In fact, India’s trade deficit with China reached a record USD 99.2 billion in 2024-25, driven by imports of active pharmaceutical ingredients, electronics, and other products. Indian drug manufacturers continue to source around two-thirds of key active pharmaceutical ingredients from China. India’s import dependence on China for antibiotics is an indicative case: between 2005 and 2024, it has grown from 62 percent to a staggering 87 percent in USD value terms (see Graph 1). 

The lesson for the Global South is clear: political rivalry does not end interdependence in health supply chains. Just as the US cannot easily delink from Indian generics, India cannot sustain those exports without Chinese inputs. This creates a constant requirement for negotiation, even when other channels narrow. Health diplomacy is, therefore, a core instrument of economic stability, public health security, and foreign policy. For most countries in the Global South, the central question is not whether to “join” health diplomacy. They are already in. The question is whether they can shape outcomes, and this article discusses where think tanks can help build that ability. Their role can be understood in four linked areas: agenda setting, providing negotiation-grade evidence, convening and translation, and long-term capacity-building.

Agenda Setting Rooted in Southern Realities

Global health diplomacy has been described as the set of multi-level, multi-actor negotiation processes through which states and other actors shape the global policy environment for health. These processes are increasingly employed in trade, finance, foreign policy, as well as technology and security forums, not only in health forums. But the starting question in many negotiations is still framed outside the South. Delegations from low- and middle-income countries are often brought in late, after the first draft is largely set. At that point, they are asked to comment, not to define.

Indian drug manufacturers continue to source around two-thirds of key active pharmaceutical ingredients from China. India’s import dependence on China for antibiotics is an indicative case: between 2005 and 2024, it has grown from 62 percent to a staggering 87 percent in USD value terms

Think tanks can move Southern priorities to the start of the process. This requires structured engagement with ministries of health, finance, commerce, and foreign affairs, as well as drug regulators, procurement agencies, national insurance schemes, manufacturers, civil society, and patient groups. The task is to document the pressures these systems face, including the volatility in the price and availability of active pharmaceutical ingredients, exposure to unilateral export controls, shortages of essential antibiotics, staffing challenges, and fiscal stress from chronic disease programmes. 

Those pressures should then be translated into first-order negotiating questions. When these are framed as starting positions, rather than late additions to a text already centred on intellectual property for high-value biologics, the agenda reflects Southern needs. Agenda setting itself is, in this sense, a form of democratisation of global decision-making.

Supplying Negotiation-Grade Evidence

Negotiators need concise material, often across sectors and in real time. Academic publications have depth, but they often arrive with reflective analysis after decisions have been made. Advocacy messages can mobilise attention, but are rarely useful in line-by-line drafting. The space in between is frequently empty.

The experience of the proposed United Nations political declaration on noncommunicable diseases (NCDs) and mental health in September 2025 shows why that gap matters. The declaration aimed to strengthen global action on cardiovascular disease, cancer, diabetes, and mental health. These conditions cause an estimated 43 million deaths a year, most of them in low- and middle-income countries. Early drafts included language proposing higher tax targets on tobacco, alcohol, and sugar-sweetened products. The World Health Organization and many finance ministries in the Global South view such measures as both public health tools and domestic revenue sources. 

However, over successive rounds of negotiations, references to specific fiscal measures were weakened or deleted, likely as a result of lobbying from alcohol, food, and tobacco interests. The US then refused to support even the diluted text, stating that it contained what it called “destructive gender ideology” and implied abortion rights. Without US support, the consensus failed.

Think tanks in the South can respond to such situations not only with critique but with usable inputs, including revenue projections for ministries of finance under different tax designs, distributional notes on who pays and who benefits, and a clear record of when and how specific commitments were watered down. This gives Southern delegations material they can insert directly into negotiations. It also builds an archive for future talks at the World Health Organization, the United Nations, and the G20. In short, producing negotiation-grade evidence — not only post-hoc analysis — is itself a diplomatic function.

Convening and Translating Across Actors

Health diplomacy is not conducted by health ministries alone and requires coordination between diverse stakeholders. However, many of these actors do not speak to each other before negotiations begin. Think tanks can convene structured dialogues that bring these groups together early on and translate across their different priorities. 

Such formats are widely used in security and trade. They are increasingly relevant to health. In these settings, a regulator can state plainly what inspection capacity is required to implement a surveillance clause. A domestic manufacturer can warn that a strict price ceiling, without guaranteed purchase volumes, will force exit from a production line and lead to shortages. A civil society group can identify gaps in patient protection in a draft data-sharing provision. These details rarely enter formal plenary statements, but they determine whether any agreement can work on the ground.

This convening role also supports practical South–South coalition building. Coalitions are most credible when they are built on complementary strengths. One country may have strong regulatory inspection systems. Another may manufacture vaccines and generics at scale. A third may have digital public infrastructure that can administer entitlements and track delivery. A fourth may have access to a key regional market. Mapping those assets in advance allows countries to present a joint language and propose shared implementation mechanisms.

Developing Human Capital and Institutional Continuity

Health diplomacy now demands mixed skill sets. Foreign ministries need staff who understand health systems and pharmaceutical supply chains. Health ministries need staff who can work with trade law, financing, procurement, and data governance. Finance and commerce ministries need staff who understand the public health consequences of shortages and price shocks.

Some foundations already exist. The Sushma Swaraj Institute of Foreign Service, India’s diplomatic academy, runs regular training programmes for diplomats from India and partner countries in the Global South. The Institute describes these courses as covering negotiation practice, crisis response, multilateral processes, and current thematic issues such as pandemic preparedness and health diplomacy. This creates an early-career network of officials from Southern countries who share vocabulary, understand one another’s constraints, and can coordinate later.

Digital health is another emerging arena of health diplomacy. The World Health Organization and the Government of India announced the Global Initiative on Digital Health in 2023, during India’s G20 presidency. The Initiative is described as a World Health Organization-managed network that aims to align financing, technical support, and standards for national digital health systems, especially in low- and middle-income countries. This links health delivery to questions of data governance, security, financing and sovereignty, and it requires negotiators who can move across those domains.

After the pandemic showed the world how health is key to national security, health systems now sit at the centre of many trade, finance, and security conversations. The globalised world has developed structural interdependencies that refuse to go away even in times of apparent conflict, which opens up vast possi

Think tanks can work with diplomatic academies, ministries, and multilateral platforms to design fellowships, short secondments, and simulation exercises. Placing analysts and young negotiators inside health ministries, foreign ministries, pooled procurement mechanisms, World Health Organization collaborating centres, and digital health initiatives during active negotiations builds a cadre with shared experience and institutional memory.

Conclusion

After the pandemic showed the world how health is key to national security, health systems now sit at the centre of many trade, finance, and security conversations. The globalised world has developed structural interdependencies that refuse to go away even in times of apparent conflict, which opens up vast possibilities for negotiations and win-win solutions. The Global South cannot afford to approach health diplomacy reactively. Think tanks across countries are essential to building the global capacity to act early, argue with evidence, align actors, and train the next generation, in order to direct diverse stakeholders linked to the health sector towards a public purpose. 

Oommen C. Kurian is Senior Fellow and Head of the Health Initiative at the Inclusive Growth and SDGs Programme, Observer Research Foundation.

This article builds upon a presentation made by the author at a consultation jointly organised by DAKSHIN - Global South Centre of Excellence at RIS and NIMS University. 

• Healthcare
• India
• global health diplomacy
• health diplomacy
• india pharmaceutical exports from china
• indian drug manufacturing
• pharma diplomacy global south
• us tariff on india

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