By Anita Santosh
The United States’ decision to withdraw from the WHO is being seen as a turning point, prompting countries like Argentina, Hungary, and Russia to reconsider their ties. The criticism that the WHO functions at the whims of a few powerful donors and external interests grows every day. This points to a broader problem: a global health system that often sidelines national realities, resists adaptive policymaking, and prioritizes ideology over practical outcomes.
India: A Firm Policymaker on Health Issues
For a country like India—home to 1.4 billion people with diverse health challenges—this rigidity presents serious constraints. India has consistently charted its own course. During the HIV/AIDS crisis, it resisted multinational pressure to provide affordable generics, redefining global access to medication. India’s polio campaign succeeded through local innovation and community-led outreach rather than imported frameworks. During the COVID-19 pandemic, India not only developed its own digital vaccination platform (CoWIN) but also led the global call for a TRIPS waiver to ensure vaccine equity. These aren’t just health success stories—they’re blueprints for health sovereignty.
Tobacco Control: A Case Study
Nowhere is this more evident than in tobacco control, where global policy has become heavily donor-driven. Following the U.S. withdrawal, the Bill & Melinda Gates Foundation and Bloomberg Philanthropies have emerged as the largest funders of global tobacco control—surpassing even major state contributors like China.
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India’s Position On Tobacco Control
India’s tobacco policy landscape demonstrates how these global imbalances play out in reality. With over 267 million users—many relying on smokeless or informal products—India has one of the world’s largest and most diverse tobacco-using populations. Yet despite this complexity, over the past decade the country has adopted multiple policies under the WHO’s Framework Convention on Tobacco Control (FCTC)—often shaped more by external influence than local evidence. While India generates over ₹76,000 crore annually in tobacco taxes, only ₹5 crore was allocated to cessation programs in 2024-25—revealing a stark disconnect between the scale of the issue and the response. Enforcement remains inconsistent, support systems are underdeveloped, and lower-risk alternatives stay banned despite growing scientific evidence supporting them.
The Need For An Atmanirbhar Approach
As India envisions an Atmanirbhar Bharat, this self-reliance must extend to public health policymaking. This includes:
- Advocating for greater Global South representation in setting international health priorities
- Encouraging more flexible, context-sensitive implementation
- Ensuring global funding complements rather than overrides national expertise
- Investing meaningfully in domestic public health infrastructure (particularly tobacco cessation and harm reduction)
- Fostering structured public-private partnerships that incorporate Indian industry, research institutions, civil society, and state health systems to develop sustainable, locally appropriate solutions.
The world stands at a crossroads—and so does India. This isn’t about rejecting multilateralism, but about assuming a leadership role that better reflects our identity and needs. If global frameworks are to truly serve the Global South, they must be shaped by those who live and lead there. There’s no better moment—and no better country than India—to begin this transformation.
About: Anita Santosh is an author and journalist on Economic and Policy Affairs.
