India is often described as a natural leader in global health. The claim is not rhetorical. The country supplies roughly 60% of global vaccine demand, dominates the generics market, and has demonstrated operational reach—from Vaccine Maitri during the Covid-19 pandemic to sustained engagement with low- and middle-income countries across Africa and South Asia. Yet India still lacks a coherent institutional strategy to convert this capacity into durable global influence.
That gap matters now. The global health system is fragmenting. Multilateral leadership is thinning. Funding flows are being rerouted. No single country is positioned to replace the vacuum. But several can shape parts of what comes next.
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The US exit and the leadership vacuum
The United States’ formal exit from the World Health Organisation on January 22, 2026, marked a structural break in global health governance. Washington had been WHO’s largest donor—over $1.2 billion per biennium—and a central provider of technical expertise through agencies such as the CDC, NIH, and USAID.
The withdrawal created immediate funding shortfalls and technical gaps. Access to US-based polio laboratories was curtailed, forcing the Global Polio Eradication Initiative to seek alternative diagnostic capacity. WHO programmes dependent on US grants—from malaria surveillance to maternal health—entered abrupt contraction.
More consequential is the strategic shift. Washington is moving away from multilateral coordination toward bilateral, security-linked health arrangements. PEPFAR, long the most successful disease-specific global programme, has been reoriented from a multilateral public-health framework to a bilateral instrument tied to data-sharing and biosecurity priorities. Projections now suggest millions of treatment disruptions and up to four million additional AIDS-related deaths by 2029.
This retreat has costs even for the US. Exit from WHO technical working groups limits access to real-time pathogen surveillance, including emerging influenza strains, with downstream consequences for vaccine readiness.
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Human capital drain at WHO
The institutional shock has been amplified by a human-capital collapse. Following the January 20, 2025 executive order initiating withdrawal, an estimated 400–600 US government staff and contractors embedded in WHO operations were recalled from Geneva and regional offices. Their roles were terminated, not transitioned.
WHO itself, facing an annual funding loss exceeding $700 million, plans to cut about 2,400 positions globally by mid-2026. US nationals—historically 5–8% of WHO professional staff—are disproportionately affected. In parallel, contracts with US-based consulting firms managing WHO projects in polio and malaria have been cancelled.
The question now facing WHO members is not whether capacity will be rebuilt, but where.
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Collaborating centres: A strategic opening
The United States currently hosts 75 WHO Collaborating Centres. These centres underpin WHO’s research and assurance functions and are institutionally anchored in universities and public laboratories. Their continuation is no longer automatic.
For India and other Global South members, this is a tangible opening. Hosting or co-hosting these centres is not symbolic. It brings data access, standard-setting authority, and long-term technical depth. India has the laboratory base, human capital, and regulatory scale to absorb such functions—if it chooses to.
India’s expanding health diplomacy
India’s global health diplomacy has broadened over the past decade, moving beyond the “pharmacy of the world” narrative. Vaccine supply has been paired with systems export—digital health platforms, regulatory standards, and manufacturing partnerships.
During its G20 presidency, India anchored the Global Initiative on Digital Health within WHO structures and promoted interoperable digital public infrastructure as a public good. Platforms developed domestically—CoWIN and the Ayushman Bharat Digital Mission—are now being adapted in parts of Africa and Southeast Asia.
Manufacturing strategy is also shifting. India is no longer exporting only finished doses. Partnerships with countries such as Nigeria and Egypt focus on local vaccine and API production, embedding India deeper into regional supply chains.
Traditional medicine has become another axis of influence. The WHO Global Centre for Traditional Medicine in Gujarat has positioned India as a standard-setter in evidence generation and clinical protocols for integrative care, an area used by a majority of WHO member states in some form.
Trade, standards, and regulatory reach
Health diplomacy is increasingly intertwined with trade. Since late 2025, India has begun integrating health-related annexures into free trade agreements, formally recognising Indian pharmacopoeial and traditional medicine standards. Several countries—including Liberia, Botswana, and Nicaragua—have adopted the Indian Pharmacopoeia as a national benchmark.
This regulatory diffusion is quiet but consequential. Standards travel further than aid.
India’s external posture sits uneasily with its domestic realities. Public health spending remains below 2% of GDP. Rural-urban access gaps persist. R&D financing is thin relative to ambition. At the same time, outward migration of doctors and nurses—amid a projected global shortfall of 11 million health workers by 2030—erodes domestic leadership capacity.
These constraints do not negate India’s global role. But they limit how far credibility can stretch without institutional reinforcement.
The question of global health leadership
The coming WHO Director-General transition will test India’s seriousness. Tedros Adhanom Ghebreyesus’ term ends in June 2027, with nominations opening in 2026. India has never placed a candidate in the final round.
The obstacles are structural: regional rotation norms, geopolitical rivalries, and the need for broad coalition-building among 194 member states. India’s case—vaccine capacity, digital health leadership, Global South advocacy—is stronger than before. Whether it converts that into a candidacy remains an open question.
The global health system is no longer anchored by a single hegemon. It is splintered, negotiated, and increasingly transactional. India already operates across these fault lines—within WHO, BRICS, QUAD, and bilateral health agreements.
What is missing is an institutional spine: a defined global health doctrine, a coordinating structure, and clear political ownership. Without that, India’s influence will remain episodic—visible in crises, diluted in governance.
This is not a call for grandstanding. It is an argument for institutional readiness. The opportunity will not wait.