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EDITORIAL| VOLUME 401, ISSUE 10387, P1473, MAY 06, 2023
India's ascendancy: leadership demands integrity
The Lancet Published:May 06, 2023DOI:https://doi.org/10.1016/S0140-6736(23)00904-2
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2023 is an important year for India. The UN estimates that the country has now surpassed China as the world's most populous nation. It holds the G20 presidency, taking over from Indonesia, and its New Delhi Leader's Summit in September will be the first to be hosted in south Asia. What will these developments mean for its role in the international system? India says that it wants to amplify the voice of the Global South, and its G20 goals reflect this ambition. But the nationalist agenda of Narendra Modi's government, its resistance to multilateralism, and a raft of pressing domestic concerns threaten the chances of making these aims a reality.
India has undoubted strengths. Demography is not destiny, but it is powerful. While China's population is declining, India's is projected to continue increasing. Its economy is the fifth largest in the world and growing. The number of young people entering the workforce is increasing, presenting a potential demographic dividend. Realising the benefits, particularly the health returns, will demand investments in health, education, and skilling to address stark regional disparities in wealth, education, reproductive health, and women's empowerment.
India's G20 priorities are based around inclusive and resilient growth. They include climate finance; ensuring global food security; accelerated progress on Sustainable Development Goals; access to vaccines, therapeutics, and diagnostics; democratising global financial governance; building global health resilience; and increasing access to digital health innovations. India is also pressing for debt relief for low-income and middle-income countries (LMICs). The steep global rise in the proportion of public spending dedicated to repayment of debt is bound to hamper investment in much-needed health and social programmes. Restructuring international debt conditions with the interests of LMICs in mind is vital for wellbeing.
India has already shown global leadership in access to medicines. Alongside South Africa, it was one of the first nations to propose intellectual property waivers during the COVID-19 pandemic. Its immense generics manufacturing industry provides affordable medicines to many parts of the world, including about two-thirds of antiretroviral drugs for HIV, although a series of fatalities resulting from contaminated medicines raise questions over regulatory oversight. Its new digital health programme, the Ayushman Bharat Digital Mission, could serve as a model for other countries and the government intends to make its vaccine distribution platform Co-Win an open-source digital public good for international use. Such action demonstrates how India could enhance South–South cooperation.
However, there is danger that India's domestic potential and its international aspirations will amount to little more than platitudes, given the direction that Modi is taking the country. India's climate policies are a contradiction. It is seeking more than US$100 billion annually to support renewable energy transition in LMICs. Huge investments in green hydrogen and solar energy could reduce its dependence on fossil fuels, which account for more than 80% of India's energy needs. India has shown some enthusiasm for building greenhouse gas infrastructure, but softening of the language on coal at COP26 invites scepticism. Despite low health sector and per capita emissions, India remains the world's third largest CO2 emitter. India is already feeling the consequences of failing to act. Last year, devastating heatwaves wreaked havoc, and India recorded its hottest March on record. Articulating a clear pathway towards net zero, and having the data to support it, are imperative.
Modi's government have shown themselves to be wholly untrustworthy on COVID-19 health data. Official government figures place deaths at more than 530 000, while WHO excess death estimates for 2020 and 2021 are near 4·7 million. The fact that the Indian Government attempted to delay the publication of such figures while also censoring criticism during the pandemic seriously undermines its integrity. Press freedom in India has diminished since Modi's ascent to power in 2014. Of the 180 countries in the Reporters Without Borders press freedom index, India is ranked 150th, just five places above Russia. Civil society is increasingly constrained and violent Hindu nationalism is suppressing non-Hindu voices. Without a space for debate, activism and accountability are impossible, and India's place as the world's largest democracy is threatened.
Ultimately, the leadership of any country on the global stage depends upon its legitimacy. Are people able to believe in it? The Modi government has failed to show a commitment to transparency, integrity, and equity. As a result, India risks squandering its formidable opportunities.
