Introduction

The conventional understanding of the term security-both traditional and non-traditional is heavily influenced by the state-centric approach. The proponents of various security policies use concept of security that has military dimension to it- defensive, offensive or preemptive in nature aimed to preserve sovereignty and territorial integrity of the state against adversarial state and non-state actors. The discourse, however, has slowly started to accept the fact that food, environmental and biological security are integral to the well-being of the nation. Harshly, the notion of biological security has been largely limited to the idea of bio-terrorism and use of biological agents against states and its citizens. However, a more critical aspect of biological security requires widening the normative understanding of the threats posed by spread of transnational disease and the potential risk attached to it. There has been occasional and sporadic attempt by the scholars and professionals of medical science to expand the umbrella of the definition of global security to include the threat posed by pandemics and its implications. In fact there are schools of thought that emphasise on integrating issues of other sectors like military, political, and economic with the biological security dimension. As suggested by Professor Michael D. Intriligator, world need to incorporate traditional military dimension with the interrelated political, economic, environmental, health, and other international and global threats arising mainly from our global interdependence.

This is also the time to put the issue of public health at the top of foreign policy agenda for cooperation amongst states. The various dimensions of the threats to and vulnerabilities of global pandemics should be matter of foreign policy, primarily directed towards greater cooperation between states. David P Fidler Professor of Law and Ira C Batman Faculty Fellow, School of Law, University of Indiana, suggest that Global Health as an issue has undergone tremendous political revolution; however political revolution remains enigmatic and incomplete, meaning that both danger and opportunity await this area of world politics¹. Identification and prioritization of a health issue as a foreign policy or security issue, or both, may lead to higher prioritization and more attention from top policy-makers, in turn, bringing greater political support and more funding². The nature of risk of global health is such that it in turn demands more cooperation amongst states, rather than competition or contestation required to deal with other traditional and non-traditional security threats.

Organisations like World Health Organisations (WHO) started to look into this aspect of global security only in mid 1990s. In 1995, the World Health Assembly (WHA) agreed to revise the International Health Regulations (IHR), the only international legal framework governing how WHO and its member States should respond to infectious disease outbreaks and it took them 10 years to adopt the revision as WHA Resolution 58.3³. Amidst the rapid outbreak of coronavirus, and the kind of havoc it is creating globally, this is the pertinent moment for the world to relook into the concept of global security in terms of human security.

China is facing the heat of the world and is accused of being delinquent in carrying out its responsibilities in preventing the spread of the virus. India has largely been successful in containing the spread of various through non-pharmaceutical public health measures. The West is reeling under the pressure of the damage caused by the virus. The US is struggling to handle the pandemic in a way, a superpower was expected to. The WHO is under tremendous scrutiny for its alleged role in allowing China to hide information regarding the virus, and continue with its disinformation campaign. Overall, due to lack of coordinated response from states, emergency-response resources, and other mechanisms to handle public health emergency there has been a failure to provide adequate security against the virus. The speed at which the virus is spreading and impacting the well-being of institutions of the world, it has become imperative for countries to join hand in its battle to fight the pandemic. The world is looking towards India and the US to jointly develop some response to the pandemic, primarily because the two countries have time and again jointly worked on healthcare issues that have threatened world security. Secondly, as highlighted during the first US-India Strategic Dialogue on Biosecurity in 2016, India and the US are also regional leaders in responding to public health emergencies of all kinds, including both natural disasters and biosecurity threats. The recent weeks have hinted towards a possible future cooperation between the two countries.

India- US Cooperation

The US Agency for International Development (USAID) has announced a grant of $2.9 million to India to help it in the fight against the coronavirus pandemic. The aim of the grant is to further support India's response to COVID-19. The announcement came days after India agreed to export anti-malaria drugs Hydroxychloroquine, a drug seen as key in the treatment of the covid-19 virus. India agreed to export the medicine after the Trump administration mildly threatened India of retaliation if it doesn’t support the US government in its fight against the pandemic. The foundation for Indo-US health care collaboration was laid back in 2010, under the U.S.-India Health Initiative, in which four working groups were organized in the areas of Non-Communicable Diseases, Infectious Diseases, Strengthening Health Systems and Services, and Maternal and Child Health. The two sides have since then worked together at regional and international level to combat the menace of infectious diseases.

Talking about India-US cooperation against the Coronavirus, the US Secretary of State Mike Pompeo said people in country like India and in other democracies around the world will “actually provide solutions, and in this case, solutions for global pandemics⁴”. He also highlighted the fact that India and the US are jointly working by way of sharing of resources in terms of critical drugs like hydroxychloroquine and personal protective equipment (PPE). This is not the first time that India and the US have worked together on global health crisis and humanitarian issues; however the scale of the pandemic requires extraordinary level of partnership and trust, which has the potential to open scope for better synchronization and coordination of interests and resources for an array of issues.

The US National Biodefense Strategy (Strategy) along with National Security Presidential Memorandum-14(NSPM-14) highlights the need for the opportunity to design new approaches to identifying and building a core set of surveillance and response capabilities for emerging infectious diseases⁵. The National Biodefense Strategy of the US builds on lessons learned from past biological incidents, such as the 2001 anthrax attacks, the 2009 influenza pandemic, and the 2014 West Africa Ebola epidemic, to develop a more resilient and effective biodefense enterprise⁶. Similarly, India has first-hand experience in handling various biological security threats in the past; it has recent successes in containing deadly outbreaks of Nipah and other high threat pathogens; and building on the success in eliminating polio, as well as addressing the threat of an influenza pandemic⁷. This makes India and the US ideal partners for cooperation on biological security threats.

This isn’t the first time; India will be cooperating in the field of health and medical science. The most comprehensive outline for cooperation on health and infectious disease was presented during the former US President Bill Clinton’s first official visit to India in 2000. In his speech, the former US president said, “India is at the forefront of the global effort that has brought us to the threshold of the eradication of polio. With leadership, joint research, and application of modern science, we can and will do the same for the leading killers of our time, including AIDS, malaria and tuberculosis⁸.” To put in perspective the magnitude of humanitarian aspect of the relationship, we need to look into the kind of assistance the US has provided India over a period of time. The USAID over the last 20 years alone has provided more than $1.4 billion in health assistance and nearly $3 billion in total assistance⁹.

A MoU on the Establishment and Operation of Global Disease Detection Centre (GDD) in India was signed between Centres for Disease Control and Prevention, Atlanta, USA and National Centre for Disease Control, India on 6th November, 2010. GDD – India Centre became operative since April 2011¹⁰.

The Indo-U.S. Vaccine Action Program (VAP) is a bilateral program, which supports a broad spectrum of activities relating to immunization and vaccine related research. Under the VAP, U.S. and Indian scientists carry out collaborative research projects directed toward development of vaccines and immunodiagnostic reagents, or to address other issues which are important for vaccine research¹¹. In early years of the current decade, India US jointly worked together to combat HIV/AIDS in India. India’s AIDS programme regularly received US Government Assistance (USG) through several agencies and programmes, including USAID, CDC, and PEPFAR (The United States President’s Emergency Plan for AIDS Relief) etc¹². The US based philanthropy groups like the Bill and Melinda Gates Foundation (BMGF) and Clinton Foundation were actively assisting India in the fight against HIV/AIDS. The U.S. National Institutes of Health (NIH) has been working robustly with India’s medical research community in the biomedical and behavioral health sciences. The Rotavac vaccine for rotavirus, developed through joint partnership has the potential to save many lives. The U.S. Department of Health and the Indian Council of Medical Research are also working together public health aspects of household and ambient air pollution, water quality and access, exposures to hazardous substances, strengthening of laboratory capacity, road safety and burn injuries¹³.

Internationally, in 2016, USAID launched the Global Linkages project to facilitate the transfer and adoption of Indian innovations and best practices in family planning, child, and maternal health care to select African and Asian countries¹⁴. The project has completed country profiling and needs assessment of five Asian countries. The Global Linkages project also aims to support USAID/Afghanistan mission and nearly 10 Indian and Afghanistan business enterprises to facilitate trade and investment collaborations in healthcare. Through the platform called SHARE (South to South HIV-AIDS Resource Exchange) partnership, the US shares India’s successful HIV/AIDS prevention, care, support, and treatment efforts that have been undertaken in African countries¹⁵.

The Existing Gap and Lessons Drawn from the Past

The unique and key gap in the response mechanism of the international community has been the lack of understanding of the nature of the coronavirus threat and means to prevent it. Much like the international response to the Ebola outbreak, the current response also demonstrated how poorly-prepared the world was such infectious-disease crises. Identification of the outbreak, its magnitude, and mode of transmission in the human and community and raising alarm took too long, partially because of failure on part of Chinese administration and WHO officials. Local health systems were quickly overwhelmed. Response teams did not adequately engage communities and deepened distrust in health authorities. The international response was slow, cumbersome, and poorly coordinated. The problem is coupled by lack of well-trained medical professionals, and socio-economic and demographic factors. The alleged failure of the World health Organisation to come up with a proper coordinated response to the pandemic is a matter of worry for both the developed and the developing countries. India and the US have the capacity to influence the functioning of the WHO in order to make it more accountable. The biggest problem which has also hampered response to past pandemic is the lack of robust and effective technology ecosystem that is needed to needed to detect, understand, and respond to pandemics¹⁶. This problem is particularly of greater importance for India, where US technological and scientific community can help to fill the gaps.

India-US joint cooperation in the field of science and healthcare has not been without its share of trouble in the past. There are lot of lessons to be learnt from it, and the most important, consultation at highest level has been witnessed of late. One of the most critical episode has been the case of the US based groups Ford and Rockefeller foundations funded “population control” programs during the emergency period under the leadership of Indira Gandhi, which went dramatically and violently awry. The compulsory sterilization program soon turned out to be most disturbing practice with vast human rights violations cases¹⁷. The second case has been during India’s fight against HIV/AIDS. Methodological errors in calculation lead to erroneous figure of 5.1 million people infected with HIV/AIDS in India. Despite protests from a section of scientists in India over the accuracy of the figure, the international community lead by the US insisted India to take corrective measures, forcing India to divert much of its limited financial resources to combat the menace of the HIV/AIDS. By 2007, National AIDS Control Organisation (NACO) and UNAIDS revised the number of Indians infected with the HIV and put it substantially lower than the official estimate of 5.2 million, however the damage has been done¹⁸.

The Way Ahead

India-US joint health care initiatives have tremendous potential to develop further and more rigorous scientific and technological cooperation is required to achieve the desired results. India’s favourable image of responsible global player in the field of science and health care is coupled with a large pool of human resources. It has also the technical and manufacturing capacity, which can be augmented by scientific and technological knowhow sharing by the US. The scientific and technological giants in health care sectors in the US could cooperate at private players’ level too. The appropriate example of it is the recent tie up between Serum Institute of India, the world's largest vaccine maker by number of doses produced and sold globally and Codagenix, an American biotech company, to develop a "live attenuated" vaccine for the treatment of the virus that causes Covid 19. The state to state and private player to private player cooperation will improve the quality of manufacturing and will also help the two countries economically.

Endnotes

1. Fidler, David P. “Electronic Law Journals Law Social Justice and Global Development Journal.” Law Social Justice and Global Development Journal, 2004.https://warwick.ac.uk/fac/soc/law/elj/lgd/2004_1/fidler/
2. “Health and Security in Foreign Policy.” World Health Organization. World Health Organization, March 4, 2011.http://www9.who.int/bulletin/volumes/85/3/06-036889/en/
3. “National Security and Pandemics.” United Nations. United Nations. Accessed May 1, 2020.https://www.un.org/en/chronicle/article/national-security-and-pandemics
4. Basu, Nayanima, D.K. Singh, Swagata Yadavar, and Snehesh Alex Philip. “Democracies Will Emerge Stronger from Covid-19, India Will 'Provide Solutions': Mike Pompeo.” ThePrint, April 19, 2020. https://theprint.in/diplomacy/democracies-will-emerge-stronger-from-covid-19-india-will-provide-solutions-mike-pompeo/404689/
5. The National Biodefense Strategy (Strategy), Report to Congressional Committees, February 2020 https://www.gao.gov/assets/710/704698.pdf
6. Statement from the President on the National Biodefense Strategy and National Security Presidential Memorandum.” The White House. The United States Government. https://www.whitehouse.gov/briefings-statements/statement-president-national-biodefense-strategy-national-security-presidential-memorandum/
7. “India Readies Itself to Address the Threat of Pandemic Influenza.” World Health Organization. World Health Organization. https://www.who.int/india/news/detail/16-12-2019-india-readies-itself-to-address-the-threat-of-pandemic-influenza
8. U.S. Department of State. U.S. Department of State. Accessed April 28, 2020. https://1997-2001.state.gov/global/human_rights/democracy/fs_000321_us_india.html
9. “USAID Provides $2.9M to Support India's COVID-19 Efforts: Press Release: India.” U.S. Agency for International Development, April 6, 2020. https://www.usaid.gov/india/press-releases/apr-6-2020-usaid-provides-29m-support-india-covid-19-efforts
10. “Establishment of Global Disease Detection Centre (GDD).” Government of India Ministry of Health and Family Welfare, July 15, 2014. https://pib.gov.in/newsite/PrintRelease.aspx?relid=106597
11. “Indo-U.S. Vaccine Action Program Overview.” National Institute of Allergy and Infectious Diseases. U.S. Department of Health and Human Services. https://www.niaid.nih.gov/research/indo-us-vaccine-action-program-overview
12. “Bilateral and Multilateral Partners: National AIDS Control Organization: MoHFW: GoI.” Bilateral and Multilateral Partners | National AIDS Control Organization | MoHFW | GoI. http://naco.gov.in/bilateral-and-multilateral-partners-0
13. U.S. Mission India. “Fact Sheet: U.S.-India Science and Technology, Innovation, and Health Cooperation.” U.S. Embassy & Consulates in India, March 15, 2016 https://in.usembassy.gov/fact-sheet-u-s-india-science-and-technology-innovation-and-health-cooperation/
14. “U.S.-India Triangular Cooperation: India.” U.S. Agency for International Development, November 24, 2017. https://www.usaid.gov/india/us-india-triangular-cooperation
15. “South-to-South HIV / AIDS Resource Exchange.” vhschennai.. https://vhschennai.org/global-work/south-to-south-hiv-aids-resource-exchange/.
16. Kang, Gagandeep, George Perkovich, and Shruti Sharma. “India's Pandemic Preparedness and Response.” Carnegie India.https://carnegieindia.org/2019/12/06/india-s-pandemic-preparedness-and-response-event-7276
17. Matthews, Dylan, and Byrd Pinkerton. “‘The Time of Vasectomy’: How American Foundations Fueled a Terrible Atrocity in India.” Vox. Vox, June 5, 2019. https://www.vox.com/future-perfect/2019/6/5/18629801/emergency-in-india-1975-indira-gandhi-sterilization-ford-foundation
18. “'Incorrect Figures of HIV Cases in India' - Times of India.” The Times of India. Home, June 9, 2007. https://timesofindia.indiatimes.com/home/science/Incorrect-figures-of-HIV-cases-in-India/articleshow/2111409.cms

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