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US-India relationship: Can it trump the odds?


20170415ep02Affordable and efficient healthcare systems is listed out as an area chosen for “Growing Convergence, Collaboration & Cooperation between United States and India” in a blog post dated March 14 on the US-India Business Council website.

In his speech on the same day to the Council, George Sibley, Acting Deputy Chief of Mission, US Embassy New Delhi criticised India’s recent decision to add coronary stents to India’s National List of Essential Medicines (NLEM). He cautioned that the US is concerned that “these types of actions send a worrisome signal that India is not in fact fully open for business. Worse, however well-intended the action, this may ultimately result in limiting patients’ access to the latest technologies.”

Sibley suggested that a better path forward would be to allow more trade of the two countries’ respective healthcare products. He pointed out that the US is India’s number one export destination, buying more than 15 per cent of its exports of goods and approximately 60 per cent of its service exports. “India is the number one supplier of generic medicines to the US and more than 80 per cent of the medicine consumed in the US is generic. So India’s exports truly benefit Americans and save American lives. By the same token, growing America’s exports can provide significant benefits to India, and I hope to see trade growing in both directions in the future.”

Speaking in the presence of CK Mishra, Health Secretary, Ministry of Health and Family Welfare, Sibley mentioned how the USFDA’s close engagement with Indian drug regulatory authorities, manufacturers and stakeholders was not to obstruct Indian access to the American market. He hoped they could work towards “a similar win-win … collaborative model on medical devices here in India in the near future.”

Trade diplomacy is fully of such carrots and sticks, threats and promises. The US interest and posturing is understandable as India is a huge market. According to industry estimates, imports from MNCs across the world, including US companies, make up more than 70 per cent of India’s stent market.

On the same day of the blog post and Sibley’s speech, the Ministry of Chemicals and Fertilizers re-stated that it was mandatory for hospitals to issue detailed bills to patients, separately disclosing the cost of heart stents. The Ministry also advised state governments and state drug controllers to exercise their powers under Para 30 of the DPCO, 2013 to check artificial shortage of stents. Thus is it very evident that the government is not backing down.

Two days later, on March 16, the cabinet approved the National Health Policy 2017 (NHP 2017), in which the government is clear that there has to be engagement with the private sector. As Jagat Prakash Nadda, Minister of Health and Family Welfare says, “While the policy seeks to re-orient and strengthen the public health systems, it also looks afresh at strategic purchasing from the private sector and leveraging their strengths to achieve national health goals.” And lest there be any doubt, the Minister spells it out, “In order to provide access and financial protection, it proposes free drugs, free diagnostics and free emergency and essential healthcare services in all public hospitals.”

The US will continue to put pressure to counter some of these moves. End April should see the release of this year’s United States Trade Representative (USTR) Special 301 Review, in which India is sure to make it, once again, to the Priority Watch list. Can PM Modi soften the stance of President Trump’s administration during his slated visit in May? Both leaders have their own constituencies to play to and finding a win-win situation seems difficult … but not impossible.

Viveka Roychowdhury

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