Redefining Global Health Leadership

On January 20, 2025, President Donald Trump issued an executive order titled “Reevaluating and Realigning United States Foreign Aid,” mandating an immediate 90-day suspension of all new foreign development assistance obligations and disbursements. During this period, the effectiveness and policy consistency of aid programs will be assessed by relevant agencies. Based on the findings, programs may be continued, modified, or terminated.

President Trump has also initiated the process of the US’s gradual withdrawal from the World Health Organization (WHO). With 2026 as the deadline, the United States’ disassociation with WHO will significantly impact global health initiatives. The US has been the largest contributor to the WHO, providing nearly $261 million between 2024-2025, accounting for approximately 18 per cent of the organization’s funding. This funding supports essential programs such as disease control, polio eradication, and vaccine development.

These executive orders have in essence cut off US foreign funding also to frontal health-care agencies like the US Agency for International Development (USAID), National Institutes of Health (NIH) and President’s Emergency Plan For AIDS Relief (PEPFAR). This decision would have some effect on India’s short-term goals in health and environment management programs. But given India’s growing self-reliance in recent years, the nation can turn around and offset the adverse effects of the US’ disengagement costs.

India has shown remarkable resilience over the past decade. The steady decline of US’ financial support to India following the latter’s 2004 decision to reject conditional foreign aid could not browbeat the country’s resurgent morale. The impact of Trump’s executive orders could be greater in regions such as Africa, where the dependence on foreign aid is much higher.

The global research landscape has traditionally been shaped by funding and leadership from the Global North, particularly the United States, where a large portion of international research and program grants, especially in the public health and science sectors, are allocated. However, this support has come with a rider: the leadership, direction, and primary authorship of studies have predominantly remained with researchers working in Western institutions. The lure of it all has been unavoidable. Scores of scholars and young scientists from India and the global south have migrated to these institutions for better facilities and recognition. The role of practitioners and researchers from the Global South, particularly those in India, Africa, and parts of Latin America, has often been relegated to secondary roles.

While the global health community is alarmed by US presidential orders, generating a tremor across vulnerable communities who depended on frontal health care agencies for philanthropic support, this moment also presents an opportunity to reflect on and strengthen the global health network. The WHO operates through its 194 member countries, which establish health priorities and coordinate efforts to share vital data, treatments, and vaccines during global emergencies. Without the US, other nations would take on a greater leadership role. This marks a geopolitical shift as the US reduces its influence on the global platform. If the Trump government shifts upon WHO the onus of what was an ill-managed pandemic situation at home, and cools its heels by pulling out of the global organization, it will have an indirect effect on its domestic institutions engaged in healthcare research and education. With a shift in global healthcare leadership, countries will look back on their own bit of contributions to the global scenario. Their dependency zones being disturbed they would strive to realign themselves substantially and awaken more to the need for self-reliance. Nations will emphasize funding their healthcare while India can repatriate some of its brains back to domestic labs. COVID-19 in the USA had already induced the trend only for India to make absorption of the homecoming talents more comfortable.

In fact, India’s pandemic plans did not go haywire. It has addressed the consequences of funding shortfalls of global healthcare agencies in two ways: domestically, by increasing public funding in healthcare and by resorting to what can be called transnational vaccine diplomacy through the ‘Vaccine Maitri’ initiative. India sent out 5.6 million doses of COVID-19 vaccines as gifts to other countries. More importantly, this shift underscores the growing capacity of India and other Global South nations to lead their development efforts, making this moment not just a challenge but also an opportunity to build greater independence and resilience in global health and beyond.

With its growing scientific talent, robust public health workforce, and thriving pharmaceutical and biotechnology sectors, India can play a pivotal role in shaping global health solutions. The country’s commitment to improving health outcomes has driven context-specific research that offers valuable insights for other nations in the Global South, especially in controlling communicable diseases and improving Maternal and Child Health. India has already demonstrated its prowess by providing generic drugs at a fraction of the cost to various countries, offering affordable solutions for life-saving medications. Additionally, initiatives like “Make in India” have further positioned India as a global leader in healthcare. The country’s research ecosystem, supported by institutions like the Indian Council of Medical Research (ICMR), Department of Bio-Technology (DBT), Department of Science and Technology (DST), and home-grown universities with strong research programs, is becoming a hub for innovation.

In terms of research leadership, India’s growing emphasis on “decolonizing” global health research aligns with a broader shift toward more equitable partnerships between the Global North and South. India’s scientific contributions in low-cost diagnostics, vaccines, affordable healthcare solutions, and epidemiology are addressing health disparities in resource-strapped settings across the Global South. By focusing on homegrown research and promoting collaborations with other Global South nations, India can build a more independent and resilient research ecosystem. Indian Universities through the mandates of the University Grants Commission (UGC) and the National Education Policy (NEP) 2020 are increasingly focusing on multidisciplinary research, enhancing the potential for a more inclusive systemic structure and socially more responsible and effective outcomes. To maximize its potential, India must prioritize support to early-career researchers, high ethical standards, and research-based policy frameworks.

Furthermore, a significant 10.8 per cent increase in national budget allocations for healthcare and a 7.7 per cent surge in outlay on education this year are crucial markers for India’s sustainable quest for leadership in healthcare and education. Making domestic healthcare more affordable to the masses and the plan for promoting the country as a global medical tourism hub through the “Heal in India” initiative are significant moves in the context of the Trump government’s pull-out from leadership positions in this sector. As the country invests more in its own public health systems, it will be better positioned to share expertise and resources with other nations and have a voice in global policy shaping, reinforcing its role as a global health leader. By fostering stronger, more inclusive partnerships with other Global South nations, India can drive a shift toward greater self-reliance in global health, making this moment an opportunity to build a more independent, resilient, and globally influential health system.

Ramya Pinnamaneni is the Director, KIIT School of Public Health. Debashis Bandyopadhyay is the Pro-Vice Chancellor of KIIT Deemed University.

Views expressed are personal