India–Africa pharmaceutical cooperation and the future of global health

As many Western donors retreat from the aid world and the multilateral health system fragments, the supply of essential medicines to the African continent increasingly depends on a production chain linking Chinese active ingredients, Indian medicines, and African distribution. We argue that the resilience and expansion of this South-South pharmaceutical arrangement, rather than the reconstruction of the old global health and aid architecture, will shape much of the African continent's access to medicines in a multipolar and fragmented world order. In this scenario, we propose three recommendations for strengthening India-Africa pharmaceutical cooperation. First, to improve access to medicines and markets, there is a need to move from regulatory sovereignty to reliance models. Second, escaping the local manufacturing trap will require plants to serve markets beyond national borders, and intellectual property flexibilities represent an underutilized avenue to build manufacturing. Finally, durable India-Africa health cooperation will require replacing the paradigm of knowledge transfer and benevolent assistance with co-ownership and two-way learning.