Prakash Narayanan

Health diplomacy has become a pivotal aspect of India's engagement with the Global South, intertwining foreign policy, public health, and global collaboration to address disparities while pursuing strategic interests. India's pharmaceutical industry, which accounts for nearly 20% of the world's generics, has positioned the nation as the “pharmacy of the world,” particularly through its significant contributions to HIV/AIDS treatment and the COVID‐19 Vaccine Maitri program. In parallel, India's emerging medical technology (MedTech) sector has expanded access to affordable diagnostics, ventilators, telemedicine, and digital health innovations, with significant implications for healthcare delivery in low‐ and middle‐income countries. This article analyzes the dual function of India's pharmaceutical and MedTech industries in shaping health diplomacy, highlighting their transformative impact on global health governance, South–South collaboration, and capacity development. Despite challenges such as regulatory barriers, geopolitical rivalry, and reliance on active pharmaceutical ingredients, India is at the forefront of global health collaborations, thanks to its cost advantages, innovation, and digital health. It is thus of interest to analyse India's shifting health diplomacy as both a humanitarian and a strategic endeavour to spread sustainable healthcare solutions globally.

Amid rising packaged food consumption in India and its associated health risks - including obesity and non-communicable diseases - this scoping review synthesised India-specific evidence on consumer awareness, comprehension, and behavioural responses to food labels on pre-packaged products. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews checklist and Arksey and O'Malley framework, five databases (PubMed, Scopus, Embase, Web of Science, and CINAHL) and Google Scholar were searched for peer-reviewed primary studies conducted in India between 2014 and 2024. Studies were included if they assessed food label literacy, interpretation, or use in purchase behaviour in Indian settings. Thirty-two studies were included, covering diverse populations and geographic settings. Bibliometric synthesis showed a predominance of cross-sectional knowledge, attitudes, and practices studies, with limited experimental or multidisciplinary research. Findings were organised into three analytical themes: a) determinants of food label literacy, including socio-demographic and cognitive factors; b) consumer perceptions of label components, their placement on packaging, visual appeal, and cognitive utility; and c) behavioural implications of label engagement and its perceived influence on purchase intentions. Evidence from this review highlights persistent gaps between label awareness, engagement, and purchase intentions. To inform policy and practice - and to advance Sustainable Development Goal 3 (Target 3.4 - reducing premature mortality from non-communicable diseases) & Goal 12 (Target 12.8 - promoting awareness and information access) - future research should prioritise experimental and implementation-focused designs tailored to India's demographic, cultural, and market heterogeneity.

Background: Global health diplomacy (GHD) is an emerging intersection of health and international relations, particularly in transnational health challenges. Though growingly important, especially in the current global health scenario, this study aimed to perform a bibliometric analysis of GHD to identify emerging themes, leading contributors, research gaps for further studies and policy directions. Methods: A bibliometric analysis was done on SCOPUS, and a return of 242 articles published between 2007 and 2024 contained the keyword "global health diplomacy." The data was analyzed using Biblioshiny and then exported to Microsoft Excel for thematic coding. Key indicators included publication trends, co-authorship networks, and keyword co-occurrences to establish key trends and gaps. Results: A growing body of research observed an annual growth rate of 7.65% [95% CI]. North American and European countries led the research, especially the United States, Canada, and the United Kingdom. The dominant themes included vaccine diplomacy, global health, Artificial Intelligence-Machine Learning and digital health, governance, and international cooperation. However, there were significant gaps, including underrepresentation from low-and middle-income countries (LMICs), limited focus on noncommunicable diseases (NCDs) including mental health, and neglected climate-health intersections. Conclusion: This study highlights the fast growth and changing nature of GHD research while indicating some key gaps that deserve further research. Strengthening contributions of LMICs, expanding thematic focus to NCDs and environmental health, and fostering interdisciplinary approaches are crucial for advancing the field. The findings are highly relevant for policy and research purposes and will push forward an impactful GHD for global health challenges.

There is growing recognition of the health impacts of climate change, prompting numerous calls and proposals in recent years for its inclusion in medical curricula. A scoping review was conducted according to JBI methodology to map and assess the integration of climate change and health content in undergraduate medical education globally and to identify existing curricula, educational strategies, and thematic coverage. Three scientific databases were searched for studies and articles that had instances of climate change integration in undergraduate medical curricula. The screening was done in stages following the PRISMA-ScR process, and there were 24 final inclusions. Data extracted include course type, duration, content, year of implementation, motive, challenges, enablers and recommendations. The review synthesized evidence from schools in North America, Europe, and Australia. There was a lack of studies from Low- and Middle-Income Countries (LMICs). The earliest instance of integration of climate change and health education was found to be in 2018, most schools started between 2020 and 2021. Common methods included stand-alone modules, electives, workshops, and modifying existing core curricula to include climate change and health components. Student-led initiatives significantly drove efforts in some schools. Courses emphasized climate change fundamentals, health impacts, vulnerabilities, communication and advocacy, interdisciplinary perspectives, and some practical applications. Challenges included integrating new content into existing curricula, requiring strategic planning and support. Recommendations include core curricular integration, experiential and practical learning, and encouraging research and advocacy.

Borges and colleagues’ article entitled "More Pain, More Gain! The Delivery of COVID-19 Vaccines and the Pharmaceutical Industry’s Role in Widening the Access Gap," analyzes the role of pharmaceutical companies in providing equitable access to COVID-19 vaccines. They concluded that with the failure of COVID-19 Vaccine Global Access (COVAX), the health gaps have widened due to the profit-driven pharmaceutical sector. In this commentary, we highlight the role of COVAX and its attempt to bridge some access gaps since its inception and the need for reforms in policy-making and global health governance. The commentary highlights the role of global health diplomacy in promoting equity and negotiating the Trade-Related Aspects of Intellectual Property Rights (TRIPS) waiver for COVID-19 vaccines at the World Trade Organization (WTO) thereby promoting global solidarity, global partnerships, access to medicine and health products, and the right to health. We conclude that political prioritization is the key to balance the impact of profit-driven pharma industry and addressing the needs of low- and middle-income countries (LMICs).

As the world has a history of vaccine nationalism, especially during the 2009 Swine flu pandemic, the COVAX alliance, a globally collaborated mechanism, was created by World Health Organization (WHO), GAVI, and UNICEF to address the inequity of COVID‐19 vaccines. One of the primary aims of this alliance was to deliver vaccines to low‐ and middle‐income countries (LMICs), which otherwise have less or no capacity to access vaccines from the open market. It is crucial to explore the contribution of COVAX in bridging the gap in equity, accessibility, and affordability of COVID‐19 vaccines between high‐ and low‐income countries (LICs). We selected Group 20 (G20) COVAX participants and the African Union (AU) as case studies to estimate these gaps. The bilateral purchase data shows that by December 2021, the G20 countries had vaccines more than double their population, whereas the AU could procure only about one fifth (19%) of their population. Out of 52 AU countries whose data was available, only 21 of them could strike a bilateral deal with vaccine manufacturers. Even after COVAX delivery, the share of the population that could be vaccinated in AU was just 36.8%, less than the target of WHO (40%) for December 2021. It was found that the COVAX alliance worked better than the open market competition for LMICs and LICs. The cost of vaccinating 20% of the population was 0.7% of the current health expenditure for G20 countries, whereas AU countries had to spend 5.5%. COVAX bears more cost (1%–3%) for AU countries than G20 countries (less than 1%). COVAX made COVID‐19 vaccines more affordable and accessible to these countries. However, LICs were disproportionately affected even with the COVAX Facility mechanism owing to their lack of vaccine deployment infrastructure.

The implementation of Human Papillomavirus (HPV) vaccination is crucial for eliminating cervical cancer in India. The infodemic, characterised by misleading information, could hinder the successful implementation of the initiative. Misinformation related to the HPV vaccine, such as rumours, has been reported and circulated, contributing to an alarming pattern of vaccine hesitancy observed on social media. This study aimed to identify the public sentiment towards HPV vaccination based on the 'Behavioral and Social Drivers (BeSD)' framework through geospatial, content and sentiment analysis. A total of 1,487 tweets were extracted. After preprocessing, 1010 tweets were identified for sentiment and content analysis. The sentiments expressed towards the HPV vaccine are mixed, with a generally positive outlook on the vaccines. Within the population, there is a pervasive proliferation of misinformation, primarily focusing on vaccine safety and efficacy, contentious subjects, ethical considerations, and a prevalent sense of uncertainty in selecting the appropriate vaccine. These observations are crucial for developing targeted strategies to address public concerns and enhance vaccination rates. The insights gained from these results will guide policymakers, healthcare practitioners, and public health organisations to implement evidence-based interventions, thereby countering vaccine hesitancy and improving public health outcomes.

Background: Following the mpox 2022 outbreak, several high-income countries have developed plans with inclusion criteria for vaccination against the mpox disease. This study was carried out to map the factors influencing mpox vaccination uptake to help address the challenges and increase vaccination confidence. Methods: This was a study based on Tweet analysis. The VADER, Text Blob, and Flair analyzers were adopted for sentiment analysis. The “Levesque conceptual framework for healthcare access” was adopted to evaluate the factors impacting access and the decision to get mpox vaccination. Consolidated Criteria for Reporting Qualitative Research (COREQ) criteria were adopted. Findings: A total of 149,133 tweets were extracted between 01/05/2022 and 23/09/2022. Around 1% of the random tweets were used for qualitative analysis. Of the 149,113, tweets were classified as positive, negative and neutral, respectively, by (a) VADER: (55,040) 37.05%, (44,395) 29.89%, and (49,106) 33.06%, (b) TextBlob: (70,900) 47.73%, (22,729) 15.30%, and (54,921) 36.97%, and (c) Flair: (31,389) 21.13%, (117,152) 78.87%, and 0.00%. Sentiment trajectories revealed that communication, stigmatization, accessibility to and availability of vaccines, and concerns about vaccine safety as factors influencing decision-making in the content and flow of tweets. Interpretation: Twitter is a key surveillance tool for understanding factors influencing decisions and access to mpox vaccination. To address vaccine mistrust and disinformation, a social media-based risk communication plan must be devised. Adopting measures to remove logistical vaccination hurdles is needed. Obtaining fact-based information from credible sources is key to improving public confidence.

Cervical cancer is a significant public health concern globally, with low and middle-income countries bearing the highest burden, specifically the South Asian region. Therefore, the current scoping review aimed to highlight the factors influencing the implementation of human papillomavirus (HPV) vaccination in South Asia. Adopting the 'Arksey and O'Malley and Levac et al.' methodology, multiple electronic databases were searched to identify relevant records. The results were narratively synthesised and discussed, adopting the Consolidated Framework for Implementation Research (CFIR) model. We identified 527 records, which were assessed for eligibility based on title, abstract, and full text by three reviewers, followed by data extraction of 29 studies included for analysis in the review. Implementing HPV vaccination programs in South Asia faces various challenges, such as economic, health system, financial, health literacy, and sociocultural factors that hinder their successful implementation. To successfully implement the vaccine, a tailored risk communication strategy is necessary for these countries. Knowledge gained from the experience of South Asian nations in implementing the HPV vaccine can assist in policymaking in similar healthcare for advancing the implementation of HPV vaccination.