On 20 January 2025, India marked the fourth anniversary of Vaccine Maitri (Maitri means friendship in Hindi), its global vaccine initiative. On the same day, President Donald Trump signed an executive order withdrawing the United States from the World Health Organisation, citing its mismanagement of the COVID-19 pandemic, among other reasons. As the world’s most powerful nation reassesses its role in global health security, India’s response to the crisis offers a vital perspective on global leadership in times of need.
India, a fast-growing economy home to one-sixth of humanity, could have bolstered global health and economic resilience simply by safeguarding its own population. However, it embraced a broader responsibility, providing timely and critical support to nations worldwide. India’s pandemic response embodied its civilisational philosophy of Vasudhaiva Kutumbakam – the world is one family.
While several advanced economies looked inward, India emerged as a lifeline, supplying essential medicines, medical equipment, vaccines, and food assistance to many nations. India was more than an emergency responder; it became a reliable pillar of global stability. Despite facing significant challenges of its own, India’s actions reflected both capability and intent, making it imperative to revisit its role, especially in light of the shifting global health landscape under Trump 2.0.
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Vaccine Maitri: India’s Hand of Humanity
“I personally want to thank you, the people and government of India for reaching out to us at a time of such need. I also sort of do a double take when I hear the expression of ‘vaccine diplomacy’. I wouldn’t call it that. I think it was just extending the hand of humanity. I think there were other countries involved in vaccine diplomacy, not India.”
Dr Vince Henderson, Minister for Foreign Affairs, International Business, Trade and Energy of Dominica, September 2023
On 20 January 2021, just four days after rolling out its domestic vaccination programme, India launched its global Vaccine Maitri initiative. While conducting the world’s largest phased vaccination drive at home, India simultaneously worked to bridge the global vaccine divide through donations and supplies.
India was the first vaccine donor to several countries, enabling them to initiate their vaccination drives. Many nations received shipments even before Indian Prime Minister Narendra Modi took his first jab on 1 March 2021. Within the first three months of the rollout, India had sent out three times more vaccines globally than it had administered at home. This stood in stark contrast to advanced economies, including the United States, which engaged in ‘vaccine nationalism’ by stockpiling three to eight times their actual needs.
According to the Ministry of External Affairs, by 22 April 2021, India had supplied 66.37 million vaccine doses to 93 countries, including 10.52 million doses as grants. Additionally, 0.2 million doses were sent as a grant to UN peacekeepers, covering two shots for the contingent. By 15 June 2023, the total figure had risen to 301.25 million doses, reaching 99 nations. This included 14.93 million doses donated to 51 countries.
Beyond its immediate neighbours, India was the first to deliver vaccines far and wide, reaching nations such as Mongolia, Fiji, Botswana, Eswatini, and the CARICOM states, enabling them to launch their vaccination drives. In Nauru, India’s contribution helped vaccinate the entire adult population. Similarly, it enabled Bhutan to vaccinate its entire adult population with the first dose.
India’s help came without conditions. For example, some Latin American nations faced pressure from certain vaccine companies to pledge sovereign assets as collateral or make foreign policy concessions to China. In contrast, India delivered millions of vaccines, with no political strings attached.
Vaccine Maitri filled a critical gap when advanced economies prioritised their own needs. It was driven by humanitarian concern, not strategic calculations or the size and significance of the recipient nation. While it earned global praise, its real impact was in inspiring hope among small and low-income countries, reassuring them that they were not alone. The initiative set an example of responsible global action in times of crisis, demonstrating how nations can contribute to the greater good.
*Figures rounded off; minor variations may exist.
The World’s Pharmacy and a Trusted Partner in Crisis
India’s pandemic response went beyond vaccine sharing, playing a crucial role in international efforts from the outset.
In February 2020, before the WHO declared a pandemic, India evacuated its nationals from COVID-affected regions in China and from a quarantined cruise ship in Japan. It also facilitated the evacuation of 48 foreign nationals from Bangladesh, China, Madagascar, Maldives, Myanmar, Nepal, Peru, South Africa, Sri Lanka, and the US.
As the crisis intensified, India’s role evolved beyond its borders, delivering critical medical relief on both a humanitarian and commercial basis. Accounting for 60 per cent of global vaccine production and 20 per cent of generic medicine exports, it lived up to its reputation as the Pharmacy of the World, supplying:
- 400 million Hydroxychloroquine (HCQ) tablets to 114 countries
- 96 million Paracetamol tablets, along with other forms, to 24 countries
- Other essential medical supplies to ~57 nations
After briefly restricting exports, India resumed HCQ shipments on 17 April 2020, dispatching 2.8 million HCQ tablets to 25 countries and 1.9 million Paracetamol tablets to 31 countries as grants by 30 April 2020. At the request of President Donald Trump, India also supplied 5 million HCQ tablets to the United States.
In April 2020, The European Foundation for South Asian Studies noted, “India has taken a rather empathetic view of the crisis and has begun providing a whopping 85 million hydroxychloroquine tablets and 500 million paracetamol tablets to a total of 108 countries. It had initially banned the export of these drugs, but reversed that decision as soon as it became apparent that the ban was out of place given the larger humanitarian challenge at hand.”
In Financial Year 2020-21, it delivered INR 1000 million worth of medical aid to 82 countries, including 25 in Africa and 27 in Latin America. India also deployed Rapid Response Teams comprising doctors, nurses, and paramedics in Comoros, Kuwait, Maldives, and Mauritius. Under the Indian Technical and Economic Cooperation Programme, India provided online training for pandemic management to multiple nations, strengthening their capacity to handle the crisis.
To address both local and global needs, India scaled up production of medicines and medical supplies. In November 2020, it launched Mission COVID Suraksha, providing financial and technical support to accelerate indigenous vaccine development and production. Additionally, it provided an advance payment of INR 45 billion, enabling vaccine manufacturers to scale up production.
Neighbourhood First
Under its Neighbourhood First policy, India extended timely assistance to countries in South Asia, delivering vaccines, medical and humanitarian supplies, and financial aid. Bhutan and the Maldives were the first recipients of Indian-made vaccines on 20 January 2021, the day Vaccine Maitri was launched. By 2 April 2021, India’s immediate neighbours had received substantial vaccine grants from India – Afghanistan (0.5 million), Bangladesh (3.3 million), Bhutan (0.55 million), Myanmar (2.7 million), Nepal (1.1 million), Maldives (0.2 million) and Sri Lanka (0.5 million).
Indian naval ships traversed 40,000 nautical miles, delivering 3,000 MT of food aid, 300 MT of liquid medical oxygen, and 900 oxygen concentrators to 15 nations in the Indian Ocean Region under Mission Sagar – demonstrating India’s vision of Security and Growth for All in the Region (SAGAR). India was not only the first vaccine donor or crisis responder but also addressed critical shortages in neighbouring countries.
- Afghanistan: Supplied half a million vaccines, over 20 MT of life-saving medicines, and 75,000 MT of wheat in 2020-21. In 2021-22, four additional aid consignments, including vaccines, were dispatched. Shipments were routed through Iran’s Chabahar Port, which remained a vital supply corridor.
“While we must remain vigilant about a potential third wave, vaccinations have now begun, thanks to the donations from the Government of India and the support of the COVAX facility.”
Deborah Lyons, Special Representative of the Secretary-General of the United Nations for Afghanistan and Head of the United Nations Assistance Mission in Afghanistan, March 2021.
“Today, India supplied the next batch of humanitarian assistance consisting of 500,000 doses of COVID vaccine (COVAXIN) to Afghanistan… Another batch of additional 500,000 doses would be supplied in coming weeks. Thank you India for providing Afghan people life saving gift on the first day of 2022!”
Farid Mamundzay, Afghanistan’s Ambassador to India, January 2022
- Bangladesh: Received the largest initial vaccine grant in 2021 – 2 million doses (21 January), 1.2 million (26 March), and 0.1 million (2 April). The biggest overall recipient of Indian-made vaccines that year, with 3.3 million doses in grants, alongside additional supplies through COVAX and commercial agreements. Between 24 July and 12 August 2021, India delivered about 1,402 MT of Liquid Medical Oxygen to Bangladesh via seven Oxygen Express trains.
“I thank Prime Minister Narendra Modi for sending the vaccine as a gift.”
Sheikh Hasina, Bangladesh Prime Minister, January 2021
“India had stood by Bangladesh during the [1971] Liberation War, and today, when the pandemic is rattling the world, India again came with gifts of vaccines.”
Dr AK Abdul Momen, Bangladesh Foreign Minister, January 2021
- Bhutan: India’s grant covered the first vaccine dose for its adult population. Extended foreign currency swap support of USD 200 million. The SAARC Food Bank mechanism was activated for the first time in May 2020 to supply Bhutan with rice from India’s reserves.
“…more than 90 per cent of our entire population stand fully vaccinated. This, in no small measure, was possible due to the heart warming goodwill of friends and partners, including India, whose Vaccine Maitri initiative enabled the full first round of vaccinations for our adult population.”
Lyonpo Tandi Dorji, Bhutanese Foreign Minister, September 2022
- Maldives: Airlifted 6.2 MT of medicines under Operation Sanjeevani in April 2020. In May 2020, an Indian naval ship delivered 580 MT of food aid under Mission Sagar. USD 250 million in budgetary support and foreign currency swap assistance worth USD 150 million in 2020.
“India donated the most number of vaccines.”
Ibrahim Solih, Maldives President, March 2022
“The recent budget support [by India] of 250 million US dollars, was the single largest financial assistance from a donor during this pandemic.”
Abdulla Shahid, Maldives Foreign Minister, September 2020
- Myanmar: Contributed USD 200,000 through the ASEAN Centre for Humanitarian Assistance, in addition to bilateral COVID-19 medical aid worth USD 2.3 million between 2020 and 2022. Grant assistance of 10,000 MT of rice and wheat in 2021-22 and an oxygen plant in January 2022. Received the largest vaccine grant tranche of 3.7 million.
“Hindi-Myanmar Bhai Bhai! A helping hand from a long-standing friend & neighbor. India yesterday donated medical supplies worth US$ 900,000 to aid containment & treatment of COVID-19 in Myanmar. Gift was presented by Indian Amb. H.E. Mr.Saurabh Kumar to MOHS DG Tha Tun Kyaw.”
Thaung Tun, Myanmar Union Minister of Investment and Foreign Economic Relations, May 2020
- Nepal: Gifted 150 ICU beds in July 2021. Installed a Medical Oxygen Plant at B.P. Koirala Institute of Health Sciences, Dharan, in August 2021, with the capacity to serve 200 patients simultaneously. By mid-2021, provided ~USD 6.5 million worth of COVID grant assistance, including essential medicines and other medical supplies.
“We got an early chance to administer the COVID-19 vaccine. For this, I extend my gratitude to our neighbour: India, its people and government and especially to Honorable Prime Minister Narendra Modi. They sent the vaccine to us within about a week of its roll out in India.”
KP Sharma Oli, Nepal PM, January 2021
“Nepal has been getting liquid oxygen from India and it is the only country from where we are getting liquid oxygen.”
Rajan Bhattarai, Nepali PM’s Foreign Policy Adviser, May 2021
- Sri Lanka: Grant assistance of over 25 MT of medicines in May 2020, and over 26 MT of drugs and other medical supplies in April-May 2022. Gifted 100,000 Rapid Antigen Test kits in February 2022. Provided over USD 900 million in foreign currency swap, deferred a USD 500 million Asian Clearance Arbitration payment, and gave a USD 1 billion credit line for essential imports from India.
“I wish to convey my heartfelt appreciation to Hon PM @narendramodi, Govt & people of #India for your warm gesture in sending medicines to #LKA on a special chartered flight. Your kind & generous support is deeply appreciated in this hour of need.”
Gotabaya Rajapaksa, Sri Lankan President, April 2020
- SAARC: Established the SAARC COVID-19 Emergency Fund with a USD 10 million contribution. Launched an information exchange platform, and provided COVID-related online training for healthcare professionals across SAARC countries.
“I think India did a great job… As early as March 15, 2020, Indian PM called all SAARC leaders and came forward to help, to work together. Since Covid-19 is a global issue we have to work together in collaboration. The Indian PM took leadership, we joined in.”
AK Abdul Momen, Bangladesh Foreign Minister, March 2021
(Data, unless linked otherwise, is from the 2020-21 and 2021-22 annual reports of the Ministry of External Affairs, Government of India.)
Global Acclaim
India’s humanitarian outreach transcended regional boundaries, reaching nations as diverse as Mongolia in Asia and Guyana in South America. Beyond reinforcing global healthcare efforts, it provided food relief internationally – all while ensuring food security for 810 million Indians through one of the world’s largest domestic welfare initiatives. With timely, wide-ranging assistance, often given as unconditional grants, India reaffirmed its role as a dependable ally. At a time when several developed nations prioritised domestic needs, India was a beacon of hope and a first responder for many. Leaders worldwide commended India’s proactive stance and helping hand.
The high praise from the Caribbean Community (CARICOM) – the traditional sphere of influence of the US – is particularly noteworthy. It later translated into official recognition, with Prime Minister Modi receiving the highest civilian awards from Guyana, Dominica, and Barbados – an acknowledgment of India’s steadfast role during the crisis.
Dr Ralph Gonsalves, the Prime Minister of St. Vincent and the Grenadines, pointed out the significance of India’s assistance: “It is timely to remind all of us that the noblest form of solidarity is to give not from the abundance or surplus that we may have but from the little that we possess. That is the lesson of the proverbial widow’s mite. In this regard, on behalf of the Caribbean, I thank the Government of the Republic of India for their early and meaningful gift of Covishield AstraZeneca vaccines.”
Dominica PM Roosevelt Skerrit posted on a social media platform, “Even though I trust every word of the bible, I must confess that I did not imagine that the prayers of my country would have been answered so swiftly. Thank You India.” While receiving the vaccines sent by India at the airport, he said, “One would have thought and understood that in a global pandemic such as this, a nation’s size and might would have been the primary considerations. But it is to the credit of Prime Minister Narendra Modi that our request was considered on merit and the equality of our people was recognised.”
Dr Mohamed Irfaan Ali, the President of Guyana, stated in January 2023, “India used the fruits of its independence to assist other developing countries… When the world locked its borders and globalisation failed, you showed that globalisation can still succeed and there is still love when the hardest of times hit us.” In an interview the same month, he added, “India has shown the world that even in a time of greatest need and crisis, there could be a reliable partner. They can offer solutions, they can share their technology, they can share their know-how, they can share their wealth, they can be part of a process through which the human family of humanity can advance.”
As the US prioritised domestic concerns, India emerged as a friend in need to many nations in the Americas.
Vaccine Inequity: A Crisis Within a Crisis
In September 2020, the WHO and the European Commission chiefs emphasised, “A global pandemic requires a world effort to end it – none of us will be safe until everyone is safe.” Yet, vaccine distribution reflected stark inequalities.
In January 2021, the International Chamber of Commerce Research Foundation estimated that vaccine inequity could result in up to $9.2 trillion in global economic losses. Despite this, high-income nations stockpiled vaccines through advance bookings, limiting availability for other nations. A report by the Duke Global Health Institute revealed that of the 7 billion vaccine doses purchased globally, high-income nations secured 4.2 billion, despite comprising only 16% of the world’s population. In contrast, upper middle-income nations received 1.1 billion doses, lower middle-income countries 411 million, and low-income nations just 270 million.
On 20 January 2021, as President Biden took office, he pledged to vaccinate 100 million Americans in 100 days. That very day, India launched the Vaccine Maitri initiative, treating the world with the same priority as its own citizens. By April 2021, India had supplied 66.37 million vaccine doses to 93 countries, including 10.52 million as grants. In contrast, the G7 donation only began in late April, when France contributed 0.1 million doses to COVAX. The US’s first major vaccine donations came only in May 2021, after mounting global pressure.
From mid-March 2021, India witnessed a sharp surge in infections. On 5 April, it recorded 100,000 new cases in a single day – the highest globally at the time. On 30 April, India became the first country to report over 400,000 new cases in a 24-hour period, with 3,462 deaths that day. Given this dire crisis, India had imposed a de facto ban on vaccine exports.
To deal with the deadly second wave, the Indian government ramped up its vaccination efforts. By 7 October 2021, India had administered 500 million doses, reaching 1 billion doses just two weeks later – making it the fastest vaccination drive in the world. By early January 2022, over 1.5 billion doses had been administered. A significant milestone was achieved on 27 August 2021, when India administered 10 million doses in one day – equivalent to vaccinating the entire population of Sweden in 24 hours.
By December 2021, India had reached 90% first-dose coverage, surpassing the US (73.2%), UK (75.9%), France (78.3%), and Spain (84.7%). In second-dose coverage, India reached 65%, more than the US (61.5%) and closely matching the UK (69.5%) and France (73.2%). By ensuring rapid vaccinations, India minimised wastage due to expiry and freed up supply for global needs from October.
India’s temporary export pause, necessitated by an existential crisis, disrupted COVAX supplies – preventing access to 140 million doses in May 2021, with another 50 million in June. Yet, as COVAX’s largest designated recipient, India could reasonably view at least part of these delayed consignments as securing its share amid a devastating second wave. Dr Bruce Aylward, the Lead for the ACT Accelerator, reflected this in a WHO press conference in September 2021, stating, “Remember again just the incredibly important role that India has played in supplying the world vaccines and also of course the largest country, which is a member of the COVAX AMC group and that is India itself.”
However, it would be unfair to attribute global immunisation delays solely to India when multiple other factors played a significant role.
- Vaccine Hoarding: G7 nations had secured far more doses than required – Canada (8.3x its population), Italy (7.5x), the UK, Germany, and Japan (~6.7x each), France (6.3x), and the US (4x). A UK National Committee for UNICEF analysis (2021) found that G7 nations and Team Europe could have shared 153 million doses if they shared just 20 per cent of their available supply over June, July and August without compromising their own vaccination targets.
- Surplus Wastage: By September 2021, Airfinity estimated that G7 and EU nations had stockpiled 1 billion surplus doses, of which 10% were expected to expire. Of these near-expiry doses, the EU accounted for the highest share of 41%, the US 32%, the UK 13%, and Canada 12%.
- Delayed and Unpredictable Donations: Pledges from high-income nations often arrived late, in inadequate numbers, or with near-expiry doses, making timely immunisation difficult.
- Severe Funding Gaps: By April 2021, COVAX had received only $600 million, leaving a $7.3 billion shortfall. The World Bank, despite committing $12 billion for vaccines, had only disbursed $2 billion of a $12 billion financing package intended to help countries purchase vaccines, and strengthen healthcare systems.
- Lack of Infrastructure in Low-Income Countries: Many nations lacked cold-chain storage, distribution networks, and trained personnel, significantly delaying vaccine rollouts even when doses were available.
- Raw Material and API Export Restrictions: The US’s invocation of the Defense Production Act restricted vital raw materials, disrupting global vaccine production, including in India. (Earlier, China’s API export curbs had contributed to medicine shortages and rising costs.)
- Blocked Efforts to Expand Global Vaccine Production: India and South Africa, with support from many Global South nations, pushed for a temporary WTO TRIPS waiver to allow wider vaccine production. However, the US, UK, Canada, Norway, and the EU opposed it. Ironically, as the Presidential nominee, Joe Biden had endorsed sharing vaccine technology, stating, “Yes, yes, yes, yes, yes. And it’s not only a good thing to do, it’s overwhelmingly in our interest to do.” A survey had also shown strong US public support for the waiver, yet the US delayed backing it for months – ultimately limiting its impact.
A Tale of Two Democracies
While global immunisation efforts faced multiple challenges, the responses of the world’s largest democracy, India, and the world’s superpower, the US – stood in stark contrast.
Despite having an economy roughly one-seventh the size of the US, and needing to vaccinate four times its population, India acted early to help the world. In contrast, the US had focused inward. Economic constraints further widened the gap. The cost of vaccinating 40% of the population was just 0.1% of the US health expenditure but a staggering 8.53% for India. Alongside this, India had to support 800 million people with food assistance due to lockdowns and the suspension of financial activities. While the pandemic caused a global increase in poverty levels, the percentage of people living in extreme poverty in India remained under 1%. However, both this percentage and the total number of people living in poverty were still significantly higher than in the United States.
While the US ultimately donated 685.1 million vaccine doses, this came after securing domestic needs, and amid global criticism and pressure. India, on the other hand, gifted 15.13 million doses (including 0.2 million to UN peacekeepers) early on, prioritising equitable access despite its own constraints.
In absolute numbers, the US contributed much more, but true commitment is rarely measured by quantity alone. For example, India’s total expenditure on vaccine donations amounted to approximately INR 3,130 million. This included 2.98 million doses of Covaxin at INR 215 per dose (costing approx. INR 640 million) and 12.15 million doses of Covishield at INR 205 per dose (costing approx. INR 2,490 million; including 0.47 million doses of Covovax for ease of calculation). These costs, calculated based on data provided by the MEA and the cost per dose presented in the Lok Sabha, exclude taxes as well as any expenses incurred in supplying the doses to recipient nations. For perspective, India’s Mars mission cost INR 4,500 million – underscoring the scale of India’s commitment to global health.
The pandemic was a test of global solidarity, and India, despite limited resources, led by example.
Conclusion
When Brazil sought India’s help to compensate for its people’s lack of trust in the Chinese vaccine, India responded promptly. To express his gratitude, Brazilian President Jair Bolsonaro shared a message on social media featuring an image of the Hindu god Hanuman carrying vaccine doses from India to Brazil – drawing a parallel to the Ramayana, where Lord Hanuman brings the life-saving sanjeevani booti to save Lord Ram’s brother. Few images could have more powerfully symbolised India’s role during the COVID-19 crisis.
India was not behind the COVID-19 pandemic, but it was at the heart of the solution. While advanced nations resorted to nationalism, India extended a helping hand – not out of compulsion, but conviction. This was more a moral choice rooted in a civilisational ethos than a strategic calculation. While the devastating second wave undeniably overwhelmed India, it is essential to remember that India was not merely a manufacturing hub but a living, thriving democracy, which had the responsibility of safeguarding its 1.39 billion people. That India turned inward when it had no choice, that its response may not have been flawless but was principled, did not go unnoticed – as reflected in the global recognition of its efforts.
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