With key members exiting; is WHO losing relevance? Will India reconsider its position?

The global trust in WHO is currently subject to re-evaluation. The U.S. exit marked a watershed moment that led Argentina, Hungary, and Russia to reassess their ties. Critics argue that WHO has increasingly ceased to be a health body with neutrality and has instead come under influence from a few donors with their own external interests. 

Going beyond this are issues concerning a global health system that too often disregards the national realities confronted, resists an adaptive approach to policy making, and chooses ideology over real-life consequences. Such rigidity poses a severe constraint for a country like India, which has 1.4 billion people with all sorts of health challenges. India has a known history of finding its own path. During the HIV/AIDS onslaught, it stoutly resisted multilateral pressure to provide affordable generics and in doing so redefined global access. With its polio campaign, it did so through local innovations and community outreach as opposed to imported models. Alongside developing its digital vaccination platform CoWIN, India spearheaded calls for a waiver of intellectual property on vaccines (TRIPS waiver) to support equitable access. These are not merely stories of success in public health but rather exemplars of health sovereignty.

This is very much the case for tobacco control, where global policy has been heavily donor driven. Following the U.S. withdrawal, the Bill and Melinda Gates Foundation and Bloomberg Philanthropies have emerged as the largest single contributors to global tobacco control—now outstripping even most important state contributors like China—with funds of $616 million (Gates) and $1.58 billion (Bloomberg) since 2005. In this context, the Indian policy landscape on tobacco reflects how these global imbalances play out in real time. More than 267 million people use smokeless and informal products in India, and it has one of the largest and truly diverse populations addicted to tobacco in the world; however, despite such complex facts, over the past decade, the country has implemented many WHO Framework Convention on Tobacco Control-FCTC policies, usually influenced by external powers instead of local evidence. The results continue to be disappointing. India stands at Rs 76,000 crores worth of tobacco tax collections per annum, but only Rs 5 crore was planned for cessation in 2024-25. As dismal, it shows the gulf between the actual problem and the response towards it. Law enforcement across the board is rank, these systems of support are underdeveloped, and even lower-risk alternatives have still been banned, despite growing empirical evidence supporting them. This raises an essential question as to whether these international tobacco control frameworks serve the purposes of the public health goals of a nation like India-or do they merely bolster a standard that favors a few while ignoring the realities on ground?

This would give self-reliance to public health policymaking in India at present, as Atmanirbhar Bharat envisions. That would mean having greater representation of Global South voices in setting international health priorities, willing to consider much flexible agenda of context-sensitive implementation. India should also demand integrating global funding mechanisms with national expertise and evidence instead of supplanting them. Not only that, but serious domestic public health investments such as tobacco cessation, harm reduction, and structured public-private participation and voices from Indian industry, research institutions, civil society, and state health systems need to be created to provide context-aware, sustainable solutions based on real Indian realities.
 
World and India, at both ends, stand at crossroads. Not a withdrawal from multilateralism; rather stepping up into a leadership role that better depicts who we are and what we want. If global frameworks are to really mean something for the Global South, they should be created by those who live and lead in it. And there is no better moment—or country—than now and India, for beginning that shift.