The COVID-19 pandemic underscored a fundamental truth—epidemics cannot be contained unilaterally. The rapid spread of the virus highlighted the global interdependence of health systems, where technology, medicine, expertise, and vaccine production relied on the complementary strengths of each state. Multilateral efforts—such as the COVAX initiative, ASEAN’s collective pandemic response, or the Quad and interested partner countries’ coordination calls—demonstrated the necessity and potential of cooperation. In South Asia, India and Pakistan’s geographic proximity and shared health and climate vulnerabilities make them a compelling case study for regional health collaboration, an area often overshadowed by their historical mistrust and their military and political conflicts.

The South Asian Association for Regional Cooperation (SAARC), despite its dormancy since the cancellation of the 2016 summit, remains the only institutional framework for structured regional collaboration. The SAARC Health Ministers’ Conference in April 2020 provided a rare moment of unity, facilitating discussion on regional pandemic response strategies and proposing mechanisms for documenting national experiences, sharing best practices, and ensuring continued high-level exchanges. There is an urgent need to resuscitate SAARC to serve as a vehicle for more structured and sustained health cooperation going forward and provide an opening for cross-border goodwill and stability. 

The Case for Health Diplomacy in South Asia

Despite ongoing tensions between the two neighbors, Pakistani NGOs offered assistance to India during its oxygen shortage during the 2021 Delta wave of the COVID-19 pandemic. Discussions that took place at the highest Indo-Pak levels to cooperate over polio eradication in 2012 suggests that health diplomacy can create space for dialogue and working together on common challenges even during periods of strain.

Sharing a long border, India and Pakistan face common vector-borne diseases, exacerbated by similar climatic conditions, weak surveillance, uncoordinated vector control, and cross-border wildlife and livestock movement. Despite limited human movement across the border, confidence building measures (CBMs) built on shared health challenges offer cooperation potential. As the World Health Organization has stated, cross-border collaboration is essential to prevent, detect, and respond to infectious diseases, as no country can fully protect itself in isolation.    

Currently, the most viable pathway for a resilient framework for South Asian stability would be to build  ties by incorporating human security, health security, and individual well-being, as conceptualized by The Mahbub ul Haq Human Development Center. Given the region’s shared geography, transboundary health risks, and climate vulnerabilities, this approach shifts from traditional state-centric policies to inclusive efforts in order to reduce mistrust and create pathways for broader dialogue between the historic rivals.

Key Areas for Regional Health Cooperation

A key area for potential cooperation between India and Pakistan is vector-borne disease control. Both neighbors experience seasonal outbreaks of dengue and report millions of cases of malaria annually, posing significant public health challenges.  Furthermore, both countries have experienced outbreaks of the Severe Acute Respiratory System virus (2002-2003), equine influenza (2007), the H1N1 flu (2009-2010), as well as what some experts consider the cross-border spread of chikungunya from India to Pakistan (2016-2017). While there is a deadlock between India and Pakistan when it comes to state-to-state diplomacy, nontraditional health security threats can be a potential area of cooperation and engagement between these two nuclear arch-rivals.

The First and Second SAARC Health Ministers’ Meetings (2005 and 2007) and the Islamabad Declaration on Health and Population emphasized regional cooperation in surveillance, diagnosis, reporting, and disease management. Key initiatives acknowledged the necessity of establishing national focal points, a Rapid Deployment Health Response System, and a regional mechanism to combat vector-borne diseases. Both countries have pursued national efforts to address these goals, and there have been some regional initiatives such as the 2014 Dhaka Declaration by the WHO South-East Asia Region. However, while these offers reflect broader regional health commitments, they lack direct India-Pakistan collaboration. SAARC’s health cooperation too has stalled, with the last formal Health Ministers’ Meeting in 2017 and only a virtual session during COVID-19 in 2020.

To advance cross-border disease surveillance and response, SAARC should coordinate on mass drug administration and a Vector-Borne Disease Research Initiative, modeled on ASEAN’s Field Epidemiology Training Network. This expert-driven initiative, comprising public health professionals, epidemiologists, researchers and disease control specialists, would operate independently of political influence to facilitate real-time data sharing, monitor disease trends, and ensure rapid responses during outbreaks. Additionally, the SAARC Regional Strategy on Communicable Diseases could be a common framework and standards to enhance the collective response of member states in the prevention and containment of the spread of vector-borne and communicable diseases. Revitalizing SAARC’s health diplomacy efforts by drawing inspiration from successful regional initiatives—such as in Africa, Latin America, and Southeast Asia – could further enhance disease control regionally.

A second potential area for collaboration could be tuberculosis eradication, given that these countries were two of the highest contributors to global TB cases in 2023 (India 26 percent and Pakistan 6.3 percent). ASEAN’s Airborne Infection Defense Platform offers a regional model to draw lessons from. Collaboration through the SAARC Tuberculosis and HIV/AIDS Center and SAARC’s Regional Strategies on HIV/AIDS can enhance prevention and control. Establishing a SAARC Emergency Medical Supply Chain Mechanism or implementing the SAARC Plan of Action—covering medical expertise, pharmaceutical harmonization, and affordable medicine production—could reduce Pakistan’s 98 percent reliance on medical imports by leveraging India’s pharmaceutical strength as the world’s largest generic medicine producer, instead of relying on long-distance imports with uncertain delivery times. Lessons from the European Union’s Critical Medicines Act could be instructive on the benefits and challenges of intra-regional sourcing.

Third, building on SAARC’s Telemedicine Network Project proposed during the 13th SAARC Summit, India and Pakistan can collaborate on medical research and providing healthcare regionally. Institutions like the All India Institute Of Medical Sciences and the Aga Khan University could lead joint research on diseases such as liver disease, cancer, and hepatitis. With over ten million hepatitis C cases (the largest in the world), Pakistan has a small number of liver transplant centers, while India’s 90+ centers perform 1,800 transplants annually. In this regard, institutionalizing the efforts of the Fifth Meeting of the Technical Committee on Health and Population Activities at SAARC 2015, which recommended setting up an Expert Group on Hepatitis, could be instrumental. The Expert Group could focus on coordinating research, sharing best practices, developing regional treatment protocols, and fostering collaboration between healthcare institutions.

Moreover, Pakistan reports 200,000 new cancer cases annually but has only 260 oncologists. Expanding patient quotas at India’s Tata Memorial and Rajiv Gandhi Cancer Institute, along with offering tele-oncology treatment and joint cancer research, could improve accessibility at affordable prices for cross-border patients. SAARC can build on past initiatives and encourage hospitals and medical institutions to undertake  cross-border living donor liver transplantation procedures, such as at Pakistan’s Sheikh Zayed Hospital (2011-2012), and “peace clinics,” which facilitated liver and cancer transplants with pre- and post-operative care across borders.

Challenges and Recommendations

While these proposed health CBMs could be a boon to the citizens of both countries, they are likely to be fraught with challenges. Deep-seated political and militarized trust deficits, bureaucratic inertia, and stark asymmetries in healthcare capacity—with India’s advanced medical infrastructure outpacing Pakistan’s—could complicate meaningful collaboration. Despite SAARC’s potential as a facilitating platform, restrictive policies could also hinder progress. For instance, the SAARC Visa Exemption Scheme currently excludes medical professionals and patients, restricting cross-border healthcare access, while the SAARC Regional Inter-Professional Master’s Program in Rehabilitation Science enhances regional collaboration on education but fails to address urgent medical mobility needs.

Legal and political barriers, as seen in cross-border organ transplant cases, further complicate cooperation. For instance, in 2016, a Pakistani national’s plea for a liver transplant in India was rejected due to concerns over the donor-recipient relationship and the potential for a commercial transaction. Additionally, obtaining No Objection Certificates (NOCs) are required for any cross-border procedures, even for life-threatening emergencies. Establishing joint medical relief corridors at Wagah and Kartarpur could expedite emergency aid. Additionally, with Pakistanis comprising a significant portion of India’s medical tourists, as of 2013, reviving medical tourism is an urgent need and could be addressed by easing the visa restrictions that have been in place post-2016. This could be done on humanitarian and people-to-people grounds and could help build mutual goodwill.

Beyond traditional attempts at conflict resolution through political or military means that have proven futile in several instances, health diplomacy could open up new channels for interaction and lead to genuine collaboration, offering a low-risk, high-reward option despite political obstacles. By utilizing SAARC’s institutional and facilitation abilities, India and Pakistan could coordinate focused actions, combine scientific knowledge, improve disease surveillance and pandemic preparedness, and create South Asia-specific plans for vaccine and diagnostic development. By embracing health diplomacy, India and Pakistan could transform intractable challenges into opportunities for meaningful cooperation, potentially paving the way for broader regional reconciliation and shared human security.

Also Read: India’s Visa Policy Can Better Reflect “Neighborhood First”

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Image 1: CDC via Picryl

Image 2: Gwydion M. Williams via Flickr

Views expressed are the author’s own and do not necessarily reflect the positions of South Asian Voices, the Stimson Center, or our supporters.