India’s drug industry saved the world once. Can it do it again? |
The phone rang just before midnight.
It was early February in 2001 in Mumbai, and Yusuf Hamied, a seasoned chemist at the Indian multinational pharma company Cipla, was at a dinner party. He picked up the phone anyway. A New York Times reporter was on the line, calling to check a rumor: Was Hamied really offering HIV meds for $1 a day?
This story is part of the 2025 Future Perfect 25
Every year, the Future Perfect team curates the undersung activists, organizers, and thinkers who are making the world a better place. This year’s honorees are all keeping progress on global health and development alive. Read more about the project here.
In 2001, AIDS — which develops when HIV goes untreated — killed around 3 million people, 70 percent of whom were in Africa. The main treatment, antiretroviral therapy, was remarkably effective but out of reach for most of the world, running about $10,000 to $15,000 a year per patient. Millions of people were dying because they couldn’t afford those prices.
The Times reporter’s rumor turned out to be true. Hamied’s company Cipla had just publicly offered the latest HIV treatment to the aid group Doctors Without Borders for only $350 a year — a 97 percent price cut over prevailing drugs. Almost overnight, a therapy once priced for rich countries was suddenly within reach for the countries hit hardest by AIDS.
“Dr. Hamied, your life will not be the same from tomorrow,” the reporter said, and hung up.
The next morning, the story of Hamied’s accomplishment was on the front page of the Times. The news ricocheted through aid agencies, health ministries, and the halls of Washington. The Cipla offer “changes everything,” Toby Kaspar, an official of Doctors Without Borders, said at the time.
Indian generics would soon become the backbone of the global HIV response. Within two years, the US launched PEPFAR, the President’s Emergency Plan for AIDS Relief, a massive $15 billion program to deliver HIV treatment to sub-Saharan Africa and beyond. In the last two decades, that single program has helped save more than 25 million lives.
That victory was only possible at that scale because of cheap Indian generic drugs, which helped PEPFAR save nearly $1 billion early on, according to a US Government Accountability Office report. The competition created by those generics also drove the cost of HIV drugs further down.
That dollar-a-day offer in 2001 felt like a miracle, but it wasn’t. It was the payoff of a pharma revolution that had been quietly building for decades. India didn’t just stumble into becoming the world’s pharmacy. It got there through a series of intentional and defiant choices.
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Today, Indian generics dominate the world. By one estimate, roughly 60 percent of prescription tablets and capsules for the US market are now made in India. Across Africa and many Asian countries, the share is even higher. Major aid agencies like UNICEF and Global Fund source most of their HIV drugs and other essentials from Indian drugmakers. And generic competition has pushed the preferred HIV treatment in poor countries to under $45 a year.
But India’s dominance came at a cost.
Recently, contaminated cough syrups from India have been linked to the deaths of more than 140 children overseas. And dependence on the country’s manufacturers has become so great that when a single Indian factory making a critical cancer drug shut down in 2023, US hospitals were forced to ration chemotherapy, even turning to China for emergency imports.
For decades, there was an implicit bargain made with India. In exchange for a flood of affordable, lifesaving medicines — the same generics that turned HIV from a death sentence into a treatable disease — the world would tolerate a system built for the lowest possible price. Now, that bargain is breaking, and the pharmacy of the world is becoming a choke point.
And this is all unfolding just as the world is set to lean even harder on India. Demand for drugs that treat chronic conditions such as diabetes and heart disease is climbing. Patents on weight-loss blockbusters like Ozempic will start to expire over the next decade,........