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Hold up. India is catching strays here for no good reason.
We have DOTs programs. They're paid for domestically, and while I'm sure donations are accepted, the largest source of foreign aid I could see is a $400m loan from the World Bank. I believe USAID has spent about $140M since 1998.
TB treatment is a national priority, and immense amounts of effort are put into DOTs, surveillance and follow-up.
India has a compulsory licensing scheme for life-saving drugs, which you're free to disagree with (good luck coercing a nuclear power or directly attacking it). It sells generics for about 10% of the retail price in the States.
I did some napkin maths:
The Indian state saves about $1 billion through CL a year, so about 5 billion USD by 2030. The US would lose a maximum of around 3 billion a year on pharma revenue, but that's with the unrealistic assumption that there wouldn't be any cost-negotiation or the availability of generics.
The CDC shows that TB treatments in the US can cost tens of thousands for normal TB, 150k for MDR and >500k or more for XDR.
You guys have around an order of ~100 MDR cases a year already. That is despite screening for immigrants and travelers being put in place.
If India paid standard prices, they're looking at about $100 billion for the same level of care. This would be untenable in practice, and TB incidence would soar. This would have knock-on effects, both globally, and in the States, existing screening is already rigorous, so God knows how much you'd end up paying when more MDR and XDR TB cases pop up. I'm not qualified to put firm numbers on the expense, but it ranges from anywhere between 10 million USD to 1 billion USD a year in treatment costs.
You'd be looking at quite serious economic fallout from sanctions, and the theoretical gains of about $2B USD PA are unlikely to manifest, since if India somehow was forced to stop using generics, they'd likely just spend less and then face an explosion in TB cases that wouldn't particularly respect borders. If the US really put the squeeze on, then India could well retaliate by flooding international markets with generics for other drugs.
And of course, do you really want to piss of another >billion strong nuclear power which is a willing partner against China? From a pragmatic point of view, I'd wager not.
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