As vaccines for COVID-19 were first being approved for use, there were widespread calls for it to be assigned a 'global public good'. However, allocating the COVID-19 vaccine globally poses a novel challenge of redistribution, one that cannot be effectively undertaken using current mechanisms for the dispensation of aid. An examination of the origins and implicit logic of global public goods theory shows that it would not be effective as a framework in this context. I argue that while it is a useful rhetorical tool to underscore the need for global access, it fails to account for concerns arising out of structural inequities between countries in the Global South and North. In addition to being illdefined, the phrase encodes a neoliberal logicone that prioritises the protection of private capital over democratic claims of redistribution and social justice. To ensure global access, our attention must be focussed instead on explicitly accounting for inequities, securing access for countries in the Global South and addressing the norm-setting powers of pharmaceutical companies.

In August 2020, India announced its vision for the National Digital Health Mission (NDHM), a federated national digital health exchange where digitised data generated by healthcare providers will be exported via application programme interfaces to the patient’s electronic personal health record. The NDHM architecture is initially expected to be a claims platform for the national health insurance programme ‘Ayushman Bharat’ that serves 500 million people. Such large-scale digitisation and mobility of health data will have significant ramifications on care delivery, population health planning, as well as on the rights and privacy of individuals. Traditional mechanisms that seek to protect individual autonomy through patient consent will be inadequate in a digitised ecosystem where processed data can travel near instantaneously across various nodes in the system and be combined, aggregated, or even re-identified.In this paper we explore the limitations of ‘informed’ consent that is sought either when data are collected or when they are ported across the system. We examine the merits and limitations of proposed alternatives like the fiduciary framework that imposes accountability on those that use the data; privacy by design principles that rely on technological safeguards against abuse; or regulations. Our recommendations combine complementary approaches in light of the evolving jurisprudence in India and provide a generalisable framework for health data exchange that balances individual rights with advances in data science.