Why is India not following Italy?
A recent Indian news story describes the reticence of the government to issue compulsory licenses in cases that are not health emergencies, or for export. An official at the Department of Industrial Policy and Promotion indicates that "There is no point in going in for CL unless there is an epidemic which impacts a large chunk of the population, and needs immediate solution."
This suggests that the government will not issue a CL for manufacture and export of a drug that is patented in India to a country where there is no patent (I assume).
A refusal to grant a license under similar circumstances was ruled to be anticompetitive in Italy and subject to a competition based CL. See http://www.wcl.american.edu/pijip/competitionpolicyproject.cfm
This looks like a prime area where developing countries should be following a pro-access competition doctrine established in the north. Certainly India should have a strong interest in erasing barriers to its generic export industry.
Using competition as the basis for the CL (e.g. under a theory that a patent should not be used to expand power into markets where it does not provide an exclusive right) provides an avenue around the TRIPS requirement that CLs normally be predominantly for the local market.