Are We Doing Enough For The Ones Risking Their Lives For Us? India's Frontline Warriors Need So Much More

"In nothing do men more nearly approach the gods than in giving health to men" - Cicero (106 B.C. - 43 B.C.)

The entire world is facing a time that no one in the living generations would have ever even thought of.  Coming from a random organization, at a random time and place, something so minuscule in size, literally brought the world to a standstill. It is rightly said that size doesn’t really matter. At an estimated population of 7,800,000,000 (in 2020), this Planet experienced something which was on one hand horrifying for the Man, while on the other hand, brought back life to everything except for the Human Being. Places like Mumbai started getting views of something as rare as Dolphins being spotted at coasts. However, there were even bigger things happening at the frontline with the notorious Corona Virus.

While we were all busy chilling and making all things at home with our families, there were, or rather there are still people who are risking their lives on a daily basis saving lives and making sure the virus doesn’t spread.

Calling them Frontline Covid Warriors. Banging utensils for them. Lighting up diyas. Praising them all day, every day. Makes sense, right? But is it enough?

Let us see how much the Frontline Warrior Sector of our country, the Health Care Sector is being rewarded for the thankless job that they’ve been doing all through this pandemic of COVID-19.

India’s response to the COVID-19 pandemic has been characterized as being amongst the foremost stringent, consistent with the Oxford COVID-19 Government Response Tracker. The country has been under a lockdown since March 24, and given India’s inadequate health infrastructure, a stringent response had to be undertaken early to contain the spread of the virus. In recent weeks, the main target has increasingly shifted towards a gradual exit from the lockdown, and a number of other economists have suggested ways of managing the many economic fallouts that individuals and businesses have faced as a result of the extended lockdown.

On May 12, Prime Minister Narendra Modi announced a Rs 20 lakh crore economic package like 10 percent of GDP. While the package has targeted liquidity issues for MSMEs, due attention should even be given to the healthcare system, and therefore the increasing strain it'll face once the lockdown is lifted. There are several samples of how public research laboratories, public institutions just like the IITs, and personal players including startups have risen to the challenge of performing on COVID-19 testing kits, masks, alcohol-based sanitizers, personal protective equipment (PPEs) and ventilators, to beat challenges of worldwide supply chain disruptions and to cater to domestic needs. it might be prudent to anticipate that a number of these needs are only getting to increase during a post lockdown world, and with the spotlight currently on India’s indigenous innovative capabilities within the fight against the COVID-19 virus, the time has come to spice up India’s healthcare infrastructure and push for greater technology deepening within the healthcare sector.

To put India’s poor health infrastructure into perspective, consider this – consistent with a Brookings study by Prachi Singh, Shamika Ravi, and Sikkim Chakraborty published in March 2020 and using data from the National Health Profile-2019, the entire number of hospital beds within the country was 7,13,986 which translates to 0.55 beds per 1000 population. Furthermore, the study also highlighted that 12 states that account for 70 percent of India’s 1.3 billion population were found to possess hospital beds per 1000 population below the national average of 0.55 beds. In terms of access and quality of health services, India was ranked 145 out of 195 countries during a Lancet study published in 2018, below countries like China (48), Sri Lanka (71) Bhutan (134), and Bangladesh (132).

India’s general government expenditure on healthcare as a percent of GDP was just 1.0 percent in 2017, consistent with WHO data, placing it at number 165 out of 186 countries in terms of state expenditure on healthcare. Compounding this problem of poor health infrastructure and low spending, especially within the current environment that has caused significant disruptions to the worldwide supply chains, is India’s dependence on medical device imports.

According to the Association of Indian Medical Device Industry (AiMeD), India’s medical device imports were around Rs 39,000 crore in FY2019, having seen a growth of 24 percent from the previous year. Furthermore, these imports were said to account for around 80 percent of India’s medical devices requirements, with the majority of the devices coming from the US, China, Germany, and Singapore.

Much of the info presented above highlights the very fact that fighting any major health emergency including an epidemic of this magnitude was always getting to be a troublesome task for India. The pandemic has provided India a chance to specialize in its indigenous innovative capabilities, with some commendable public and personal partnerships currently underway to tackle the crisis. It is important to notice that India’s expenditure on R&D as a percent of GDP has continued to stay stagnant at 0.7 percent of GDP for 3 decades, with the general public sector accounting for 51.8 percent of national R&D expenditure. This compares to around 2.8 percent of GDP for the US, 2.1 percent of GDP for China, 4.4 percent of GDP for Korea, and around 3 percent for Germany where the dominant sector by spending on R&D is that the private sector. Furthermore, while India’s public R&D expenditure on healthcare as a share of central government spending on R&D has increased to five .5 percent, a figure that's now like that in Germany, it remains low compared to over 25 percent within the US and around 9 percent in Korea. When one considers the ranking of the world’s top 2500 R&D firms globally consistent with the 2019 EU Industrial R&D scoreboards, there are 13 Indian firms present within the Pharmaceuticals & Biotechnology sector as compared to 221 firms from the US, 44 firms from China, and 9 firms from Germany, whereas India has no R&D presence within the healthcare equipment and services sector as compared to 48 firms from the US, 6 from China and eight from Germany.

The structure of India’s healthcare industry means  India now must repose on its competitive position within the Pharmaceutical and Biotechnology sector, where it's established a reputation for itself in delivering low-cost drugs and vaccines. The industry has been at the forefront globally within the fight against COVID-19, with medical supplies having been provided to over 120 countries. Given the huge industrial base and demand for healthcare in India, a build-up in spending on health infrastructure and healthcare R&D with attention on healthcare equipment and services would surely aid in India’s economic recovery, by not only protecting the well-being of its own citizens but also providing access to top quality and affordable healthcare equipment globally.

To build a strong health system for the longer term, that specialize in India’s infrastructure and technology needs, would require emphasizing the triple helix model of innovation, i.e., bringing together the govt, academia, and industry, now quite ever. to the present end, the govt of India has established a ‘COVID-19 Taskforce’ with the target of mapping together various technological advancements associated with COVID-19 publicly R&D labs, academia, start-ups, and industries. The task force has already identified over 500 entities within the fields of medicines, ventilators, protective gear, among others. India has seen the advantages of such collaborations within the past – in 2014, the Rotavac vaccine was developed under the leadership of Dr. M K Bhan, as a part of a world consortium that included India’s Department of Biotechnology and other partners from academia and industry.

Several public-private partnerships and collaborations are already underway. The Defence Research and Development Organisation (DRDO) which has developed ventilators, is collaborating with industry to proportion production to 10,000 units per month. Nocca Robotics, a start-up incubated at the Indian Institute of Technology Kanpur, has entered into an agreement with Bharat Dynamics Ltd. (BDL), a public sector undertaking where the latter is going to be involved in the large-scale development of ventilators. Startups like Marut Dronetech are partnering with various state governments to use drones to watch adherence to social distancing norms. The Pune-based startup, MyLab Discovery Solutions, has developed an economical indigenous testing kit, Pathodetect, and has not only received approval from ICMR and CDSCO but has also been selected to receive financial assistance from the Technology Development Board to build up the manufacturing of those kits. The Pathodetect test kit costs almost 1 / 4 of the value of kits from its international competitors and also provides the leads to but 3 hours compared to alternative testing kits that take up to 7-8 hours to supply results. The Mahindra & Mahindra group has recently launched its low-cost ventilator AIR 100 and is an outcome of the collaboration between the Mahindra & Mahindra group and therefore the Indian government.

Better coordination of the varied technological developments through greater synergy between the govt, academia, and industry with reference to research and manufacturing could help minimize duplication of efforts and end in a simpler use of resources at this point of great uncertainty. As we move towards an eventual exit from the lockdown, several initiatives like those being undertaken by public R&D labs on plasma therapy and genome sequencing of SARS-CoV-2, by startups from the IITs that are developing personal protective equipment or maybe antimicrobial agents that would be wont to coat textiles, and by the industry that's using AI to for purposes of drug discovery, for instance, got to be closely evaluated and provided necessary regulatory and funding support to bring these technologies into production.

The new economic package that has been announced by the govt should include a package for the healthcare industry of around Rs 2.1 lakh crore. the govt should allocate around Rs 2 lakh crore towards boosting the country’s health infrastructure and around Rs 10,000 crore towards developing healthcare technologies that India would wish in combating the spread of the virus once the lockdown is lifted. The expenditure on healthcare infrastructure would take India’s general government expenditure on healthcare as a share of GDP to around 2.0 percent, while the Rs 10,000 crore allocation would take India’s healthcare R&D spending to shut to twenty percent of central government expenditure on R&D.

More than applause, healthcare workers need safe working conditions. The current funding landscape for collaborative research includes grants that change from Rs 50 lakh to Rs 1 crore counting on whether it's an early-stage proposal or a more advanced workable solution, like the ‘ignition grant’ from the US-India Science & Technology endowment (USISTEF). The National Research Development Corporation (NRDC) is offering support up to Rs 10 lakh for necessary infrastructure for researchers and innovators involved in the development of eco-friendly sanitizers, rapid test kits, PPEs, ventilators, medicines, and vaccines. The Department of Science and Technology (DST) also found out a rapid response center CAWACH – Centre for Augmenting WAR with COVID-19 Health Crisis – to supply support to 50 innovations and startups addressing various challenges posed by the pandemic. the size of funding required however is significantly larger than what's currently available.

In the current context, a crucial aspect to think about here while increasing the quantity of funding is that the promotion of open innovation models. The open innovation model allows for the mixing of an external knowledge talent pool with the in-built capabilities of a firm, thereby bringing together a network of collaborators involved in biomedical research and drug discovery. The Pharmaceutical industry has traditionally followed the closed-innovation model characterized by centralized R&D. However the industry has been experiencing a decline in productivity also as a rise within the cost of operations worldwide – consistent with a report by Deloitte Centre for Health Solutions, twelve major drug companies had a return of mere 1.8 percent against their R&D spending in 2019 compared to a return of 10.1 percent in 2010. Of late, key pharma majors like Johnson & Johnson have begun to resort to models of open innovation. Similarly in Japan, Takeda, a pharmaceutical giant has launched the “Shonan iPark” an innovation park that promotes cross-industry collaboration. India too has experimented within the past with a hybrid model of open innovation when it initiated the Open Source Drug Discovery (OSDD) platform, which brought together experts from the government and therefore the private sector to seek out a coffee cost cure for tuberculosis. Going forward, an open innovation model especially for state-funded research would offer a channel for researchers to share their R&D outcomes, thereby enabling maximum involvement of all parties within the collaborative effort and also ensure much-needed transparency. These models would also help overcome challenges like the monopoly power and benefits that accrue to a firm thanks to patents.

Structural Changes needed in India’s health policy: The ongoing response to the pandemic involves a replacement strategy to rework and rejuvenate India’s healthcare sector. it might be prudent to incorporate a package for the healthcare industry totaling Rs 2.1 lakh crore to spice up India’s healthcare infrastructure and support more R&D and innovation in healthcare. The triple helix model of the state, academia, and industry are ever more important at this point of uncertainty. Accompanying this scale of funding would be the necessity to market open innovation models for better coordination of the efforts and for greater transparency within the research collaborations. this is often a health crisis that's expected to remain with us for a few times to return. The response to the pandemic offers a chance to cause structural changes in India’s health policy, see greater technology deepening within the healthcare sector with attention on healthcare equipment, reduce India’s dependence on imports of medical devices, and aid in India’s economic recovery.