Investment in health innovations
Committing to funding long-term health innovation will enable India to realise today’s most urgently-needed solutions
Over the last 30 years, India's disease burden has changed dramatically — child mortality has dropped, people are living longer lives and fewer people live in extreme poverty.
But some things have stayed the same. Take the front-line diagnostic we use for Tuberculosis (TB), one of India's most rampant (though curable) infectious diseases. The sputum microscopy test, which is over a century old, detects only around half of the TB cases, and we still lack an adequate diagnostic tool for TB in children. No patient should have to endure (avoidable) suffering simply because we're relying on outdated tools and technologies.
Fortunately, governments, including the Indian government, are stepping up their health innovation commitments. According to latest estimates from the annual G-Finder report, released by Policy Cures Research, global money invested in research and development for neglected diseases reached a new high in 2017, exceeding $3.5 billion — up by 7 per cent from 2016.
The increase in Indian funding is even more dramatic. From 2016-2017, the Indian government upped its investments in neglected diseases' research and development by 38 per cent, making India the fourth-largest public funder globally.
Looking at just the emerging economies, India now accounts for nearly three-quarters of government spending on Research and Development (R&D). Commitments like these can help the Indian government achieve its goal of being among the top three countries globally in science and technology by 2030.
Thus, an increase in Indian health innovation is urgently needed. India ranks number one globally for diseases like TB, visceral leishmaniasis (VL), roundworm, hookworm, whipworm, dengue, lymphatic filariasis (LF), tapeworm and leprosy.
While active trachoma has been eliminated in India, trachomatous trichiasis — seen among adults and leads to blindness if untreated — still persists. India still accounts for a significant proportion of the global Hepatitis-C burden with an estimated 12–18 million chronic carriers of the virus.
There is an urgent need for research funding for mycetoma, which results in severe physical disabilities and social stigma leading to isolation, but was only recognised as a neglected disease in 2016.
We are beginning to see the impact of sustained investment in neglected disease R&D. A new triple-drug-therapy for lymphatic filariasis, for example, is likely to help achieve the goal of eradicating the disease.
In December last year, India successfully rolled out the new triple-drug therapy in one district each in Bihar, Jharkhand and Nagpur, as part of the phased roll-out strategy, targeting approximately 6 million people.
This scientific advancement in treatment promises to accelerate efforts to eliminate LF. India's efforts will impact the global fight against the disease, as the country bears 40 per cent of the global burden.
Another disease ripe for innovation is TB, which sees nearly 3 million new cases each year in India — the highest in the world. Current treatments and diagnostic pathways are complex and costly and long-drawn — or increasingly ineffective, as a growing number of cases become resistant to existing drugs.
The G-FINDER data shows that the Indian Council of Medical Research (ICMR) placed in the top four largest funders of TB R&D for the first time ever, signalling a commitment to fast-track the development and uptake of new tools against the disease.
Moreover, the India TB Research Consortium (ITRC), a diverse stakeholder initiative that brings the government, industry and research institutions together to prioritise TB research to develop new tools and interventions. An ICMR initiative, the ITRC is a first of its kind of collaborative approach to addressing India's TB challenge.
India also accounts for about 50 per cent of the global burden of Kala-Azar or VL. A debilitating and fatal disease if untreated, VL has remained in the shadow for long and only drew attention after elimination efforts intensified globally in 2005.
While there has been significant progress with a 59 per cent decline in cases reported in 2017, focus in a few high-endemic areas remains a priority for India. Research in treatment strategy, more responsive diagnostics tools and technology along with active surveillance and monitoring can pave the way to reduce the burden.
Research institutions such as Rajendra Memorial Research Institute of Medical Sciences (RMRIMS) are leading the way to identify alternative drug regime to achieve the 'zero-mile' walk to VL elimination.
Despite this progress, sustained funding for game-changing health innovation remains a huge challenge. The World Health Organisation (WHO) recommends that countries spend 0.01 per cent of their GDP to research the health needs of developing nations. Even with these recent increases, not a single country met the WHO's target, underscoring how far we have to go.
We are still falling short of the funding levels required to ensure healthcare for all. There is a need to invest in strategies that focus on the entire circle of healthcare —from prevention to management and overall health behaviour change.
Most importantly, we must nurture and inculcate curiosity in the minds of young scientists and encourage scientific rigour. Health innovation can create breakthroughs that change the world in an instant, but these breakthroughs rarely happen overnight.
We have to be patient with investments as translating some of the R&D efforts to product development takes longer. Indian lawmakers will need to sustain funding and find new ways to incentivise urgently-needed innovation.
Lest we forget, we always remain at the risk of diseases making a comeback unless we continue to adapt our responses. Only by committing ourselves to funding health innovation
in the long term will India be able to realise today's most urgently-needed solutions, and lay the groundwork for the breakthroughs we cannot yet imagine.
(Soumya Swaminathan is Deputy Director-General (Programmes), WHO. Views expressed are strictly personal)