‘Just use one blood test to identify many pathogens that cause overlapping signs and symptoms’

After the pandemic, we are trying to see how we can ensure international cooperation for not just manufacturing but also research and development on medical countermeasures. So, India’s G20 presidency has taken an approach of a network rather than a hub and spoke model because that implies that some countries are superior and some are not there yet. None of the countries then wants to be the spoke in the wheel.

It is much better and more equitable if we think of a network. Now, a network and coordination mechanism can only be strong if the partners are strong. So, how do we make a strong partnership for research and development? It requires three pivots — development of infrastructure, manpower and funding.

We are largely dependent on technology transfer right now but the platform will promote technology sharing instead. There is a big difference. Each of the countries in the R&D network will do some research themselves and though many things will be shared freely, others can be at a cost. The platform will be made under the World Health Organisation (WHO) for sharing technology.

How would the network help?

We need to invest in future research now. India had invested in manufacturing through public-private partnership and it helped us during the pandemic. We had also invested in a BSL-4 laboratory so that we could grow the virus and give it to a company to make a killed vaccine. Or, take for example the United States, which was able to quickly develop a vaccine, because there was investment in the vaccine platform before the pandemic. Whichever country was good at whatever was able to do that better during the pandemic.

Another example would be diagnostics in India. When most countries were struggling to get diagnostic kits, we were able to develop them because we were prepared. For the last 10 years, the ICMR and department of health research have been funding the viral research and diagnostic labs. At that time, we did not even know what would happen with them or where they would be required. But when the pandemic struck, there were already 70 viral laboratories and a few others under other science departments that could do RT-PCR as well as hold hands of other labs to start the testing. Now, we have 3,500 laboratories across the country that can do PCR.

So, what happens to these labs now that COVID-19 is no longer a public health emergency of international concern?

Now, we are using the laboratories for tuberculosis. We have scaled up TB molecular testing to the entire country. Other than that, we are trying to develop kits and technologies for other infectious diseases as well. We are working on seven syndromic tests, meaning if you have respiratory symptoms, the respiratory assay can be used to test for say the five most common causes of these symptoms. We have already identified these five or six most common bacteria and viruses for seven syndromes and now we are encouraging companies to develop these kits. An expression of interest by ICMR is in the offing.

The seven most common syndromes that we will focus on are respiratory diseases, diarrhoea, fever of short duration due to dengue or malaria, fever of long duration due to typhoid and scrub typhus, neurotropic conditions such as encephalitis or meningitis, hepatitis and sepsis. The tests will be for both viral and bacterial pathogens. That is the beauty of these tests, they look for pieces of DNA, so that they can detect any type of organism.

Our hope is that blood is drawn from a patient with any of these seven syndromes only once and used for testing the most common pathogens. This will make it very affordable. For example, a company on its own has developed a three-test respiratory kit for COVID-19, RSV, and flu that costs only Rs 250, the same as the COVID-19 test. Instead, if you do a full viral panel test, it will cost about Rs 25,000. Once these kits become available, all the 3,500 laboratories will be able to do it. We have told the companies that we will help them validate the kits.

Is ICMR also studying the long-lasting impacts of the pandemic on people’s health?

We are doing three studies. First, we are studying all the sudden deaths that are now happening between the ages of 18 and 45 years along with the autopsy report and tests to see what happened. Second, we are doing a case control study for these sudden deaths to see what are the differences between those who died and those who survived such as their vaccination status, severity of the previous COVID-19 infection and so on. Third, we are doing a case control study on heart attack and other thrombotic events in people with a history of COVID-19 infection. We are doing a retrospective analysis of the follow-up data collected on patients with severe Covid-19 from the ICMR network of 39 hospitals from across the country to see what is the difference in people who have died and who have survived.