Written by Anjali Taneja and L S Shashidhara
We are surviving through a challenging time. How it will be described by future historians depends on how well we save lives and livelihoods of diverse socio-economic populations of our country. Irrespective of the data on the spread of the virus and the level of mortality, India’s problem is far greater than any other country of the world. Nobody can deny the fact that we are in an unenviable situation.
A single largest problem, of course, is the huge socio-economic disparity in the society. In the context of the current pandemic, another major problem pertains to the unequal distribution of essentials due to the nation-wide lockdown that has led to severe restrictions in movement of goods even within a city/district/state, suspension of imports and disruption in domestic economic activities. However, Government and NGOs working for social welfare of poor and migrant workers could have still managed undisrupted supplies of essential items, had India been comprised of strong and reliable supply-chain networks (SCNs) connected through modern communication and technology. Such networks would have also ensured continuous generation of revenue for small and marginal farmers, small traders and for Micro, Small & Medium Enterprises (MSME).
While India is self-sufficient in food and raw material for clothing and housing, the focus should be on the development of robust SCNs, particularly for food and other essentials, that saves lives during pandemics such as the current one. But when it comes to medical supplies and innovations in healthcare services, we largely depend on imports. Starting from testing kits, reagents or devices used to develop new diagnostic tools and ventilators or its components to almost all major medical equipment and active pharmaceutical ingredients (API), are imported. The country’s import share of high end medical devices is almost 80% and that of API is nearly 69%. Producing any of these within the country isn’t rocket science! Indian industry, R&D labs and scientists have immense potential and demonstrated expertise on all these fronts. Still, we are all heavily dependent on imports for all our R&D work, be it basic biomedical biology or drugs, neutralizing antibodies or vaccines.
A case in point, India is currently witnessing a shortage of testing kits to diagnose people with possible infections from SARS Cov-2. Nearly 90% of the approved antibody test kits and over 50% of RT-PCR kits are manufactured by foreign companies. While newer techniques such as LAMP and serological tests are being introduced, qRT-PCR based tests need to be carried out widely as first line of diagnostics and/or for reconfirmation assays, particularly to quantitate viral load. Moreover, few Indian companies which are making the diagnostic kits locally, are importing most of the reagents or components from abroad. In times like these, we are severely constrained to import much needed testing kits and reagents, owing, in part, to very high demands from all over the world, and to cargo flights flying at minimal capacity due to the lockdown. All of this is adding pressure on the already stressed healthcare services in the country. Testing, contact tracing, isolation and quarantine are key parameters that determine the nature and length of the lockdown. Insufficiency in such essential needs is seriously impacting all aspects of our lives, making the end-path of this pandemic even more uncertain.
Many industries and/or institutes are already producing all reagents needed to put together testing kits, albeit in smaller quantities mainly for R&D purposes. Until now, they were not thinking of any of these reagents at a scale needed to test millions of individuals, as much of the demands were for domestic R&D and less for diagnostic purposes. Given the current capabilities, it is unlikely that any one industry or institute would be able to single-handedly manage the domestic healthcare needs of the entire nation during a crisis such as the Covid-19 pandemic. Social solidarity and a sense of wanting to help people that were strengthened during the pandemic, are conducive to build friendly collaborations, leaving aside aggressive business strategies. In this context, a consortium-driven approach would reduce import dependency, strengthen domestic manufacturing capabilities and create effective SCNs in any sector. The formation of national consortia of academic institutions and industry will ensure uninterrupted supply of quality goods and services within the country, and thereby, sustainable healthcare solutions.
If all organizations involved in making reagents that are used in assembling molecular diagnostics such as qRT-PCR, collaborate together with those who have the capabilities to scale up, a good SCN could be established for testing kits. One such consortium of domestic research institutes and interested companies is in the making as per the announcement of NitiAyog. We need multiple such consortia to mitigate the existing shortage of diagnostic kits and ensure equitable and quality healthcare facilities.
Another consortium that could be quite effective in the Indian context is of manufacturers, suppliers and retailers of components needed for the production of medical devices. For example, companies have been frantically on the look-out for makers/sellers of various components of ventilators such as O2, flow and pressure sensors, filtering system to trap virus particles in exhaled air, or the right fabric for PPEs and material for large scale production of N95 masks. A consortium would help streamline such a supply chain production network.
From the policy perspective, these consortia will not only help the country deal with the immediate crisis but would also form an indispensable asset for any future eventualities. Furthermore, post-COVID-19, the Indian medical fraternity would be better equipped, which improves healthcare management. For example, by expanding molecular diagnostics to other diseases, particularly, cancer.
Such consortia would also help in enhancing India’s export potential of value-added goods and enabling its greater integration in global value chains (GVC). At present, India’s contribution to GVC is below the desired potential as the country primarily imports high components, assemble final products and export them to other countries. GVCs could be a source of higher productivity, better employment, accelerated growth and reduced poverty.
Finally, these initiatives must be supported by suitable healthcare and manufacturing policies. Right blend of national policy interventions and infusion of necessary capital will nudge MSMEs to work together in consortium mode. A special policy cell or unit in the government could be formed as the nodal point of contact to formulate policies, complete digitization of supply-chain networks, streamline guidelines and standard operating procedures, as well as trouble shooting various issues. This could be supplemented with national and state level efforts towards advanced research, information dissemination, education on the consortia- driven SCNs and disaster management.
Dr. Anjali Taneja is Associate Director (Science Policy Initiative, Office of Research) at Ashoka University. Prof L S Shashidhara is Professor and Dean (Research) at Ashoka University and Professor at Indian Institute of Science Education and Research Pune. The opinions expressed are personal.