India has been at the forefront of making healthcare affordable through generic manufacturing. Jugaad finds its way everywhere without compromising on quality. This same jugaad has helped in bringing down the cost of antiretroviral drugs used in the treatment of HIV from $10000 a year to $100 a year, making it affordable for everyone in the world. And recently, Zydus Cadila’s generic remdesivir, used for treatment in COVID-19, Remdac’s price was cut to Rs 899 from earlier Rs 2800 while its competitors Hetero Labs and Cipla sell at Rs 5000-6000.
More often than not, people are faced with the dilemma of choosing between branded and non-branded in the market, unwittingly associating superior quality with the former. The West has refused to equate the two, and rightly so, with 89% of all prescriptions dispensed in 2020 containing a generic drug. India is the largest supplier of generic drugs in the world. Over 50% of global demand for vaccines, along with 40% demand for generic drugs in the US is met by Indian pharma companies. Patents worth $251 Billion are expected to expire between 2018 and 2024 bestowing a profitable opportunity in the pharmaceutical sector.
With the undoing of globalisation, being aatmanirbhar (self-reliant) is more of a necessity than a mere long-term, ambitious goal. Of the 63 per cent of India’s pharmaceutical imports that are Active Pharmaceutical Ingredients (APIs) and intermediates, 70 percent comes from China. Refusal to allow export of raw material for Covishield vaccines by the US is another instance of how dangerous this dependence can prove to be, at the whims of governments.
“Everyone is safe or no one is” democratised science albeit the degree to which it shall continue to be after the pandemic remains to be seen but it surely has set it in motion in the desired direction. The stark imbalance between the global distribution of vaccines resulted in a call for a waiver on intellectual property rights for COVID-19 vaccines and treatments initiated by India and South Africa in the WTO with popular support from the likes of the WHO. Unsurprisingly, strong opposition came from the US, the UK, the EU and other high-income countries who argue it would kill innovation even as people die, and the global economy continues to suffer.
Research and Reality
Going into villages to address tuberculosis and finding out that TB may be the least of their problems was some of the initial insightful experiences Ms Swaminathan had with ground reality as a young scientist. Villagers with dark brown stains on their teeth and pain in their bones, oblivious to the abnormal fluorine levels in their drinking water. Living in a hut by dirty sewage, having to choose between working that day to feed their family or visiting the doctor for the ongoing treatment of their tuberculosis.
Dr Swaminathan says, “Sometimes you don’t see a problem because it’s been a part of our daily life… I always felt that TB was invisible because it’s been there forever”. Here is where health literacy steps in, empowering communities against immediate and emerging threats such as from the COVID pandemic, non-communicable diseases and climate change is critical. Different stakeholders need to be consulted and a top-down approach does not make for the best of policies as it may be distant and unempathetic. A researcher needs to be in touch with ground reality for research done in an ivory tower may not be the most useful, making a combination of research, teaching and clinical care, with dedicated time for each, the best approach in medicine.
A 2016 study found that 57.3 % of the 579 medical colleges did not have a single publication in a decade. Around the same time, the annual research output of the Massachusetts General Hospital was 4,600. There is an abysmal scarcity of funds, potential researchers overworked with patient care, and if that weren’t enough to shatter scientific spirits, a lack of sophisticated research infrastructure accompanied by inadequate exposure to research, you have a vicious cycle as a consequence of which the little research that we do produce is substandard.
For the same reasons, many scientists leave for abroad but that by itself should not be a serious concern rather reverse brain drain or brain gain should be focused on with incentives. For example, China was able to bring back many Chinese scientists who were previously in more developed countries like the United States due to China’s inviting economy, large government investment in education and technology infrastructure for research, and the opportunity to build a science program from the ground up at Tsinghua University in Beijing.
Encouraging private sector investment to play a more consequential role in conducive governance, risk-managed research and development ecosystem is one of the ways of luring scientific talent which companies like Ranbaxy and Dr. Reddy’s have been engaging in actively through collaboration with government, financial investors, and academia.
While generic manufacturers have been successful in finding pathways and the know-how to produce drugs, the same may not be possible for the development of a vaccine, technology of which takes years and years of development.
Investments made in research today repay many times over in the times to come like the uphill struggle of thirty years to develop mRNA platforms due to little funding. The unprecedented rate at which the COVID-19 vaccine has been developed is again a payoff to the investments, collaboration and cooperation that happened in these trying times. Public-private partnerships like Operation Warp Speed helped drive investment and produce an extraordinary number of vaccines.
If advancements in science and technology enhanced the lives of the privileged with complete disregard for equity then it does not serve its purpose, says the Chief Scientist at the WHO, highlighting how one-in-four people in high-income countries have been vaccinated against coronavirus, compared with just one-in-500 in low-income countries. Government lays the groundwork to ensure equity by attracting attention of stakeholders towards the sectors they envision taking to a stage of self-sufficiency in a given timeframe. Be it through a nudge by increasing spending from 1 to 2.5% of GDP as stated or straightforward provision of Production Linked Incentive (PLI) Scheme to promote domestic manufacturing of APIs.
As growth in the developed world will slow down, the centre stage awaits the takeover by emerging markets like India which is only even a consideration if doors are opened to immense opportunities through the resolution of systemic impediments, with a population on the side. Essentially, the only thing in India’s way of becoming an unparalleled global pharmaceutical giant is India itself- a situation ameliorated by the ‘virus’ in the room getting undivided, at times wavering, attention of the state. Necessity is the mother of invention but having curiosity and status quo scientific dispensation makes a hotbed for innovation, research and a well-informed people. Such an unprecedented and unpredictable crisis of our times tests human organisation and the modern order to its very core, making innovation and research not an accoutrement rather an ineluctable and desirable development.
By Shreya Shukla
shreyapshukla2015@gmail.com