This month marks the introduction of the Sustainable Development Goals (SDGs), which aim to dramatically improve lives across the world by 2030. The SDGs will help countries frame their policies and strategies towards achieving these mutually agreed upon goals and targets. SDG 3, which aims to ensure good health for all, is a priority for India. There is no doubt that good health underpins a productive and satisfying life. Even though an average Indian can now hope to live for approximately 68 years, about 8-10 years are spent in tackling chronic ill health.
It is necessary to provide cost-effective solutions for diseases that affect India’s population. Infectious diseases, which accounted for most of the disease burden 25 years ago, have been substantially reduced through immunisation and the use of appropriate treatments including antibiotics. However, the so-called “non-communicable diseases”, such as diabetes, high blood pressure, cancer and chronic lung diseases, are increasing rapidly. This is true of rural and tribal populations as well as of urban dwellers. To radically improve the lives of millions in the country and realise the aim of “good health for all”, we need to follow two paths simultaneously: scale up the implementation of proven strategies and enhance research to develop new technologies, drugs and innovative service delivery mechanisms.
Health policies that are backed by sound research that are evidence-informed and have a much better chance of having the expected impact.
Epidemiological and clinical research is needed to improve our understanding of the epidemiology, transmission and risk of infections such as tuberculosis, malaria and dengue as well as to study trends in diseases/ like diabetes, cancer or stroke. A national prevalence study of diabetes conducted by the Indian Council of Medical Research (ICMR) has shown that prevalence among adults varies from 4 to 13 per cent across States and that pre-diabetes rates are worryingly high in most places. Clinical trials are necessary to test new treatment strategies. For example, treatment for kala-azar was shortened to a single injection from the previously painful course over six weeks while malaria treatment regimens were made more effective. Much of the ongoing biomedical research in India, in government and private institutions, is focussing on the development of indigenous devices, drugs and vaccines for diseases that affect us. Therefore, we must continue to support and promote an environment conducive to research and innovation in our schools, colleges and academic centres.Legacy of research, innovation
We have witnessed tremendous advances in medical research led by Indian scientists and institutes. The government’s Department of Health Research (DHR) and ICMR have piloted several innovations — shorter, more effective treatment regimens for leprosy and lymphatic filariasis, m-health technology for malaria management, and community-based interventions to reduce the burden of hypertension and diabetes. Further, indigenous diagnostic kits have been developed for improved diagnosis of dengue fever, tuberculosis (TB), food-borne pathogens and kala-azar and a portable, efficient and low-cost device to detect cervical cancer.
Since diseases are global in nature, there is a need for global partnerships to find solutions. A prime example of this is the ROTAVAC vaccine that will be launched this month. India’s first indigenous rotavirus vaccine, ‘ROTAVAC’, developed as a result of a public-private partnership, will help reduce the mortality due to severe diarrhoeal diseases in children caused by rotavirus. While it is truly an example of how many partners and groups came together with a common aim and took on different aspects of the work needed to move ahead, the fact is that it took almost 20 years and crores of rupees in investment. The lessons from this successful experiment are that truly collaborative and open partnerships, sustained funding and a common goal as key ingredients work. Of course, it helps to have a team of dedicated scientists and a champion who relentlessly pursues his/her dream. For diseases like TB, it is worth approaching the scientific challenges in “mission mode” with clear goals and timelines, and with a common platform that helps bring everybody together.Community care
We have several good examples of innovations in service delivery and community-based care. The Gadchiroli service delivery model of Home-based Newborn Care, developed by Dr. Abhay and Rani Bang has been instrumental in lowering infant mortality rates in settings within and outside India, leading to its acceptance as an effective strategy by the World Health Organization and the United Nations Children's Fund. Baba Amte showed that it is possible to provide high quality care at reasonable cost for leprosy treatment and rehabilitation. Many other non-governmental organisations working in remote and tribal areas have shown that training community volunteers in providing basic health care as well as preventive and promotive services can improve health parameters. It is important we derive inspiration from these successes and support more innovation in the area of health systems research to tackle India’s public health challenges.
Public health research is a long-term investment. We need an ideological shift from the focus on publications, products and patents as the dominant yardsticks of success and recognise that every study or trial, whatever its outcome, adds value to our understanding of and fight against disease. It is important to realise that trial and error is part of the process of improving our understanding of diseases and we must continue to support and motivate researchers by rewarding curiosity, originality and innovation.
Financial incentives, as tax credits and tax deductions, are also necessary to nurture research and encourage a culture of innovation. Fiscal concessions have in the past led to large investments which have enhanced India’s intellectual capital. Tax deductions for research and development in the pharmaceutical industry have been instrumental in shaping a competitive and proficient pharma market in India. Between 2000 and 2015, we have witnessed over $13 billion in foreign direct investment and around 10 million people have been employed as a result. India’s pharmaceutical industry and biotechnology sector have prospered due to these tax breaks, which have ensured that drug prices in India are among the lowest in the world and India is the largest vaccine producer. It is hoped that these tax incentives will encourage more private investment in research, especially if it is for public good. Further, there is scope for philanthropic organisations and foundations as well as Corporate Social Responsibility funds to support a researcher’s endeavour.
Research needs to be guided by appropriate regulations, strict ethical norms, standardised methodologies and good oversight. The creation of large data repositories and the application of modern computational tools could help address fundamental questions of disease susceptibility as well as enable the effective use of resources and be a powerful tool to guide health policy.
Fulfilling our potential as a globally forward-thinking nation requires us to be at the forefront of scientific learning, building an environment that stimulates innovation and encouraging public and private investment in research and development. It is most important that we work towards developing the next generation of researchers who work in the field of science to provide solution for public health issues that affect the world.
Dr. Soumya Swaminathan is Director General, Indian Council for Medical Research, Government of India