India’s position as far as many health-care metrics is disappointing. By 2020, non-communicable diseases will be the cause of 73% of deaths. With diabetes emerging as the fastest growing disease, India will have 49% of the global burden of diabetes. Not far behind will be cancer as the second most common disease. Evidently, we need more than just policies to counter the disease burden. Although we like to think of innovation as the light bulb moment of massive change, 70% of all innovation is incremental innovation, according to a 2012 study ( Harvard Business Review) .
Incremental innovation is ‘the process of expanding therapeutic classes, increasing the number of available dosing options, discovering new physiological interactions of known medicines, and, improving the secondary properties of existing medicines. This process is often dependent on the experiences of health-care providers and patients’ needs. Incremental innovation can include expanding existing therapeutic classes by improving complex molecular structures, reformulating medicines to improve patient administration, or exploring new uses for existing medicines. For example, one way to improve a medicine’s therapeutic-efficacy profile is to ensure that patients comply with dosing requirements’. Looking at the disease burden today, India needs to harness it more than ever before.
The health-care industry is on the brink of massive change. There are many forces driving the need for innovation. As organisations face unprecedented challenges in improving quality and access, increasing efficiency and lowering costs, incremental innovation is taking the lead in transforming health-care dynamics.
In a nutshell
Let’s understand what incremental innovation is and why it matters. In short, we need simpler solutions to those already existing. Why the emphasis on ‘incremental’ innovation and not just innovation? By 2050, the elderly will form 20% of India’s population. This means diverse patient profiles, rising health-care costs and a significant number of people needing frequent hospitalisation, regular follow-up and preventive care. Medical sciences have ushered in a new era where technology and research are changing the way patients are treated.
Take, for instance, cancer. In 2016, it was reported that the disparity in availability of advanced therapies in cancer was the most disappointing over a 10-year period till 2016, with not even one-third of 270-odd-onco-molecules (cancer-fighting drugs) being available in India. The lack of advancements in medical sciences in India highlights the dire need for incremental innovation. Incremental innovations in the treatment of tuberculosis (TB) are reducing mortality rates. For tangible outcomes, requisite investment and a policy environment that makes cutting-edge medicines accessible to Indian patients are a must.
For decades, the policy towards incremental progress in pharmaceutical innovation has remained a bottleneck, affecting India’s place among the top global drug innovators. A recent PricewaterhouseCoopers report says, “India invests just 0.9% of its GDP towards overall research and development... The inflow of adequate funds into R&D is currently a critical issue faced by the country. In general, India spends less than other countries in these areas, including pharmaceutical R&D.” The report also shows that brought to fore, the Indian biotechnology parks are extremely small when compared to those in leading countries, with limited proximity to centres of excellence.
To achieve the vision of Ayushman Bharat, we need more than just tall claims. We need to strengthen our pharmaceutical innovation ecosystem across multiple dimensions. A strong collaboration between the government, academia and the pharmaceutical industry and a policy framework that supports innovation will help India move up the value chain.
While incremental innovation is improving the quality of health care, India is still struggling with the basics — a substandard quality of medicines and policies that deter incremental innovation from reaching Indian shores. Over the years, incremental innovations in branded generics have paved way for the development of treatments for diseases such as malaria and TB. It is these that have helped in reducing health-care costs by improving the quality of drugs, thereby making lives better. Today, India needs an environment conducive for the most advanced drugs to reach patients and this choice should not be restricted by policies in favour of, or against, generics or branded generics. Doctors and patients should be able to make an informed choice.
Dr. Gajendra Singh is a public health researcher .
