India holds the key for solutions in global health
[Nature India Special Volume: Biotechnology — An agent for sustainable socio-economic transformation]
doi:10.1038/nindia.2016.52 Published online 21 April 2016
In 2011, shortly after joining the Bill and Melinda Gates Foundation (BMGF), I was invited to attend the first Grand Challenges meeting in Delhi, co-hosted by BMGF and India’s Department of Biotechnology (DBT). The meeting brought researchers, government officials, industry experts and policy people together and was an ideal venue to help get up to speed on many issues in the global health arena as well as exciting developments in India. It turned out to be a rich learning experience with a talented and committed group of partners who possess both real scientific depth and passion for solving problems within India and globally.
I heard repeatedly from experts across the board the need to customize solutions for local context instead of simply borrowing existing solutions from the west, a philosophy that DBT has embraced in much of its work. For example, we jointly launched with DBT a “Grand Challenge” to identify Indian innovations to reinvent the toilet that are uniquely suited to the India context. As part of that meeting, the Gates Foundation and DBT signed a Memorandum of Understanding (MoU) to capture our mutual interests in pursuing innovative approaches to developing new preventive and therapeutic interventions to solve health, food and nutritional inequities.
India has a high burden of diseases that affect the poor and is a hotbed of innovation aimed at finding solutions for these problems; the growing tuberculosis (TB) epidemic serves as a good example. TB prevalence is reaching alarming levels for both drug resistant and sensitive forms1 and innovation is needed across the value chain: new drugs, and a universal regimen that can cure TB in under two months; a vaccine that can protect both children and adults; diagnostic tests that don’t rely on sputum samples; better monitoring tools to document adherence for drugs that require prolonged treatment; and innovative financing mechanisms to help scale up programmes that work. Efforts in India to pilot many of these innovations are showing promise and are being supported by the government. However, the nature of the problem is serious enough that constant focus and new partnerships are needed to reach the required level of impact.
Growth-stunting is another major problem in India. The prevalence of stunting in children under five years of age is close to 50% in certain areas2. The factors contributing to stunting and potentially to impaired cognitive development are complex and not fully understood. A range of causes including nutritional deficiencies, open defecation, and exposure to mycotoxins have been implicated. Yet we don’t really understand their relative importance. There is great interest in understanding the factors involved so that targeted and effective local interventions can be developed.
At the Gates Foundation, we recently launched a programme called Healthy Birth, Growth and Development to gain a comprehensive understanding of stunting. DBT played a lead role along with WHO in helping to bring Indian investigators together to discuss potential solutions and pool data from multiple studies to gain deeper understanding of this issue in the Indian context. As part of this effort, the Biotechnology Industry Research Assistance Council (BIRAC) launched a Grand Challenge in 2015 focused on innovations to ensure all children thrive with funding from DBT and the Gates Foundation. I hope to see great strides in our understanding of this issue and implementation of solutions for this hidden yet major problem.
The accomplishment of polio eradication in India in 2014 provided a huge boost in confidence to the global community that major efforts at disease elimination can be successful in India. Many diseases that affect the poor such as lymphatic filariasis (elephantiasis), kala-azar and malaria have effective, low cost treatments available today. By building upon the successful experience with polio, India is in a unique position to lead the way towards the elimination and eventual eradication of these diseases too.
India is the most important supplier of affordable vaccines and therapeutics to developing markets, especially for global institutions such as GAVI and the Global Fund3. DBT’s partnership with the National Institutes of Health (USA), Program for Appropriate Technology in Health (PATH), and with local vaccine manufacturers has had a catalytic role in the development of an indigenous, low-cost and effective rotavirus vaccine in India, soon to be introduced in the Indian Universal Immunization Programme. Introduction of this vaccine in India will save thousands of lives lost every year due to dehydrating rotavirus diarrhoea.
As I look at the next 5-10 years, I see huge potential in India for the next generation of low cost vaccines, new drug formulations and advances in biologics. To realise this, it is critically important that regulatory process reforms keep pace with technological changes and the strong culture of innovation in India.
*The author is the President of the Global Health Division at Bill and Melinda Gates Foundation.