Digital health cooperation with Israel is in India’s health interest

By Shambhavi Naik and Gedaliah AftermanIndia’s dramatic surge in COVID-19 cases has refocused the local debate on the mismatch between demand and supply of medical services across the country. This discrepancy is aggravated by local lockdowns impeding access to doctors and fear of infection, as people are encouraged to seek medical attention at home. Pleas on social media have demonstrated the need to use digital tools to address issues of information asymmetry and access of health services in non-urban areas.Noticeably, countries have been able to direct their existing digital health solutions to augment their health infrastructure to respond quickly to COVID-19. Israel, which this week removed most COVID-19 related restrictions, is an excellent example of deploying digital health solutions. India can collaborate strategically with Israel to develop capacity in digital health, in preparation for future pandemics.India’s experiments in recent years with adopting digital health have led to mixed responses. Challenges include lack of digital infrastructure in non-urban areas, language barriers, and the absence of basic health services in remote areas. Thus, a blanket one-size-fits-all approach to digital health adoption is unlikely to work in India.Instead, a tiered approach or ground up building of infrastructure is required. Nonetheless, it is important to build to this goal, as digital health tools can help close several current gaps in healthcare. Electronic health records (EHR) maintained in an inter-operable manner, as envisioned under India’s Data Empowerment and Protection Architecture (DEPA), can reduce diagnostic costs and ease access to a patient’s health history for medical professionals. Such records can also form the basis for health information exchange, where EHR from remote areas can be sent to specialist doctors for their opinion.Telemedicine can be used by doctors to patients or consult amongst his peers. COVID-19 has highlighted the importance of developing telemedicine services even in urban centers, so that patients can continue receiving health services without endangering their lives. In addition, diagnostic tools such as wearables can enable real-time monitoring of patient’s health data, leading to more effective decision-making by medical professionals.While these tools cannot replace core medical functions, they can supplement operations and increase medical outreach. The implementation process is however accompanied by concerns about consent mechanisms for data acquisition, storage, and possible cybersecurity threats. Successful implementation of digital health therefore depends on an ecosystem that fosters not only innovation, but also trust and an adequate formulation of appropriate policies to govern digital health.Extending the India-Israel partnershipTo effectively plan and implement digital health policies, governments can learn from each other and work together. Furthermore, only by creating long-lasting cooperative structures and partnerships can they effectively prepare for future crises. Israel and India offer a particular case in point.Israel has actively engaged digital health tools in its public health service and is well placed to share its experience and knowhow with international partners. Under the aegis of Healthcare Israel, it has already provided professional assessments on health care programs in Africa, Asia, and Europe.Israel has successfully deployed digital health tools, but its population and infrastructural challenges are relatively small. On the other hand, India’s adoption of digital tools is still in its infancy, and choosing the right partner can help it expedite this growth. Both stand to benefit from increased cooperation in this field: India can provide an opportunity for Israel to trial technologies at scale in preparation for their international deployment. An effective way to achieve this, while safeguarding rights and health of Indian citizens, would be to create “regulatory sandboxes,” where innovators can trial promising solutions in a controlled environment under a regulator’s supervision. In exchange, Israel’s innovative capabilities make it a highly suitable partner for India.A good starting point for such a collaboration would be to map technologies for preventive healthcare. Point-of-care diagnostics and screening, as just one example, can help in the early detection of cancer and early intervention, which would not only save lives but also reduce the demand for tertiary healthcare and the costs of surgical treatments. Collectively gathered population-level data could inform on developing infectious disease outbreaks, underpinning a health response to prevent further spread. Such preventive strategies would provide relief to strained health resources and allow their effective use, even as India builds up more capacity.Increased investment in health infrastructure, legislation safeguarding the privacy of citizens, and the strengthening of the health regulator are three key actions that are critical for the successful adoption of digital health in both Israel and India. Creating this ecosystem can not only enable government-to-government collaboration, but also facilitate the growth of the domestic and international private sectors providing digital health services. Private sector participation will underline greater outreach of health services, contributing to improved health outcomes.The ongoing COVID-19 outbreak has demonstrated the urgency of increased international cooperation to protect global health interests. No country can be safe from a pandemic unless all countries have adequate, accessible, and affordable healthcare. Therefore, it is a national and global interest for India, Israel, and others to use this opportunity to collaborate and lead the way in creating world-class products and services that can benefit all.Download this article as a pdf.Authors: Shambhavi Naik (PhD) is the Head of Research at the Takshashila Institution  Gedaliah Afterman (PhD) is Head of the Asia Policy Program at the Abba Eban Institute for International Diplomacy.

Vaccine diplomacy post-Covid-19

Vaccine diplomacy is state-led action of leveraging vaccine expertise for furthering foreign policy goals. These goals can range from maintaining ties between nations, burnishing an international reputation, or developing influence within a region. A robust framework can aid in the identification of vaccine diplomacy opportunities and allow India to quickly respond to such need.According to GAVI, the international organisation aimed at improving access to vaccines, “today the potential for diseases to spread is actually increasing,” due to an exponential increase in international travel, an increasing majority of people living in urbanised areas and climate change. (Read more)

DNA Technology Regulation Bill: Will the Standing Committee's concerns about privacy, capacity be addressed by Parliament?

This article first appeared in FirstpostThe DNA Technology (Use and Application) Regulation Bill, 2019 is listed for consideration in the ongoing budget session of the Parliament. The Bill is aiming to create a DNA Regulatory Board to oversee the standardization of DNA profiling – a technique widely employed in forensics, where databanks of DNA from victims, deceased remains, crime scene, suspects and offenders can be compiled. DNA profiling has so far been used for forensic purposes in India, where it has been used to solve individual crimes. The new Bill may go a long way in streamlining the use of DNA profiling, and widen its purpose in identifying the deceased (in case of missing persons or disasters) and track down repeat offenders based on the data available in the DNA data bank. (Read more)

STIP2020: A wish-list, not a policy

This article first appeared in IndiaTogetherThe COVID-19 experience has brought attention to the importance of science, technology and innovation. Researchers facilitated the rapid understanding of a new virus. Technology underpinned efforts for curbing the spread of the disease. Entrepreneurship led to quick production of diagnostics, treatment and vaccines. But within this global picture, there are vast differences between countries. Only some nations have been able to marshal the science and the resources to respond to the pandemic.What about India? The country has significant manufacturing capacity, but the lack of homegrown vaccines as well as a generally weak public health system are major obstacles, and reaching vaccines and treatment to our large population will not be swift. We simply haven't invested enough in the past - in science as well as in healthcare - to be able to do what is needed today. [Read more]

Will Indian Scientific Temper Survive 2021?

(This article was first published in The Wire)2020 was a disaster year for almost everyone – but it was a unique opportunity for Indian science. An oft-neglected enterprise, it received unprecedented attention as scientists tried to innovate in the diagnostics, treatment and vaccine spaces. Taken together, this was an opportunity to demonstrate India’s capabilities and expertise – not just for a domestic audience but the international one as well.The obstacles 2020 brought were a ladder for Indian science to rise up to a leadership position and become a driver of the Indian economy.

But opacity, ambiguity and distrust have squandered this opportunity. Only two weeks into 2021 and India has claimed a major casualty – scientific temper – and the suspects are not the usual zealots or the so-called “lay people” but the very custodians of the ‘temple’ of science. (Read more)

No matter what Bharat Biotech says, Covaxin is just not ready for approvals

Bharat Biotech got an approval for its COVID-19 vaccine and along with it came a lot of flak from critics who believe that the process was rushed for no valid reason. Dr Krishna Ella, the founder and chairman of Bharat Biotech, retaliated blaming everyone from the media to rival vaccine makers, except that his arguments hold no water.The drug regulator's approval for any new drug or vaccine is based on the understanding that the drug or vaccine's benefits outweigh its risks. However, considering that he admitted that Phase-III trials are still underway, there is no final estimate of Covaxin’s efficacy, and without that number, the approval should not have been granted.Benefits like how effective the vaccine is in preventing disease, and risks such as high mortality rate if the vaccine is not given or vaccine side-effects, are critical data that inform the approval. (Read more)

Centre raises hopes of free COVID-19 vaccine, but benevolence can't be at the cost of the economy

This article first appeared in the Firstpost. COVID-19 has assaulted the health of people and economies. The impact on the economy has led to further stress on people’s livelihoods. This unprecedented threat to public health has not been constrained by measures taken by national and state governments. All humankind is waiting with bated breath for a COVID-19 vaccine that can set us on a course to normalcy. The human and economic cost of COVID-19 has been immense and governments are stepping up to expedite vaccine availability.Given the vaccine’s huge impact on public health, it is reasonable to expect that the government makes it available free for all. The cost of undertaking this exercise would depend on a variety of factors – the cost of manufacturing, the cost of supply chain, and the cost of administration of the vaccine. For example, nucleic acid-based vaccines have to be stored at sub-zero temperatures and are costly to make and transport. (Read more) 

COVID-19 vaccine deployment in India: Lessons we need to learn from the past

It appears that a vaccine(s) is the only way to stop COVID-19 and return the world to some semblance of normalcy. As the race inches to a close, everybody is waiting for their turn to get the vaccine and go meet their friends for a cup of coffee.However, there are several scientific hurdles that still need to be surpassed: how effective would the vaccine be across demographics? For how long will the vaccine confer immunity? Will the virus mutate, rendering the vaccine ineffective? Even if we get a combination of vaccines that answers these questions, the capacity to produce, distribute and monitor adverse events related to the vaccine are going to limit an effective vaccine rollout. Hence, it is important India identifies the vaccine demand, invests in capacity and communicates with the public to enable a smooth immunisation programme.

Lessons from COVID-19 testing

India’s response to detecting the COVID-19 outbreak was reactive, not proactive. For weeks COVID-19 testing was limited to authorised government laboratories, and available conditional on pre-determined criteria. Instead of scaling up testing capacity and aggressively test and trace, the government took a cautious approach, most likely to protect scarce testing resources. However, a strategy to ramp up both kit manufacture and early inclusion of private laboratories could have helped India’s response in containing the spread of the virus. (Read more)

Will We Really Find Out Where the Novel Coronavirus Came From?

This article first appeared in Science The Wire.The origin of the SARS-CoV-2 virus remains mired in controversy. The virus was initially thought to have originated in a wet market in China’s Wuhan. But as it spread around the world, it fuelled many conspiracy theories in its wake. In the public imagination, the virus has often transformed (baselessly) into a bioweapon, a scientific experiment leaked from a laboratory and spread through the 5G network. Scientists have downplayed these ideas, quoting genomic analyses that clearly show the virus is of natural origin and jumped from some animal species to humans.Yet its origin remains unsettled and this ambiguity needs to be resolved soon – not to settle political agendas or conspiracy theories but simply and importantly in the larger interest of public health. Settling the question of the virus’s origins once and for all is key to take appropriate measures to prevent it from happening again, and to focus our efforts on the right things.This said, who can comprehensively investigate the origin of SARS-CoV-2?Read the full op-ed here.

The scientific argument for marrying outside your caste

Bengaluru: As India becomes more globalised, there are intense deliberations in orthodox families on the merits of getting married within their own community.

The obvious go-to-market strategy is to ask for family recommendations and visit websites tailored for the community. This is typically followed by patrika and gotra matching, and some family meetings.

But as our scientific understanding of diseases and other heritable attributes increases, we have to question whether continued insistence on community-based marriages is relevant.Endogamy is the practice of marrying within the same community, and genetic diseases arising out of a limited gene pool are a major consequence of it.There is a growing need to reflect on these practices and determine what’s the best way to choose a life partner. (Read more)

Coronavirus outbreak, N95 masks, traditional medicine and other burning questions

The coronavirus outbreak originating in China has made its way across the globe, with nearly 12,000 confirmed cases. There are three confirmed cases in India as of 5 February 2020. There is considerable panic as countries race to contain its spread through screening and quarantine measures. Companies and universities have pressed into action; trying to figure out better diagnostics and possible treatment for the new virus.The ambiguity of the virus’s origin and fear created by its rapid spread and lack of cure has incited a deluge of misinformation. So here are four questions you really need to know about this outbreak.

How deadly is the viral outbreak?

The virus is the latest member of the coronavirus family to jump from other animals to infecting humans. The scientific community has already determined the genetic sequence of the virus. We now understand that every infected person can infect up to 4 people. The virus spreads through the air, enveloped in tiny droplets released as a person sneezes, coughs or talks. Spitting in public places or coughing without covering one’s mouth are basic hygiene fails that need to be avoided. (Read more)

Wuhan and the Need for Improved Global Biosecurity

The Wuhan coronavirus, or nCoV-2019, is likely to become a pandemic in the coming weeks, having already infected at least 17,000 and killed some 400. The World Health Organisation has belatedly declared a public health emergency, while at least 45 million Chinese citizens remain under lockdown. Despite botching up the initial response in Wuhan, authorities in China have since been fast to share information on the outbreak and have even invited overseas experts for help. A draft sequence of the genome has also been published online and scientists from across the world have shared their analysis. Despite wild speculation about the origins of the Wuhan virus there’s absolutely no evidence it is anything other than a naturally mutated pathogen – indeed, it would make no sense for a state to produce a bioweapon that has both high communicability and low lethality.However, future threats to global health will come not only from natural viruses like nCoV-2019 but also from man-made pathogens. Mechanisms that aid early detection and encourage transparency need to be institutionalised quickly as a combination of breakthrough technologies and human malice raise the threat from bioweapons. Major states like China and India are well-positioned to champion this institutionalisation given their high vulnerability to bioweapons attacks and their shared desire to shape global institutions. (Read more)

How can society help keep Indian women in science, get young girls interested in the field?

Research institutions around the world on average have 28.4 percent women employees. Indian research institutions have been unable to make even this poor benchmark. Women make up only 14 percent of 2.8 lakh scientists, engineers, and technologists in research and development institutions in India. In the past few decades, while the number of women enrolled in science higher education has steadily increased, the number of women entering the science workplace has not shown a commensurate rise. This suggests that women are either not willing to continue in science jobs or are not being provided suitable opportunities to do so.

Pros of gender-balanced in scientific campuses

There is a school of thought that women bring a distinctly different perspective to science than men. Studies have shown that diverse groups have more collective intelligence than groups made up of men only. The implication is that gender-balanced teams are likely to be more productive and “smarter” as compared to all-male teams. It, therefore, makes sense that we would like more laboratories to try and achieve an equal male: female ratio. (Read more)

Genomics data banking could revolutionise healthcare, but comes with unmitigated risks

You read a brochure that promises to tell you what diseases you are likely to get in the next decade. Obviously you want to lead a longer, healthier life. So you send a cheek swab to the clinic and await test results. Thankfully, your reports are largely all-clear except a minor mutation which would likely pre-dispose you to diabetes in your 40s. Your doctor dutifully prescribes diet control, exercise and a pill.

A few months later, you hear that your cousin has got convicted in a hit-and-run case. Unwittingly, you played a role in the conviction because it was your DNA that led the police to identify him. Your chances of getting diabetes may be lower, but your cousin’s chances of proving himself innocent are nil. Sounds unbelievable? (Read more)

IndiGen project — how mapping of genomes could transform India’s healthcare

The Council of Scientific and Industrial Research (CSIR) has launched an ambitious project, IndiGen, to sequence whole genomes of diverse ethnic Indian population to develop public health technology applications.

The CSIR last month announced sequencing of 1,008 Indian genomes as part of the project. It aims to complete sequencing of at least 10,000 Indian genomes over the next three years.

A genome is an organism’s complete set of DNA. It includes all genes, which house the DNA, and chromosomes. The genome contains all the data that is needed to describe the organism completely — acting essentially as a blueprint. The genome can be understood through the process described as sequencing. (Read more)

DNA Technology Bill: Why the Standing Committee Has Its Work Cut Out

[Co-authored with Murali Neelakantan]With a decade-long history of deliberations, the DNA Technology (Use and Application) Regulation Bill 2018 is no stranger to the halls of Parliament. It is currently being scrutinised by the Parliamentary Committee on Science and Technology, after it was reintroduced in the Lok Sabha earlier this year.The Bill seeks to regulate DNA laboratories and proposes to establish a DNA databank, although there are already many unregulated DNA databases with various authorities. There seems to be widespread support for use of DNA evidence, primarily on the understanding that (i) it is “new scientific technology” used widely around the world; (ii) India needs modern weapons to fight crime; and (iii) similar laws exist in other countries, including the US, the UK, Ireland and South Africa, for helping convict criminals and acquit innocent persons.However, there are three broad areas of concern – capacity, training and consent – that authorities need to iron out before unleashing the DNA Bill in India. (Read more)

Cap on age limit for IVF could be allowed, but only with checks and balances

Septuagenarians in India using in-vitro fertilisation (IVF) technologies have met with mixed responses.

While IVF is becoming the most common infertility treatment, many countries, including the US, UK and Australia, have recommended age limits for accessing the technology.

India, however, currently has no laws restricting IVF access for women of advanced ages. Consequently, in the last three months, at least two IVF-assisted births by women in their 70s have been reported from Tamil Nadu and Rajasthan.The idea of a 70-year-old woman giving birth to a child shocks the sensibilities of a lot of people. Though there is no legal age restriction, the state-funded Indian Council of Medical Research (ICMR) advises an upper age limit of 50 years. In 2017, the ICMR proposed the IVF Bill to regulate access to IVF based on age, but the Bill is yet to be taken up by the Parliament. (Read more)

GMO: let's take a balanced view

At least 12 farmers have been booked in Maharashtra for planting banned genetically modified (GM) cotton and brinjal seeds. Undeterred by this, farmers have been protesting the blockade of new technologies that could aid farming. This movement has elicited mixed responses from farmer groups — some support the idea; others oppose the introduction of GM technologies in Indian agriculture.The anti-GMO argument rests on three pillars: first, that GMOs are controlled by large companies and are essentially anti-farmer; second, they are harmful to biological diversity and third, they are harmful to human health. They also argue that the Maharashtra farmers have been paid by large companies to pressure the government into accepting the technology.On the other hand, pro-GMO groups such as the Shetkari Sanghtana backing the Maharashtra protest argue that farmers need to adopt more GMOs to get better yields and more income. This is by no means a new argument. In 2001, farmers were accused of illegally planting GM cotton, much prior to India permitting the commercialisation of Monsanto’s Bt cotton. So, as these two groups tussle it out, who will blink first? Read more

The gene of prejudice in gender determination

From impeding track stars like Caster Semenya and Dutee Chand to laws restricting bathroom access and a proposal in the US for genetic determination of sex, the issue of gender identity remains mired in controversy.Can there be a sensible and humane resolution to this debate? Or does this debate represent an unwarranted imposition of societal perception of gender on the scientific determinants of sex? If that is the case, the resolution definitely does not lie in force-fitting science to societal concepts. In a landmark decree, the World Health Organization (WHO) announced that it was shifting gender incongruence (i.e., being transgender, when your gender identity is different from the one assigned at birth) from its mental disorders chapter to the sexual health chapter. It basically means that the WHO recognises that being transgender is not a mental health problem as was initially thought, but is probably normal biology. (read more)

Biological Weapons: The Impact of New Technologies

In June 2018, German police arrested a Tunisian man in Cologne for trying to build a biological weapon using the deadly toxin, ricin.1   In October 2018, researchers flagged a US agricultural program funded by DARPA (Defense Advanced Research Projects Agency) as a potential mask for a bioweapons project.2 At the same time, Russia also claimed that the US had tested biological weapons in Georgia killing over 70 people.3 Further, suspect packages were sent to select targets in the United States in October 2018;4 these packages in addition to being mail bombs also carried a white powder reprising concerns of the anthrax attacks from 2001 which led to the death of 5 people.There has been no incident of biological agents being used as a weapon of mass destruction in the recent past. Yet as the above examples show, there have been attempts to explore and create technologies that could be weaponised by both state and non-state actors. The threat was made apparent by James Clapper, US Director of National Intelligence, who added gene editing in their annual worldwide threat assessment report in 2016.5 Since then, there has been a wider recognition that the advances in technologies and improved access to science have lowered the barriers to creating designer bioweapons. [Read more]