Mankind has greatly benefitted from the scientific and technological advances in medicine over the years. Science has advanced our understanding of anatomy, physiology and pathology at cellular and molecular levels. Parallel advances in medical technologies are transforming medical practice in terms of diagnosis and treatment.Hitherto, these advances were evaluated on a representative randomized sample of the population and the evidence generated was extrapolated to entire populations. Advances in human genome sciences and in molecular technologies are uncovering individual-level variations in response to a pathogen, risk factors, drugs, and vaccinesamong others.This has initiated the momentum towards what is being labelled as ‘precision medicine’ or ‘personalized medicine’ or ‘personalized healthcare’.
The world has been witnessing rapid advances in information and communication technologies. Likeothers, health systems are also impacted by these advances. The Covid-19 pandemic has demonstrated the power of these technologies in healthcare. Wearable and implantable devices are able to gather personal health information like never before. Payers are increasingly demanding personal health data from providers. Regulatory bodies are insisting on more health data for post-market surveillance of drugs and devices. Mobile carriers are able to carry enormous health data across global networks at unprecedented speeds. Artificial intelligence (AI) and machine learning (ML) tools are able to process enormous data to come up with valuable insights. Block chain technologies are able to secure data while sharing. Cloud storage has eliminated the need for servers.
Many countries have started building population level genomic data and creating biobanks. When linked to personal health data, new insights are emerging on genomic association of diseases and drug responses. Deeper insights are emerging on the mechanisms of diseases, thereby paving the way for designer drugs, diagnostics, and biologics. New gene editing tools based on CRISPER technology are offering the hope of cure to some genetic diseases. As digital and molecular technologies converge and as the information flows across world wide networks, the world will witness a major disruption in personalized healthcare in particular and health systems in general. The power of this convergence is being witnessed in the rapid responses to the raging Covid-19 pandemic, be it in isolating the virus, sharing its genomic data, developing rapid diagnostics, repurposing drugs and testing them in large populations, and in developing vaccines in just one year.
Like all technologies, these are double-edged swords that can harm as much as they can benefit. Self-monitoring of vitals and their misinterpretation based on easy access to information have led to a rise in anxiety disorders not seen before. Concerns on data privacy and security are mounting across the globe. Traditional methods of testing technologies for their safety and efficacy are becoming obsolete in the context of the speed of innovation. The technology divide is widening social disparities. Runaway costs are making financing healthcare increasingly challenging. Given the above context, how should India prepare its health systems for the future?
Governments are mandated to keep all its people healthy. Access to high quality healthcare in an equitable and dignified fashion is a fundamental human right. India should work towards this goal in the face of rapid advances in science and technology. India boasts of a vast networks of public research and development institutions, exemplified by labs under the Council of Scientific and Industrial Research (CSIR), Department of Science &Technology (DST), Department of Biotechnology (DBT), Indian Council of Medical research (ICMR), Defense Research Development Organization (DRDO), Indian Institutes of Technology (IITs), All India Institutes of Medical Sciences (AIIMSs) and autonomous institutes like the Indian Institute of Sciences (IISc)and the Tata Institute for Fundamental Research (TIFR). The recently formulated National Science, Technology, and Innovation (NSTI) policy is in the right direction. The government should provide the needed resources for the effective implementation of the above.
The Covid-19 pandemic opened up public Research and Development institutes for effective partnership with private industry. In addition, labs and scientists collaborated with each other as never before. The innovative spirit of private entrepreneurs was on full display. From a position of limited availability of personal protective equipment, India went to a position of surplus capacity to export these. India became one of the few countries to have developed the vaccine from scratch to finish within a year.
India has been promoting the growth of digital information and communication technologies as part of the Digital India policy. It has been working towards digital and financial inclusivity through Jan Dhan accounts, Aadhar card, and Mobile penetration. Unified Payment Interface (UPI) and GST platforms are examples of what India can achieve if these technologies are properly harnessed. The recently announced National Digital Health Mission (NDHM) guided by the well-designed National Digital Health Blueprint (NDHB) is in the right direction to transform health systems. Data privacy laws are under consideration by the select committee of the parliament to address growing concerns over data privacy and security.
There is an urgent need to strengthen regulatory systems to enable the health system to become more efficient and agile in keeping up with the pace of technology advances, while ensuring safety and quality of these tools. There is a need to harmonize applicable national standards with global standards while balancing quality and cost. Strong quality regulatory systems will build people’s trust and confidence in indigenous products in addition to making them competitive globally. Realtime health data will enable us to evaluate innovative technologies in larger and more representative population cohorts than is possible in randomized clinical trials. An iterative approach to regulation may be more suitable than the present monolithic systems.
Lastly, strategies should be developed to finance these technological advances innovatively such that access to them is universal. We should build agile health technology assessment (HTA) capabilitiesso that the health payer systems can integrate these in their benefit packages. Fintech-based health consumer financing will address access to those technologies that are not yet covered. The economic impact of transformed health systems that improve health and thereby productivity, is self-evident. In addition, the economic potential of leveraging these technologies to export to other countries in need can more than compensate the increased healthcare costs. There is also an opportunity to derive geopolitical and diplomatic gains as low-to-middle income countries benefit from high quality affordable technologies from India.
India should not miss this opportunity to prepare itself for the future of personalized health care!
Dr Krishna Reddy Nallamalla
Regional Director (South Asia), ACCESS Health International