India led health innovation(s) for achieving the SDG health goal in the global South

This opinion piece reflects upon India’s health innovations and its potential contribution to public health in the country and beyond, particularly the global South. While India’s health innovations, particularly the vaccines, are vital for meeting the Sustainable Development Health Goal (SDG-3) in the global South and beyond, India’s contributions are also crucial for Covid-19 immunisation and achieving the Immunisation Agenda 2030.

Health innovation responds to, and closes, unmet public health needs by identifying new or improved health policies, systems, products and technologies, as well as services and delivery methods that improve people’s health and wellbeing. Health innovation adds value in improved efficiency, effectiveness, equity, quality, sustainability, and safety and/or affordability. Health innovation can be preventive, promotive, curative and rehabilitative and/or assistive care. ¹ By explicitly prioritising the needs of vulnerable populations, health innovation can have a major equity impact in pandemic recovery and achieving the sustainable development health goal.

India has a strong tradition and demonstrated capacity for health innovations, particularly products and technologies and service delivery. The information and communication technologies were instrumental in research and development of health innovations. Vaccine development and production in India date back to the late 19th century when Indian research institutes developed vaccines against plague and cholera. In recent years, India has also established a reputation as a significant global supplier of high-quality, low-cost vaccines based on its vaccine industry’s technological sophistication. The Indian vaccine industry supplies a large share of the basic vaccines used throughout the developing world and exports more sophisticated Hep B-containing and Hib-containing vaccines. India, a world leader in vaccines, produces 60% of the world’s supply. The country also supplies more than half of all the vaccines to international organisations, such as the World Health Organization (WHO) and UNICEF.^2,3

India is at the centre of global Covid-19 vaccine manufacturing and distribution in the global South and beyond. World leaders and ambassadors are applauding India’s vaccine manufacturing capacity as, Australian Ambassador to India, Barry O’Farrell reiterated that ‘only India can satisfy the world’s demand for Covid-19 vaccines’. ⁴ While ‘vaccine nationalism’ emerged as a dominant narrative, India embraces the ‘vaccine multilateralism’ in supplying and distributing Covid-19 vaccines for immunisations. India’s contributions are vital for Covid-19 immunisation and for achieving the Immunisation Agenda 2030. ⁵

Therapeutic innovation and new drug discovery are important aspects of access to medicines. The Government of India’s National Health Policy ‘stimulates innovation and new drug discovery, and, distinctively, ensures that new drugs discovered and brought into the market can be afforded by those who need them most’. ⁶ The therapeutic industry also made significant contributions to global health by providing low-cost generic anti-retroviral, antimalarial antibiotics and other medicines to aggregated markets like the Global Fund and the Stop TB Partnerships’ Global Drug Facility, as well as directly to developing countries. India thereby emerged as the ‘pharmacy of the world’. ²

Diagnostic tests can play several roles in combating diseases, whether communicable, non-communicable or neglected diseases. The diagnosis tests refer patients for treatment and are also important for detecting drug susceptibility, monitoring treatment side effects and response, and blood screening in measuring the disease burden. Some of the innovations in diagnostics include the following: (1) ICGEB developed innovative dengue and hepatitis C tests; (2) NIMHANS in partnership with XCyton developed Japanese Encephalitis test; ⁷ (3) AIIMS is involved in the development of Span’s leishmaniasis rapid test; (4) AIIMS developed a test for extra-pulmonary TB; (5) TouchHb, a portable, needle-free anaemia-screening tool; (6) the uCheck and SuCheck are smartphone-based portable urine and blood sugar screening tools respectively, ⁸ to name a few.

WHO and its Member States have committed to Universal Health Coverage (UHC), for which primary healthcare is critical. Unique models of primary healthcare initiatives have emerged from several Indian states. The Electronic Urban Health Centre model in Andhra Pradesh ensures specialist care and patient satisfaction at the urban health centre level. ⁹ Boat clinics in Assam are mobile clinics on water bodies which provide health services to the residents residing in remote islands across the state. ¹⁰ These models can potentially be replicated in other countries that are aiming to achieve UHC.

India has a conducive ecosystem for health innovations. The political will of the Government of India, Indian Council of Medical Research scientific leadership and the dynamic pharmaceutical industry have been contributing to health innovations for affordable healthcare in India and beyond. The favourable demographics, availability of resources at economical rates and enabling technologies such as mobile internet, social media, cloud computing and big data are creating a fertile basis for particularly frugal innovations. ¹¹ Also, the policies and services that support health innovations in the country are growing. While contributing to achieving the country’s health goal and targets, these innovations also ensure meeting the health goal in lower and middle-income countries of the global South is possible. Towards this end, international cooperation in health is gaining momentum in Indian foreign policy as evident in Covid-19 vaccines.