By Gopala Krishnan and Monish Verma
Delivering high quality healthcare is a continuous challenge for all countries. As the digital transition accelerates across all scales, there is a massive opportunity for developing a vibrant healthcare innovation ecosystem between Germany and India. In fact, there are some clear pathways that can significantly augment approvals and commercialisation of new technologies and therapies, thereby supporting the healthcare systems to deliver better service to all.
One of the early successful cooperation between Google and Shankar Netralaya shows what one can and must do to expand the scope and scale of such collaborations. In light of the success of such models, there is a strategic opportunity to extend testing, deployment and validation of disruptive technologies to millions of patients in a short period of time.
The solution that can exploit this opportunity is the development of a specialised healthcare accelerator that can establish an ecosystem for innovations, and also guide the flow of innovative technologies between German startups and industry as well as the various medical academies existing in India.
The establishment of such a dedicated accelerator will be able to harness efficiency by using the existing base of millions of patients of Indian clinicians for deploying and testing new treatments and technologies. The control of such a trial will be efficiently monitored by analysing the data metrics in a non-partisan manner by the academies themselves.
This calibrated approach can result in rapid approvals and commercialisation in India through the leverage and regulatory salience of the academies. It is conceivable that the commercial availability in India will happen even before German (EU) approvals.
Also, the India test results will help to speed up the EU approval process while dramatically reducing costs.
Collaboration – Technology has created new possibilities
Germany and India can leverage their complementary strengths in mass healthcare technology by harnessing each other’s talents and possibilities more effectively.
In the current era, drugs are regarded as the core mass technology for healthcare and due to the conflict between the need to protect intellectual property and the need to deliver affordable medicines to low-income populations, collaboration has been limited to the introduction of low-cost drugs. However, this does not have to be the case going forward. Large scale collaboration in healthcare can be an immediate reality as the most rapidly growing, disruptive, emerging healthcare technologies are no longer drugs. They are diagnostic tests and personalised therapies. It is no longer about the discovery of drug molecules, but more about devices, sensors, imaging, computing, data sets and artificial intelligence.
Across genetic, bio-chemical and bio-mechanical areas, emergence of a host of technologies is accelerating and this will significantly empower the frontline medical practitioner to diagnose and treat faster and better.
The healthcare technology wave
A combination of technologies working in sync and across geographies will disrupt healthcare across the world. These technologies will accelerate the availability of advanced diagnostics and personalised medicine at the point-of-care.
These include rapid innovation in the following areas, usually in combination:
- Internet-connected (IoT) devices and sensors
- Core diagnostic technologies
- Artificial intelligence-driven diagnostics and personalised treatment
Thousands of innovative teams, in startups and within enterprises in Germany and the EU are working on new technologies. These technologies are making inroads in new diagnostic and predictive capabilities and are also poised to disrupt (lower) the cost. Capabilities that only large hospitals or labs could afford will be available as a result of these technologies, even in small clinics and with individual/independent medical practitioners.
The innovators, however, struggle to bring their technologies to market because of the high costs of testing, validation of the technology and eventual approvals (often) for every market. As a result, many promising technologies get discarded early, and the technologies get shelved. In the global healthcare chain, the Indian Medical Academies can provide a low-cost, high-trust, test-bed for healthcare innovations.
The Academies in India
Medical Associations in India, as elsewhere, work to enhance the opportunities and capabilities of their doctor members. They routinely conduct professional training for their members and channel research opportunities to them. The patient reach of some of these associations is extensive indeed.
For example, an association like IAP (Indian Academy of Pediatrics) has over 32,000 members. Each member has a post-graduate qualification in Pediatrics. Assuming an average of 20 appointments a day by a practising pediatrician, we are looking at about 250 million patient consultations a year by members of IAP.
IAP is keen to enhance the diagnostic and therapeutic capabilities available to its members. It has the power of numbers to negotiate attractive offers for its members. It’s members, in turn, benefit from new services capabilities, enhanced patient outcomes and increased clinic income by offering these services to their patients.
Associations like FOGSI can also help to fast-track approvals and certifications of promising technologies within India.
The Value of Collaboration
For most diagnostics technologies the core value is the ability to diagnose early and start treatment as soon as possible. Pre-approval technologies accepted as an indicative test enables early treatment that can be confirmed subsequently by a conventional investigation.
Deployment of pre-approval technology at a few hundred clinics with a patient consultations base of a few million will be a sufficient testbed. The active cooperation and participation of these clinics in these tests will be ensured through the advisories from the medical academies. Further, this will also ensure that the costs of this can be a small fraction of what it would cost for even modest scale trials in the EU. Besides, the Academy itself will conduct a non-partisan analysis of the results and publish it. The Academy can also make a representation to government and fast track certifications for India.
All this reduces the costs and risks for many technologies which will otherwise fail to cross the clinical testing chasm of death. We estimate that over 95% of promising technologies fail at this stage, for want of capital to go through these test-fix-test cycles.
How will this work?
The low-cost testing can be financed in two ways. The first is risk capital at angel or accelerator levels. The second is by equipment financing through existing DFIs like DEG, KFW, IFC, ADB and others.
The better approach is to develop a dedicated healthcare accelerator that seeks to identify, incubate, validate and scale healthcare technologies for India and the World. The accelerator will be a platform with at least one major Academy participant, a couple of leading VC funds and deep linkages with international organisations such as DEG, KFW, IFC, GIZ, ADB or others.
Very briefly the accelerator will assist in:
- Seeking and identify promising healthcare technologies
- Evaluating and refining technologies/products
- Promoting the innovative aspects of technology to the Academy (health system)
- Setting up a testing and validation protocols for the technology in consultation with the Academy and as per International (EU) norms
- Distributing and local service and support
- Local in-clinic and at-home sample collection services
- Local certifications where needed
- Developing business models for technology development
- Enabling financing support for machines and devices through CSR, Grants, and other blended instruments including support from DFIs like DEG, IFC and others.
- Raising impact and venture capital for the enterprise (after robust trials and validation)
- Market access and navigation
Promising technologies can score €50K to €0.5M of funding on this platform, specifically for the India test and commercial pilot.
What to do?
A couple of leading Academies in India are already keen to participate. End-to-end execution capabilities for conducting the extensive scale tests, analysis and certifications in India is also available.
As the case for setting up a dedicated healthcare accelerator is compelling, there is a need for interested enterprises – both public and private – to collaborate to design as well as set-in-place financial and institutional support to enable the accelerator to be a fecund ecosystem for technologies from anywhere and anyone (not just start-ups). Undoubtedly the first step would be to access venture and even impact funds to set up the accelerator. If this is in place, the institutional structure and participants will then not be a significant challenge.
The authors of this article are currently in the process of establishing such an accelerator, in partnership with IAP, for technologies originating in both the US and Europe.
More about the authors:
Gopala Krishnan https://www.linkedin.com/in/gkinchina/
Monish Verma https://www.linkedin.com/in/monish-verma-1bba1b5