Reduced Level of Disease Possible by India’s 100th Year

Dr. Amita Gupta, associate professor of medicine and international health. Deputy director at Johns Hopkins University’s Center for Clinical Global Health Education.

In 30 years, when India reaches its centenary of independence, it will have reduced its burden of acute and chronic disease by more than 50 percent.

In light of the facts, this sounds either naive or crazy. India ranks number one in the world for infectious disease burdens. It’s #1 in tuberculosis, #3 in HIV, and #1 in childhood pneumonia deaths. The country is crushed by chronic diseases, ranking #2 in diabetes, #1 in coronary artery disease, and leading the world in factors that undermine health—like malnutrition and air pollution, the latter of which is causing asthma and lung disease to become a fact of life.

India holds the 154th spot out of 195 countries in access to healthcare and in care quality. Furthermore, investment in public health programs and medical discovery has been woefully inadequate, and provides no room for nurturing biomedical curiosity and encouraging dogma busting. So here we sit, mulling over appalling global health scores.

But India has everything it needs to reduce acute and chronic disease by more than 50 percent. It has the proven human talent with world class doctors, chemists, engineers, and problem solvers. It has demonstrated capacity for frugal innovation. The nation is a tour de force in so many high stakes fields. India has all but taken over information technology and software engineering. In defense and space, India launched its own mission to orbit Mars.

When medicines were too expensive in the West and not accessible for India and other countries, it was Indian engineers and chemists who reverse-engineered and optimized compounds at a fraction of the cost to come up with affordable therapies. Because of India’s innovation in pharma, the price of HIV medicines — actually priced at more than $10,000 a year in the U.S. and Western Europe — were brought to low- and middle-income countries at a cost of $250 a year.

That innovation is responsible for the dramatic reduction in mortality among people with HIV in India and Africa. Process innovation in India made high quality vaccines available for just $2 a dose for children in low- and middle-income settings. Cataract and heart bypass surgeries are being done in centers of excellence in India at 2 percent of the cost with the same quality as they are done in the U.S., U.K. and other high-income settings.

Why can’t India move forward? A seismic shift is needed in the way clinicians and medical scientists are trained. Innovation does not come from rote memorization and textbook learning. Innovation does not come from what we already know.

It is not possible to provide answers to questions that haven’t been posed. The next generation must have the freedom and be supported and encouraged to question the status quo, to prove wrong existing medical dogma, and to challenge the people who teach it. India must commit sustained financial resources and political will toward building medical research innovation, biomedical discovery and effective health care delivery using the same models that encouraged explosive growth in IT and other industries. Is it aspirational to think the nation can reduce illness rates by half over the next 30 years? If India doesn’t try, we will never know.

As told to Aziz Haniffa in Washington, D.C.

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