In step with support

Technological breakthroughs, its adoption and scaling up, and committed partnerships are the potent ingredients that the India Health Fund seeks out to counter tuberculosis, malaria and other infectious diseases

Tuberculosis is a disease transmitted by coughing or sneezing, and is highly infectious, spreading from one infected individual to up to 15 others. It kills in excess of 1,200 Indians every single day. That makes the toll taken by the raging Covid-19 virus seem paltry, but then tuberculosis (TB) has always been a much deadlier beast.

Latent in more than a quarter of the world’s population and responsible for more than 1.5 million global deaths every year, of which 440,000 deaths are in India alone, TB is one of the country’s toughest disease challenges. Malaria — which accounts for some 300,000 cases in India every year, primarily in remote, hilly regions — is another.

Eliminating these two diseases is one of the toughest healthcare goals set by the Indian government, with 2025 as the deadline for TB and 2030 for malaria. To reach these audacious targets, the country has to overcome huge stumbling blocks in the areas of prevention, screening, testing, ensuring adherence to treatment, and capacity building.

TB and malaria affect marginalised populations to a much greater degree, and solutions in the form of public healthcare investments are inadequate, with the focus primarily on service delivery and infrastructure.

What is needed is scientific, technology-driven innovations that have the potential to bring about non-linear and disruptive impact in an accelerated manner. The solution lies in the convergence of innovative thinking and tech solutions. To find that, the Tata Trusts set up the India Health Fund (IHF) in 2016 in collaboration with the Global Fund.

IHF’s objective is to get India closer to the point of eliminating TB and malaria. “With the rise of noncommunicable and lifestyle diseases in India, the attention given to communicable diseases like TB and malaria had been reducing, but Covid-19 has opened that debate again,” says Jayeeta Chowdhury, IHF’s programme director.

Capital handicap

TB and malaria do not attract enough capital investments for solutions, adds Ms Chowdhury. “For any scientific and technological breakthrough to actualise, there is a long journey that requires an appropriate ecosystem. It also involves risk taking as failures are common. But these risks do bring about groundbreaking solutions that can bridge gaps faster.”

Capital support to innovators and scientists, mentorship, access to healthcare networks, and implementation design for taking novel technologies to the last mile — these are the areas that IHF looks at. Set up with a corpus of $15 million, its role is to support innovations — in surveillance, diagnosis, monitoring and prevention — that can be scaled up and, more importantly, taken to the field and placed in the hands of community health workers.

The other important goal for IHF is to aggregate resources from the private and public sector to support programme offerings and take approved health technologies to the field.

IHF works with companies and innovators that have proven prototypes or mid-to-late stage products with proof of concept. “We aim to offer end-to-end support for accelerating the development and scaling up of innovations on infectious diseases in partnership with ecosystem players,” says Madhav Joshi, IHF’s chief executive officer.

The organisation has been transitioning towards multi-disease, platform-based solutions and getting beyond the focus on TB and malaria. “One pertinent step in this strategy has been to adapt to the current pandemic situation and repurpose our portfolio of innovations to address Covid-19,” says Mr Joshi. “We look forward to working closely with different verticals of the Tata Trusts to reach the last-mile population.”

IHF’s projects comprise molecular diagnostics, artificial intelligence and digital health technology. Targeted to fill key gaps in the healthcare ecosystem, they are affordable, efficient, compact and end-user friendly, thus enabling implementation that is quicker and far reaching. These benefits also make them potential solutions in the fight against Covid-19.

One of the products developed through IHF’s support is a diagnostic solution for TB called Truelab™ Uno Dx Real Time Quantitative Micro PCR Analyser, which analyses patient sputum and delivers results within an hour. “Same-day reporting means you can start treatment as soon as possible,” says Ms Chowdhury. “This facilitates timely recovery and reduces the risk of the infection spreading, thus helping save lives.”

Developed by Goa-based Molbio Diagnostics, Truelab has been approved by the Indian Council for Medical Research (ICMR) and the World Health Organization for TB. Molbio has demonstrated the feasibility and uptake of the platform in district hospitals and community health centres in five districts of Uttar Pradesh and Andhra Pradesh.

Truelab uses a multi-disease platform-based technology. So when Covid-19 struck, Molbio was able to quickly adapt the system and integrate testing for the virus into a solution called Truenat™ Beta CoV. The device is being used for Covid-19 testing in Andhra Pradesh and Goa (ICMR will also be deploying it across its testing centres). IHF has joined hands with other players to plan and deploy this test facility in hotspots in Mumbai.

A safer TB test

IHF supports another diagnostic company, Valetude Primus Healthcare, which has come up with a safer way to collect and test TB samples. It also allows multiple testing at the same time, thus bringing down the cost per test. “By enabling TB diagnosis at primary health centres across India, we will be able to detect hundreds of thousands of patients who are missed each year,” says Saurabh Singh, the company’s cofounder.

Artificial intelligence comes into play in one of the IHF-supported solutions. Qure.ai Technologies is a startup that has developed a smartphone-based app that can diagnose TB based on an analysis of chest X-rays. Using image-recognition software, it can identify and predict presumptive TB cases.

The diagnostic tool for TB being used in Bahraich in Uttar Pradesh

TB exhibits zoonotic transmission — like Covid-19 — in that it can jump to humans from animals. IHF supports CisGen Biotech Discoveries to promote a test for bovine TB that can reduce the disease in the dairy industry. TB treatments take time and can run to months, often leading to patients falling off the regimen due to adverse drug reactions or because they cannot afford to stop working. With IHF support, SenseDose Technologies has developed a device that can help patients adhere to a medication regimen. It also allows the health system to track adherence and supervise treatments.

Another significant innovation involving IHF has been for malaria detection in the field. Hemex Health has come up with an affordable and lightweight battery-operated device that can generate a diagnostic result in just one minute. Hemex’s chief executive, Patti White, says that the IHF partnership has helped the company work with multiple governments to test their solution. “This kind of clinical validation will make our innovation a reality and help India towards its goal of malaria elimination,” she adds.

IHF has a ready pipeline of evaluated novel products for addressing and improving both demand and supply side in the healthcare spectrum. These are currently being planned for implementation. Besides backing inventive products and tools, IHF plays an advocacy role by bringing together experts to identify, select and prioritise problem areas in TB and malaria.

In search of innovation

IHF has been conducting nationwide ‘quests for innovations’ to look for appropriate novel products and processes that can combat infectious diseases. About 350 proposals have been screened, six initiatives supported, and two rolled out for implementation for TB and Covid-19.

The next wave of solutions for TB and malaria are likely to arise from these quests. By encouraging innovation and technology with funding and go-to-market support, and deployment on the ground to increase access, IHF is lending a hand in the herculean effort to rid the country of TB and malaria and tackle other infectious diseases.