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Thinking in the pink

The India Health Fund has been a benefactor for innovators working to find solutions in tackling tuberculosis, malaria and other neglected communicable diseases that affect underserved communities

Long before Prime Minister Narendra Modi announced, at a global dairy summit in mid-September, that all of India’s cattle would be vaccinated against deadly zoonotic diseases such as foot-and-mouth and brucellosis, technopreneur Maroudam Veerasami was at work in this field.

The founder-director of CisGEN, a Chennai-based biotechnology company, Dr Maroudam’s primary interest is bovine tuberculosis (BTB). That’s a field of study focused on finding ways to detect cattle infected with TB, for which there is no vaccine as yet. The World Health Organization says as much as 28% of all TB cases in humans may be of zoonotic origin, primarily BTB, which is usually transmitted through the air, close contact or the consumption of unpasteurised milk and partially-cooked meat.

CisGEN has developed a pen-sized test kit that combines various antigens to tell if a certain infection in cattle is from TB-causing bacteria. Typically, it takes a veterinary doctor three days and multiple visits to diagnose this. The CisGEN kit will do it faster and cheaper. The company is now planning to create combo kits for other zoonotic diseases.

“TB in cattle causes economic loss through reduction in milk and meat production to farmers, and the pain felt by the infected animal is neglected,” explains Dr Maroudam. Lack of knowledge among farmers about BTB make them less interested in diagnostics. The idea is that combo kits of BTB, with other zoonotic diseases such as brucellosis — which leads to loss of calves — will make them more acceptable.

CisGEN has found a staunch and steady backer in the India Health Fund (IHF), financially and for product development. A not-for-profit organisation, IHF was set up in 2017 with funding from the Tata Trusts and strategic support from the Global Fund to identify science and technology-driven solutions to tackle India’s infectious diseases through primary healthcare.

TB and malaria have been an important area for IHF because of the high disease burden, mortality and suffering they cause. “The Tata Trusts saw that communicable diseases had suffered from market failure,” says Madhav Joshi, IHF’s chief executive. “There was no capital available to take promising technology — that would aid in the diagnosis, treatment and prevention of communicable diseases — from the lab to the market.”

Continuum of care

Adds Jayeeta Chowdhury, programme director at IHF: “Philanthropic entities at the time were largely tackling these diseases through a service-oriented approach, not cultivating innovative tools and solutions in the country. IHF’s goal is to bridge the gaps in continuum of care in neglected infectious diseases like tuberculosis, malaria and others by integrating science and technology-led innovations.”

It was mainly global institutions in infectious diseases which funded development of novel solutions and accelerated  technology development for market access. Indian research in health sciences and technologies needed a similar boost with funding, technical and ecosystem support. 

The Moskeet trap being installed by a municipal staffer in Hyderabad

Apart from a few government initiatives, there is a meagre amount of money coming in for infectious diseases. Which means even the most effective science- and technology-led innovations, those worthy of being funded, adopted and deployed on the ground, struggle to find support. “Infectious diseases were not getting the attention they needed and that’s why IHF came into existence,” says Ms Chowdhury.

“IHF came into our project as a fairy godmother,” says Suman Laal, chief scientific officer and director at Stellar Diagnostics. “Not only has it provided us with additional funds when most needed, but it also backed us with advice, connections and reviews. Their understanding of the TB ecosystem in India and their consistent, positive and pragmatic support have brought a lot of clarity on strategic approaches that could help deal with the challenges in this venture.” With IHF backing, Stellar is developing a point-of-care triage test that identifies a TB patient quickly and costs less than $2 (160).

IHF is still committed to TB and malaria, but its mandate has been expanded. “What we have been able to do is establish proof of concept, to show that these technologies exist, and that it’s possible to facilitate their development with patient capital,” says Mr Joshi. “Crucially, we have been able to provide evidence, with proven outcomes, of what these technologies can do in terms of improving the ability of the healthcare system to serve the poor.”

IHF has shown that, besides facilitating the development and validation of cutting-edge medical technologies — as well as their adoption and scaling up — it is possible to create a platform where public and private players can engage and bring greater attention to communicable diseases. That was not happening earlier.

“This has been enabled, to a large extent, by the increased attention that Covid has brought to infectious diseases,” says Mr Joshi. “It has revealed to all of us in the last two-and-a-half years the consequences of living [with an infectious disease].”

IHF views itself as a multiplex platform. Even within the infectious diseases space, it wants to support innovations that look beyond one or two diseases and provide solutions for several related ailments. The intent is to ensure that technicians and healthcare providers will not have to use multiple tests for multiple diseases.

Testing becomes difficult when users have to switch from one device to another. This is challenging enough when there is a trained technician at hand; it becomes impossible in a remote primary healthcare centre that has no testing facilities or adequately trained medical professionals. Also, multiple tests mean more money, which may render detection and treatment unaffordable for a large portion of India’s population.

“We will concentrate on identifying platforms which are enabled by deep science or deep technology, which can then be adapted for one or more diseases,” says Mr Joshi. “We have a preference for solutions which are fungible across a number of diseases. In that sense, we are disease agnostic, but we remain true to our original purpose.”

At IHF this has translated into an increase in the number of innovations it supports. “We have 11 at the moment and that number will go up,” says Ms Chowdhury. “In 2020 we had searched and screened 300-plus innovations; in  2022 that number has already crossed 1,000. This has been made possible because we employ different methods to scout for novel solutions.”

Till recently, IHF used to conduct Quest for Innovations, an open call to startups to provide viable and scalable solutions to specific healthcare problems in infectious diseases. But now IHF has forged key partnerships to actively find more such novel science and technology-based innovations. This helps create a pipeline for the future and also promotes much-needed discussion and concerted action.

Tracking a menace

For instance, among IHF’s grantees is a startup called TrakITNow, which has created a mosquito ‘trap’ called Moskeet that can, using artificial intelligence, identify various species of mosquito from their wing-beat frequency. This AI and IoT-based platform is able to differentiate between mosquitos carrying malaria, dengue, chikungunya, zika and Japanese encephalitis, and also determine their hotspots for more effective vector control and surveillance. The platform goes the extra mile in helping control the disease.

“Mosquito-borne diseases infect 40 million Indians every year,” says Satish Cherukumalli, the chief executive of TrakITNow. “Moskeet collects real-time data and provides analytics for efficient control of mosquito populations, disease outbreak and risk analysis.”

IHF has also provided funding to Hemex Health, which has developed Gazelle, a one-minute test for malaria. All that this device needs is a single blood sample to detect the presence of plasmodium falciparum or plasmodium vivax, the two most common types of malarial parasites found in India. And the test costs just $1 (80).

Another beneficiary of IHF’s support is OmiX Laboratories. This company’s offering, iAMP, is a diagnostic platform that uses a specific technology to distinguish between Covid, TB and influenza. These three diseases have similar symptoms so a patient has to undergo multiple, costly and time-consuming tests to figure out which disease she has. One test to identify the condition would be a game-changer.

“Poor healthcare outcomes correlate to socioeconomic status, and it begins with lack of access to accurate and early diagnosis,” says Sudeshna Adak, who heads OmiX. “Imagine being sick and the nearest laboratory is 50km away, or the cost of a test is equal to a week’s wages.”

Thanks to IHF, many technologies that may have fallen by the wayside are now being used to support underserved communities. An example is Molbio Diagnostics, which in 2020 launched Truenat, a polymerase chain reaction-based test that can tell within 90 minutes if a patient has TB. This is ideal for rural areas where inadequate testing facilities lead to a large number of cases going undiagnosed.

Proving its mettle

In the early days of Covid, when testing centres were struggling with a huge load of cases and were unable to provide quick results, Mumbai’s municipal corporation employed Truenat to carry out, according to an IHF report, “India’s largest bi-directional testing initiative for TB and Covid-19… without the need for additional manpower”.

Five years in existence, the obvious question for IHF now is, will it also begin to look at noncommunicable diseases (NCDs)? “Our emphasis will remain on platforms that address infectious diseases,” says Mr Joshi. This is not a priority as yet for IHF because “there is still so much to be done in the communicable diseases space and NCDs actually get more support”.

IHF is currently exploring the option of setting up India’s first dedicated incubator for neglected infectious diseases. “The present incubation ecosystem is centred on NCDs and we want a shift there,” says Mr Joshi. “A lot of our work involves first-time entrepreneurs or early-stage startups who know the technology well but have no idea how to set up a business. Often, they only want to concentrate on the science.” Such startups will certainly benefit from IHF.

“We will need many partners to come together because we are not an implementing organisation,” says Ms Chowdhury. “Our job is to be a catalytic fund that enables the lab-to-last mile journey.” Adds Mr Joshi: “For us, innovation is a means to an end; it’s not an end in itself. That’s the biggest value add that IHF provides.”