The healthcare and biopharma industry have come into sharp focus since the beginning of the novel coronavirus pandemic — be it for testing kits, vaccines or medicines. In a rapidly evolving situation, the industry is racing to catch up at a time when India has started to detect more cases due to increased testing while most of the nation remains on lockdown.
In an interview, Biocon Chairperson and Managing Director Kiran Mazumdar Shaw speaks about India’s rate of testing, what steps the country must take, the future of the biopharma industry and more.
TNM: The Supreme Court has directed private labs to make testing free. Do you think they will be able to sustain? What do you think is the best way to go about this?
Kiran Mazumdar Shaw: These are small organisations which need to run their operations. They cannot do free testing because they will have to downsize their operations — and this will only lead to job losses and layoffs. You will also see a plummeting of the number of tests that the private sector can provide. That is my big concern and I think that whilst there is absolutely a need to have free testing in the country, we cannot be putting the onus on small laboratories. You need to then make sure that these costs are paid for by the government. That is why every state government, or the Centre, can potentially say that we will actually underwrite these costs, pay for these costs. They should find a mechanism that allows these companies to get paid immediately. For instance, suppose you have a portal that basically allows diagnostic centers to upload the tests that they've done based on Aadhaar and the test result. Then, the government should put the payment into their account. If that can be done, definitely I think private labs will be willing to adopt this model and give free testing. But you cannot expect them to say give free testing and then we'll see when we pay you. That cannot work.
These are small organisations. These are not large companies with huge cash reserves that they can afford to do this as CSR. Everyone needs to be a bit understanding of this, whether it is civil society, the government or the judicial system. They need to be aware of what small businesses are challenged with. No judge can just order a small business entity to offer free testing because there are many things that we need under the present crisis. Are you going to tell every one of those service providers or manufacturers to give it for free? How will the country run, how will the economy run? How will the businesses sustain? I think the government needs to play its role. Those who are insured should be paid for by the insurance company and insurance companies should be ordered that people don't need hospitalisations. Today, the problem with insurance companies in India is that they will only pay for any procedure or treatment that is delivered in a hospital. That should be tweaked and said that for COVID-19 testing, if you are insured, the insurance companies will pay for that test. I would have liked that to have come out in the judgment. And those who are not insured, the government should pay for it and the government should pay the diagnostic companies in a seamless way so that the companies receive their payments so that they can continue with their businesses and augment that testing.
Community transmission has been talked about since the lockdown began, and the government has also denied it. At the rate we are currently testing, do you think we will be able to confirm it?
First and foremost, I think the testing rates have gone up, they are close to 14,000 tests a day, but I think they are nowhere near the levels we should be at. I think we should be testing at least a hundred thousand a day. Now, this hundred thousand tests a day — obviously we are talking about RT-PCR (real-time reverse transcription polymerase chain reaction) testing. But, even if we share it between serological (rapid antibody) testing and RT-PCR testing for some time, that will also give us some good data on how many people are infected, how many people are recovering and how many people have recovered. This data is extremely important. That's where you need to do some large-scale community testing using serological kits, that is what the government is talking about.
On a larger scale, do you think that the serological testing will be effective?
Yes, but it has to be done in a certain way. Because you need to wait for a certain time before you can test people. You cannot be testing (the patient) early. If you test too early, then you might get a false negative so you need to test after a certain period of time. That's why they're saying that you have the earliest you can test these people is after 14 days and that's when you can get some reliable data.
The virus takes at least five days to actually show up, because otherwise you are very asymptomatic. Then it gets into a growth mode and has a growth cycle. Then, when your body starts attacking it, it comes up. In the process of dealing with an invading virus, the body produces immunoglobulins which you can test and measure through serological tests. That is why you need 14 days before you can get at least some reliable data.
At the beginning of the lockdown, you had mentioned that we must analyse patient data to make our response effective. Is that an option that is still on the table?
If you lockdown people for a long period of time, obviously you can test people much more and you will also know that there will be many people who have recovered. You will also see that many people will be negative, and they are safe to then go into the community. That data analysis is very important after 21 days. It's still a big option.
For instance, right now, what the government is very widely doing is mapping out the hotspots. If you have red hotspots where you must completely clamp down those areas, you must do that. There are green hotspots, you should allow them to operate freely, but making sure that the ingress and egress is very well controlled because you don't want them to be contaminated. You want to make sure that this red hotspot is totally clamped down so that you only make them orange when people become negative. And then you have the amber zones, where you can have a partial lifting of the lockdown. This is the way you have to assess the threat levels and start lifting the lockdown or not lifting the lockdown. You don't have to put the entire country under lockdown, but you must be very judicious about how you are lifting the lockdown based on the threat level.
The economy has, obviously, taken a hit. When operations start again, where do you think the biopharma industry stands and what opportunities does it have?
First and foremost, our reliance on China can be reduced and that offers a lot of opportunities for the small molecule companies who are making APIs and generic drugs. Then, there is a huge opportunity to revive antibiotic production in the country. India has a huge opportunity to dominate vaccine manufacturing for the world. I think biologics, biosimilars and generics are going to play a very important role going forward because the world needs to bring down its healthcare costs. You also have this huge emerging area of biomedical supplies, bio medical equipment. This whole sector is going to benefit a lot if you really put the right resources and build economies of scale.
What does our focus need to be on as far as research is concerned?
I think we need to really strengthen our entire research ecosystem. We need to understand what our resource requirement is, for making us self-reliant on research. Right now, we are importing far too many research resources. Today we need to see how much - can we be 90% self-reliant on research? There was a time many years ago when biotech research started, we started making the restriction enzymes and that led to at least starting to get a lot of the biotech research resources produced indigenously. The time has now come again to reassess what we need to do to make ourselves completely reliant in terms of research resources. Today, even though we are producing kits, a large number of these key components are still imported. In a large sense, we're actually assemblers of kits, not really end-to-end producers of those kits. I think we need to make sure that we produce every component of that kit.
This interview has been edited for length and clarity.