APRIL 2021, VOLUME 5 ISSUE 4 `200 INDIA MED TODAY
European Excellence in India
APRIL 2021
PULSE
APPROACH
INTERVIEW
FEATURE
Achieving Healthcare Equity in Dialysis Care
Making Health Equity a Strategic Priority
Prof. Marc Van Ranst, KU Leuven, Belgium
A Leaking Pipeline
EDIT NOTE www.indiamedtoday.com
April 2021 EDITORIAL Editor Neelam Kachhap
Removing Barriers to Healthcare Equity
BOARD OF ADVISORS Dr Alexander Thomas Dr Girdhar Gyani
Sub-Editor
Dr Prem Kumar Nair
Sanjiv Das
Dr Bhabatosh Biswas
Healthcare equity is the new mantra for World Health Day 2021.
editorial@
Dr Alok Roy
The WHO is working towards ensuring a fair chance for the
indiamedtoday.com ART & PRODUCTION ScreeTract Shylesh
Ramesh Kannan
best health of every individual. This means eliminating barriers
CONSULTING EDITOR
of accessibility, affordability, disparity based on gender, caste
Dr Libert Anil Gomes
and race. Unfortunately, social, economic, geographical and
Dr Salil Choudhary
environmental factors limit us from achieving a healthy life.
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policy enhancements. Many healthcare providers in the country
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voice to the long-overdue equity conversation. As COVID-19 pandemic resurfaces we are witnessing the response of the government and the providers, working in tandem to facilitate healthcare access for all.
IndiaMedToday’s current issue focuses the lens on healthcare equity in India. We talk about how different stakeholders are working towards providing equal opportunity for health to all. We bring together healthcare leaders to share their perspective on healthcare equity. They talk about ways in which healthcare systems, providers and healthcare entrepreneurs can progress to eliminate barriers to better health for all. In the end, it is our collective responsibility to ensure that we dedicate available resources to improving equity at every level until the systemic bias, both conscious and unconscious, are countered. While we continue to fight for the right to health, it is unacceptable to deprive people of a chance to a dignified healthy life.
IndiaMedToday expressly disclaims liability for errors and omissions in this publication. While we try to keep the information timely and accurate, we make no guarantees. The views and opinions expressed in the magazine do not necessarily reflect the official policy or position of IndiaMedToday or the publication. Information on IndiaMedToday should not be used as a substitute for professional healthcare advice. Readers are advised to always seek specialist advice before acting on information contained in this publication. Never disregard professional medicaladvice or delay in seeking it because of something you have read on IndiaMedToday. No part of this publication or any part of the contents thereof may be
Editor M Neelam Kachhap
reproduced, stored in a retrieval system or transmitted in any form without the permission of the publishers in writing. Printed and published by M Neelam Kachhap, 301, Grazia, 1st main, 2nd Cross, Lingrajpuram, Bangalore 560084 on behalf of Neelam Publishing (OPC) Private Limited, Printed at Paradise Graphics, B-15, Mittal Tower, MG Road, Bangalore-1. and published at 301, Grazia, 1st main, 2nd Cross, Lingrajpuram, Bangalore 560084.
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3
APRIL 2021
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CONTENTS
29
18
34
DRIVE
OPINION
APPROACH
Healthy Granulation
Healthcare Expenditure and Sustainability
Making Health Equity a Strategic Priority
UPFRONT
21 COVER STORY
European Excellence in India
03 Editorial 06 News Roundup 30 Round Table 36 Interview 38 Feature 41 Pulse www.indiamedtoday.com
CHECKIT OUT ONLINE
LETTERS World Kidney Day ith the outbreak of the pandemic, kidney patients faced the fear and burden of contracting COVID-19 while balancing
W
their treatment plans. We are the first private hospital to undertake free vaccination for all its patients undergoing dialysis at hospitals. Through this initiative, we hope to ease their lives by taking the first step to protecting them
from the virus. Dr Sudarshan Ballal, Chairman, Manipal Hospitals
COVID-19 infection can damage the kidneys directly, or cause injuries indirectly to them due to severe inflammation called cytokine storm, or excessive blood clotting.About 20 per cent of hospitalized COVID-19 patients develop acute kidney injury due to the infection. Many of them experience renal shutdown.Some patients may need temporary hemodialysis treatment, mostly those who develop complications of covid pneumonia and require ventilator support. We have till now seen hundreds of chronic kidney disease patients developing serious complications due to COVID-19.Kidney transplant recipients are also much more prone to covid as they are on immunosuppressants. Dr Rajesh Nair, Professor and Head, Dept. of Nephrology and Renal Transplants, Amrita Hospital, Kochi
This move by the government was taken in a bid to make dialysis accessible to all kidney patients in the country. Notwithstanding the right intention behind the move, the policy lacks a tangible and cohesive adoption plan to address problems related to chronic kidney disease (CKD) in the country. Today, the policy is incorporated only by four Indian states. Considering the burgeoning CKD numbers, conventional treatment options to treat kidney patients alone cannot suffice. It is imperative to understand the crucial role played by alternate methods such as PD in giving respite to patients Dr E Mahesh Prof and Head Dept of Nephrology M.S.Ramaiah Medical College, Bangalore
We believe the kidney care journey begins with symptom management and extends to a more-holistic approach to dialysis so that patients, families and care-partners can have a better health-related quality of life. Andrew Frye, Vice President and Asia Pacific President, Baxter International
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5
NEWS ROUNDUP
Dr Harsh Mahajan
Umang Vora
Sujeeth Pai
Dr Harsh Mahajan joins NATHEALTH as president
filing. Vohra had joined Cipla in 2015 and has been the MD and Global CEO of the company since September 1, 2016, it added.
Danfoss Drives appoints Sujeeth Pai
Dr Harsh Mahajan, Founder and Chief Radiologist, Mahajan Imaging has taken over as the new President of NATHEALTH. He succeeds erstwhile President, Preetha Reddy,
Executive
Apollo
Hospitals.
Vice The
Chairperson, newly
elected
NATHEALTH leadership team also includes other
senior
industry
luminaries:
Dr
Thermo Fisher Scientific collaborates with Artificial Thermo Fisher Scientific has announced
Sujeeth Pai has been appointed as the new Director of Sales and Service for Danfoss Drives in India. Pai, a mechanical engineer by qualification, has rich experience in the B2B segment, having spent the last 16 years of his career spread across India and the Asia Pacific working with various
engineering
companies
like
Shravan Subramanyam, President & CEO,
a strategic technology collaboration to
GE Healthcare India & South Asia and
develop an integrated and comprehensive
etc. in several senior leadership sales
Managing Director, Wipro GE Healthcare
software automation platform for Thermo
positions and delivering remarkable sales
as Senior Vice President, NATHEALTH; Dr
Fisher’s standardised COVID-19 testing
growth. He will report to Ravichandran
Ashutosh Raghuvanshi, Managing Director & CEO, Fortis Healthcare as Vice President, NATHEALTH;
Ameera
Shah,
Managing
platform. The integration will result in increased testing throughput and support
as
global healthcare initiatives. As part of
Secretary, NATHEALTH and Sunil Thakur,
the collaboration, Artificial will provide
Partner, Quadria Capital as Treasurer,
access to its aLab Suite software, designed
NATHEALTH.
to
Cipla approves reappointment of Umang Vohra as MD and GCEO
Scientific Momentum Workflow software
Director,
Metropolis
Healthcare
seamlessly
integrate
with
Thermo
and robotics hardware. This will form part of the COVID-19 Testing Platform that will enable laboratories to quickly upscale
The board of directors of Cipla has
COVID-19 testing volumes to help reduce
considered
re-
the spread of the disease and restore
appointment of Umang Vohra, Managing
economies and communities. The aLab
and
approved
the
Director, designated as ‘Managing Director and Global Chief Executive Officer of the company, for a further period of five
Suite software facilitates the dynamic scheduling of protocol runs with batch
years with effect from April 1, 2021, to
optimisations to maximise the number of
March 31, 2026, Cipla said in a regulatory
tests run.
6
April 2021
National Instruments, Fluke Corporation,
Purushothaman, President, Danfoss India.
Society of Interventional Radiology names Matthew S Johnson, President for 2021-2022 Matthew S Johnson, an interventional radiologist and Gary J Becker Professor of Radiology Research at Indiana University School of Medicine in Indianapolis, assumed the office of president of the Society of Interventional Radiology (SIR), during the society’s annual Members’ Business Meeting held recently. Other incoming officers of SIR’s 2021– 2022 Executive Council include Presidentelect Parag J Patel, Medical College of Wisconsin, Milwaukee; newly appointed Secretary Alda L Tam, Anderson Cancer
Center, Houston; and Immediate Pastpresident Michael D Dake, University of Arizona Health Sciences, Tucson. New and re-elected members of the SIR Executive Council are Derek Mittleider, SIR Councilor-at-large: private practice (fouryear term); Saher S Sabri, Graduate Medical Education Division Councilor (four-year term); Constantinos T Sofocleous, FSIR, International Division Councilor (fouryear term); Kelvin Hong, Post-graduate Medical Education Division Councilor (reappointment: three-year term) and Mark Baerlocher, Standards Division Councilor (appointment to fill the vacancy created by Alda Tam).
Dr Tapan Dash rejoins CARE Hospitals Hyderabad Dr Tapan Dash has rejoined CARE Hospitals Hyderabad.
Dr
cardiothoracic
Dash
is
surgeon
a
with
renowned over
15
years of experience in treating paediatric and congenital heart conditions. He has received his MS from AIIMS Delhi and further pursued his fellowship in paediatric cardiac surgery from Children’s Hospital of
Michigan,
Detroit
Medical
Centre,
Wayne State University, USA and Medical University of South Carolina, Charleston
Preetha Vasanji
Susheel Umesh
Doceree Engage appoints Preetha Vasanji as Senior VP
Biocon Biologics appoints Susheel Umesh as CCO for emerging markets
Doceree announced its foray into enterprise-level network solution with Doceree Engage, appointing Preetha Vasanji as Senior Vice President to lead the vertical in India. Based in Mumbai, Vasanji brings over 20 years of experience from the healthcare and pharmaceutical sector. Before Doceree, she worked with McCann Health in the capacity of Senior VP and General Manager, Mumbai.
Biocon Biologics, a unit of biotechnology major
Biocon,
has
appointed
Susheel
Umesh as the Chief Commercial Officer (CCO) for emerging markets with effect from March 1. Umesh, who has over 30 years of experience in the pharmaceuticals industry, has worked in India, France and Sub-Saharan Africa for leading global pharma companies. He will drive the
USA. Dr Dash has conducted over 500-
company’s
600 paediatric cardiac surgical procedures
Cleveland Clinic partners with IBM
markets and will also be responsible for
Cleveland Clinic and IBM have announced the Discovery Accelerator, a joint Cleveland
… promotes Shreehas Tambe as Deputy CEO
Clinic – IBM centre with the mission of
Shreehas Tambe has been promoted to the
fundamentally advancing the pace of
position of Deputy Chief Executive Officer
discovery in healthcare and life sciences
of Biocon Biologics. A Biocon veteran,
and has successfully performed over 7000 congenital heart surgeries.
a planned 10-year partnership to establish
through the use of high-performance computing on the hybrid cloud, artificial intelligence (AI) and quantum computing technologies.
Dr Tapan Dash
business
in
the
emerging
the branded formulations business.
Tambe joined Biocon in 1997 and has, since then, taken on positions of increasing responsibility. He has over 20 years of leadership experience in operational and
The collaboration is anticipated to build
strategic roles and has led large, diverse
robust research and clinical infrastructure
teams at R&D, Manufacturing and Projects
to empower big data medical research
& Engineering during his tenure. Tambe
in
ways,
began his professional journey at Biocon
discoveries for patient care and novel
as a Management Trainee starting in the
approaches to public health threats such
R&D department, where he led the design
as the COVID-19 pandemic.
and development of a novel bioreactor, the
ethical,
privacy-preserving
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7
NEWS ROUNDUP helped transform Dr Lal PathLabs into its current network of over 200 labs, more than 2,500 patient service centres, and close to 6,500 sample pick-up-points.
Smile Train appoints Roberto L Flores Smile Train has announced the addition of Roberto L Flores, to its Global Medical Advisory Board. Dr Flores, the Joseph G
McCarthy
Associate
Professor
of
Reconstructive Plastic Surgery at NYU Grossman School of Medicine and Director of Cleft Lip and Palate at NYU Langone Shreehas Tambe
Runam Mehta
PlaFractor, a unique solid-state bioreactor that got Biocon its first US patent and went on to win the National Award for the Best Technology of the Year in 2001.
in diverse areas across the healthcare spectrum. She pioneered the first and most comprehensive home isolation programme for COVID-19 patients as part of Portea Medical.
Feedback appoints two industry specialists in India Feedback, the specialist medical imaging technology company, has confirmed the appointment of two leading industry specialists in India, Siva Ramamoorthy and Dr Venkat Ramana Sudigali. The focus will be to evaluate the potential prospects for Bleepa, the company’s flagship clinical communications platform, in the large and growing Indian health care market, which is projected to grow to $372 billion by 2022.
has
announced
to the Global Medical Advisory Board, with expertise in reconstructive plastic surgery and surgical simulation education.
NephroPlus appoints Om Prakash Manchanda as Independent Director NephroPlus has appointed Om Prakash Manchanda into the Board of Directors as an Independent Director. This induction will further help NephroPlus in its scaleup journey as it expands in domestic and international markets. Manchanda is the Managing Director of Dr Lal PathLabs. With its strategic vision and operational abilities, Manchanda has
HealthCube appoints Runam Mehta as Chief Growth Officer HealthCube
Health, brings over 20 years of experience
Roberto L Flores
ICICI Foundation to donate over 100 dialysis machines the
ICICI Foundation for Inclusive Growth
appointment of Runam Mehta as its
(ICICI Foundation), the CSR arm of the ICICI
Chief Growth Officer. Mehta will chart
Group, announced that it will donate over
the course for a market-leading and
100 dialysis machines to enhance the
beneficial technology-driven product and
healthcare infrastructure in the country.
explore scalable business solutions across
ICICI
segments.
machines to various hospitals free-ofaffordable
strategy expert with over 14 years of avenues
of
8
April 2021
these
treatment
to
the
lesser
in the country.
healthcare
delivery in India. She has achieved success
provide
privileged across 60 districts in 14 states
experience in building businesses and new
will
cost. This initiative is aimed at providing
Mehta is an out-of-the-box thinker and
creating
Foundation
Dr Om Prakash Manchanda
ICICI
Foundation
is
procuring
these
state-of-the-art imported machines and providing them to the identified hospitals with a four-year warranty to ensure uninterrupted operations at the dialysis centres.
country, Biocon said in a statement. This partnership, which marks the entry of Biocon’s generic formulations into Latin America, builds upon a successful association with Libbs, which began in 2017 to launch biosimilar Trastuzumab in Brazil, it added. As part of the outlicensing deal with Libbs, Biocon Pharma will be responsible for drug development and manufacturing, while Libbs will leverage its deep expertise and reach in Brazil to import, distribute and market, subject to approvals from the Brazilian health regulatory agency, ANVISA.
Shriram Vijayakumar joins IHH Healthcare as CEO Shriram Vijayakumar has been appointed as the Chief Executive Officer of IHH Healthcare India. Vijayakumar joined IHH Healthcare as Chief Operating Officer
TechInvention in tie-up with Eubiologics
(COO) of its India Operations Division Professor M F Martelli his achievements in haematology and haploidentical stem cell transplantation with the Mechtild Harf Science Award 2021. The Italian physician has made seminal contributions to the treatment of patients with high-risk acute leukaemia. Martelli is the 20th recipient of the annual €10,000 prize, which recognises the outstanding scientific work of internationally renowned physicians in the field of stem cell donation and transplantation.
Shriram Vijayakumar in December 2019. He oversaw the operations of our five Gleneagles Global hospitals and Continental Hospital in India. As the newly promoted CEO of IHH Healthcare India, Vijayakumar will work with the Board of Directors to guide and advise the management team as it delivers on its business strategy while ensuring alignment and continual improvement in its service development, physician engagement, and clinical quality.
ITALIAN physician Prof Massimo Martelli bags Mechtild Harf Science Award
CSIR-IICT ties up with Bharat Biotech, Biovet and Sapigen Biologix
TechInvention Lifecare has tied up with South
Korea-based
biopharmaceutical
firm Eubiologics Co for bringing in oral cholera vaccine ‘Euvichol-Plus’ to India. The vaccine is prequalified by the World Health Organization (WHO), TechInvention Lifecare said in a statement. Eubiologics has so far supplied 55 million doses to UN
healthcare
agencies.
Euvichol-Plus
has been supplied to around 22 countries across the globe, it added.
Amazon’s COVID-19 test kit bags US FDA approval Ecommerce giant Amazon has received
Bharat Biotech International, Biovet and Sapigen Biologix have signed a joint Master Collaborative Agreement (MCA) with CSIRIndian Institute of Chemical Technology (CSIR-IICT) for the development of novel platform technologies. The collaboration will be for biotherapeutics and vaccines to support indigenous and affordable healthcare solutions for humans and animals. The collaborators will identify mutually interesting projects to pursue under the agreement.
the emergency use authorisation (EUA) from the US Food and Drug Administration (FDA) for a COVID-19 test kit made by its subsidiary STS Lab Holdco. Amazon plans to use the real-time RT-PCR Test for detecting SARS-CoV-2 as part of the company’s overall preparedness and response programme. Individuals who are permitted to enter Amazon facilities under this health and
Biocon partners with Libbs Farmaceutica
safety measures will be invited to be
Biocon Pharma, a unit of the company,
the “Amazon real-time RT-PCR test for
DKMS Stiftung Leben Spenden (DKMS
has
Libbs
detecting SARS-CoV-2 will be performed at
Foundation for Giving Life) has honoured
Farmaceutica
generic
laboratories designated by STS Lab Holdco
Professor Massimo Fabrizio Martelli’s for
formulations
tied
up
with to in
Brazil-based introduce
the
Latin
tested periodically using the Amazon Test. The US FDA said in a statement that
American
(a subsidiary of amazon.com)”.
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9
NEWS ROUNDUP
Meenakshi Mission Hospital and Research Centre (MMHRC), Madurai
Pharma majors invest Rs 40 crore each in ABCD Technologies
out basic clinical examinations (such as
cancer units in the following cities of Bihar
checking blood pressure and heart rate) on
namely Buxar, Jehanabad and Bhagalpur.
their own, as instructed by the doctors. As
These centres will connect cancer patients
IoT devices, they can be used to control
of those districts by telemedicine to
Drug majors Sun Pharma, Lupin, Cadila Healthcare and Torrent Pharma have subscribed to a partnership interest in healthcare services firm ABCD Technologies which will be renamed as IndoHealth Services. The four pharma majors are investing Rs 40 crore each in the target entity which is a recently incorporated limited liability partnership and has not commenced any business activities, they added. Sun Pharma and Cadila Healthcare said one of the wholly-owned Indian subsidiaries have subscribed to partnership interest in ABCD Technologies.
other
equipment
HBCHRC, Muzaffarpur. Also, these centres
such as CT and MRI scan machines.
will work with the district administration
Meenakshi Mission Hospital introduces telemedicine robots Meenakshi Mission Hospital and Research Centre (MMHRC), Madurai, has deployed 16 mobile Teladoc Health Robots for clinical examinations, diagnosis and monitoring of health parameters of both out-patients and in-patients. MMHRC is the only healthcare institution in India to deploy these. The Teladoc telemedicine robots have the capabilities to carry
10
April 2021
advanced
diagnostic
Applying Artificial Intelligence, the robots can collect and process data from other diagnostic equipment and present it to the doctors to help them make precise clinical decisions. The robots can also enhance patient relations, as they are fitted with cameras and display monitors to enable patient-doctor interaction.
Alkem partners with Tata Memorial Hospital Alkem Laboratories has agreed to partner with Tata Memorial Centre (TMC) to establish an advanced radiotherapy facility as a part of the Homi Bhabha Cancer Hospital and Research Center (HBCHRC), Muzaffarpur, Bihar. As part of Alkem’s CSR activity, Alkem has sanctioned the purchase of the two most advanced versions of the teletherapy and brachytherapy units for this facility. The facility is being developed as a spoke model shall also provide chemotherapy, minor operation, basic laboratory, treatment planning, etc. Alkem and TMC have collaborated to also establish three mini
on community activities such as cancer awareness and screening.
Veeda Clinical Research acquires stake in Bioneeds Veeda Clinical Research has acquired a significant minority stake in Bioneeds, a preclinical CRO based in Bengaluru. Veeda will seek to further increase its stake in Bioneeds in the near term. Veeda’s investment in Bioneeds comes shortly after its launch of Ingenuity BioSciences, an innovation-centric bioanalytical laboratory for biosimilars, in a joint venture with Somru BioScience, a leading Canadian biotechnology company.
Banaras Hindu University signs MoU with Indian Cancer Society The Banaras Hindu University (BHU) and Indian Cancer Society (ICS) signed an
will receive an upfront payment, launch and sales-based milestone payments in addition to royalties and supply price from sales of RYALTRIS.
Premas Biotech ties up with Oramed Pharmaceuticals
The MoU signing ceremony MoU for conducting a cancer screening programme to facilitate early detection. The initiative called ‘Ganga Godavari Cancer Screening Programme’ by AstraZeneca India, intends to create awareness, and detect oral, breast and cervical cancers at early stages among women at specialized cancer screening camps. Doctors For You is the implementing partner for this programme in Varanasi. The current phase of this programme will be initiated in Varanasi, Uttar Pradesh in consensus with NHM and the Ministry of Health and Family Welfare( MoH&FW). The Department of Community Medicine at the Institute of Medical Sciences, BHU will act as a nodal agency for this programme. The Department of Obstetrics and Gynaecology, General Surgery and Dentistry will provide an expert team of medical professionals for the provision of screening services at the Health and Wellness centre at Tikri. ICS would act as executing agency and will supervise and ensure effective implementation of this programme at the ground level.
WHO announces 2nd edition Health for All Film Festival The second edition of the Health for All Film Festival has attracted nearly 1200
short film submissions – both amateur and professional – from 110 countries. These have now been shortlisted to 15 to 16 titles in each of the three competition categories: Universal Health Coverage, Health emergencies, and Better health and well-being. The shortlisted films can be viewed by the public as of today through Youtube playlists available on the Festival’s website as well as WHO’s Youtube channel. The public is invited to post comments and questions on the short films and a selection of these questions will be featured during the online award ceremonies in May.
Glenmark in tie-up with Bausch Health Glenmark Pharmaceuticals announced that its subsidiary Glenmark Specialty in Switzerland and an affiliate of Bausch Health Companies have entered into an exclusive licensing agreement for the commercialisation of Glenmark’s innovative nasal spray RYALTRIS under review by Health Canada. Under the terms of the agreement, Glenmark will be responsible for regulatory approvals and supply of RYALTRIS for the Canadian market. Bausch Health, Canada will be responsible for the commercialisation of RYALTRIS in the Canadian market, following regulatory approval. Glenmark
Gurugram-based biotechnology firm Premas Biotech, a developer of novel biotherapeutic and vaccine candidates has tied up with Israel-based Oramed Pharmaceuticals to develop an oral COVID-19 vaccine that has shown efficacy after a single dose. Premas, Oramed and other shareholders have formed Oravax Medical which has received exclusive licenses from Oramed and Premas to develop oral COVID-19 vaccines. The vaccine candidate could be ready for human trials in the next three months. After a single dose of the Oravax COVID-19 capsule, efficacy was evident through antibody production in a pilot animal study. Oravax’s vaccine promoted both systemic immunity through Immunoglobulin G (IgG), the most common antibody in the blood and bodily fluids that protects against viral infections and Immunoglobulin A (IgA) which protects the respiratory and gastrointestinal tracts against infection.
AIIMS to start virtual autopsy All India Institute of Medical Sciences will start conducting the virtual autopsy, wherever possible. Dr Balram Bhargava, Director General, will inaugurate the facility. Virtual autopsy involves examining the internal organs, tissues and bones without touching the body. The body is packed in a bag and put in a CT scan machine. Thousands of images of the internal organs are captured within seconds, which can be analysed by forensic experts. According to Dr Sudhir Gupta, Professor and Head of Forensic Medicine Department, AIIMS, the facility will be the first medical institution in South and Southeast Asia. In a virtual autopsy, the deceased’s records are available in digital format, which permits additional analysis by other forensic pathologists and second or the third opinion even after years if some allegations crop up in the future.
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11
NEWS ROUNDUP
President Ram Nath Kovind inaugurates super speciality hospital in Rourkela
President Kovind inaugurates super speciality hospital in Rourkela President Ram Nath Kovind recently inaugurated a super speciality hospital of Rourkela Steel Plant in Rourkela, Odisha. The newly inaugurated 200-bedded hospital has facilities for neurology, neurosurgery, cardiology, cardiothoracic and vascular surgery and nephrology. This hospital would not only cater to the super speciality medical needs of Odisha but also adjoining areas of Jharkhand and Chhattisgarh, the President said.
Stelis Pharma concludes $195 million series B, C fundraise Strides Pharma Science said its biotech arm Stelis Biopharma concluded Series B and Series C fundraise for a cumulative amount
of $195 million, Strides Pharma Science said in a regulatory filing. Strides Pharma Science with the current capital raise, Stelis is now well-positioned to pursue its growth initiatives and scale its business model to deliver promising returns in the coming years.
Thermo Fisher Scientific signs MoU with National Forensic Sciences University Thermo Fisher Scientific has signed an MoU with the National Forensic Sciences University (NFSU). The collaboration is to establish the NFSU-Thermo Fisher Scientific Centre of Excellence for DNA forensics. The centre will be at NFSU’s premises in Gandhinagar, Gujarat. The state-of-the-art facility will focus on conducting research, method/workflow development and provide scientific demonstrations and training in the field of DNA forensics.
of $195 million (approx Rs 1,415 crore). Post money valuation for Stelis will be pegged at $350 million. Stelis Biopharma has successfully concluded its Series B and Series C fundraise for a cumulative amount
12
April 2021
Pharma
has
entered
into
Metropolis Healthcare launches COVIPROTECT Metropolis
Healthcare
has
launched
COVIPROTECT, a blood test, which helps to measure the immunity status of a person vaccinated with the COVID-19 vaccine. The new and upgraded quantitative test will help to understand seroprevalence in a community and determine the possibility of
past
infection.
The
sensitive
and
specific antibody assay detects IgG type of antibodies to S1 & S2 subunits of spike proteins of SARS-CoV-2. COVIPROTECT is
Gland Pharma inks pact with RDIF Gland
agreement with the Russian Direct Investment Fund (RDIF) to supply up to 252 million doses of Sputnik V COVID-19 vaccine. The agreement will see the company utilising its Drug Substance and Drug Product facilities at its sites in Hyderabad. The production is expected to commence from the third quarter of 2021 for estimated delivery starting from the fourth quarter of 2021, it added.
Conformité Européenne (CE) marked and is approved by the US Food and Drug an
Administration (FDA) EUA.
as on February 21, 2021. The drug has been approved by the Drugs Controller General of India (DCGI) in the adjunctive management of partial-onset seizure with or without secondary generalisation. The drug has exhibited a faster onset of action, efficacy with a favourable safety profile.
Cardinal Health in agreement with Hellman & Friedman Cardinal Health has signed a definitive agreement to sell its Cordis business to Hellman & Friedman (H&F) for approximately $1 billion, which includes the buyer’s assumption of certain liabilities and seller’s retention of certain working capital accounts. The transaction is expected to close in the first half of Cardinal Health’s fiscal year 2022, subject to customary closing conditions and regulatory clearances. NerveTrack
Samsung Medison collaborates with Intel on NerveTrack Samsung
Medison
and
Intel
are
collaborating on NerveTrack, a real-time nerve tracking ultrasound feature that helps anesthesiologists identify nerves in a patient’s arm to help administer anaesthesia Leveraging
quickly the
and
Intel
accurately.
Distribution
of
OpenVINO toolkit for computer vision and annotation, Samsung Medison’s NerveTrack can potentially reduce scanning time by up to 30 per cent.
Alkem launches epilepsy drug Brivasure Alkem
Laboratories
Brivasure,
an
has
affordable
launched
anti-epileptic
drug for the treatment of epilepsy in India. Brivasure,
Alkem’s
anti-epileptic
drug
(AED) is a generic version of the parent molecule. Alkem has launched the drug in the market at price, Brivasure 25mg Rs 79.50/strip, Brivasure 50mg 148.50/ strip, Brivasure 75mg 230/strip, Brivasure 100mg
295/strip,
post-patent
expiry
of innovator product, of Brivaracetam
Sankara Eye Foundation ties up with Singaporebased Leben Care Sankara Eye Foundation and Singaporebased Leben Care are deploying a comprehensive retina risk assessment software-as-a-service platform in India. Netra.AI, the cloud-based artificial intelligence (AI) solution, is powered by Intel technology and uses deep learning to identify retinal conditions in a short period with the accuracy level of human doctors. Netra.AI can accurately identify diabetic retinopathy (DR), greatly reducing the screening burden on vitreoretinal surgeons.
Fujifilm FDR nano 80 per cent reduction in its total weight as compared to traditional mobile X-rays. It offers a significant reduction in terms of
the
external
dimensions,
enabling
smooth movement in the hospital and at the bedside. The high-performance built-in Lion
battery
enables
12
hours
of
continuous use at 20 shots per hour and radiology can be performed even when the battery is empty by simply using the ac power cord. By combining it with Fujifilm’s FDR D-EVO II DR cassette, highquality X-ray images can be acquired even at a low dose. The FDR D-EVO II cassette utilizes the ISS method*3 and Noise Reduction Circuit*4 which are Fujifilm’s
Fujifilm India launches FDR nano Fujifilm India has launched its mobile digital radiology system – FDR nano. Offering high-resolution imaging with low X-ray doses in healthcare settings, this new digital radiology technology enables noise reduction circuits that in turn, improves the granularity of low-density regions, and achieves high image quality. The lightweight and compact FDR Nano have achieved approximately
special image processing technologies.
Fujifilm Sonosite launches new point-of-care ultrasound system FUJIFILM Sonosite has launched Sonosite PX ultrasound system in Canada. Sonosite PX is the next generation in Sonosite POCUS, with the most advanced image clarity ever seen in a Sonosite system, a suite of workflow efficiency features, and an adaptable form factor.
www.indiamedtoday.com
13
NEWS ROUNDUP
Fujifilm Sonosite
Disney Stories
Sonosite PX launches with a new family of transducers, such as the L19-5, the highest frequency transducer Sonosite has ever produced, providing well-defined near field resolution and a minimum scan depth of 1 cm. With a small footprint of 20 mm the L19-5 transducer is ideal for superficial scanning such as vascular access, and paediatrics and musculoskeletal exams.
as dynamic lighting, video projections and sound, to allow patients and staff to personalise the environment to create a relaxing atmosphere. Philips’ clinical research project will commence this summer in six hospitals across Europe and the results of the pilot project will be completed later this year. It is the first time Disney has collaborated as part of a clinical research project of this kind.
SpiceHealth extends RTPCR testing to consumers
4baseCare raises $2 million
SpiceHealth announced the launch of the country’s cheapest testing facility for the general public at just Rs 499. SpiceHealth has also tied up with SpiceJet to offer a special price of Rs 299, which is onethird of the prevailing market rate, for its passengers who wish to get the crucial Covid test done and thus contributing to making flying even more safe and convenient. The company will make its testing facility available for the general public in two of the most affected cities in India – Mumbai and Delhi.
Philips ties up with Disney Royal
Philips
and
The
Walt
Disney
Company EMEA have teamed up to test the effects of custom-made animation, including specially-made Disney stories, within solution
Philips that
Ambient integrates
Experience,
a
architecture,
design and enabling technologies, such
14
April 2021
4baseCare, an Illumina Accelerator backed precision oncology start-up, has raised an investment of $2 million, led by investors Mount Judi Ventures, growX Ventures, Season Two Ventures, First In Ventures and a few strategic angel investors. The investor group has a strong understanding of healthcare and technology and focuses on creating social impact through their investments. 4baseCare aims to make precision oncology a standard of care in Asia by increasing the utilisation of genomic tests in oncology and is working towards developing a first of its kind, Indian population-specific gene panel that will analyse a large number of genes for cancer-associated mutations to identify optimal treatment options leading to improved outcomes. 4baseCare will utilise the funds for expansion of the genomic tests portfolio and for increasing its geographical presence across Asia. Additionally, it will also focus on strengthening its R&D and operations.
Clinton Health Access Initiative in agreement with American Cancer Society Clinton Health Access Initiative and American Cancer Society Announce Agreement to Expand Cancer Access Partnership. The Clinton Health Access Initiative (CHAI) and the American Cancer Society (ACS) announced the expansion of the Cancer Access Partnership (CAP) to further increase access to lifesaving cancer treatments in low- and middleincome countries in Africa and Asia. The announcement was made alongside the launch of the World Health Organization’s (WHO) new Global Breast Cancer Initiative which aims to bring together partners to reduce global breast cancer mortality by 2.5 per cent per year, thereby averting 2.5 million breast cancer deaths globally between 2020 and 2040.
Vikram Hospital ties up with MGM Healthcare, Chennai Vikram Hospital has tied up with MGM Healthcare,
Chennai
state-of-the-art
to
programme
establish for
a
heart
and lung transplant and contemporary heart failure management. Heart failure services at Vikram Hospital will be led by Dr Ranganath Nayak, Senior Consultant
performed at Vidya Ankur Basti Vikas Kendra, Badarpur, New Delhi recently.
World University of Design, IIT New Delhi, AIIMS launch Mamma Pod garment
Dr KS Satish, Consultant Pulmonologist & Chest Physician, Vikram Hospital, Dr Sunil Dwivedi, Consultant Cardiologist, Vikram Hospital, Dr Padma Kumar, Consultant Cardiologist, Vikram Hospital, Bengaluru, Dr Narendra V Consultant Cardiovascular surgeon, Dr Ravikumar R, Sr. Consultant & Associate Clinical Lead -Cardiology & Heart Failure Program, MGM Healthcare, Chennai, Dr Suresh Rao K G, Co-Director - Institute of Heart and Lung Transplant & Mechanical Circulatory Support and HOD – Cardiac Anesthesia MGM Healthcare, Chennai Dr Girish Godbole, Consultant Cardiologist, Vikram Hospital,
Lung Transplant & Mechanical Circulatory
ITI, Thalamus Irwine work towards ‘One Nation, One Health Card’ concept
Support, will provide expertise for patient
ITI, a state-run PSU under Ministry of
management at all stages, including pre-
Telecom and Thalamus Irwine, Delhi-based
operative, intra-operative, intensive care
AI Firm, under its healthcare platform
and follow-up. The heart-lung transplant
Garuda, have demonstrated a working
team at MGM Healthcare, led by Dr
proof of concept of the technology that
Balakrishnan, has successfully performed
can accelerate the rollout of ‘One Nation,
over 400 heart and lung surgeries to date.
One Health Card’. The demonstration was
Cardiologist.
The
team
from
MGM
Healthcare, under the guidance of Dr KR Balakrishnan, Director, Institute of Heart &
World University of Design, in collaboration with Prof Deepti Gupta at Dept of Textile & Fibre Engineering, IIT New Delhi and Dr Ramesh Agarwal at Neonatology division of Department of Pediatrics, AIIMS have created a miraculous product to sustain the lives of fragile newborns with low birth weight. The product called – Mamma Pod – an Assistive Garment for giving Kangaroo Mothercare – has been selected for the ‘Biotech Product and Process Development and Commercialization Awards 2020’ by the Government of India. Mamma Pod is an ergonomically designed innovative carrier to keep the neonate securely in contact with the mother’s skin, helping the baby to stay warm and supported. As the name suggests, Kangaroo Mother Care or KMC draws inspiration from kangaroos who keep their newborns safely in the pouch whilst carrying out their life activities from feeding to hopping and even sleeping. KMC helps a mother to keep her child in close contact with her and carry on with the multiple chores at hand without feeling the usual fatigue. The path-breaking design allows anyone and everyone to use the garment and is as good in the rural setting as much as it is in the urban setup.
Abbott launches NeuroSphere Virtual Clinic Abbott
announced
the
US
launch
of
NeuroSphere Virtual Clinic, a first-ofits-kind technology that allows patients to communicate with physicians, ensure proper settings and functionality, and receive new treatment settings remotely as needed. Approved by the US Food and Drug
Administration,
the
NeuroSphere
Virtual Clinic has the potential to increase access to optimal treatment for patients suffering from chronic pain or movement disorders who don’t live close to a care provider, have difficulty accessing care, or are unable to go to the doctor because of circumstances like COVID-19.
(L-R) Rishabh Sharma, Founder, Thalamus Irwine, Garuda Blockchain Platform and ILA Bahadur, Executive Director, ITI
www.indiamedtoday.com
15
NEWS ROUNDUP
Apollo Hospitals
Apollo Hospitals achieves feat
contract
The Apollo Hospitals group notched up
US-based
a record milestone with the successful
on TGF-β inhibitors as therapies against
completion of four consecutive MitraClip
cancers and infectious diseases, launched
procedures in one day. The MitraClip
an
implants were carried out on four patients
PulmoHeal + ARTIHealth as a complete
suffering from severe heart failure on
respiratory wellness solution. The AI-app
the same day. This record surpasses
based platform ARTIHealth, developed
Japan, where MitraClip procedures were
by
performed on three patients in a day. Dr Sai
patients to monitor the progress of their
Satish, Senior Interventional Cardiologist,
respiratory function over time by enabling
Apollo Hospitals, Chennai performed the
them to upload daily cough and speech
four procedures. The minimally invasive
recording and receiving feedback on the
Max Healthcare Institute (MHC) announced
method used to implant the MitraClip
health of their lungs. The platform is a
the successful completion of its Qualified
allows repair of a leaking mitral valve
self-assessment and monitoring tool that
Institutions Placement (QIP). MHC raised
without open-heart surgery and is a
provides >90 per cent accurate feedback
Rs ~1,200 crore (approx. $165 million)
lifesaver for patients at high surgical risk.
used for suitable self-care and remote
through its QIP, which saw participation
All four patients, the oldest of whom was
healthcare. This is part of a long-term joint
87 years old, went home walking within 3
development agreement with IBM Watson
from highly reputable global and domestic
days and are currently doing well.
Health Research and Mateon.
Windlas Biotech, Mateon Therapeutics launch drugdevice lung therapy
Wolters Kluwer partners with Cloudnine Hospitals
face value of Rs 10 per equity share for Rs
Wolters Kluwer, Health, provider of trusted clinical technology and evidence-
of MHC stands at 96,59,45,006 equity
Windlas Biotech, an Indian pharmaceutical
16
April 2021
drug
development
and
manufacturing organisation, in partnership with Mateon Therapeutics (Mateon), a oncology
innovative
Mateon
company
drug-device
Therapeutics
will
focusing
therapy
enable
based solutions, announced its association with Cloudnine Hospitals to integrate its clinical decision support (CDS) resource, UpToDate to enhance patient care and quality throughout its group. Wolters Kluwer’s UpToDate will now be available to Cloudnine Group of Hospitals across geographies in India.
Max Healthcare raises ~Rs 1200 crore through QIP
investors. MHC has accordingly issued 6,14,12,482 fresh equity shares of the 195.40 per equity share. Post the QIP, the issued and subscribed equity share capital shares.
Indoco launches Teva Pharma’s ophthalmic drug in US Indoco Remedies has launched Brinzolamide Ophthalmic Suspension 1 per cent in the US, the first generic version of AZOPT by Teva Pharmaceuticals. The product is developed and manufactured by Indoco Remedies for TEVA at its facility in Goa. The ANDA approved by the US Food and Drug Administration for Brinzolamide Ophthalmic Suspension 1 per cent, is used to treat high pressure inside the eye due to ocular hypertension and open-angle glaucoma. Brinzolamide Ophthalmic Suspension 1 per cent works by decreasing the amount of fluid within the eye. The US market size of this product is $184 million, according to IQVIA data as of December 2020.
ActivArmor launches 3D-printed orthopaedic casts The days of the plaster and fibreglass casts for immobilising injured or broken limbs may soon be over, like rotary phones and party lines. With the introduction of 3D-printed, durable plastic casts by ActivArmor, of Colorado, many of the inconveniences of traditional casts could become history, replaced by a range of benefits. ActivArmor is a custom-made
ActivArmor - 3D-printed orthopaedic casts device that form-fits the anatomy: hands, wrists, arms and lower limbs. St Luke’s University Health Network is the first healthcare organisation in Pennsylvania to offer this innovative option, possibly rendering traditional casts obsolete in time.
Vivimed Labs bags approval from Uzbekistan govt Vivimed
Labs
has
received
approval
from
the
Uzbekistan
government
for
two products. The company has received approval for Bilastin tablets, which are used for the treatment of allergic Rhino conjunctivitis and Urticaria, the Hyderabadbased company said in a regulatory filing. Vivimed has also received approval for Orzole combi, which is used to treat gastrointestinal infections such as acute diarrhoea or dysentery, gynaecological, lung and urinary infections, it added.
www.indiamedtoday.com
17
DRIVE
Healthy Granulation How AxioBio Solutions Powered Expansion and Innovation during COVID In 2020, responding to the growing demand for healthcare solutions that align with changing realities and challenges of the pandemic world, Axio Biosolutions made the strategic decision to enter the retail space in India with all its products- wound care and Covid essentials. Here Leo Mavely, Founder and CEO, Axio Biosolutions, talks about the expansion of the company powered by innovation and plans with M Neelam Kachhap
Tell us about your journey so far?
Leo Mavely Founder & CEO, Axio Biosolutions
Have you heard about an Indian company that conquered the world in 10-years of its existence? Well, Bengaluru-based AxioBio Solutions is doing just that. The company founded in 2008, by a bioengineering student in his final years of college has captured the imagination of the entire wound care market. The company’s strength is novel biopolymer and the best thing is that AxioBiosolution has created several high performing medical products based on this platform. This start-up has established offices in Europe and America and has made a name for itself in the wound care market. So much so that giants of the wound care market Smith & Nephew; Mölnlycke Health Care; B. Braun; ConvaTec and 3M are all strengthening their positions to compete with this tiny but impactful company. Given its success, it has gained a slice of funding from the most coveted leaders in the industry. Axio has raised more than $14 million from Ratan Tata’s UC RNT, Omidyar Network, Accel & Chiratae Ventures.
18
April 2021
Our journey began as a single category company that worked mostly on controlling bleeding; servicing the military and surgical departments at the hospital. We were the first company from India to design, develop and commercialise an Emergency Haemostat for trauma care. Axiostat is our flagship product developed to reduce mortality due to traumatic bleeding. Then we launched MaxioCel that is based on Bioactive Microfiber Gelling technology for advanced wound care. We took the leadership position in interventional cardiology procedures, vascular closure market, primarily angioplasty procedures which became one of our major segments. To give you an idea of our leadership, we did about 50,000 closures in a year as compared to 20,000 done by Terumo. We are still a B2B-focussed business in India and what we can proudly say is that we have taken this product to the global market and have performed well. During the last 18 months, our product got approved in 42 countries and more than a billion units of Axiostat have been shipped. We entered Europe with a focus and serve about 10 European countries right now. We have a local team there. Our other focus has been
on the South-East Asia market and it is the second-largest market after Europe for us. Hemostat was accepted well outside India and we are expecting the US launch of the product this year. We are very close to receiving the FDA goahead and we will take this product to the hospital segment there. This was before the pandemic. Our story took a break when COVID hit and most elective surgeries came to a screeching halt. The business went back to zero and but now it is slowly coming back. So the hemostat business is going strong but we asked ourselves is this all we wanted to achieve. That is when our digital business started but I will come to that in a bit. What is exciting for us is the two segments that we worked on and launched in 2019-20. We spent a significant amount of time and effort on advanced wound care and it is paying off now. One of the product is MaxioCel, targeting diabetic foot patients. India is becoming a world diabetic capital with millions of patients needing advanced wound care products every year. MaxioCel fulfils a large gap in the market with its combined hemostatic, pain management and scar improvement properties. It is a Bioactive Microfiber Gelling technology that accelerates healing through quicker granulation. Approximately 15 per cent of people with diabetes are prone to foot ulcers. In fact, out of 50 million diabetic patients, 10 million are having ulcers and one lakh get amputation because of this. One of the major challenges is treatment time. Bring down treatment time for diabetic foot ulcer patients from months to a week.
in this year itself. This is our next product launch globally after Axiostat. Next month we will be launching in the European market. This is our biggest milestone the CE mark. The European market is undergoing a transition from the Medical Device Directive to European regulations on medical devices (EU MDR) and to get CE certification in the middle of all that is extremely gratifying. We are also exploring FDA certification and a US launch early next year. In a nutshell, we are focussed on building integrated play in wound care advanced wound care, by playing to our strength that is biomaterial technology.
in this product segment. Now we are expanding this portfolio into hygiene and wellness product. So from sanitisers and disinfectants, we have moved on to non-alcoholic wipes, skincare, lotions and hand wash; Resist is a Rs 200-crore brand for us. Soon we will launch 10 more SKUs under resist and then take it outside India. Currently, in India 30 per cent of the revenues come from Resist. By next year, we can expect a 3x jump in revenues from this product segment.
What happened to your plans during the pandemic?
Imagine in the previous year, we used to launch 4-5 SKUs and this year we have launched 42, so research and development worked hard to build this segment during the challenging pandemic. This innovation was possible because of our medtech background.
We were limited by the pandemic as everyone else. But we got back on our feet with a lot of learnings ventured into the retail market. We build an independent brand called RESIST+, a hygiene and protection range. We invested half a million dollar in research and development
One of the limitations during the pandemic was the lockdown that brought a lot of sales and supply channels to a standstill. We focussed on direct sales in hospitals and individual doctors. We took the online digital-first policy last year and made sure to have a digital angle, an online store. Now 10 per cent
In the last year, we shipped close to one lakh MaxioCel units in India. The CE approval for the product last month will help Axio with access to the second-largest global market for advanced wound care products. As part of its strategic plans, Axio will soon be launching MaxioCel in 15+ countries in Europe including reimbursement markets with multi-million revenues
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19
DRIVE investor to expand into targeted global markets. The current round is ongoing around so we might have more funds coming into it. The idea is to remain well capitalised before we launch in the US.
Tell us about your plans? Building an Indian brand for the world. In India, we will own the wound care market as we will launch more products that are being developed in-house and in various stages of approval. Post covid, a lot of distributors have shut shop, we believe our next step would be to provide an entire portfolio, end-to-end solutions right from wound cleaning to irrigation healing to post-care the whole spectrum. Through e-comm, we will make these of our domestic sales come from online channels. We also developed clinical marketing and patient consultation for wound care as a one-stop-solution for patients. We do this in stages-free consultation with our product manager in the first stage. Consultation with the vascular surgeon is the second stage, provide doorstep delivery and dressing is the next stage. Doctors take the call on a hospital visit and actually, six out of 10 patients could be managed at home and avoid COVID-burdened hospitals. We ran a pilot in Delhi which was very well received then we reached Bengaluru. We partner with foot clinic and diabetologists and even partnered with online firms like e-pharmacy. This kind of tele-outreach was new to us but we like helping patients with online consult, phone call, and on-call nursing staff. This segment contributes 12 per cent domestic revenues and we will invest more in this to take it to 25-30 per cent of our domestic revenue. We are cautious also as we plan to grow as per demand. We will put more people on the road after March 2021.
Tell us about your pet care segment? We ventured into the veterinary wound
20
April 2021
management space with the launch of the SureKlot range of products this week. The veterinary market is often neglected without any medical products to treat common injuries. We are glad to address this by providing worldclass products to manage bleeding and infected wounds quickly. We were already exporting this product to Europe as we started manufacturing this product about 18-months back. This is a completely new segment in India, as a modern medicine based animal stopbleeding product does not exist. We pilot in around 15 vet hospitals in India and work with veterinarians and pet-parents primarily through our online store and in Ahmedabad, Delhi and Bengaluru. The response has been good because animals need this to not only stop bleeding but also prevent infections. The investment in animal health R&D is less than a crore.
products mainstream. So far, we are only introduced to patients through a doctor or hospital but we are looking at this vast unmet need and diverse patient population majority who do not have access to doctors but will have access to the Internet. So we want to reach out to these group and we already serve more than 500 pincodes in India in 30 states and UT. Due
to
the
COVID
pandemic
and
lockdown, we got a lot of traction online. We work with five military establishments outside India in Europe, Asia and South East Asia. This is more than 10x business that we do with the military in India. Advanced stop bleeding kit is available on Amazon, Flipkart and our online store. True change from B2B to B2C bring us closer to our customers. We ship products directly to clinic and nursing homes. Website visitors
Tell us about your funds?
have gone up by 500 per cent and we
Last year we raised Rs 36 crore ($5.2 million) in Series B-1 round of funding led by Omidyar Network India, along with participation from existing investors Accel, University of California, Ratan Tata’s UC-RNT Fund, and Chiratae Ventures. We brought in the global
reaching customers.
have adopted the hybrid approach to
We
have
recently
signed
a
multi-million euro deal with a large European company that will market our products in western countries. We are looking at more such partners.
COVERSTORY
European Excellence in India How Medicover Global is forging ahead in India
M Neelam Kachhap
www.indiamedtoday.com
21
COVERSTORY
S
ince its foray into the Indian market, Medicover Hospitals has been consistently expanding its footprint while proactively promoting the development of a healthy nation. With the strength of 18 hospitals and 16 fertility centers, Medicover is all set to become the leading healthcare provider in India. “India is the land of great opportunities! Medicover
will bring best-in-class technology, capital, world-class infrastructure, artificial intelligence, and other elite services to deliver quality, process-oriented, patientcentric healthcare in India. This market is all set to witness tremendous growth over the next few decades, and Medicover is rightly positioned to tap into this opportunity,” Fredrik Ragmark, CEO, Medicover Global says.
European Excellence Medicover Global is a 25-year-old company headquartered in Poland, dedicated to improve and sustain the health and wellbeing of the people they serve. The company is known for long-term investment in client relationships, improving access and quality of care, as well as focusing on early diagnosis and preventive measures. Medicover Global operates through two divisions – Diagnostic Services and Healthcare Services, focusing on markets mainly in Central and Eastern Europe and India. Today, Medicover’s Healthcare Services encompasses 117 medical clinics, 20 fertililty clinics, 52 dental clinics, 25 hospitals and 25 gyms; spanning Poland, Germany, Romania, India, Ukraine, and a partner network of more than 2,300 local healthcare service providers.
22
April 2021
India Story Medicover Fertility was the first step in bringing Medicover’s comprehensive range of healthcare services to the Indian market. The company entered the Indian healthcare market in 2016, with $100 million investment in the IVF segment. Medicover was the first single European family-owned organization bringing in 100 per cent investment in healthcare delivery in India. The Swedish family that runs Medicover is the same family that launched the Oriflame cosmetics brand that has a strong presence in India. The family’s values are evident in all aspects of the business, particularly in its relationships with its patients and its employees. In August, 2017, Medicover entered the hospital market in India through an initial investment in Sahrudaya Healthcare that owned the Maxcure Hospitals which had nine hospitals in the region of Andhra Pradesh and Telangana in India. The company initially picked up 22 per cent stake in Maxcure amounting to EUR 13.2 million. In
December,
2019
Medicover
increased its ownership in MaxCure from 49.2 per cent to 53.1 per cent and acquired majority ownership and started to consolidate its business in India. “This is a significant milestone in our development in India where we
“This market is all set to witness tremendous growth over the next few decades, and Medicover is rightly positioned to tap into this opportunity”
now have 18 hospitals and 16 fertility
Fredrik Ragmark, CEO, Medicover Global
In 2020 Medicover’s presence in India
centres. We are excited to welcome such a great team into the group and look forward to driving further growth in coming years,” says John Stubbington, COO Healthcare Services Medicover.
has grown from 11 hospitals at the beginning of the year to 17 at year-end. Today they are present in Madhapur, Hyderabad and in Vizag, Srikakulam, Karimnagar, Nizamabad, Nashik, Nellore,
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23
COVERSTORY
“We are excited to welcome such a great team into the group and look forward to driving further growth in coming years,” John Stubbington, COO Healthcare Services Medicover
Kurnool,
Sangareddy,
Zaheerabad,
IVF cycles are performed. Medicover
In
fertility clinics are among the top
addition, Medicover runs two radiology
fertility clinics there, offering some of
centres and two cancer centres in
the highest success rates in the region.
Chandanagar
and
Aurangabad.
Mysore and Bengaluru. Medicover Medicover
owns
56
Hospitals
Medicover per
cent
India
recognised
the
potential
of
of the Indian market and is dedicated
and
to make this market a focal point to
the company has more than 8000
Medicover’s
employees in India. By the end of 2020,
The company has said that it will
Medicover also had 16 fertility clinics in
continue to invest in this fast-growing
India, mostly located in the Delhi area,
market. The Group has to date invested
where around one-third of Medicover’s
Rs 700 crore in the form of debt and
Source - Medicover Annual Report 2020
24
April 2021
international
business.
“We aim to serve 5 crore population for both outpatient and inpatient services, we are targeting to reach a topline of 2000 crore by 2023 and 5000 crore by 2027” Dr Anil Krishna, Chairman, Medicover Hospitals India equity; and has committed another Rs 300 crore towards upcoming projects. Dr Anil Krishna, Chairman, Medicover Hospitals India says, “We aim to serve five crore population for both outpatient and inpatient services, currently we are serving one crore population. In addition we are targeting to reach a topline of 2000 crore by 2023 and
and Karnataka as well.” Recently, Neeraj Lal, joined Medicover Hospitals
as
Group
President-Telegana,
Senior
Andhra
Vice
Pradesh,
Maharashtra. In an interaction with M Neelam Kachhap he outlines the unique initiatives to increase efficiency and improve patient care.
Medicover Hospitals India says, “We
How do you look at the recent developments at Medicover Hospitals?
will be the leading healthcare chain
Medicover hospitals started two years
in
and
back after the strategic investment
Maharashtra by 2023 and will expand
of Medicover from Sweden and has
our bed capacity from current 3000
expanded in a short time to 18 hospitals
beds to 5000 beds by 2023. By 2027,
spread
we have plans to expand in Tamil Nadu
Pradesh and Maharashtra. We aim to
5000 crore by 2027.” P
Hari Krishna, Executive Director,
Telangana,
Andhra
Pradesh
across
Telangana,
Andhra
Source - Medicover Annual Report 2020
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25
COVERSTORY “We will be the leading healthcare chain in Telangana, Andhra Pradesh and Maharashtra and will expand our bed capacity from current 3000 beds to 5000 beds by 2023” P Hari Krishna, Executive Director, Medicover Hospitals India
Achievements First-of-its-kind OPD centre: Medicover Hospital’s dedicated OPD centre launched in January 2021, is sprawled across 40,000 sq. ft. It is quite the milestone in its category and space. It has been designed to separate the outpatient services from the rush of inpatients that will reduce the risk of infections. A one-of-its-kind destinations for outpatient services in India this OPD is equipped with next-gen amenities and cutting-edge technology. It has 75 OPD consultation rooms, battery operated cars to carry patients from OPD to IPD, and drones to transfer pathology and lab samples to the main reference lab in Madhapur. Also, in efforts to be more eco-friendly, the new OPD centre is striving to be a complete paperless system.
26
April 2021
be in the top three best healthcare
AI cameras to capture the emotions of
company in India by 2022 and bringing
the patients and employees and we also
McDonaldisation of healthcare services
started Asset management application
across all our units. So, the terrain is
for smoothening the workflow and
tough, but I enjoy riding through it.
for better management of the assets.
I worked for Rainbow Children’s Hospital for a period of four years and joined
We also stepped into home healthcare to provide improved accessibility of
Medicover Hospitals last year as Group
healthcare and continuity of care.
Senior Vice President for the group. The
a fascinating journey as the challenges
What were the initial challenges Medicover hospitals faced in India?
in
Out of 18 hospitals, we have five
transition from a child multispecialty to a multinational hospital chain has been both
the
facilities
are
entirely
different.
hospitals in Hyderabad and the rest
How has your journey been for the past six months?
are in Tier II and Tier III Cities and we
The
company
is
going
through
target to take healthcare deeper into the society where there is an actual need for healthcare. We faced a major a
dynamic change as it is on the verge of rapid expansion and structural change. Standardization of the operations and leveraging technology are the major
challenge to get highly qualified doctors in the interior towns. We have acquired some hospitals and build some from scratch.
The major
focus areas as we are moving ahead. In
challenge we faced as we rapidly grew
a journey since I joined, there has been
is of streamlining operations and to
a major drift as we worked towards
connect all the units together to have
strengthening
a standardized system in place. We
introducing
our patient
IT
framework, applications,
are
continuously
working
implementing EMR and working towards
achieving
international
innovative solutions. We have started
healthcare across all the units.
towards
standard
of
Revenue by Country
40% 24% 13%
8% 8% 7%
Photo Courtesy - Medicover Annual Report 2020
Neeraj Lal
What has been your focus since you joined Medicover? Medicover handles various specialties under its umbrella. Be it a multispecialty hospital, a cancer institute, a dedicated women and child hospital, or fertility clinics
and
radiology/
diagnostic
centres. I joined the organisation with a vision to bring McDonaldisation of healthcare across all the units which means when you enter any unit of Medicover, whether in Metro or in Tier II or Tier III, you will receive the same
hospitals on board in a short span of time. The major USP which I feel is that unlike other large hospital chains, Medicover has shown its presence in Tier II and Tier III cities which is the future of Healthcare in India and the metros are already saturated and the actual need of healthcare is in these areas. The doctor to patient and nurses to patient ratios gap is the highest in these places and there has been a big void of quality of healthcare also which, according to me will help Medicover to stay in the business and lead the market.
Achievements South Asia’s first True Beam identity system with fastest Installation of High Energy Linac: Medicover Cancer Institute (MCI), a unit of Medicover Hospitals in Hitech City, Hyderabad,
trust of our patients but also help us
How is Medicover positioned in the market today?
project ourselves as a strong healthcare
Medicover is the second hospital chain
usually takes 6-18 months
chain of India.
in India, after Parkway where foreign
for installation. It is South
investors have their landed money.
Asia’s first True Beam identity
services throughout your journey in the hospital. This will not only build the
The brand has grown many folds since it started operations in India. How do you perceive this growth? There is no doubt that Medicover has expanded in a big way to have 18
We have more than 3000+ beds and a manpower force of more than 8000+ employees and 700+ consultants which
India installed True Beam SVC with FFF, a high energy LINAC in three months which
system and the first machine to have SGRT capabilities.
is one of the largest in India with a turnover clocking around rupees 800 crores per annum which places us in top ten hospitals according to revenue earned.
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COVERSTORY How is Medicover India performing as compared to the other Medicover businesses globally?
Medicover At a Glance
Medicover is one of the most respected healthcare brands in the world with presence in 12 countries across the globe
–
Turkey,
Germany, Belarus,
Sweden, Bulgaria,
Poland,
and
India.
There
are
26
Hospitals, 16 fertility centres in India and Europe and 125 medical centres. In India, we have a chain of 18 hospitals which is governed by Medicover India spread
across
Telangana,
Andhra
Pradesh and Maharashtra.
What are your expansion plans? As a multi super speciality hospital we provide all super speciality services to our patients and community at large. We are majorly known for best recovery and precision care in specialties like interventional thoracic
cardiology,
surgery,
neuro
1995–2020
Georgia,
Hungary, Romania, Serbia, Moldova, Ukraine
25 years of experience,
cardio surgery,
orthopedics, transplant surgeries and
From Poland to a leading international company, present in more than
10 countries From
EUR <0.1m to EUR 997.8m in revenue.
Medicover is a specialised provider of diagnostic and healthcare services, focusing on markets mainly in Central and Eastern Europe and India. The company operates through two divisions – Diagnostic Services and Healthcare Services.
many more. Now we have stepped into home healthcare to reach out to the community at large and hold their hands even after they get discharge from the hospital. It will allow people who require extra care to remain in their
homes,
reducing
the
burden
otherwise shouldered by health care facilities. The services also can be less expensive than these other facilities. We are also working on Teleradiology and transitioning from traditional form of healthcare delivery to a digital one.
How do you see the next five years for Medicover in India? In the next five years, we aim to come in top three healthcare chains in India delivering healthcare of international standards.
28
April 2021
Diagnostic Services
47% share of revenue; 32,387 Co-workers, 104 million Laboratory tests
Healthcare Services
53% share of revenue; <1.4 million Members, 6.7 million Medical visits
OPINION
Healthcare Expenditure and Sustainability sector, which is a boon. Needless to say, this will increase investment in buying better and latest technologies by hospitals and healthcare institutions.
Bhavesh Bhatt Consultant Medifa Healthcare Group and Medtech Industry Veteran
In
recent
years,
healthcare expenditure has been steadily rising in most countries around the world, as it has in India. The government while focusing on increasing total expenditure on health is also looking at ways to sustained public spending on healthcare. Of course, there are many factors that drive up health costs and most of them are rooted deeply in a complex health system we follow. The government today is looking for ways to contain the rise in health care expenditure, without compromising the quality of care. Health and wellbeing were on the priority list in this year's Budget 202122 with the finance minister increasing investment in health infrastructure by 137 per cent. The budget has allocated Rs 64,180 crore for the new scheme under PM Atma Nirbhar Swasth Bharat Yojana over the next six years to advance in primary, secondary, tertiary healthcare and strengthen the existing national institutions. Under the scheme, the government will support rural and urban health and
wellness centres, establish critical care hospital blocks in 602 districts and 12 central institutions, integrated public health labs in all districts and public health units in 11 states. The budget mentioned the operationalisation of 17 new public health units and the strengthening of 33 existing public health units at entry points viz airports, seaports and land crossings. Besides, the budget also mentioned the setting up of 15 health emergency operation centres and two mobile hospitals. Following the COVID-19 pandemic, the medical sector was expecting a reduction in customs duty. However, the finance minister didn't mention anything new and the rates were kept unchanged. It was announced that a revised customs duty structure will be implemented from October 1, 2021, and we hope that the new structure will be uniformly applied across all medical equipment/devices. An increase in FDI in the insurance sector will ensure more investment and better offering, especially for the healthcare
The pandemic has exposed our healthcare system and we witnessed the haphazard purchase of medical equipment like BiPAP, ventilators, ECMO etc. Of course, this was a unique situation as we never predicted the severity of COVID-19. It resulted in a shortage of beds, unavailability of critical medical equipment due to conservative planning. As we are all aware that India has a lower beds/ population ratio, which is below the global average and there is a huge gap between demand and supply. I see that more hospitals can be set up in Tier II and III cities, which can cater to the local/rural population. Last year, we saw most hospitals had to shut down their surgical units thereby increasing the load on their operating rooms. Now with surgical admissions being started, hospitals have to be productive to cater to the huge backlog and existing load. Especially since there is pent-up demand, there is a valid reason to invest in better equipment and productivity-enhancing systems and operating rooms. Technologies like image-guided surgeries or you could say diagnostics in a surgical room will make treatment faster and safer. In my opinion, this will create more opportunities for healthcare infrastructure like well-equipped operating rooms, critical, intensive care units with life-saving medical equipment and advanced diagnostics centres.
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29
ROUND TABLE
The Health Equity Push World Health Day 2021
Assembly, they approved our fiveyear strategic plan for 2019-2023 (the General Programme of Work or GPW13); it includes an ambitious target to see one more billion more people benefitting from UHC by 2023.
Dr Harsh Vardhan
Dr Tedros Adhanom Ghebreyesus
Union Health Minister India
Director-General, WHO
Under the visionary leadership of Prime Minister Narendra Modi, the government has not only fulfilled its duty, by providing relief to the citizens in the unprecedented times of COVID-19 but has also turned the crisis into an opportunity by embarking on a mission to establish an Atma Nirbhar Bharat to further growth and development. A radical improvement in government facilities for the poor rather than only glitzy hospitals for the well-heeled along with the recent moves to lower prices of essential drugs and health equipment are steps in the right direction. The funding for the healthcare sector needs to be stepped up greatly and it has to be ensured that there is equity in the delivery of healthcare.
India and Kenya are just two recent examples.
All over the world, there are examples of countries making bold steps towards universal health coverage:
30
April 2021
I am a firm believer in the right of every person to the highest attainable standard of health. This is what WHO has stood for since its founding. No one should die because they are poor. Universal health coverage is the means by which that right can be realised – it is an achievable goal, although countries follow different pathways to reach it. The foundation of universal health coverage is strong primary healthcare, with a focus on health promotion and disease prevention. I also see an unprecedented political commitment to achieving UHC. The strongest expression of that is the Sustainable Development Goals, in which the governments of the world have committed to achieving universal health coverage by 2030. Finally, it’s what our Member States want. At the most recent World Health
This World Health Day WHO is highlighting building a fairer and healthier world. The focus of the theme of health equity is a value that we in the South-East Asian region have for many years championed through our eight flagship priorities and across all programme areas. Health service coverage in the region is now on average is above 63 per cent as compared with 49 per cent a decade ago. The density of health workers around 70 per cent of whom are women have substantially increased with nine countries now above the WHO threshold compared with six in 2014. The region continues to be rapid in sustained progress against diseases of poverty and marginalisation.
Dr Poonam Khetrapal Singh WHO Regional Director for South-East Asia
In the spirit of this World Health Day let us take every chance possible to identify and remedy preventable social and economic inequities that impede the right of everyone everywhere to achieve the highest attainable standard of physical and mental health. To do this, we must work hand in hand with effective communities and individuals to address the root causes of equities and to implement solutions. We must enhance the collection and use of timely reliable health data that is disaggregated by gender, age, income, education, migratory status and disability among other factors. We must tackle the social determinants of health while also increasing investments in primary healthcare and we must act beyond national borders and strengthen regional and global health security including by working towards a new international treaty for pandemic preparedness and response. I reiterate WHOs’ full support to all countries and partners in the region in their efforts to advance health equity and achieve universal health coverage, the flagship priority and sustainable development goals target that underpins all others. A fairer and healthier region and the world is possible. Together we must dare to be bold and achieve our mission.
Of late, healthcare has attained political significance in our country and in this context, it is worthwhile to understand two concepts related to this. One being 'healthcare equality' means that everyone receives the same standard of care, and the other being 'healthcare equity', meaning everyone receives individualised care that aims to bring the same level of health. India is a country of diverse cultural beliefs and has a highly varying economic status. Providing health equity is a herculean task and the government is trying to address this through various health schemes such as Ayushman Bharat and the state-specific schemes for the underprivileged of the society. Regarding the concept of providing 'health for all,' it is an all-inclusive
Dr Alexander Thomas,
Aishwarya Vasudevan,
President, AHPI
Group Chief Operating Officer, Neuberg Diagnostics
statement wherein the involvement of the individual is pivotal to the theme whereby it attains the status of an eternal endeavour.
More than social, accessibility is a major determinant of health equity. Today, quality healthcare is available in the bigger cities. However, people from smaller towns and villages have to walk miles to get access to even basic healthcare facilities or diagnostics. Infrastructure is not available at remote locations. The problem of accessibility can be solved through:
Therefore, selective involvement of the government and private at different levels of care such as preventive, primary, secondary and tertiary along with the participation of individual citizens is the important key towards ensuring health for all. The COVID-19 pandemic has thrown challenges and has once again brought to the forefront the importance of resilience in the face of disasters. This pandemic has to some extent shown the world the resilience capability of our healthcare system. The selector should learn from lessons, especially over the past year, and ensure that capabilities of resilience are inbuilt into the system to face future challenges.
Healthcare equality encompasses everyone in the country, or the world has equal access to quality healthcare regardless of their income, caste, and creed. The system should appreciate the diversity between different people regarding their beliefs, cultures and lifestyles and should look after their healthcare needs equally.
a. Improved public health policies and investment in public health infrastructure by the government b. A great deal of progress can be propelled through PPPs in healthcare Digital transformation and machine intelligence (Artificial Intelligence or AI) are helping companies to achieve cost-effective medicine and superior health outcomes. Digitisation has allowed us several luxuries including cross consultations between domain experts, accessibility to experts across geographies, using AI tools to make decisions more objective and datadriven. We are running several neuronal networks and AI tools to solve simple problems such as using peripheral smears and CBCs to differentiate between several forms of anaemias to complex problems like diagnosis of genetic diseases. A gene sequencing generates more than 100 GB of data and with the help of AI, it has become
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31
ROUND TABLE easy to screen and analyse this vast amount of data in a matter of time. It is helping the industry in reducing the cost, streamline R&D efforts and time for the clinical trials.
healthcare systems need to strive for the elimination of all systematic differences in health status between groups on the basis of socio-economic status, ethnicity, age, gender and so on.
We are in the digital age and healthcare is at the forefront of adopting these tools, however, one must always remember medicine is an empirical science and not an exact science like mathematics and all digitisation should be done with sure diligence in accordance with clinical guidelines and requirements.
Our health system faces the ongoing challenge of responding to the needs of the most disadvantaged members of Indian society. Despite progress in improving access to health care, inequalities by socioeconomic status, geography and gender continue to persist. This is compounded by high out-of-pocket expenditures which are overwhelming on private households, which account for more than threequarter of health spending in India. Health expenditures are responsible for more than half of Indian households falling into poverty; the impact of this has been increasingly pushing around 39 million Indians into poverty each year.
One of the most important and underpinning principles of healthcare systems in the developed world is based around the notion of equity, whereby healthcare services should be provided solely on the basis of clinical need. However, we have seen that access to, quality of, and outcomes from healthcare are inequitable across a number of clinical areas, including screening for a variety of cancers, surgical interventions and even simple primary care. There is a huge urban and rural disparity in terms of reach for basic healthcare needs. It is a fact that the groups that require the highest levels of healthcare need receive the lowest levels of service. That is our greatest tragedy. By striving for a goal of ‘equity in health’,
India accounts for a substantial part of the global burden of disease, with 18 per cent of global deaths and 20 per cent disability-adjusted life-years One-fifth of maternal deaths and one-quarter of child deaths in the world occur in India. While health outcomes have improved over time, they continue to be strongly patterned along dimensions such as gender, caste, wealth, education, and geography. There is no better time than now to correct this anomaly but do we have the will is a million-dollar question!!
Dr Prem Nair Medical Director, Amrita Hospitals, Kochi Healthcare professionals should play a major role in seeking to improve health outcomes for disadvantaged populations and this requires a systemwide, leadership-driven priority. They should adopt non-medical vital signs to screen non-medical factors influencing health and guard against the potential for bias in medical care. It is crucial to have 100 per cent of the population covered by some form of health insurance.
In today’s scenario, equality in the healthcare ecosystem talks more in terms of affordability and accessibility to all, however, in reality, both aspects are available at the bare minimum.
Dr Naresh Shetty, President, Ramaiah Memorial Hospital
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April 2021
Health inequalities are unfair and avoidable differences in health across the population and between different groups within society. These inequalities arise because of the conditions in which we are born, grow, live, work and age.
Most of the private and government
Examples of social determinants of health are income level, educational opportunities, occupation, workplace safety, gender inequity, racial segregation, food insecurity, social support, crime, non-availability of transportation, lack of safe drinking water, air pollution, lack of recreational facilities.
accessibility of good hospitals, good
hospitals are found extensively in urban and metro cities and 80 per cent of the treatment procedures are done in these locations. When we look at tier 1 or tier 2 cities, there's a huge gap seen in the consultants and also the affordability of these services, which needs to be bridged. To an extent it can be resolved by providing the right knowledge about the importance of health insurance, preventive health check-ups at regular intervals
and
thereby
making
it
Social determinants of health equity
a single platform where the patient
should be based on the demographic
has the choice of location, procedure
or
on
and consultants and to avail other
the different level of income group.
healthcare services. Once this platform
Population working in the corporate
is introduced, a lot of fair treatment will
sectors does enjoy the benefits and
be available, fair pricing, affordability
cover all the insurance to secure the
and it will see transparency in the
employee’s family but people who don’t
healthcare system. This will give a clear
have a consistent revenue source, who
picture of what patients can afford and
are depending on daily wages, find it
what are comparative charges in other
difficult to maintain a similar level of
hospitals. This will help the government
health equity. This can be dealt with, to
to
some extent, through OP insurance and
affordable for the patients and curbing
a mechanism of enrolment through a
the premature death of a patient.
geographical
presence
and
regulate
the
costs,
making
it
Sandeep Kumar
walk-in.
CEO, BGS Gleneagles Global Hospital
We are witnessing a revolution in
in the healthcare sector is by bringing
other sectors, now it’s the time for
transparency and visibility, by putting
the
integrate
a monitoring mechanism, introducing
government or private hospitals, all
government principles and an audit
the consultants and bring them into
mechanism.
affordable coverage
through to
avail
proper the
financial healthcare
services based on the requirement.
healthcare
The best way to make a transformation
sector
to
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33
APPROACH
Making Health Equity a Strategic Priority How to prioritise the allocation of the resources to the most eminent tier of the healthcare structure
Rachita Ota Academician Amity University
India, next only to China in population, faces the herculean task of not only feeding and clothing its teeming millions but also in providing adequate healthcare to all. Although, giant strides have been taken by the government in this direction to overcome the problem of healthcare, yet they all seem inadequate when it comes to high-end health facilities for the poor and those people living in far off and remote villages. The poor cannot afford it and for those in far off places, it is inaccessible due to poor connectivity. India is divided on its opinion on several issues, and so also in healthcare. This too is unequally distributed. Here too as per our research, it is based on affordability, gender, accessibility and finally caste. In the urban areas, this is
34
April 2021
mainly affordability that matters. In the rural areas, the discrimination is genderbased, which means men receive more priority over women when it comes to nutritional food, education, and finally better healthcare facilities. Next is the caste of the person. Even today, rural India is highly caste-based where the society is divided into watertight compartments of high caste and low caste or worse may be the problem of untouchability that persists and plagues the lives of people. Finally, we have the twin problems of unavailability of primary healthcare centres and lack of accessibility to the nearest healthcare centre or district hospital. The proposed framework consists of five major dimensions which revolve around the basic determinants which
can be used to measure the performance of healthcare organisations based on health equity. The dimensions were: • Making health equity a strategic priority • Develop structure and processes • Strategies meant for different determinants that play a major role in influencing the healthcare demand in India; • Decrease in institutional racism; • Develop a partnership with a community organisation. Although there is no dearth of good hospitals, healthcare centres and clinics are spread everywhere, but the question is how many of India’s urban poor can afford it. They finally rely on the government hospitals where the apathy of doctors and paramedics puts their lives at risk and chance. Hence, it has been mandating for the government to make health equity a major concern and their strategies should revolve around the same. The government has tried its best to bring facilities into the system by providing a proper flow of funds in the sector. Hospitals may have
facilities like laboratories, labour rooms and also blood banks but are they functioning properly? In many cases, the labour rooms are used as storerooms, laboratories are left unused and uncared for and all the testing that could have been carried out there are diverted to private testing laboratories. So is the case with blood banks which also are used for purposes other than they should be. Hence, how to ensure proper healthcare? Can there be a monitoring agency that can look into the affairs of the health centres, the inadequacies they suffer from, improper use of existing infrastructure and proper utilisation of equipment etc?
for the poor under certain schemes. But
Due to poverty, the urban poor can ill afford the cost of treatment in reputed private hospitals and as stated above the primary health centres and government hospitals that are there do not function that well. In the case of health equity, despite certain steps by the government, the condition is far from satisfactory as the poor continue to suffer from the lack of proper treatment due to poverty.
this lack of proper hygiene that leads to
The government has ensured funding
ensure its success.
due to the lack of proper awareness, this facility remains unutilised. Other than the economical factors, there are many social factors, which have acted as great hurdles in the path for health equity. These factors range
from
various
socio-economic
aspects to behavioural aspects which can only be taken care of by bringing proper community participation and involvement and for this, we need to change the mindset of people towards health and hygiene. The scene in rural areas is even worse considering the poor personal hygiene practised. It is a high level of infant mortality rates in villages. This has been a major challenge for healthcare officials to combat. How about roping in the corporates for such CSR activities wherein the corporate and the poor can benefit from such schemes. This way the government can
undertake
such
ambitious
programmes through the PPP mode and
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INTERVIEW
Looking Ahead Why history suggests COVID-19 is here to stay By Anthony King
A mysterious flu-like illness that caused loss of taste and smell in the late 19th century was probably caused by a coronavirus that still causes the ‘common cold’ in people today, according to Professor Marc Van Ranst at KU Leuven in Belgium, an expert on coronaviruses. Prof. Van Ranst is involved in two EU-funded projects: MiCoBion – Microbial Communities in Biomedical and Environmental Areas, and Systems Biology, as well as HONOURs, a training network on host switching pathogens, infectious outbreaks and zoonosis. He says that the foothold of the SARS-CoV-2 virus in the human population today means it is likely to follow a similar pattern and become a continuously circulating, or ‘endemic’ virus, joining four other human coronaviruses that infect people with common cold symptoms.
Could you tell us about your work showing that a coronavirus called OC43 may have caused the ‘Russian flu’ pandemic of the 1890s, which spread from St Petersburg across Europe to the US?
“All the ingredients are there to have this virus become an endemic coronavirus.” Prof. Marc Van Ranst, KU Leuven, Belgium
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April 2021
Yes, the first study was in 2005. We redid the genetic analysis (of OC43 evolution) to see at what point the bovine and the human viruses started to diverge (which indicates OC43 jumped species) and we found exactly the same date (as the Russian flu epidemic). Even at the time people were debating about the cause of this weird flu, though they
did not even know about viruses. But it was striking even then that this might be something different. In recent months, journalists have searched through archives and, especially in Russia, they found old newspaper articles with references to the loss of taste and the loss of smell, which is definitely not characteristic of an influenza pandemic (but is a symptom of Covid-19). It fits with a coronavirus origin for this pandemic too. This wasn’t a pandemic with a clear beginning and end, and it probably lasted a fair number of years.
Is there a way to be certain that a specific coronavirus caused the 1890 pandemic? There is no doubt that it was caused by a virus. I don’t think we will be able to recover the virus from corpses frozen in the permafrost, which is what we were able to do for victims of the Spanish flu in 1918. The timeframe for the 1918 pandemic was short, while the Russian flu was much wider and people would have died for other reasons too. But if someone is patient enough to try, then I hope someday someone will find more evidence. It won’t be easy. If I had time, I would love to dig into the archives myself.
What has happened to the virus that likely caused this 19th-century pandemic? OC43 is still around. It is now responsible for common colds, albeit the more severe common colds. And probably in some elderly people it can lead to severe illnesses. We might want to look more for OC43 in weird pneumonias in the elderly. This is because before last year, if an elderly person had pneumonia, only in a university hospital would they have been tested for OC43. A person could have been sick from it in intensive care in a local hospital but they would never know. Now though, we are extremely motivated to hunt for coronaviruses in the elderly. These coronaviruses are not a major cause of mortality, but elderly
people can die from them. SARS-CoV-2 is now the most intensely studied virus ever. These other viruses received far less attention.
Did the four coronaviruses we now associate with the ‘common cold’ likely cause epidemics or pandemics in the past? I am sure they did, though we will never know if they caused a pandemic or a series of rolling epidemics. It depends on how linked to the outside world was the place where it jumped from an animal to a human. Hundreds of years ago it might have taken a while for a new virus to travel around the globe. But if we had a coronavirus outbreak 200 years ago, it might be seen in the historical records, as even then people would notice if elderly people started dying in droves.
We have had SARS, then we discovered Middle Eastern respiratory syndrome (MERS) virus and now SARS-CoV-2, all lethal coronaviruses that jumped from animals to people. Can we expect more of them? I think we are detecting them more frequently. I am sure that incidences like this happened all the time and we did not notice them. If some of these outbreaks, like SARS in 2003, happened one hundred years ago, then it would not have been noticed. It would be a local outbreak. These coronaviruses were little studied for a long time. In 2003, we were the first to sequence OC43, which is one of the most common cold viruses and yet had not even been sequenced.
What is the future for the SARS-CoV-2 coronavirus likely to be now? The virus is now present in both hemispheres and has had successive waves of infection. All the ingredients are there to have this virus become an endemic coronavirus that might be
around for hundreds of years. More and more people will become immune to the virus, and the chances are that this will become a disease that you encounter when you are a child, and the rest of the population will have some antibodies against the virus and not become as sick. Children do not mount an exaggerated immune response to the virus, but that is what can happen when you get older. That is one reason elderly people may remain vulnerable to this virus.
What can we learn by looking at the 1890s pandemic or the Spanish flu pandemic of 191819? The first thing we learnt is that we didn’t learn a lot. Because a lot of the things that we did in 2020 were the same as what they did in 1918 – social distancing, wearing masks, quarantining, travel restrictions. Yet we had to almost relearn to take these measures. We are now better at detecting a pandemic. Also, the vaccines have been developed at a speed that would not have been possible even a few years ago, especially the messenger RNA vaccines. But even though we are better equipped to detect the pandemic, and at developing vaccines, it still has created havoc.
After the COVID-19 pandemic, will coronaviruses attract much more attention from scientists? After the SARS outbreak in 2003, coronaviruses got a lot more attention and that is how we found the other coronaviruses (MERS, and two endemic coronaviruses that cause common colds, HKU1 and NL63). Coronavirus research and virology, in general, will get a boost after this pandemic but it will only last a couple of years and then wane. For pandemics, we will be better prepared for the next ten years, but then people will be pensioned and move on, and the collective memory will be lost. This article was originally published in Horizon, the EU Research and Innovation magazine
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FEATURE
A Leaking Pipeline Addressing gender inequities in medical leadership
third) of female full-time faculty. Historically, medicine has been a maledominated field. Increasingly, over the past decade, shifting perspectives on gender in the workplace has emerged. Perhaps on the wing of worldwide movements such as #TimesUp and #metoo, the spotlight on gender inequity is becoming ever more visible. November marked the historic win of Kamala Harris, who is the first Black, South-Asian female to become a vice-president elect in the US. But while the political glass ceiling has begun to shift, has medicine kept pace in addressing gender inequities?
Nathasha Dias Family Medicine Resident, University of Toronto
“Are you married?” That was the first thing Michelle Cohen heard on her first day of training with a surgeon. “As soon as I walked into the OR to introduce myself … it was an older doc and he turned and looked at me and his very first question was ‘Are you married?’ He continued to pester me on that,” says Cohen, a family physician from Brighton, Ontario, and faculty member in the Department of Family Medicine at Queen’s University. Gender discrimination is a frequently cited culprit for inequity in the workplace. Based on 2019 US data, approximately one in four female staff in the departments of anesthesiology, emergency medicine, orthopaedic surgery and general surgery reported experiencing disrespect based on their gender. Two of these departments (orthopaedics and general surgery) were also among the departments with the smallest proportion (less than one
38
April 2021
Interest in pursuing academic medical leadership is often cultivated during medical training. Despite a continuing trend of more women than men enrolling in Canadian medical schools – 56 per cent of first-year medical students in 2017-18 were female – fewer women advance in their careers to hold academic leadership positions. During her training, Lesley Barron, a general surgeon who practiced at Georgetown Hospital in Halton, Ontario, says, “There were only two female surgeons, a vascular and a general surgeon, and another one joined in the time that I was doing my surgical training in Canada, and none of them were married or had children. They certainly weren’t supportive of female trainees in terms of acknowledging that there was a gender bias, or that it was harder for women trainees to get through training.” Much of the existing data on gender inequities in medical leadership stems from the US. In 2018, the Association of American Medical Colleges (AAMC) conducted a survey among 154 US medical schools and found that despite a progressive rise in the number of
female department chairs over 10 years, women only made up 18 per cent of all department chairs. Within cohorts of both new assistant and associate professors starting in 2008-2009, a greater percentage of men than women advanced after seven years. While there is fewer data available in Canada, it is known that out of the 17 Canadian medical schools, five had female deans in 2020, up from two in 2017. The obstacles are multifaceted and complex. They include gendered expectations and implicit biases on women’s perceived merit and capabilities. Cohen, who has published work on the Canadian gender pay gap in medicine, wrote about her encounter in a blog post. “I remember he (the surgeon) gave us this long lecture about the problem with lady doctors: ‘The problem with lady doctors is your standards are too high. You think because you’re so educated and accomplished that no man is good enough for you and you end up unmarried and having to go through fertility treatments because you wait too long to have babies,’” she says. “There is absolutely no way he would have spoken to a male trainee that way.” A survey about gender equity in medicine that involved 431 respondents ranging from Canadian medical students to physicians indicated that 69 per cent of female respondents agreed with the statement that gender plays an important role in determining future career opportunities. Only 33 per cent of male respondents agreed.
A leaking pipeline is an analogy used to describe the loss of women leaders somewhere along the journey toward their leadership goals. “There are these pipeline pathways to become a physician-in-chief at a hospital, to become a CEO, to become a dean,” says Lisa Richardson, a general internist at University Health Network who holds several leadership appointments including vice-chair of culture & inclusion the University of Toronto’s Department of Medicine, strategic advisor in Indigenous health for U of T’s Faculty of Medicine and strategic lead in Indigenous health for Women’s College Hospital. “In fact, you have to have done all of these other jobs beforehand. So, there’s all of this planning that has to go into it … and nobody knows about that. How do we make explicit those pathways? Because it’s not appropriate that they’re just within certain circles or known by those that are chosen. It needs to be transparent.” Richardson says she did not have the same access to leadership as her male colleagues during her training. “And I’m not sure why … I thought about why I was never encouraged, for example, to apply for a teaching medical residents initiative. I looked back at my (evaluations) and they were really good and I was always wondering, why? I thought, maybe it was because people thought I wasn’t interested because I
had my kids.” Family medicine is recognized as being among the most flexible specialties when it comes to work-life balance. Interestingly, Canadian Institute for Health Information data from 1978 to 2019 show that women have consistently represented a larger portion of family physicians compared to specialists. In 2019, 47.5 per cent of family medicine physicians were female while 38 per cent of specialists were female. The historically female burden of household responsibility perhaps explains why there are fewer women in surgical specialities, and accordingly, fewer women in positions of academic leadership within those specialties. The AAMC reported that departments with the most full-time female faculty in 2018 were similar to specialties with the most female residents, including obstetrics and gynaecology (64 per cent female residents), paediatrics (58 per cent female residents) and family practice (51 per cent female residents). Meanwhile, among the specialities with the fewest women in positions of academic leadership were surgery and orthopaedic surgery. “We aren’t yet at the point where men can breastfeed. There are certain realities that are gender-based,” says Batya Grundland, who is a family physician and obstetrical care provider
Furthermore, trainees of diverse specialities have been shown to regard female physician instructors as less able as educators. Ultimately, implicit biases against women can contribute to low confidence and self-doubt and can adversely impact upward mobility. The gender equity survey showed that 54 per cent of female respondents felt they received less recognition than their male colleagues for the same work compared to just 13 per cent of male respondents feeling the same way about their female colleagues.
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FEATURE broad search, making sure search committees represent the diversity of the population, making sure we address unconscious bias as well as conscious bias, making sure that we have a standardised process in the questions that we use so that we don’t ask different candidates different questions (…) providing opportunities for informal networking, in particular, with senior people who may be good role models.”
at Women’s College Hospital as well as the associate programme director in curriculum and remediation in the Department of Family Medicine at U of T. “When I was on maternity leave with my third child, I had about three job offers for different leadership opportunities … and I had to say no,” she recalls. “I had to call my chief and ask them, ‘Are they ever going to offer me anything again?’” One area of improvement involves addressing the deficiency of Canadian data. Barron, who formerly sat on the board of the Ontario Medical Association and the Physician Payment Review Board in Ontario, says, “Data is power. When you don’t value something and don’t want to correct these problems, you don’t research it. “Lack of data is a way of the patriarchy suppressing this issue when you don’t release: ‘Well, how many women are there in leadership?’” Barron says institutions need to ensure that there is an adequate female representation at leadership tables. “It’s a circle of women not being at the table to demand the data is collected,” she says. “We haven’t seen men who are willing to step back at these leadership positions to make space at tables.” She says a potential solution is term limits. “You shouldn’t be able to hold the same leadership position for eight, 10, even 20 years.”
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Sharon Straus, geriatrician and clinical epidemiologist who also serves as physician-in-chief at St. Michael’s Hospital and director of the site’s Knowledge Translation Program, says the paucity of Canadian data is systemic. “Partly it’s because of the way we work in Canada – that as academics, for example, we are not employed by the universities. I’m based at St. Mike’s and we’re considered self-employed. We don’t have data even across all of our academic hospitals.” While research in the area is limited, in a qualitative study in 2018 on the organizational impact of gender bias involving faculty members at the Department of Medicine at U of T, Straus and her colleagues found that participants described reinforced stereotypes, unprofessional behaviours and social exclusion as consequences of an identified gender gap on organisational effectiveness and workplace culture. One improvement discussed in the study involves revising processes of recruitment, hiring and promotion. “A lot of what we found in our work was that jobs just get created for people,” Straus says. “Women are less likely to be a part of informal networking so then they might not have jobs created for them. “So, it’s about having explicit job postings, making sure there’s a
Working from the ground up to ensure that female trainees are well-supported by their mentors may also help mitigate these gaps. Elaborating on her role as a mentor, Grundland says, “The leadership trajectory for women, whether justifiably or not, tends to be different from men. I’ve had women mentors who have reminded me of this—that often, when we are in the peak of our childbearing years, for many of us our productivity goes down, the amount of leadership we take on goes down. When that’s done and our kids get older, we tend to move forward and excel (…) I’ve had that reassurance and I try to remind women of that.” Richardson says more diversity needed in academic appointments.
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“Diversity of all kinds is important around leadership tables,” she says. “We know that if one looks to the bottom line, for example, in the business sector, more diverse boards have a better bottom line in terms of productivity. “In the academic sector, diverse departments have increased productivity based on all of the metrics, like grants and publications. To create inclusive policies and environments for people to feel a sense of belonging, having representation is really important at the senior level – not only to influence decisions that are made but also so that others can see themselves represented in those senior roles.” Richardson adds a final thought: “We need to be more intentional with mentorship, with transparency and with pipeline development and understand the specific barriers that women face, and in particular, women from underrepresented groups face… and focus on building that work.”
PULSE
Achieving Healthcare Equity in Dialysis Care Vikram Vuppala, Founder & CEO, NephroPlus talks about what it takes to maintain equity in dialysis care The state of End-Stage Renal Disease
Vikram Vuppala Founder & CEO, NephroPlus
(ESRD) is alarming and according to estimates, about 1.4 lakh patients are on dialysis in India, currently. However, this is only 15 per cent of the 10 lakh patients who need kidney failure treatment either dialysis or transplant. Due to financial constraints, around 85 per cent of the patients currently cannot access the treatments available. The incidence of kidney failure is roughly 232 PMP (Patients per Million) as per studies conducted by Dr Vivek Jha and Dr Modi (Nonmedical Factors and HealthRelated Quality of Life in CKD in India). This roughly translates to an addition of more than three lakh new patients per year entering the system. On the other hand, kidney failure impacts both the affluent and the poor in similar ways contrary to the belief that it affects the rich more. Various studies have shown that diabetes impacts roughly the same way regardless of the socio-economic status. Also, there is no direct linkage to geography being a factor in kidney failure statistics. We are currently operational across 145 cities in 22 states.
Current State of Dialysis Care in India Until 10 years ago, dialysis was only available in the top 10 cities. With the advent of new dialysis networks, accessibility vastly increased in the last decade and it may be noted that our dialysis centres are present across 75+ cities. Though the government has made an impact by going in for a few statelevel PPPs (Public-Private Partnership projects), a lot more needs to be done
to make the system more accessible. It is hard to fathom that dialysis is not available in more than 25 per cent of district headquarters in the country. Further, private sector dialysis centres still accounts for a vast majority of dialysis capacity ~75 per cent of the capacity) in India. Though during the last five years, we have seen PPPs happening in this space, unfortunately, many public hospitals end up buying expensive dialysis machines through tenders, only to realise later that the machines require efficient manpower and operational facilities, leading many of these machines to lie idle in the storerooms. Geography-wise, the north-eastern part of the country has a very low capacity even now. We are working hard to improve the scenario where we opened the first centre in Guwahati a few months back and hope to launch more centres to improve access in the North East.
Breaking the Socioeconomic Barriers We have the same clinical backbone regardless of the type of project we executes. For example, apart from running dialysis centres of Max, Medanta, Fortis and Ruby Hospitals, we are also in PPPs with a few state governments. With the clinical backbone remaining the same, valueadded services and infrastructure vary depending on the type of facility. Each cluster of NephroPlus has a dedicated quality manager whose job is to audit the facilities each month and ensure that the quality is not compromised.
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Whether the centres are in Guwahati or Alappuzha or Srinagar, efficient quality managers ensure that the overall system runs efficiently.
Achieving Healthcare Equity We strive very hard to improve healthcare equity. We are working with hospitals across the country regardless of the location to partner with us to ensure standardisation of care and clinical outcomes. We are also working with the government authorities to ensure that dialysis providers are accountable for clinical outcomes. This is a sensitive healthcare procedure wherein if outcomes are not measured and clinical excellence is not strived for, many patients can get cross infected with Hepatitis C, Hepatitis B and HIV infections. We measure various clinical data points and one key measure of how we benefit the patients is by our decreased mortality rate as compared to other markets in India. The average life expectancy of our patients is close to two years while this number is ~1.25 years in the overall market. Another measure of benefit to patients
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is the massive reduction of crossinfection rates in our network. We have a close to zero cross-infection rate due to our standardised stringent protocols. On the contrary, roughly 25 per cent of the patients overall in India get cross infected post-dialysis in a year.
Key factors to achieve nationwide health equity The three key factors, according to me, to achieve nationwide health equity are • Publishing of clinical outcomes by all service providers NephroPlus publishes clinical outcomes every year in national and international nephrology conferences. We have published manuscripts in international journals. The government should mandate all providers to publish these outcomes so that patients will receive appropriate standards of care in India and gain healthcare equity. • The government ensures clinical quality as key criteria in PPP projects The government currently focuses on L1 (lowest cost) in PPP tenders and does not make providers accountable for inferior clinical outcomes. It is high
time that the government authorities bring objective clinical outcomes as a measure of quality and penalise inferior providers in PPP projects as scores of people are vulnerable to get cross infected or dying due to lack of attention to clinical protocols among service providers. •
Improvement of dialysis pricing
We all know that quality comes at a cost. The government should make dialysis pricing sustainable in India. The Central Government Health Scheme has not increased dialysis pricing for the last six years. For example, the Telangana Aarogyasri scheme has not increased the price for dialysis for the last 11 years.
The Future The Government of India and various state governments have to play a key role to positively change the access of dialysis across the country and also ensure basic quality is provided to patients. Maybe, sometime in the future, every patient with kidney failure anywhere in India can get access to basic quality dialysis. We are all hopeful.
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https://www.mcafee.com/enterprise/en-us/assets/reports/restricted/rp-carr-wfh.pdf https://www.mcafee.com/enterprise/en-us/assets/reports/restricted/rp-carr-wfh.pd Source: https://www.darkreading.com/cloud/as-cloud-adoption-grows-dlp-remains-key-challenge/d/d-id/1335000 https://newsroom.ibm.com/2020-07-29-IBM-Report-Compromised-Employee-Accounts-Led-to-Most-Expensive-Data-Breaches-Over-Past-Year https://www.gartner.com/smarterwithgartner/is-the-cloud-secure/ https://media.nominet.uk/wp-content/uploads/2019/02/12130924/Nominet-Cyber_CISO-report_FINAL-130219.pdf
8 https://www.mcafee.com/enterprise/en-us/assets/reports/rp-cloud-adoption-and-risk-report-work-from-home-edition.pdf McAfee and the McAfee logo are trademarks or registered trademarks of McAfee, LLC or its subsidiaries in the US and other countries. Other marks and brands may be claimed as the property of others. Copyright © 2020 McAfee, LLC. 4619_0920 SEPTEMBER 2020
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