IndiaMedToday Dec 2020 by IndiaMedToday

DECEMBER 2020, VOLUME 4 ISSUE 12 `200 INDIA MED TODAY

PERSPECTIVE: 2020

A YEAR OF UNPRECEDENTED CHALLENGES AND NEW LEARNINGS

DECEMBER 2020

INTERVIEW Jatin Mahajan, MD, J Mitra & Company

APPROACH We need these two policies to drive our recovery from COVID-19

OPINION MBBS Online

HEALTH-IT Lurking cybercrime in healthcare sector

EDIT NOTE www.indiamedtoday.com

December 2020 EDITORIAL Editor Neelam Kachhap

BOARD OF ADVISORS Dr Alexander Thomas Dr Girdhar Gyani

Sub-Editor

Dr Prem Kumar Nair

Sanjiv Das

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editorial@

Dr Alok Roy

indiamedtoday.com

2020: Year of Unprecedented Challenges and New Learnings

Ramesh Kannan

This year by far had been the most unexpected and eventful for us in the healthcare industry. That 2020 has been game changing for some is an understatement. How else do you

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CONSULTING EDITOR Dr Libert Anil Gomes Dr Salil Choudhary

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explain the development of COVID-19 disease testing and management capabilities around the world. Thinking of the same time last year, as the curtain came down

Gunjan Chauhan

on 2019; can you think of even one moment that can be so life

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altering? Who would have thought of this new and changed

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world. Here we were on the cusp of the new decade, but instead of moving forward we just stopped. The world as we know it just took a break. The lockdown, travel restrictions and interrupted trade flow has impacted all of us. Be it a nurse, doctor or an administrative assistant, all of us have stories to tell. Some of these stories are scary, some reflect the never-ending endurance of the human nature but most of these stories are about kindness, hope and resilience.

Throughout, this year we have shared these amazing stories with you. We have kept you abreast with the daunting challenges our industry faced and the innovations that helped them. With this current issue we bring to you more such stories; experiences and learnings from industry leaders across India. We also bring you a comparative perspective on the vaccine development highlight for COVID-19 and a look at the policy initiatives that could help us get through post-COVID era. The next issue, Jan 2021, focuses on the challenges and learnings in the radiology and imaging world. Looking forward to the insights from world renowned radiologists and leaders and practicing radiologist in India who will outline the upcoming trends in this field.

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.

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Editor M Neelam Kachhap

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DECEMBER 2020

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CONTENTS

Facebook

12 16

INTERVIEW

OPINION

PULSE

Innovation and business foresight are important for the survival of any business

MBBS Online

Oxford-AstraZeneca Vaccine is Cheaper than Pfizer’s and Moderna’s and Doesn’t Require Supercold Temperature

18 COVER STORY

Perspective: 2020 A Year of Unprecedented Challenges and New Learnings

UPFRONT

03 Editorial 06 Letters 07 News roundup www.indiamedtoday.com

CHECKIT OUT ONLINE

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LETTERS

ccording to the World Health Organization, currently, there are 422 million people battling diabetes globally, and India has the second-highest number of diabetes patients in the world. Treating diabetes requires a multidimensional approach. To prevent people from developing diabetes, it is crucial to inform the pre-diabetic population about the right lifestyle options to keep blood sugar, lipids, and blood pressure under control. This year, World Diabetes Day and Diwali fall on the same day. At Siemens Healthineers, we are making a conscious effort to support India's medical professionals, who call for a "Blue Diwali" to spread awareness on diabetes amidst the pandemic. With so many diabetics undiagnosed, understanding the risk factors, the symptoms, and the long-term impact is a crucial first step toward making communities in India and around the world healthier. Gerd Hoefner, Managing Director, President , Siemens Healthineers

India has a huge diabetes epidemic. The number of people with Type 2 diabetes is escalating in both the urban and rural areas of the country with almost 60% of Asians reported having diabetes or pre-diabetes by age 60. While we have seen a focused effort to teach people about Type 2 diabetes in the last few years, awareness about Type 2 diabetes or juvenile diabetes is still largely lacking. As a lifelong condition, families of affected children must be taught about daily glucose monitoring, timely insulin injections, and screening for complications. We should also counsel them on the psychological fallout and the need for emotional support. As it cannot be prevented or cured, the responsibility for educating families on the management of juvenile diabetes lies with the healthcare community and the government. This diabetes day we must also thank our nurses, who have been an essential part of our prevention and management strategies.

As the whole world is under the right grip of Covid 19, pneumonia

Dr Altamash Shaikh, Consultant Endocrinologist and Diabetologist, Saifee Hospital

Dr Vasunethra Kasaragod, Consultant Chest Physician, Vikram

has yet again attained the centre stage. Pneumonia is infection of the lungs and can be caused by various organisms that include viruses, bacteria, fungi and protozoan; the most common route of infection being inhalation. Patients have fever, cough with yellow or brown coloured sputum, breathlessness and tiredness as common symptoms. Early medical attention and diagnosis is imperative for early recovery. Patients are treated with antibiotics, oxygen and nebulisation most of the times. Itâ&#x20AC;&#x2122;s more common among immuno compromised individuals like diabetics, chronic kidney and cardiovascular disease patients etc. Hence keeping these diseases under control is necessary to prevent pneumonia. Vaccination against flu and pneumococcus is helpful to prevent severe infections.

Hospital, Bengaluru.

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December 2020

NEWS ROUNDUP One crore frontline healthcare workers to receive vaccine in first phase

Commission (UGC), according to the AYUSH ministry.

An estimated one crore frontline health workers will receive the first dose of COVID-19 vaccine whenever it becomes available, with around 92 per cent of government hospitals and 55 per cent of private hospitals across all states and UTs providing data identifying the workers, official sources told PTI. Five vaccine candidates are in advanced stages of development in India, out of which four are in Phase II/III and one is in Phase-I/II trials. States have been asked to accelerate the process of identifying frontline healthcare workers including doctors, MBBS students, nurses and ASHA workers etc, so that the exercise gets completed in another one week. It has asked states to do planning and mapping of vaccination sessions where healthcare workers will be vaccinated during the first phase and mapping human resources across departments that could be deployed for vaccination sessions for verification of beneficiaries, crowd management and overall coordination.

WHO to set up global centre for traditional medicine in India The World Health Organisation (WHO) will set up a Global Centre for Traditional Medicine in India. WHO Director-General Tedros Adhanom Ghebreyesus announced in a video message at an event in which Prime Minister Modi inaugurated two future-ready Ayurveda institutions in Jaipur and Jamnagar via video conferencing on the occasion of the 5th Ayurveda Day. The Institute of Teaching and Research in Ayurveda (ITRA), Jamnagar (Gujarat) and the National Institute of Ayurveda (NIA), Jaipur (Rajasthan) are both premier institutions of Ayurveda in the country. The Jamnagar institute has been conferred the status of an Institution of National Importance (INI) by an act of Parliament and the one at Jaipur has been designated an Institution Deemed to be University (De novo Category) by the University Grants

Manipal buys Columbia Asia lock, stock and barrel Bengaluru-based Manipal Hospitals based multi-speciality healthcare providers, today announced the acquisition of Columbia Asia Hospitals. The transfer of ownership to Manipal Hospitals is expected to be completed post regulatory approvals. This acquisition makes Manipal Hospitals India’s second-largest hospital chain after Apollo Hospitals. Post the deal, Columbia Asia will be rebranded as Manipal Hospitals. Columbia Asia Hospitals is part of Seattlebased Columbia Pacific Management, a private healthcare company owned by a US-based investment fund, International Columbia USA Columbia Pacific. The company has 17 hospitals in South-East Asia – 12 in Malaysia, three in Indonesia and two hospitals and a clinic in Vietnam and 11 hospitals in India. Manipal Hospitals will add these 11 hospitals to its existing hospitals to command strength of 27 hospitals across 15 cities with 7,200+beds, and a talent pool of 4,000+doctors and 10,000+employees.

Director General CSIR (Guest of Honour) also welcomed the startups, investors, panellists and other partners of the BIRAC’s innovation ecosystem.

Elekta appoints Gustaf Salford as President and CEO Gustaf Salford has been appointed to the role of President and CEO, Elekta, effective immediately. He has been acting CEO since early June 2020. “I am honoured to take on the role of President and CEO of this fantastic company. And I will, together with my team, accelerate Elekta’s strategy and future profitable growth. As the leader in precision radiation medicine we strive to increase accessibility to cancer care, build resilience and continue to push and expand the boundaries for innovation,” said Salford.

Sixth edition of BIRAC’s BIG Conclave held in Kanpur Biotechnology Industry Research Assistance Council (BIRAC) along with Startup Incubation and Innovation Centre (SIIC), IIT Kanpur recently organised the 6th edition of its annual flagship event BIG Conclave. The theme for this year’s two-day virtual conclave was ‘Resilience Redefined’ and has brought technical experts, global business leaders, innovators and entrepreneurs on a common virtual platform to unveil the innovations supported by BIRAC through its Biotechnology Ignition Grant (BIG) programme. The inaugural session of the event was graced by Jayant Sinha, Member of Parliament and former Union Minister, Government of India as the chief guest of the BIG Conclave 2020. Dr Renu Swarup, Secretary Department of Biotechnology, Government of India and Chairperson, BIRAC along with Dr RA Mashelkar, Former

Gustaf Salford

RDIF, Hetero to produce 100 million doses of Sputnik V vaccine in India The Russian Direct Investment Fund (RDIF, Russia’s sovereign wealth fund), and Hetero, (through its biologics arm ‘Hetero Biopharma’) have agreed to produce in India over 100 million doses per year of the world’s first registered vaccine against the novel coronavirus infection – Sputnik V. The parties intend to start the production of Sputnik V at the beginning

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NEWS ROUNDUP of 2021. Currently, Phase III clinical trials are approved and are ongoing in Belarus, the UAE, Venezuela and other countries, as well as Phase II-III in India. Requests for more than 1.2 billion doses of Sputnik V vaccine came from more than 50 countries. The vaccine supplies for the global market will be produced by RDIF’s international partners in India, Brazil, China, South Korea and other countries.

Rishihood University to launch School of Healthcare Rishihood University announced the upcoming launch of the Rishihood School of Healthcare. Considering the need, both at the national and international levels, the university is launching its School of Healthcare for its first cohort, from the academic session 2021-22 onwards. The School of Healthcare will be offering various UG & PG degree programmes, such as B.Sc. cardiovascular technology, medical laboratory technology, MBA in healthcare management, amongst others, under the allied healthcare domain. The courses have been designed to help the students to develop a high level of expertise and technical skills with detailed learning.

Rishihood University

December 2020

WB expands government health scheme Months ahead of the 2021 state polls, West Bengal Chief Minister Mamata Banerjee expanded the state-run ‘Swasthya Sathi’ health scheme to cover the entire population of the state. The decision will be applicable from December 1, 2020, Banerjee announced. “Earlier, we had decided to enrol at least 7.5 crore people under ‘Swasthya Sathi’. I am announcing today that every family in West Bengal, every person, be it a child or an old man or woman, irrespective of their religious affinity will be covered under this scheme,” Banerjee told newsmen. Every family will be provided with one smart card to avail the benefits of ‘Swasthya Sathi’ in which all state-run hospitals, as well as private hospitals in the state, have been roped in, she added.

AstraZeneca signs MoU with RSSDI AstraZeneca India (AstraZeneca Pharma India has signed a memorandum of understanding (MoU) with the Research Society for Study of Diabetes in India (RSSDI). This MoU is aimed at digitising

and driving correct awareness of diabetes amongst people to prevent complications arising from the uncontrolled incidence of the disease. RSSDI has been instrumental in extensive research on diabetes, as well as continuing diabetes education initiatives in India. As a key facet of this dual association, AstraZeneca unveiled a campaign-‘Beyond Sugar’, a three-year patient awareness programme developed to benefit over one crore people living with diabetes across the country. This initiative will empower patients/caregivers to have conversations around diabetes and make informed decisions about the management of the disease.

Lupin launches generic immunosuppressant drug in US Lupin has launched generic immunosuppressant Tacrolimus capsules in the American market after its alliance partner Concord Biotech received approval for the product from the US health regulator. The company has launched Tacrolimus capsules USP in the strengths of 0.5 mg, 1 mg, and 5 mg, after Concord Biotech received approval for its abbreviated new drug application (ANDA)

from the United States Food and Drug Administration (US FDA), Lupin said in a regulatory filing. The capsules are generic versions of Astellas Pharma US Inc’s Prograf capsules in the same strengths, it added.

Evercare Hospital Dhaka receives JCI accreditation

Evercare Hospital Dhaka, part of

important

collaboration

could

finally

begin. After successful training and certification

the Evercare Group is the first and only

of doctors and nurses at HCG Cancer

hospital in Bangladesh to be accredited by

Centre in Bengaluru in India, the team

Edelweiss Tokio Life unveils organ donation programme

the Joint Commission International (JCI)

treated its first patient after the lifting of

and also to be re-accredited for the fifth

the COVID-19 lockdown.

Continuing its social initiative #NoMoreWaiting for a second year, Edelweiss Tokio Life Insurance unveiled a unique educational programme on organ donation and a plan to build a corpus for underprivileged organ recipients. The insurer will continue its partnership with MOHAN Foundation, an NGO actively working for the cause. Once again, the insurer has roped in Rahul Bose, Actor and social activist, as the face of the initiative and aims to harness his social influence in spreading awareness for this cause. The 2nd edition of #NoMoreWaiting will extend for a year and aims to create organ donation ambassadors across the country through a structured programme. As a part of this programme, the insurer, together with MOHAN Foundation, will offer a 4-hour online certification course, followed by a 2-hour interactive session with experts, organ donor families and recipients.

recognised

time in a row. The JCI Gold Seal of Approval is a globally accreditation

that

reflects

an organisation’s commitment to best practices in quality and patient safety. Accreditation by recognised international institutions such as JCI is crucial to drive

Govt allows Ayurveda practitioners to conduct surgeries

Government of India in a recent

notification

has

allowed

postgraduate

compliance and improve quality and cost

degree holders of Ayurveda to perform

effectiveness across the hospitals and

general

accreditation has become a priority for

orthopaedics and dental procedures. A

healthcare organisations around the world.

gazette notification dated November 19,

ChemoTech initiates collaboration with HCG

2020, by Central Council of Indian Medicine

Scandinavia-based

ChemoTech

such procedures. The notification further

and HCG have engaged in an agreement

stated that the amendments were being

Electroporation). The evaluation is led by HCGs Department of Translational the

training

ophthalmology,

pass outs to receive formal training for

IQwave and the TSE (Tumour Specific

After

ENT,

(CCIM) allowed Ayurvedic post graduate

to perform a scientific evaluation of

Medicine.

surgical,

and

made with the sanction of the central government. Students will be trained in two streams of surgery and would be awarded titles of MS (Ayurveda) shalya

certification of doctors and nurses that

tantra general surgery and MS (Ayurveda)

took place in early November at HCG’s

shalakya tantra (disease of the eye, ear,

cancer centre in Bengaluru India, this

nose, throat, head and oral dentistry).

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NEWS ROUNDUP The Hague Business Agency launches digital programme at Bangalore Tech Summit The Municipality of the Hague and the Department of IT, BT, Government of Karnataka have been working together under the broad MoU that was signed between the two sides in 2016. Taking the collaboration forward, The Hague Business Agency launched a digital softlanding programme, aimed at Indian startups looking for expansion into Europe, at this year’s Bangalore Tech Summit. Key dignitaries at this year’s event were Saskia Bruines, Deputy Mayor of the Hague, Jeroen Tas, Chief Innovation Officer at Royal Philips and Gert Heijkoop, Consul General of the Netherlands in South India. Through this programme, 50 Indian tech startups active in areas such as AI, cyber security,

agriculture,

healthcare,

and

smart cities will be selected for digital soft landing in the Hague. It will be a two-month online programme, which will consist of following four steps: Explore: Digital Fact-Finding Trip; Adjust: Market readiness training; Connect: Match Making and Integrate: Ecosystem integration, for Indian startups to get fully immersed into

Ratan Tata invests in healthcare startup iKure Healthcare services startup, iKure said veteran industrialist Ratan Tata has invested in the company an undisclosed sum. The company, which delivers primary healthcare services through a network of clinics, digital technologies and trained frontline health workers, said it plans to rapidly scale-up operations across India and globally with fresh funds coming in.

December 2020

is a part of the overall strategic plan of value creation for our shareholders through Biocon Biologics.”

Dr Prasanna HM takes charge as President of PHANA

Dr Prasanna HM has taken charge

Biocon Biologics receives $150 million capital from Goldman Sachs Biocon announced that the Board of its subsidiary Biocon Biologics Ltd (Biocon Biologics) has approved a Rs 1,125 crore (~$ 150 million) capital injection from Goldman Sachs. As per the terms of the proposed agreement, Goldman Sachs will be issued optionally convertible debentures at a post-money equity valuation of $ 3.94 billion. The transaction is subject to customary approvals and conditions.

of family and welfare, Dr R Ravindra,

Kiran Mazumdar-Shaw, Executive Chairperson, Biocon, said, “We are pleased to welcome a capital injection by Goldman Sachs at this inflexion point of Biocon Biologics’ journey in its quest for global

SCHOTT Glass India inaugurates new glass melting tank in Gujarat

through biosimilar drugs. This transaction

as the President of Private Hospitals and

the Hague ecosystem.

SCHOTT has inaugurated a new melting tank in its Gujarat-based facility with an approximate investment of EUR 25 Million. The new tank would help to increase the plant’s production capacity by 10,000 tonnes to reach an annual capacity of 40000 metric tonnes. SCHOTT has been a frontrunner in the global fight against Coronavirus, with a commitment to provide its specialised pharma glass used for storing billions of COVID-19 vaccines. The melting furnace has been constructed within one year, to enable a 25 per cent increase in the facility’s overall production capacity, to support the pharma industry that is facing a huge demand surge for pharma packaging products.

leadership in providing affordable access

Dr Prasanna HM

Nursing Homes Association (PHANA). Chief Guest Jawaid Akhtar, Principal Secretary to Government of Karnataka, Department Past President, along with Dr Prasanna, office bearers, guests and dignitaries were present on the occasion. While addressing the august gathering and media, incoming President Dr Prasanna requested the government to release the payments to hospitals for treating COVID patients.” He further requested the government for SME stimulus to help struggling hospitals, besides ensuring the release of GOI insurance to a family of COVID warriors in the private sector who lost their lives.

Fortis re-appoints Dr Bishnu Panigrahi Fortis Healthcare announced that Dr Bishnu Panigrahi has re-joined the company as Group Head, Medical Strategy and Operations to make a more substantial contribution to the patient care and clinical excellence parameters. In his earlier stint, Dr Panigrahi spearheaded medical operations at Fortis Healthcare from January 2012 to August 2018. He was instrumental in making Fortis, the destination of choice for those seeking medical services in India. Dr Panigrahi has an experience of 39 years out of which 12 years was as an educator and 27 years was in the corporate world where he worked with Indraprastha Apollo, Fortis and Max Healthcare. Before rejoining Fortis, he was associated with Kalinga Institute of Medical Sciences (KIMS), Bhubaneswar as Chief Executive Officer.

decades of experience in healthcare IT solutions and services, working in high growth technology-led businesses. His appointment is a strategic move for Aetna India to build on the success of the last few years and continue to develop the company. Khosla will oversee all aspects of India business which caters to over 4 million members.

limited to, the design and implementation of multiple pivotal Phase 3 trials to enable

regulatory

submission,

review,

and, if supported by data, approvals for the use of Avigan tablets in the treatment or prevention of COVID-19 in the US, Canada and internationally. The clinical development strategy will focus on evaluating Avigan tablets for early treatment and post-exposure prophylaxis in the community setting.

Dr S Rajasekaran bags Stanford University’s recognition Stanford recognised

University

group,

orthopaedic

USA,

surgeon

has Dr

Rajasekaran for his contribution in the field of orthopaedic surgery. His name has been categorised as the top 2 per cent of scientists whose work has had the maximum impact in their respective fields. The authors also refined the method of analysis by excluding self-citations. For each author, separate data for career-long and the single-year impact was calculated. Metrics with and without self-citations and ratio of citations to citing papers

Anurag Khosla

Appili Therapeutics Dr Reddy’s, GRA, FUJIFILM in tie-up

Aetna India appoints Anurag Khosla as CEO India

has

announced

22 scientific fields and 176 subfields. Field & subfield-specific percentiles were also provided for all scientists.

Appili Therapeutics has signed a collaboration, development and supply agreement with Dr Reddy’s Laboratories and Global Response Aid (GRA). This agreement follows on and is harmonised with the previously announced global licensing transaction (excluding Japan, Russia, and China) between DRL, GRA and FUJIFILM Toyama Chemical Co, (FFTC), the originator of Avigan tablets. The agreements work together to coordinate and accelerate the worldwide development, commercialisation, and distribution of Avigan tablets (favipiravir) for the potential treatment and prevention of COVID-19.

Dr Bishnu Panigrahi

Aetna

were done. Scientists were classified into

the

appointment of Anurag Khosla as the new Chief Executive Officer to accelerate its business in India. Khosla brings in two

Appili will assume key responsibilities for the design and implementation of the consortium’s global clinical programmes and related work, including, but not

Dr S Rajasekaran

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INTERVIEW

Innovation and business foresight are important for the survival of any business Jatin Mahajan, Managing Director, J Mitra & Company talks about the key learnings from the COVID-19 pandemic, the challenges faced at the company's manufacturing unit and the way forward in 202, with M Neelam Kachhap How did the COVID-19 pandemic affect medical device manufacturing? The initial two to four days of the lockdown were very difficult and challenging. Everything came to a standstill. The manufacturing units were closed; staff and workers were unable to reach offices and and essential supplies were completely disrupted. While we fall under the essential services category, and therefore exempt from the restrictions, we had to arrange passes for our staff, and in the ensuing chaos and melee, this took a lot of time and energy.

December 2020

Another key impact was the overall negative sentiment created – the fear created because of the corona pandemic created an environment of fear and mental stress for all, impacting workers morale which had a direct bearing on attendance as well as productivity. The most critical challenge that continues to

plague

the

diagnostics

industry,

especially concerning COVID-19 testing

All forms of transportation and logistics were severely affected. Raw materials in transit were held up along the route. No new orders for raw materials could be placed in the embargo situation. So, we were forced to handle the double whammy of human resource crunch and supply-side stress – the two most critical aspects for any manufacturing unit. Also, the scenario created a reduced cash flow and liquidity issue which is very detrimental for the smooth functioning of any industry.

has been the export embargo that has

What were the challenges faced by the medical devices business?

production and related costs, and then

Unlike us, most players in the medical devices industry heavily bank on import of raw materials from abroad. The logistics and import-export embargo created an immediate flux for the industry – a scenario where they did not have enough raw material to sustain production.

The prevailing inverted duty structure favoured finished products (imported IVDs) over raw materials (made in India IVDs) – consequently leading to an unequal playing field for all domestic producers of IVD devices.

been imposed by the government on Indian manufacturers. There is sufficient manufacturing capacity within the Indian medical

devices

manufacturers

for

COVID-19 test kits to cater to the domestic demands.

The

government,

however,

continues to source from international manufacturers, creating a situation of surplus stock for all Indian manufacturers. We

are

being

forced

undertake

sell in a restricted market. We are being forced to store these finished products which in many cases require a specialised temperature-controlled environment. This negatively impacts the shelf life and leads to a situation of near-expiry for the kits which affects the pricing and sale-ability of the products. This is severely hurting the bottom-line of the entire industry and needs to be addressed urgently.

Could you tell us about the innovations during this time? Innovation and business foresight are important for the survival of any business. Innovations do not necessarily have to be technical – it could be in the overall work and management style itself. While we were not majorly impacted, we could see many industry counterparts struggling to maintain business continuity because of their over-dependence on China for raw materials. A robust business continuity plan is a must to mitigate the negative impact of large-scale disruptions. Flexibility

and

adaptability

must

incorporated in the business ethos. But most importantly, while we may be a for-profit organisation, we have learnt the most critical aspect is humanity, compassion and social consciousness. It was critical to creating an environment devoid of fear, and as a company, we were able to create that mindset for the staff at work. We were able to keep the motivational levels high by meeting all legitimate financial needs while providing the

safest

and

most

sanitised

understood

work

environment As

company,

the

significance of human qualities as a driving force for professional and technical qualities which contributed to keeping the entire team together. Together, as a team, we went ahead to innovate and create/manufacture two of the best Covid-19 test kits – • COVID-19 [IgM, IgG, IgA] MICROLISA Our state-of-the-art test kit based on the Double Sandwich Elisa technology is a serology-based total antibody (IgM, IgG, IgA) detection assay for the indirect diagnosis of past exposure to COVID-19. It has a sensitivity of 94.04 per cent and specificity of 100 per cent. • J Mitra also manufactures the ICMRNIV developed COVID KAWACH IgG MICROLISA COVID-19 test kit which tests for IgG antibody in human serum/ plasma and has a sensitivity of 96.33 per cent and specificity of 100 per cent

Jatin Mahajan, Managing Director, J Mitra & Company

How are things currently?

the diagnostics industry. Being a leading

At J Mitra, things are almost back to normal. The production of the two COVID-19 test kits has kept us busy, in addition to the other test kits that we manufacture.

are likely to enjoy a sizable chunk of the

The current scenario has drawn a lot of focus on the healthcare industry and its contribution. Its criticality and yeoman services are being re-established, recognised and appreciated. The world recognises the need for early warning systems in the healthcare segment, especially for COVID-19. There is an expectation of phenomenal growth for

government lifts the embargo on exports

exporter of IVDs to the global market, we global buyers seeking these test kits apart from our other existing product lines. But this will only be possible if the Indian of COVID-19 test kits.

How do you see the situation improving in the next year? India is the third-largest producer of pharmaceuticals

and

products.

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INTERVIEW The country has the potential to become the alternative supplier to global drug manufacturers replacing China due to growing distrust and possible sanctions. There is a possibility of the world focus shifting to India as the primary producer and supplier of APIs, IVDs and generic drugs, provided we act fast. The Centre has taken cognisance of India’s potential and need for self-sufficiency in APIs, IVDs and generic drug segment. The Central Government is actively looking at various possibilities and opportunities, and if all goes well as envisaged, India could end up being a major winner from the corona disaster. Recent developments indicate a concrete step in the right direction. • Government announcement of Rs 140 billion fund for the establishment of three drug manufacturing hubs • Government allocation of Rs 3,000 crore to promote bulk drug parks in India along with a production-linked incentive scheme of Rs 7,000 crore •

The government has identified elements and APIs which will the initial thrust in phase 1 of government planning and will promoted on priority

53 be the be

The Indian government recognises aspects critical for winning this race – ensuring a cost advantage over China, faster government permissions and single-window clearances, ease of doing business, adequate financing, competent infrastructure, soft loans with longer repayments – these are aggressively being looked at.

December 2020

Speed is critical – If India has to succeed in capturing a significant portion of the market up for grabs, they have to display aggression and garner the first mover’s advantage.

What are your recommendations for the future? Yes, there are some key aspects that I would like to communicate with the policy-makers. There is a need to cut down import duty on raw materials and hike import duty on finished goods, which is the lowest in India amongst the BRIC countries. This is very critical. Just to cite an example, ELISA finished products (HS Code – 38220019 List 4 Sr. No. 32) have 0 per cent duty and 5 per cent IGST, whereas the raw material for ELISA kits under the same HS code attract 5-20 per cent import duty plus 12 per cent IGST – creating a price differential of 2025 per cent, and tilting the balance away from the home-grown manufacturers. Aspects critical for winning the Make-inIndia race are – ensuring a cost advantage over China, faster government permissions and

single-window

clearances,

ease

of doing business, adequate financing, competent infrastructure and soft loans with longer repayments. Other

key

governmental

focus

areas

should be – the creation of large clusters with a common infrastructure, facilities and subsidies for technological upgrades so that there are higher sustainability and economies of scale.

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OPINION

MBBS Online What are the challenges faced while teaching medical students virtually The medical education sector like other

the readers about some of the challenges

sectors has been hugely impacted by

which I faced while teaching via the online

the

mode.

COVID-19

pandemic.

Conducting

regular classes and examinations came to a standstill amidst the lockdown and professors and students alike are grappling with the new set of challenges. At normal times a first-year MBBS student invests more time in learning about human

Dr Ashish Banerji Seasoned Healthcare Administrator

anatomy, physiology and biochemistry. Anatomy is learnt in classrooms (through didactic lectures), but a large part of the learning

message the moment it happens), and then rejoining when he/she is able to reconnect. This is extremely disturbing for a teacher, and the students too, as they miss a few The process of leaving the online class (so and so has left) and rejoining goes on

MBBS

throughout the lecture. Apart from this,

students examine real patients, who have

the teacher is unable to see any of his

'complaints,' and work on the case history

students. There is no choice but to assume

while examining to elicit findings. All this

that those who are electronically present

is done under the supervision of doctors.

(having logged in) are paying attention. Itâ&#x20AC;&#x2122;s

Students present cases to their fellow

quite likely (and possible) that students

students and a staff member corrects in

may be busy with their cellphones or doing

case of any errors while enquiring more

some other activity altogether. I am saying

about the topic. These are also known as

this because even in classroom teaching, a

bedside clinics.

few students are inattentive and are busy

A similar procedure is also followed for

ask random questions, and although this

post-graduate students pursuing a PG

helps, a large number of students make it

degree in a clinical speciality: lectures,

difficult to implement.

presentations

third-year,

browsing with their cellphones. One can

and

discussions.

Surgical residents across all specialities are taught surgical techniques by observation, assisting

senior surgeons,

then

doing

simple surgeries under their supervision and finally operating independently.

December 2020

by without students 'leaving' (you get a

assigned a 'body' or a 'part' to dissect.

case

I would say that not a single lecture goes

minutes or a large portion of the lecture.

and

dissection

all too true!

where a group of six to eight students are

second

technical glitches,' and this is unfortunately

halls,

the

happens

I was warned that there would be 'some

What happened to 'bedside clinics, which is one of the most important methods of teaching? This mode of teaching is currently being conducted online where one student examines the patient (others can do it at different times), and he/she

Since the onset of COVID, all this has

presents the case to other students and

drastically changed. Everyone I spoke

the teacher virtually. The correct history

to said that didactic lectures which were

(complaints with duration) and physical

taken in large lecture halls, (student

findings are conveyed to the professor

numbers could be as high as 250 in a batch)

by a junior doctor in the department. The

have completely stopped. Now teachers

student who is presenting the case shows

have adopted the virtual mode of teaching

the relevant investigations like ECG, X-ray

and students have to log in and learn by

Chest, CT scans, MRIs etc to everyone using

this modality. While it may appear to be a

his/her cellphone. The entire process canâ&#x20AC;&#x2122;t

satisfactory method, I would like to inform

be compared to pre-COVID era teaching,

but itâ&#x20AC;&#x2122;s the best solution, given social distancing norms to be followed.

mode is not possible. All these problems are formidable and

Conducting exams is another challenge.

medical colleges are grappling with them.

Exams in medical colleges are conducted

New admissions are not yet done and are

in three formats. The theoretical paper usually has subjective questions with a few

overdue. NEET exams have been delayed.

short notes. Online examinations can lead

Deployment of junior doctors, often doing

to mass cheating. In most medical colleges

post-graduation, has been a subject of

students are being allowed to sit in large

intense debate. Due to the incessant

halls, ensuring social distancing, utilising

demands of residents to man the COVID

20 to 25 per cent of the hall capacity.

wards

Strict invigilation ensures no unfair means,

confirmed COVID cases), many hospitals

although I recently heard about mass-scale

have had to resort to deploying PG

cheating using technology similar to that shown in the movie Munnabhai MBBS, but in a more sophisticated way. The

second

(for

suspected

and

doctors pursuing 'non-COVID' specialities in such wards. The reason behind this was that internal medicine and chest medicine departments are unable to fill in

presentation, which canâ&#x20AC;&#x2122;t be conducted

all the required slots. Here, I am referring

online, as the examiners have to examine

to specialities like ophthalmology, ENT,

the

orthopaedics etc. While hospitals have

and

ICUs

case

patient

modality

and

converse

the

with

both

the student and the patient. It is being conducted by maintaining as much social distancing as possible, but it possesses definite challenges. The third modality is drugs, specimens and instrument tables, where the examinee is shown various drugs, surgical specimens of

realised that it is unfair, inappropriate, to deploy doctors doing PG in such disciplines in COVID wards, they often have no choice. The overall teaching in medical colleges is mired with challenges. Imparting medical education, at all levels, and managing

diseased organs (removed from patients)

COVID patients, still continues to throw up

and equipment, Here the student has to

complex challenges, which administrators

answer questions about usage of the drug

are finding solutions for. There can be no

or equipment, surgical instruments (for

doubt that the students of medicine will be

surgical disciplines). In this case, online

impacted, at least, in the short term.

www.indiamedtoday.com

COVERSTORY

Perspective: 2020

A Year of Unprecedented Challenges and New Learnings

What does the future hold for the healthcare sector? 2020 has been an adversary not many could handle and yet it forced us to look for opportunities and ways to innovate and raise up to the challenge that the pandemic brought with it. We round up the best experiences and advice from industry thought leaders to lead you through the new normal. In this year-end issue of IndiaMed Today, healthcare experts talk about the flaws in the system which need to be looked upon, ways to overcome the challenges by implementing the right decisions, economic revival for the sector and the way forward in 2021. Team IMT

November 2020 December 2020

Dr Alok Roy Chair, FICCI, Health Services Committee, Chairman Medica Group of Hospitals

COVID-19 has been undoubtedly the

We need to create a flexible workspace in the hospital and to fit the hospital in retrofit or forward format where we can change the settings in as short a period as possible

most devastating public health emergency in the last century. It reminded the entire generation that we are mere pawns in the hands of nature. Being in healthcare, we have earned the epithet, frontline warriors, deservingly so. As health workers, we must serve the society at large. As caregivers, we are learning on the job, as no classroom theory could have helped us break the shackles of the virus. The pandemic has made us better at learning on the go. Private healthcare services, which have long been neglected politically have risen to the occasion to save the populace. With nearly 80-90 per cent of COVID patient care being provided by the private sector, we have accepted this untimely challenge and taken it head-on, ably supporting public healthcare at large. Some of the major learnings are to not take life for granted. We must all learn to be flexible and engage the pandemic on the front foot. Hospitals across the country did this over the last few months. Another key learning is that in India, about 86 per cent of patients are asymptomatic or mildly symptomatic. We are dealing with the remaining moderate to severe patients who need hospital care. Over time, we have learnt, adapted and become extremely skilled at ICU patient care. With no clear evidence and strategies for ICU care at the beginning of the pandemic, our experiences have taught us well. The Indian healthcare system was not well equipped to deal with a pandemic of this nature, so we redesigned our infrastructure, treatment protocols and processes. This allowed us to protect our employees as well as the COVID and non-

COVID cohort of patients. Healthcare has undergone a 360-degree transformation while fighting COVID-19. The healthcare sector has taken a massive financial hit and for healthcare to emerge strongly from this crisis, the health budgets need to be substantially upgraded. Indiaâ&#x20AC;&#x2122;s public health expenditure stood at 1.15 per cent of its gross domestic product â&#x20AC;&#x201C; this must take a quantum leap and must be more than doubled to reach the goal of 2.5 per cent set by the National Health Policy 2017 while being further increased to 3 per cent4 per cent of the GDP in the medium term. Health and wellness have been severely impacted by the ongoing pandemic. Hence, in looking at health, and its future trends post the pandemic, we will take a more holistic approach to the healthcare scenario. We will also look at influencing factors - especially macro factors like the higher likelihood of impact on the older and ageing population, increase in chronic diseases and co-morbidities, rising health care costs and enhanced demand for product transparency. We have to adapt to the new normal. The new normal is that we have to rely on technology, the digital platforms. We need to create a flexible workspace in the hospital and to fit the hospital in retrofit or forward format where we can change the settings in as short a period as possible. In the new normal, we need to have lesser beds in larger spaces. The more we space out the bed it will probably change the way. Also, we need to invest in technology in big time. We need to think that these things can occur and prepare for such things and invest more in public healthcare.

www.indiamedtoday.com

COVERSTORY MR Rajgopal Founder & Chairman, Pallium India

I must admit this; we were afraid. It was

little about treating physical symptoms

partly the fear of the unknown; a disease

nor about the enormity of the psychosocial

about which we knew little and about

suffering. Will we recognise healthcare

whose treatment we knew even less. We

for what it should be and make sure that

were afraid for our patients who all have

the healthcare system includes enough

comorbidities. The patients and families

professionals trained in palliative care and

were afraid too. Many asked us to stop

psychosocial work?

visiting them at their homes; we were seen as carriers of the disease.

Ata Declaration of 1978 asked and what

course of our work and risking our families’

the Astana Declaration of 2018 reinforced.

Community Engagement

December 2020

need to put into practice what the Alma

We were afraid of getting infected in the lives.

The first is the need to make healthcare what it should be, health being defined as physical, social and mental well-being and not just absence of disease or infirmity

Our COVID experience also highlights the

We could no longer think about looking

Healthcare has to involve the community professionals and the community working in partnership.

after only 'our patients' – people registered

And let us hope that healthcare systems

with us. We announced a helpline in

can perceive the mountain of suffering

the newspapers, offering help to those

caused by the inequities in society. The

who needed it and asking for volunteers

vulnerable population suffered enormously

between the age of 20-40 who owned their

not only from COVID-19 but also from

automobiles.

the lock down. The inequity is something

Would the world order change and society

that happens in the invisible recesses of

with compassion emerge as a response

our society - invisible to those who are

to the catastrophic 2020? Let us hope it

in power. Those with disabilities, those

does; but the experience from the plague

geographically,

epidemic of long back tells us that while

isolated, those at the extremes of age - all

some may change, human nature will

have suffered to an unbelievable extent as

prevail.

in any humanitarian crisis.

There certainly are lessons to be learnt

“The moral test of a society is how that

from what we have gone through in 2020.

society treats those who are in the dawn

The first is the need to make healthcare

of life...the children; those who are in the

what it should be, health being defined as

twilight of life...the elderly; and those

“physical, social and mental well-being and

who are in the shadows of life...the sick,

not just absence of disease or infirmity”.

the needy, and the handicapped” (Hubert

Global healthcare systems have bothered

Humphrey).

socially

and

culturally

www.indiamedtoday.com

Dr Alexander Thomas President, Association of Healthcare Providers â&#x20AC;&#x201C; India (AHPI)

Reduced manpower has made hospitals rethink to focus on multitasking as well as to explore new technological solutions to improve the efficiency and enable staff to operate safely

The COVID-19 pandemic has become a

Healthcare workers faced challenging times

major global threat globally which has

directly catering to COVID-19 patients.

impacted the economies and livelihood of

They are overworked, which makes them

people. The private hospitals in India played

vulnerable to errors and possibly increases

a huge role in tackling the virus while

their risk of getting infected. Compounding

stepping up operations to complement and

this is the fear and mental exhaustion from

enhance the efforts of the government.

overwork, death of patients, colleagues

Many private hospitals allotted extra beds

falling ill or dying from the infection, and

and additional manpower, set up isolation

their safety. Also, healthcare workers got

wards, brought in new equipment, set

separated from their family members for

up the desired inventory and converted

a long time as many opted not to visit

their premises into COVID care and hybrid

their homes fearing infection risk to their

facilities, to ensure that other medical

families. All these took a heavy toll on

emergency needs are not compromised.

them. Hospitals have adopted new working

Though a lot of initiatives have been

social distancing at work, communicating

undertaken by the private hospitals, poor

through phone calls, instant messaging,

patient

conference calls and emails have become

elective procedures have led to reduced

the new norm. Cross-functional task forces

financial inflow to about 30 per cent.

are formed. Reduced manpower has made

As a fallout, hospitals in many instances

hospitals rethink to focus on multitasking

were unable to pay salaries to their

as well as to explore new technological

employees, found it difficult to meet the

solutions to improve the efficiency and

EMI requirements and annual maintenance

enable staff to operate safely.

footfall

and

postponement

mechanisms during COVID times. Practising

contracts. Private

Ever since the threat of COVID-19 crippled hospitals

were

functioning

our country, AHPI has been at the forefront

with 20 to 30 per cent of the capacity.

working closely with the central and state

Postponement of elective surgeries, dip

government in preparing and implementing

in footfalls, reduction in OPD patients,

ways to tackle the crisis. AHPI worked with

complete halt on international patients due

the governments, and this has led to many

to travel ban and a significant fall in bed

suggestions offered by AHPI being accepted

occupancy and inpatient treatments have

and implemented. The members of AHPI

had an impact on the revenues significantly.

continue to hold regular meetings with all

Besides increased input costs resulted in

state chapter office bearers as together we

huge losses across hospitals.

face this unprecedented challenge.

www.indiamedtoday.com

COVERSTORY

Dr S Prakash Managing Director, Star Health and Allied Insurance Co

The realisation of the need for insurance protection is now very well understood, however, availability of surplus money in the hands of industry or individual is prerequisite for growth of insurance

Lockdown and COVID-19 have given

insurance.

rise to a golden era for health insurance.

concept was introduced in 1997, it was felt

No amount of effort put by a regulator or

that in a family only one or two may get

insurance companies would have created

hospitalised during the year and the floater

such an amount of awareness among the

sum insured is sufficient to take care of

general public on the need and requirement

their hospitalisation. Now COVID-19 has

of health insurance which is now created by

made them think otherwise as the entire

COVID-19. This impact is not a short-term

family was required to get hospitalised

impact as it has changed the mindset of

and sum insured under floater policy

people. Health insurance is now purchased

found to be inadequate. This has given

for its real purpose i.e. financial protection

rise to the purchase of additional policies

at the time of need. When any insurance

or top-up policies to take care of likely

is purchased as a real financial protection

huge

law of a large number will work and the

insurance premium figures for the first half

probability of loss gets limited. Otherwise,

of this financial year reflects the impact

health insurance is purchased only when

of COVID-19 on health insurance. Though

there is an adverse health history where

the overall growth in health insurance

the probability of occurrence of loss is

premium is only 16 per cent, retail health

much higher. We have been requesting

insurance has shown the growth of 26 per

our marketing team to sell policies of

cent and Company like Star Health has

the higher sum insured but they were

shown growth of 48 in the retail segment.

reluctant. Now the same marketing persons are vehemently pitching for policies with higher sum insured. The real meaning of adequacy of sum insured is understood by an insured when he gets to know from social media about huge hospitalisation bills for COVID-19 treatment in hospitals. Concept of health insurance marketing has changed, people with the age group of below 45 were reluctant to go for health insurance but now COVID-19 made them

December 2020

Similarly,

hospitalisation

when

the

expenses.

floater

Health

Another most important aspect of lockdown and COVID-19 is forcing the industry to adapt to work from home culture and optimum use of technology. Pre pandemic, online sale of health insurance was only around 4 to 5% and now it has gone up to 80%. This aspect will make the company think about structural change in their set up which in turn, will substantially reduce the operating cost of the company.

realise that age has no bearing when it

The health insurance industry will have

comes to COVID and made them buy health

to take this challenge very seriously and

consider this as an opportunity. There is huge untapped potential available, as on date 86 per cent of the rural population

take health insurance to the next level. Pandemic has temporarily impacted the

The realisation of the need for insurance protection is now very well understood,

insurance industry as every economic

however, availability of surplus money

activity was standing still for some

in the hands of industry or individual

time, however, it will bounce back with

is a prerequisite for the growth of

vigour during the next financial year.

insurance.

the survival of the health insurance

the

Barring unexpected situations, we can

industry is more dependent on claims

economy during the last quarter of

assume that the economy will bounce

servicing.

this FY, with vaccination for COVID-19

back during the next financial year,

coming in the market, the economy

all

and 81 per cent of the urban population is without any insurance protection and with this background, we can conclude that potential is unlimited. However,

There

huge

opportunity

for

innovation of disease based policies

will

are

see

expecting

stability

exhilarated

growth

which

pending

infrastructure

projects,

industrial activities will be expedited.

and policies for uncovered medical

automatically can help the insurance

expenses In reality on an average every

industry

person is spending about 5 per cent of

casualty

and

area of operation both in marketing

his income on medical expenses during

directly linked to the growth of the

and servicing will be taken as a priority

the year. Insurance companies will have

economy. Similarly with the growth

by every insurance company. As the

to find a way out to provide cover for

of the economy, spending capacity of

rural economy is growing very fast and

these expenses.

public will increase and in turn, health

urban workforce have started migrating

insurance is likely to get the maximum

to rural areas due to the introduction

benefit out of this.

of remote working culture, we can see

diagnostic

Next year will be a golden year for the

huge potential for insurance marketing

laboratories etc., will go a long way to

insurance industry, be it life or non-life.

in rural areas.

Similarly, enduring relationships with various

stakeholders

technology

partners,

hospitals,

grow. auto

Both

property/

insurance

Extensive use of technology in every

www.indiamedtoday.com

COVERSTORY

Aditi Kare Panandikar Managing Director, Indoco Remedies Limited

We believe the Indian pharma industry can utilise this crisis of COVID-19 as an opportunity to reframe its global commitments and emerge as a significant player and associate with a large developing market

December 2020

The COVID-19 pandemic has created an

act and adapt and tackle the challenges

unprecedented disruption and impacted all

efficiently.

businesses globally. The lockdown across

Despite many odds, our company took all

countries created a negative impact on

efforts to ensure continuity in operations

the GDP, leading to a global recession. The

and supply chain, both in India and

pandemic also had major effects on the

across the world, with all the safety and

healthcare and pharma sectors. Before

precautionary measures. Indocoites across

COVID-19 also, the overall economy was

various locations rose to the occasion,

facing headwinds both domestically and

braving the risk and hardships in reporting

in key global markets. Nonetheless, many

to work, whenever possible or contributing

opportunities exist across geographies and

in a meaningful way by working from home

product classes for Indian pharmaceutical

(WFH).

players to serve the patients across the

Indoco was part of the great initiative

globe.

The pharma industry joined the team of the medical fraternity, the doctors, nurses, medical staff, government authorities, etc., and worked relentlessly and selflessly to keep everyone safe and spread awareness on the pandemic. While currently there is no definite treatment or cure for this

the

Indian

government

export

paracetamol tablets to the UK in its fight against COVID-19 and was granted permission to airlift paracetamol tablets to the UK. The first shipment of paracetamol tablets manufactured at our plant was airlifted from Goa airport on April 12, 2020 by a chartered flight for export to the UK.

infectious disease and the research for

India is one of the largest producers of

the vaccine is still on, the pharmaceutical

anti-malarial

industry has provided constant assistance

This was used in the treatment of COVID-19

to the government authorities to address

during the initial phase of the pandemic.

the unmet needs of the patients by making

India sent the drug to over 50 countries,

drug

hydroxychloroquine.

medicines available at affordable prices. It

including the US.

has been impressive to see how fast the

Many pharma companies developed and

industry responded to the outbreak. This

launched Favipiravir, an oral antiviral drug

shows the industryâ&#x20AC;&#x2122;s resilience to quickly

approved for the treatment of COVID-19

has been safe and effective in treating

In the wake of new challenges, several

mild to moderate cases. Treatment

different approaches were taken by

with this drug has led to significant

Indoco to create multiple touchpoints

improvement in the time taken for the

with

infection to be cured.

mode was effectively utilised to reach

Indoco was already in the prevention of COVID-19 with its brands, Karvol Plus, ATM (Azithromycin), Febrex Plus & Rexidin SRS and is now in the treatment of COVID-19 with the introduction of Fevindo (Favipiravir) 400 & 800 mg tablets, Poviclean Gargle & Zmun CD Chewable Tablets (Immunity Booster with Vitamin C, Vitamin D3 & Zinc). The company wasted no time in adopting measures to protect the health of its

various

stakeholders.

Digital

and connect with all key stakeholders like

doctors,

retailers,

stockists,

well as our overseas customers. Our objective was to build a much more engaging suite of virtual interaction models, e.g., care-delivery adaptation, patient-support supply-and

enhancement

and

inventory-management

innovation. This paved the way for a greater spirit of partnership. We believe the Indian pharma industry can utilise this crisis of COVID-19

employees and ensure the business

continuity

global commitments and emerge as

with

minimal

disruption.

opportunity

reframe

its

Except for the initial few days of

the lockdown, all our manufacturing

with

facilities were kept operational. To

Indiaâ&#x20AC;&#x2122;s and the worldâ&#x20AC;&#x2122;s fight against the

overcome

the

manpower

significant a

large

player

and

developing

associate market.

shortage,

deadly COVID-19 is still on and we are

the company recruited over 350 new

sure that this phase too shall pass and

employees across various locations and

we shall come out stronger from this

in the field during this pandemic.

crisis!!!

www.indiamedtoday.com

COVERSTORY

Dr Naresh Shetty

President, M S Ramaiah Memorial Hospital

The

lock

down

COVID-19

constant counselling, which is not only

pandemic has taken a toll on the operations

physically taxing but a huge mental health

burden. Shortage of PPEs, high cost of

per cent occupancy and salaries to be

masks and PPEs, shortage of essential

paid, it has never been so bad. Even the

drugs and sourcing them remained a major

government on certain occasions put forth

challenge. In worst-case scenario unused

terms where hospitals were told to admit

PPEs were disposed of without being used.

patients in large numbers. Poor pricing

Hospitals were overburdened as there was

and additional incentives to all healthcare

a sudden surge of patients. All these led to

workers added to the financial crunch.

huge expectations. Need for an unlimited

Less income increased material cost and

supply of oxygen, informing the relatives

additional

of the deceased, disposing of bodies and an

private

hospitals.

manpower

amidst With

hardly

payments

meant

most of the hospitals' health was at peril.

History always repeats itself only because mankind hardly learns from his blunder.!!!

December 2020

Uncertainty regarding the spread of corona

unrelenting media pressure made the task difficult.

virus is a new challenge and learning for

Even as the government fixed uneconomical

all. The SOP needs to be changed every

prices for COVID treatment, there are

other day depending upon the evidence.

opportunities

Healthcare workers dealing with COVID

post-covid. The other positive area was

patients are highly stressed and need

virtual consultation where the hospital

for

treating

patients

expenses were reduced substantially.

strategy implementation to reduce cost

Healthcare leaders assured productivity

and improve output. Survival of the

and cooperation from the hospital staff

fittest will ensure many of the hospitals

via constant motivation, counselling,

closing down because of the unhealthy

ensuring extra payment for COVID

financial conditions.

duties, quarantine quarters after COVID duties etc. However, the overall scenario led to no increments and no new job opportunities.

We hope that there is no repeat of 2020 as it was a year of bad dreams. Looking at the surge in COVID positive cases all around, we still have a long battle

Everyone needs to look beyond paying

to fight. Only the vaccine and the SMS

capacity. On many occasions, there

(sanitise, masks, safe distance) can save

were more confidence among the health

us from this pandemic.

workers managing the COVID patients as the work was conducted in a dedicated

History

always

repeats

itself

only

manner. Above all this is not a time to

because mankind hardly learns from his

look for profits but this is a time to take

blunder.!!!

care of the nation's needs.

The government should come up with

Hospitals need to be very stingy in

measures like rebates in essential areas

their approach and have to tighten

like electricity tariff and other taxes,

the belts further. Hospitals may not

reducing GST for all essential items,

invest in newer gadgets for the time

reducing import duties on life-saving

being and have to make the workforce

items and ensuring income tax reduction

lean and mean. The productive group

to healthcare workers. This is a better

needs to be incentivised and the non-

way to motivate the healthcare industry

productive might have to be gradually

and workers. The best time to start the

phased out. As healthcare sees itself

healing process from the government is

on a ventilator, it will mean some key

now than at any other time.!

www.indiamedtoday.com

COVERSTORY

VP Rajan Director, Veda Corporate Advisors

With the onset of COVID-19 pandemic,

KKRâ&#x20AC;&#x2122;s acquisition of JB Chemicals, Carlyleâ&#x20AC;&#x2122;s

investors took a wait and watch approach

investment in Piramal Pharma and Sequent,

through the second quarter (April-June) of

CVC investment in HCG, PAG led PE funds

the current year. While few transactions

consortium investment in Anjan Drugs were

moved ahead slowly given the macro

some of the big deals that happened since

situation, the change in business dynamics

April 2020. As you might have noticed, the

due to a series of lockdowns also led

list is dominated by pharma deals led by

to deferment of few other transactions. However, the overall pharmaceutical sector

There is an indication of green shoots in select pockets, especially medical devices and diagnostic services, which have been the beneficiary of a large number of COVID testing

December 2020

marquee funds.

remained resilient through this phase,

We believe that the situation continues to

thanks to the discomfort across the globe

improve each month with phased unlocking

arising from significant dependence on

of the economy and many healthcare

China for the pharma requirement.

businesses reverting to pre-COVID levels.

While the pharma sector continues to out beat other sub-segments of healthcare in terms of investor interest, there is an indication of green shoots in select pockets, especially medical devices and diagnostic

While

pharma

deals

will

continue

dominate through the first half of next year, we see deals in diagnostic services, medical devices and healthcare delivery likely to revive strongly from the second

services, which have been the beneficiary

quarter of the next year. With medium-term

of a large number of COVID testing,

to long-term outlook, healthcare companies

increased health and immunity awareness

are likely to work towards beefing up the

coupled with the need for a drastic increase

infrastructure, thereby kick-starting the

in healthcare infrastructure.

new cycle of investment for growth.

Sriram Natarajan Director, Molbio Diagnostics

Once the vaccination process starts and completes, we will know in time, what the future is likely to be

The pandemic - realistically speaking,

As cases picked up - adding to the number

threw all other facets of life out of gear.

of existing COVID beds (read ICU) in

It was chaos, to say the least. Even the

both public and private hospitals were

otherwise busy IVD industry - dominated

a challenge. The temporary set up was

by laboratory testing and other procedures

created within stadiums with full medical

took a hit. As indicated by a drop in

facilities to accommodate more cases, as

revenues - most facets of laboratory testing

numbers increased.

either diminish substantially or stopped as

Truenat COVID-19 test is surely one of

resources were mobilised for COVID-19

the innovations during this pandemic.

testing. Even emergency testing such as

It has enabled molecular testing using

screening of blood in blood banks etc. was

innovative RT-PCR tests be made available

hit and patients from non-covid sector took

from Arunachal in the East to Leh Ladakh

a back seat.

in the North. Every state was able to

Challenges

faced

ranged

appropriate

diagnostic

scale

them

from

tests

meet

getting

and

then

demands

providing more ventilators and critical care

deploy this state-of-the-art innovation in a district-wise

fashion

ensure

that

everyone who needed to be tested with RT-PCR - got tested. This not only saved on logistics on sample transport but also

equipment to COVID wards to save lives.

to an extent reduced the burden on Central

Making provision for medical grade oxygen

Laboratories from being inundated with

was also a challenge.

test requests.

www.indiamedtoday.com

COVERSTORY

Over five million Truenat COVID tests have already been utilised.

the future is likely to be. As the effects of vaccinations start

Other innovations like FELUDA also

showing up- we hope more lives will

needs a mention - however, their

be saved - the severe disease will be

utility will only be gauged once they

lesser. But the pandemic can be beaten

commercially hit the market.

only with a combination of vaccines,

Similarly, ventilators,

innovations

cost-effective

low-cost but

good

drugs and most importantly, responsible human behavioural changes of abiding

quality PPE kits â&#x20AC;&#x201D; the repurposing of

by the rules.

certain medicines are all innovations

COVID-19 is not going to be the last

that the medical fraternity successfully

pandemic afflicting the human race - yet

tried in combating this pathogen - about

the world as a whole would have learnt

which still, we know so little about.

that ultimately it would be prudent six

to augment healthcare facilities for

to seven years, are being innovated

the human race - as no money, power

in ways to come out in a year. So

and military is good enough when the

innovations all around, I guess.

enemy is invisible - and the enemy is

Vaccines,

requiring

than

The pandemic is far from being over.

everywhere.

Yet as time passes and we begin to

Hopefully -priorities of humans will

understand lesser lives may be lost if

change - where one would be more

the human race behaves responsibly.

inclined to live life with nature as a

Once the vaccination process starts and

partner - and benefit from such an

completes, we will know in time, what

association.

December 2020

Ayanabh Debgupta Co-founder & Group President, Medica Hospitals

The impact

of the COVID-19 pandemic

personal protective gears for staff and

followed by nationwide lockdown is huge

testing of potential carriers among patients

which is visible across various sectors. The

and staff increased the overall operational

healthcare sector is at the epicentre of this

expenditure. Further quarantine measures

unprecedented crisis and has been gravely

for COVID positive staff affected the overall

impacted

workforce. Under certain circumstances,

demand

and

meeting

the

unparalleled

subsequent

financial

reached

out

their

staff

consequences. The pandemic is adversely

monetarily to support and encourage them

impacting the private healthcare services

during the pandemic. Adaptation of various

making a deep dent in the revenues of the

operational consolidation and cost-cutting

private hospitals.

measures were undertaken by private

Due to the fear of getting infected and

Making the right decisions and taking effective action will be possible only if new approaches to care delivery and financing are incorporated

hospitals

overall lack of liquidity in terms of regular cash flows, people with reasonable healthseeking behaviour avoided opting for treatment at private hospitals unless it became an absolute emergency. At Medica Superspeciality

Hospital,

the

service

hospitals across departments to ensure that business remains viable. Amidst low patient

footfalls

revenue

and

generation,

significantly the

low

governmentâ&#x20AC;&#x2122;s

decision to curb testing and treatment charges dealt a major blow to the hospitals. The healthcare industry should focus on

utilisation numbers fell below average.

sustainability,

Outpatient footfalls dropped below 50 per

comprehensive infection control measures.

cent, bed occupancy rate across all major

Building a digital health infrastructure,

private hospitals plummeted to 20-25 per

improving procurement and supply chain

cent with only deliveries and emergency

systems

procedures/surgeries

critical equipment will help in the long run

being

performed

and Average Revenue Per Occupied Bed (ARPOB) dropped by 30-40 per cent.

with

convertible

increased

designs

and

stockpiles

in case an emergency arises. Making the right decisions and taking

Patients postponed their elective surgeries,

effective action will be possible only if new

leaving aside the otherwise steady flow

approaches to care delivery and financing

of treatments related to chronic illness

are incorporated. Healthcare leaders must

such as dialysis, chemotherapy, blood

look into revamping some of the key areas

transfusion etc. Other services suffered a

of healthcare service delivery to bridge the

downfall with reduced patient footfall. Ban

gaps and meet the needs of the population

on international flights impacted medical

in case of an emergency of similar nature

tourism in the country.

in the future.

Patients visiting hospitals on emergency

Future

were considered as covid carriers. The

well prepared to battle pandemics and

need to sanitise premises and ensure

other

healthcare medical

systems

emergencies

should

whenever

www.indiamedtoday.com

COVERSTORY they arise in the future. There is a

to transport commodities will guarantee

need to critically evaluate our existing

timely delivery of items.

healthcare ecosystem, especially the critical care segment to determine our shortfalls in terms of the availability of

that are more resilient, patient-centred

an emergency plan and backup teams

and sustainable.

and resources. Whenever a similar pandemic strikes, an action plan needs to be in place that can be implemented in the shortest time frame â&#x20AC;&#x201C; one that can

applicable

across

various

settings of our healthcare system by

and

motivated

resources

(HR)

are

adequate

health

human

essential

service

for

provision.

Healthcare leaders should not only focus on treating patients but also devote similar attention to the hospital staffâ&#x20AC;&#x2122;s

sufficient treatment centres, quarantine

physical and emotional health. Physical

and isolation centres without affecting

fitness and psychological counselling

the

sessions should be provided for the

bottlenecks

non-pandemic

population.

This

and

affected

staff. Hospitals should be by the side of

â&#x20AC;&#x201C;

the family members of caregivers who

both in the healthcare segment and

succumbed to the deadly virus. This will

the

can

private

general by

involving

done

healthcare

hospitality sector which can become isolation units. Supply chain systems were the major enablers during the pandemic even during the restricted movement and operating environment. Supply chains

December 2020

Qualified

creating

removing

Thus, we need to build health systems

turn out a good example of compassion and care amongst the other hospital staff and enable an assurance. Appreciation

posts

through

emails

and display on staff notice board will

are under enormous pressure from end to

ensure a sense of recognition amongst

end during such emergencies, to ensure

the staff. Further timely remuneration,

delivery of lifesaving drugs, equipment

performance bonuses and appreciation

and medical supplies. Alternative means

gifts can boost the morale of the staff.

Ramesh Kannan Partner, Somerset Indus Capital Partners LLC

Investments

the

healthcare

sector

by Opex and cost linked to end-use. This

were hit hard during the lockdown due to

gave the sector a boost as more and more

COVID-19 pandemic.

The initial days of

technology companies swung into action

lockdown led to zero investments. Hospitals

to capitalise on digital health and SaaS

bore the brunt as deal flow completely

platforms. Also, consumables digitally were

evaporated. The providers were very much

the favourite as providers wanted savings

focussed on optimising operations, cutting

in purchases and dealing with a few instead

costs and preserving cash because the

of many. This enabled a lot of companies

future was uncertain.

to focus on creating models which helped

Few months down the line, pharma, API,

The healthcare sector is going to see an upside and digital health across sectors is going to play a very important role

providers to save and share.

health tech, digital health, SaaS, insurance

Digital health encompassing telemedicine,

tech, injectables, health consumer tech/

telecardiology, teleradiology, telepathology

diagnostics showed some signs of revival.

and teleICU found a lot of attraction and

While SaaS health consumer tech, digital

favour as it became the new norm of

health and health tech were the domain

consulting. Investments started blossoming

of VC’s and saw a substantial hike in deal-

in the second quarter and both VC’s and

making in the second quarter of this year,

PE’s were active with deal flows looking

other components were the domain of

positive.

PEs.

Some large deals happened which

led to positive sentiment. Hospitals were impacted while diagnostics (thanks to Covid testing) saw a spurt in revenues and profits on one side and national players were looking at regional presence (in an organised fashion) on the other.

Currently, things are far better in the third quarter as the pace of investments has gone up both with VC’s and PEs. Deal flow is looking good and many deals are likely to be closed in the fourth quarter of this financial year. The healthcare sector has bounced back and hopefully will be in the

Pharma was the biggest gainer as the entire

pre-COVID phase by the end of this calendar

sector did very well and deal flow was robust.

year or maximum first quarter of next year.

There was an opportunity both within and

The digital health sector is going to be big

outside the country and this catapulted the

and operational finance compared to capital

sector to newer opportunities. Added to the

finance is going to play the roost. A lot of

fact was significant interest in API’s thanks

companies are bundling their products and

to the China problem and there was a lot

services and customers are being offered

of interest in deal-making. SaaS models

payments with upfront concessions linked

saw an increase as capex was replaced

earnings.The

consumer

health

and

www.indiamedtoday.com

COVERSTORY consumer tech sector particularly in

favoured backed by the need from the

areas where services are being moved

elderly, expected mothers and newborn

from showrooms to homes are doing

/children which will eventually lead to

very well. Particularly in the retail

consolidation and growth.

space, a lot of interest in companies which can meet the requirements of both products and services at home are facing an upside.

The healthcare sector is going to see an upside and digital health across sectors is going to play a very important role. The health insurance sector is going to

Very clearly, in the new year, while

get a very big boost and grow very fast.

hospitals on a larger scale (network

Digitisation is going to enhance value.

hospitals) could see some action, the focus is going to be on the PE side for the pharma sector and health tech on the VC side. There is bound to be M&As flowing in the larger deal pipe. While the bigger players would like to consolidate, medium players would like to increase the size and scale so that they are found to be attractive by the larger players.

Patientâ&#x20AC;&#x2122;s

safety

importance. institutions,

paramount

Development impact

funds,

finance NBFCâ&#x20AC;&#x2122;s,

venture debt and structure debt etc. focussed on healthcare and its revival. Technology will play a very important role going forward as companies will leverage technologies to offer more. Manufacturing in India got a thumbs

There could be some deals on the health

up which is a positive sign considering

tech side which can result in some

consolidation and increase in size and

requirements are imported. Screening,

scale. SaaS is bound to see an increase

prevention, remote care of infectious

in activity and spreading in different

disease etc. will see a big boost. We

subsectors. The home care sector which

shall all remember that quality is the

was much neglected initially is being

focus and the key to success.

December 2020

than

per

cent

our

Meena Ganesh MD and CEO, Portea Medical

The pandemic has shown that there is a need to reimagine public health systems and create a new healthcare model that is affordable, accessible and effective

COVID-19 hit the world suddenly, at a

need to reimagine public health systems

time when no one predicted it. The scale

and create a new healthcare model that

of the pandemic and the subsequent

is affordable, accessible and effective.

nationwide lockdown was unprecedented.

While all of the healthcare cannot be done

Healthcare was the most directly impacted

remotely on digital platforms, we can

as old operating models went out of the

still ensure primary healthcare delivery

door. Overnight, there was a need to learn

through

to diagnose, assist and treat remotely

facilities. Coupled with Ayushman Bharat,

whenever possible. There was an increase

it is possible to bring high-quality primary

in the demand for home healthcare services

healthcare to every India. However, all this

given the rising burden on hospitals and

needs to be done on a war footing and

the fear of contracting the infection. At

through a joint effort between the public

Portea Medical, we mobilised our troops,

and private sectors.

partnered with governments and provided home isolation services to hundreds of thousands of afflicted patients. With the prolonged impact of the pandemic, the home healthcare sector will continue to see massive growth going forward as well.

diagnostics

and

treatment

My leadership team and I travelled all the time to the 22 cities we operate in to understand and manage operations. It was important to motivate our teams in each city by spending time with them and observing operations first hand. The

The last few months have been a big learning experience in terms of dealing with a crisis while working remotely all the while. It is important to reimagine the company direction, products and services, and go-to-market strategies. The most important role of the leader is going to be constantly scanning and modifying the direction as things get clearer. The pandemic has shown that there is a

pandemic also provided a great opportunity to meet patients and their families to understand their problems and help solve them. During this time, we repurposed our technology and medical capability to help governments remotely monitor COVID positive home isolated patients. We are associated with six different state governments to provide these services in their respective jurisdictions. So far, we

www.indiamedtoday.com

COVERSTORY have delivered services to treat more

have ushered in the era of out-of-

than 100,000 COVID positive patients,

hospital healthcare in India. During

of which less than 3 per cent needed

this period, people have experienced

hospitalisation. This solution is now

the benefits and efficiency of home-

being offered by us to corporates and individuals too. We also used our existing digital capabilities to support this change in patient mindset by supporting them. Going forward, we are focusing a lot more on digital solutions,

based like

healthcare telemedicine

services.

Options

consultations

are

digital processes that can function effectively even when normal social life is disrupted and patients are not able to travel to a conventional healthcare facility or clinic. This will bolster the

and integrating them better with our

overall healthcare quality in India and

existing on-ground services.

will enable quality healthcare services

The innovative services offered in the healthcare sector during the pandemic

December 2020

to cover all parts of the country including the remote or rural areas.

Rajiv Nath Forum Co-Ordinator, AiMED

As India geared up to fight the COVID-19

The

crisis, the Association of Indian Medical

Incentive)

Device Industry relentlessly worked at the

investments and Make in India for high-

forefront to combat the crisis. Huge efforts

technology product segment of medical

were put into increasing medical device

devices and the medical devices park

manufacturing capacity by AiMeD through

promotion scheme by DoP are further

its members and beyond.

encouraging growth in this sector which

AiMeD worked closely with the Government

COVID-19 crisis has shown that the Indian medical devices sector can rise to the challenge

recent

PLI Scheme

(Production to

Linked

encourage

has been challenged by cash flow upsets by delayed payments from government

of India i.e. Dept. of Pharmaceuticals,

buyers. We are seeking supportive policies

Ministry of Commerce, NPPA and CDSCO

of nominal tax protection, separate medical

for ramping up capacity and addressing

device law that does not criminalise minor

production bottlenecks during the pandemic

offences, preferential pricing for domestic

to fight against COVID-19 pandemic during

manufacturers in government procurement,

the complete lockdown period.

restriction in the import of pre-owned

AiMeD

worked

with

QCI

expedite

finalisation of ICMED Plus Certification as well as with consultants consortium to provide online training on quality management new

system

entrepreneurs

garments,

textile,

certification from

auto

automakers,

parts

Industry

who had ventured into medical devices

medical equipment and price cap of import landed / ex-factory prices at rational levels as strategic support policies. These will encourage

manufacturer-turned

traders

to go back to manufacturing and seek collaboration and joint ventures globally and use the infrastructure being provided in these upcoming medtech parks.

manufacturing. COVID-19 crisis has shown that the Indian medical devices sector can rise to the challenge. When imports got disrupted, specific devices detailed with quantified production shortages and a focussed InterMinistry Group coordinating with domestic manufacturers via AiMeD had addressed production bottlenecks and challenges so that not only capacity got utilised but also ramped up rapidly.

www.indiamedtoday.com

COVERSTORY

Sudhaker Jadhav Chief Operating Officer, Oasis Fertility

When the nation called for a complete

considering a second wave of the pandemic.

lockdown on March 24, it was a chaotic

Our priority was to give a very high degree

situation and many IVF centres in the

of safety assurance to our patients and all

country were forced to pause putting a lot

our staff and stringent safety protocols

of pressure on the system with no revenues.

right from the patientâ&#x20AC;&#x2122;s phone call to the

There was no visibility and certainty as to

centre till she gets her embryo transferred.

when the pandemic would end. There were almost two months of zero revenues in the industry and only in late May and in early June, the IVF centres started to resume

I feel that next year could get better as there will be a spike in footfall at IVF centres and also people per se will feel safe going to a stand-alone clinic vis-a-vis a fertility centre being operated within a multispeciality hospital or a mother and child hospital

their operations. Liquidity was a major issue and of course paying salaries to our staff and medical teams were the biggest

According to a Grandview research report, Asia Pacific accounted for the largest share in terms of the number of IVF cycles

to 60 days which taught us how to fight this pandemic. Looking back, we at Oasis Fertility feel that we have come a long way in setting up some decent safety protocols.

taught us to be considerate and empathetic towards people and restricted us from spending money on a luxury.

performed in 2019, with Japan, China, and

I feel that as healthcare leaders, we need to

India being the major contributors to the

reassure our employees and their jobs. We

region.

always believed that patients come second.

The India IVF Services Market garnered

We have a clear understanding that a

$478.2 million in 2018 and was expected

happy employee makes a customer happy.

to reach $1.45 billion by 2026, at a CAGR

We take a lot of pride that at Oasis Fertility

of 14.7 per cent from 2019 to 2026.

we never displaced or laid off any of our

potential

COVID-19

severe

pandemic necessitated the development of an organised and well-reasoned plan

employees and during the tough time, we showed them the solidarity by paying the salaries.

embryology/

Second, I think we should be more proactive

andrology laboratories while safeguarding

and anticipate the situation to continue

the wellbeing of patients and IVF staff. We

for another year or so and start planning

at Oasis Fertility created an indigenous

resources for our goals. We all know that

and exhaustive SOP and road map even

online consultations have grown a 1000

for

December 2020

learn from the past, it was those crucial 45

On a different tangent, I think COVID-19 has

priority for us at Oasis Fertility.

The

There was no reference point for us to

the

management

fold but unfortunately in IVF treatments

On the patient front, we had launched

like IVF consumables and pharmacy.

it doesnâ&#x20AC;&#x2122;t work that way as the patients

engagement

We have been talking to the leaders

have to come to the centre, But,

platform which makes the IVF journey

from the supply side to look at a price

however, we have tried and reduced the

for a patient very smooth, right from

revision. Some aggregators are playing

no of visits by launching IVF at home

the booking of the appointment to the

a decent role a decent role who can

and also doing a lot of things remotely

day of the embryo transfer.

such

as,

registrations,

appointment

contactless

patient

bring down the cost per cycle. We feel

We at Oasis Fertility are sensitive about

that these kinds of aggregators should

booking, history taking, counselling and

the needs of the patients. We have a

be encouraged who can bring in a lot of

patient education which is now done

deep understanding of the customer

totally contactless.

value on board for both the IVF space

demographics and have also understood

and the patients.

We anticipate that the next financial

that money has become dearer. We

year would be better.

came up with some very aggressive

mentioned

earlier,

engagement

was

our

during

lockdown

top

employee priority

economical packages to cater to the patients thereby continuing

the great level of patient satisfaction

just not supporting them financially

and also offered them zero per cent

the

terms

by assuring their salaries but also frequently checking on the well being of

EMI options through different fintech companies.

I feel that next year could get better as there will be a spike in footfall at IVF centres and also people per se will feel safe going to a stand-alone clinic visa-vis a fertility centre being operated within a multi-speciality hospital or a mother and child hospital. The numbers would be very positive as

them and their family members. There

I think the industry leaders should

were instances where our admin team

look at curtailing the spiralling cost

ensured a seamless supply of groceries

of IVF and pass on the benefits to the

to corona will ease out and also hoping

and other essentials to our employees

patients. This is possible if the revisions

that by the starting of the coming year

who were COVID positive.

happen right from the supply side

we might get a vaccine.

the demand which was restricted due

www.indiamedtoday.com

COVERSTORY

Dr Biren Chauhan

Group COO, Sunshine Global Hospitals

We all can debate and discuss at length

hospitals and they consolidated and refined

if we start evaluating the pros and cons

their covid care delivery model in no time

which the lockdown won across sectors

and went back to routine work in less than

in the country. But we all agree to the

three to four months.

fact that hospitals operate and reflect the healthcare needs of the community/ city/ state that they operate from and hence

Overall, healthcare in India will be a lot different in terms of patients, providers and payers in the coming years and uptake of services will be more than ever

cannot escape the impact of micro or macro-level policy decisions in response to COVID-19 Pandemic. The lockdown had a varied impact from mid-March till date and will have for the near term future too.

providers

and

payers

were

working

very closely to fight the pandemic in the latter and end phase of the lockdown. It is reasonable to say that the principle of 'survival of the fittest' was tried, tested and proven true once again amidst the pandemic. Foundations of humanity and its

private hospitals had the only emergency

value system was yet again at its best peak

and critical care patients flow as the fear

and the fighting spirit of the human race

of COVID-19 and complexity of COVID care

was once again at its full display.

restricted both patients and the providers to get themselves ready for the new normal. As cases kept on rising amidst the

The learnings from pandemic will have long-lasting ramifications and we will see a

lockdown, the mid-phase of the lockdown

set of new rules emerging to better manage

saw hospitals offering COVID-19 care to

Hospitals. Futuristic planning will have

the patients by the caseload in and around

the inherent component of being flexible

the hospitals. Many hospitals converted

themselves into designated covid care

unfolding outside the healthcare domain.

hospitals and others into non-covid or

Hospitals

between covid and non-covid patients.

December 2020

need was done at all levels where patients,

During the initial phase of the lockdown, all

mix care models with physical segregation

Capacity enhancement as per the local

accommodate

that

got

unforeseen

away

changes

early

from

financial and non-financial stress on their functioning were also the ones that were

The mid-phase threw a range of challenges

first to mould themselves as per the need

from manpower to resource management

of the new normal. Being cost-effective

to care protocol and limited treatment

is the most important catalyst for turning

protocols, etc. All stakeholders like the

around any situation to an advantage.

federal government, state and district

Developing and nurturing spectrum of

administration,

private

the multi-faceted and diverse manpower

partnerships flourished in this challenging

resource pool, enabling outlook-oriented

time of COVID-19 Pandemic. Gradually the

systems capable enough to adapt to new

new normal was achieved by the private

challenges and value and ethos driven

public

and

organisations are more immune to the

can be done without any friction only

sharing between hospitals in the same

threat of COVID-19 on its functioning.

when a participative culture exists in

region is also a good sign and will help

hospitals. Rather than having quick

everyone to improve their performance.

hire and fire, hospitals must protect

Trust and respect of the community

and support its workforce during the

towards

pandemic and beyond. It will surely

have increased tremendously because

shape up the hospital's workforce as its

of COVID-19.

COVID-19 care offering at an affordable cost has been possible only for those hospitals who are good enough to keep

themselves

cost-effective

adopting innovative cost optimisation models.

Cost-effective

solutions

strength.

their

healthcare

providers

Deploying technological solutions and

without compromising on quality have

Similarly removing avoidable wastages

reaching to patients by innovative

been the trademark of sustainable

and

solutions will unlock the future potential

hospitals amidst the pandemic. Also,

competitive edge to hospitals. Working

successful

with vendors, partners and associates

around have become vigilant towards its

hospitals

COVID-19

optimising

will

healthcare

success.

Communities

purchase,

health and well being and will improve

BME, engineering and maintenance,

population health on a longer run.

hospitals stand out as a differentiator

outsourced services, etc will give needed

Overall, healthcare in India will be a lot

and determinant of the success of the

leverage by having cost optimisation

different in terms of patients, providers

hospitals in these challenging times of

of around 7-10 per cent over the next

and payers in the coming years and

the pandemic.

year or two in this segment. All these

uptake of services will be more than

would be possible when hospitals have

ever. Hopefully, disease patterns will

an inherent culture of sharing and

also change from communicable to

caring and positive attitude towards its

non-communicable

doctors, human resource, vendors and

diseases

associates. It can not happen overnight

behaviour will change for the larger

and

empathetic,

good. Governments will no longer be

participative and supportive leadership

able to ignore the basics of healthcare

will be critical to the success of cost

and they will have to deliver to ensure

optimisation efforts during COVID-19

that social determinants of healthcare

that

leadership

capabilities

The pandemic has changed monthly, quarterly and annual projections for hospital leaders. First and foremost, leaders

must

rework

and

redraw

projections and bring them closure to reality after considering the pandemic. Strong understanding of the virus, its multi-pronged interaction with micro and macro environments at global, national, state and community level will

firmly

general

give

and performance-oriented culture of

showed

pharmacy,

cost

believe

and post-COVID scenario.

and

infectious

healthcare-seeking

and gaps are addressed in a time-bound

surely be an added advantage. Once

FY 2020-21 will be marked as an outlier

manner. The local administration has

it is done, the next logical step would

financial year for almost all hospitals

seen a devastating impact of COVID-19

be to assess the bottom-line expenses

irrespective of whom they cater to

in the lives and livelihood of one and

of all types (direct and indirect, fixed,

(COVID or non COVID or both). On a

all. They will also give healthcare

variable and semi-variable, etc).

brighter side, hospitals will be more

much-needed attention and priority by

flexible and will not shy away from

strengthening primary and secondary

quickly changing their service offering

care delivery systems at grassroots

as per the needs of the community

levels.

Leaders must prioritise the areas where they can optimise as per the need of the

hour,

for

example,

considering

innovative ways to address fix cost/ minimum

guarantee

specialist

doctors

committed and

engaging

around. Also, hospitals will be quick to take radical decisions to ensure their viability.

Overall, the outlook for FY 21-22 is very promising and weâ&#x20AC;&#x2122;ll witness a more transparent, more coordinated

them in an empathetic way. Once

Hospitals will be likely to keep their

healthcare delivery system with the

they understand the real picture of

legal

governmentâ&#x20AC;&#x2122;s role that will take a

the pandemic and its impact on the

check. Communication with different

paradigm shift from being a regulator

financial health of the institute, to help

stakeholders within and outside the

to the facilitator. The public health

organisations become viable in coming

hospitals

cornerstone.

and healthcare delivery system will

months, doctors will stand together

A lot of hospital leaders are now

be closer to each other than ever and

with the institute and willingly take

closely working with local government

we hopefully will see a holistic care

proportional hits in their payouts and

administrations and this will be good for

delivery model across the country in

help the institute in difficult times. This

the communities around. Information

coming years.

and

statutory

will

compliance

the

www.indiamedtoday.com

COVERSTORY Dr Subhrojyoti Bhowmick Clinical Director, Academics and Research, Peerless Hospital

The year saw telemedicine practice guidelines come into existence in India and teleconsultation for patients is here to stay even in absence of the pandemic

December 2020

Looking back on the eve of December 31, 2019, I remember how excited we were to welcome a new decade of hope and prosperity, where we had no clue of the unprecedented crisis we have to face in 2020 - how it holds the capability to have changed all of our lives forever. 2020 has taught us many lessons and given us many wake up calls. Millions of people around the world have died during the pandemic. Millions in India alone have lost their jobs. Though China was struggling with this deadly virus since the end of 2019 not all of their struggling moments were clear to us at the time. China’s decision to shut down cities of millions of people in early January was staggering, however to most Indians; this new coronavirus 2019 (COVID19) remained a distant nightmare, not something that would demand our version of a lockdown. However, amid the virus spreading news from China, France and Italy, the coronavirus outbreak was declared a pandemic on March 11, 2019, by the World Health Organization (WHO) and many of us are already feeling nostalgic for our lives by the time it went global. Slowly yet steadily we were into this biggest crisis of humankind ever thought of.

warriors. Praying day and night to receive the

Every person around the globe has had their taste of fear, anxiety, and uncertainty to face from March 2020. All the blessings we enjoyed and have taken for granted since our childhood have suddenly started taking a toll. Many families are infected in front of our eyes. Some are moving on with caution and care, however, those who are reckless are endangering their lives as well as others. In the middle of all this uncertainty and losing lives, all we are left with is hope. People were looking with all their hopes for frontline

COVID19 outcomes. AI utilises deep learning

“magic vaccine” from the healthcare industry. 2020 made us focus on infection control practices like hand washing and wearing masks as the way of life to beat the virus. Never have neither the healthcare professionals nor the common people have fully complied with these infection control practices. This year the major emphasis was on vaccine clinical trials and media coverage of phases of clinical trials made these topics a household story. The year saw telemedicine practice guidelines come into existence in India and teleconsultation for patients is here to stay even in absence of the pandemic. On the same line, Artificial Intelligence (AI)driven technology enhancement is happening in the field of radio-diagnosis and laboratory medicine in much higher healthcare centres of the country. AI is not only assisting children to learn better by enlisting tailored teaching assistants but also by helping with smarter energy consuming like the US and the UK AI is analysing and uncovering patterns in huge swathes of medical data and this makes it the perfect tool for modelling and tracking models, which has also been deployed to support drug discovery that can combat the virus. Over this year, AI has been continuously used to solve some of healthcare’s most pressing issues – from reporting the power of medical records, to relieving doctors and nurses from contact-tasks, to enhancing surgical precision to a great extent, yet much more is yet to come in the next few years.

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PULSE

Oxford-AstraZeneca Vaccine is Cheaper than Pfizer’s and

Moderna’s and Doesn’t Require Supercold Temperature The biopharmaceutical company AstraZeneca has released data on what is now the third promising vaccine candidate against COVID-19 – and it has several advantages over those of its competitors, Pfizer and Moderna.

Sanjay Mishra Project Coordinator & Staff Scientist, Vanderbilt University Medical Center, Vanderbilt University

On Monday, AstraZeneca released interim analysis of its phase 3 trial data of 23,000 volunteers from the U.K. and Brazil. These results show that the test vaccine is between 70% and 90% effective in stopping COVID-19, depending on the vaccine doses administered. Although less effective than the reported results from the Pfizer or Moderna COVID-19 vaccine candidates, this vaccine is still more effective than annual influenza vaccines that reduce the risk of flu by between 40% and 60%. Notably none of the vaccinated participants needed hospitalizations or reported severe disease. Like most vaccine experts, I am intrigued by large differences in effectiveness between two tested dosages of AstraZeneca’s vaccine. Until March, I was developing vaccine candidates against Zika and dengue. Now I am coordinating a large crowd-sourced international effort to better understand the scope and severity of COVID-19 in cancer patients. The COVID-19 vaccine trials generally exclude most people with a history of cancer, so I am eagerly awaiting vaccine efficacy data for this risk group when these vaccines become widely available.

Intriguing dose response AstraZeneca’s vaccine was originally planned to be given in two full doses, four weeks apart, as injections in the upper arm. A third of the volunteers were injected with a dummy saline placebo. One of the few details that AstraZeneca released is that of 131 cases of COVID-19, only 30 cases were detected among 11,636 who were given the vaccine; 101

December 2020

cases occurred among the volunteers who got the placebo. That suggests that the vaccine is 70% effective overall. However, an error in the early stages of the trial meant that some participants received only a half-dose in the first round. In the group of 2,741 volunteers who received a lower dose of the vaccine candidate followed a month later by a full booster dose, the efficacy was 90%, according to AstraZeneca. The efficacy was only 62% among the 8,895 volunteers who received both full doses. It is not clear why the half-dose plus the full dose sequence of the vaccine performs better than two full doses. One explanation could be that since the vaccine is based on a common, although nonhuman, cold virus, the immune system probably attacks and destroys it when the first dose is too large. It is also possible that progressively increasing the dose more closely mimics a natural coronavirus infection. Beginning with a lower first dose might be a better way of kicking the immune system into action; then a stronger, more effective immune response occurs after the second full booster dose. Despite enormous progress in human immunology, scientists still don’t understand the best strategies for inducing protective immunity. These results are based on the evaluation of about one-third of volunteers who are expected to participate in this trial, which is ongoing in other parts of the world and will enroll up to 60,000 people. AstraZeneca will now seek approval from the FDA to also evaluate the half-dose protocol in the ongoing U.S. trial. The current trial involves 30,000 participants and is evaluating only the two fulldose regimen. AstraZeneca’s trials in the U.S. were halted temporarily in early September after a study participant in the

U.K. fell ill, but resumed in the U.K., Brazil, South Africa and Japan.

A modified chimpanzee cold virus The

Oxford-AstraZeneca

vaccine

another example of a new strategy being used to rapidly develop vaccines against the coronavirus that has already infected over 58 million people worldwide. A vaccine works as a primer to train the immune system against a pathogen. Conventional

vaccines

are

made

weakened viruses or by purifying their disease-causing protein, such as the spike protein, which decorates the surface of a coronavirus. But these methods can take decades to develop new vaccines. Coinvented by the University of Oxford and its spinout company, Vaccitech, this vaccine uses different molecular tools to provide a preview of the SARS-CoV-2 virus to the human body. Instead of making weaker viruses, or delivering mRNA that encodes the spike

Not-so-frigid storage requirement Despite a somewhat later arrival, with less than the effectiveness claimed by its competitors, AstraZeneca’s vaccine might be favored because it can be stored, transported and handled at standard refrigerated conditions of between 36 and 46 degrees Fahrenheit for at least six months. The competing mRNA vaccines by Moderna and Pfizer/BioNTech require ultracold temperatures for stability. So the AstraZeneca vaccine will be easier to use in normal clinics, especially in rural America and the developing world. Another important advantage of the AstraZeneca vaccine, which is being tested in collaboration with a larger number of global sites, is that it should cost less because of AstraZeneca’s commitment to COVAX, a global initiative that aims to distribute low-cost vaccines to lowand middle-income countries. Pfizer and Moderna have not joined the COVAX

initiative, but AstraZeneca has agreed to make the vaccine on a not-for-profit basis for the duration of the pandemic.

Wait and watch However, like all other candidate vaccines for COVID-19, AstraZeneca’s vaccine is also lacking in key details such as the breakdown in infections, the durability, or the efficacy in the different age groups of trial participants. For all the vaccine candidates, we have only preliminary data from a small number of infections, and none of the groups developing the COVID-19 vaccine candidates has so far published complete data. So it is difficult to fully assess the differences between them. We will have to wait for more followup and longer-term data to evaluate the effectiveness of all the COVID-19 vaccines in finally getting the COVID-19 pandemic under control. This article is republished from The Conversation under a Creative Commons license.

protein, as Moderna and Pfizer did, the Oxford vaccine packs the DNA that codes for the spike protein in the shell of a genetically altered chimpanzee virus. The original adenovirus causes common cold in chimpanzees and it rarely, if ever, infects humans. The virus is further modified to ensure that this chimp virus cannot grow in people. The AstraZeneca vaccine uses the modified virus as a vehicle to deliver the COVID-19-causing spike or S-protein of the SARS-CoV-2 virus. Under the agreement with the University of Oxford, AstraZeneca is responsible for development, worldwide manufacturing and distribution of the vaccine. This isn’t the first time that University of Oxford scientists have tried a vaccine using this harmless virus. Previously, it tested the concept against a closely related coronavirus that causes Middle East

respiratory

syndrome

(MERS)

animal studies. So this time, soon after the sequence of the novel SARS-CoV-2 became available, the Oxford scientists retooled the chimp virus for a vaccine that induced robust immune response against SARSCoV-2 in mice and rhesus macaques.

Genetic material encoding the spike protein, which enables to infect human cells, is inserted into a modified cold virus from chimps. This combination is the OxfordAstraZeneca vaccine that was then injected into volunteers. The vaccine allows the muscle cells in the arm to manufacture the spike protein, which gives the body a preview of the virus and allows it to develop an immune response should the real virus strike. University of Oxford, CC BY-SA

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APPROACH

We need these two policies to drive our recovery from COVID-19 Mandeep Dhaliwal

With more than 54 million cases of

Director of HIV, Health and Development Group, United Nations Development Programme (UNDP)

COVID-19 reported globally at the time of writing, many countries are struggling with second waves of the virus. The prospect of reimposing lockdowns and other restrictions, while necessary to bring the pandemic under control, could have devastating economic and social consequences for millions of people. At the same time, many initial government

introduced the 'Solidarity Income' scheme to deliver resources to an additional 3 million vulnerable households. Meanwhile, the government of Togo gave over $19.5 million in monthly digital cash transfers to more than 12% of its population, mostly to women who work in the informal sector. But temporary financial assistance is not

cash assistance to the most vulnerable are

enough. Without affordable healthcare,

coming to an end.

these types of programmes will inevitably

millions of people who lost their jobs or are struggling to make ends meet amid the pandemic must make difficult choices about how to use their limited resources.

fail to stimulate the economy and prevent financial hardship for the poorest and most vulnerable communities. United Nations Secretary-General

AntĂłnio

Guterres

underscored this reality in his recent

For many, the choice between spending

call for countries to urgently scale up

money on medical expenses or necessities

investment in universal health coverage to

like food and shelter is, quite literally, life

help end the crisis and build back stronger.

or death. Even if such social and economic

As he put it: â&#x20AC;&#x153;A huge gap in health coverage

protections continue, the lack of widely

is one reason why COVID-19 has caused so

accessible and affordable health services

much pain and suffering.â&#x20AC;?

means one medical bill could still force a

Women, for example, comprise 89% of

family into extreme poverty.

the informal economy in Sub-Saharan

Policy-makers must use a combination of

Africa.

tools, including both immediate measures

as street vendors or domestic workers

like temporary basic income (TBI) and

with no social protections, could face

urgent changes like achieving universal

enormous financial burdens due to health

health coverage (UHC), in their response.

costs that would erase any economic

Only then can we recover from the

gains from TBI programmes. Even before

pandemic and build back more resilient

the pandemic, 100 million people were

and sustainable communities.

pushed into extreme poverty each year

Several countries across income levels have

already

implemented

successful

programmes to mitigate the financial impact of the COVID-19 pandemic. A recent

December 2020

The Colombian government, for example,

stimulus plans that provide emergency

Without these programmes, hundreds of

effects of the crisis.

These

informal

workers,

such

because of healthcare costs. COVID-19 has only exacerbated this crisis, with disproportionate impacts on women and other marginalized groups.

United Nations Development Programme

Despite

(UNDP) report affirms that temporary

workers might forgo COVID-19 testing and

income

assistance,

informal

basic income policies can help protect

unknowingly contribute to the spread of

poor families that lack social assistance

the pandemic due to the lack of affordable

or insurance protection from the worst

and accessible health services in many

communities.

more effectively address the virus itself

COVID-19 is disrupting other life-saving

Moreover,

the stress

and its disruption of essential health

health services in these communities,

services and its socio-economic impacts,

such as childhood immunization, HIV, TB,

malaria,

family

maternal

planning

and

health

care,

treatment

for

while contributing to long-term societal and economic resilience.

non-communicable diseases like diabetes

Studies show that achieving UHC is an

and high blood pressure. These ripple

ambitious but attainable goal, even for the

effects multiply and could have harmful

worldâ&#x20AC;&#x2122;s poorest countries. Equitable access

long-term

to affordable, high-quality healthcare is

effects

for

individuals,

communities and national economies.

the foundation for resilient health systems

No one should be forced to choose

that can respond in future emergencies

between their health and their financial

and deliver essential services in times of

security. Investing in temporary basic

both crisis and calm.

income programmes and universal health coverage is the best strategy for long-

Temporary basic income can mitigate

term recovery by ensuring that people

some of the worst effects of COVID-19

can access the health services they need

on poor households, and universal health

without facing serious financial difficulties.

coverage is critical to ensuring strong

And it is possible to do both.

health systems that donâ&#x20AC;&#x2122;t drive people

UNDP found that the majority of TBI

into poverty â&#x20AC;&#x201C; now or in the future. Both

schemes would cost most developing

will take political will and investment, but

countries far less than 1% of their GDP per

now is not the time to limit or pull back. To

month while providing substantial benefits

respond effectively to COVID-19, countries

need

should implement a smart combination of

assistance to buy immediate necessities

measures that will accelerate economic

vulnerable

populations

who

like food for their families.

recovery while providing the foundation

While countries have agreed to work

for more equitable, just and sustainable

toward

2030,

development. Only then can we protect

we must accelerate this process to beat

the most vulnerable during this pandemic

this

and prevent future health and economic

implementing

pandemic

and

UHC rebuild

stronger

than before. For these precise reasons, Secretary-General Guterres has outlined how investing in UHC will help countries

crises. First published on World Economic Forum under a Creative Commons license

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HEALTH-IT

Lurking cybercrime in healthcare sector How financially motivated criminal groups continue to target the healthcare industry via ransomware attacks and the ways to prevent such attacks In 2019, the global healthcare industry

data

saw a substantial increase in the number

credentials. Criminals are after one piece

of breaches and incidents. Out of 3,950

of information – personally identifiable

confirmed breaches, the number of data

information (PII) and protected health

breaches in this sector came in at 521

information (PHI). Your PII or PHI may

versus 304, in 2018. Verizon’s Data

be collected or created by a healthcare

Breach

Prashant Gupta Head of solutions South East Asia & India, Verizon Business Group

data

and

provider, health insurer or employer. The

motivated

criminal

information can usually contain a person’s

groups continue to target the healthcare

name, address, phone number, medical

industry via ransomware attacks. Lost

insurance details, beneficiary information,

and stolen assets also remain a problem

financial account numbers, biometric data,

while basic human error is alive and well

facial images etc. There is a tremendous

financially

applications and phishing or business email compromises represented 72 per cent of breaches in the healthcare sector.

December 2020

medical

revealed

in this vertical. Miscellaneous errors, web

Report

that

Investigative

followed

amount of information flow in healthcare – prescription information sent from clinics to pharmacies, billing statements mailed, discharge papers physically handed to

The majority of the data under attack

patients, copies of identity and insurance

cards filed and so on.

the

healthcare

sector

personal

In my opinion, unless you really protect

actors fall to 48 per cent. However, this is

data at its core, no matter how many

a small percentage, and healthcare remains

network-level

the industry with the highest amount of

protection

endpoint

level protections you put in, it won’t really keep you secured for too long. Healthcare organisations need to conduct a proper risk assessment to prioritise investments and focus on the issues that matter the most and mitigate the risk or bring the risk to an acceptable level. These organisations need

approach

follow to

the

defence-in-depth

safeguard

their

critical

systems and data as our research tells us

internal bad actors. As with many things in life, as one attack grows more prevalent, others begin to decrease. So the story goes with the miscellaneous errors pattern. While it has frequently graced the top three patterns in this sector, it took the gold this year. In case you are curious, the top mistake within

healthcare

our

old

friend,

misdelivery.

that by increasing the number of layered controls (in essence the number of steps

This error tends to fall into two major

that an adversary has to clear) to protect

categories:

systems/data could be very effective in

• Someone is sending an email and

decreasing the probability of occurrence

addresses

of a data breach.

frequently wider) distribution—it’s a

In the 2019 report, we showed Privilege

bonus if a file containing sensitive

Misuse at 23 per cent of attacks, while in

data was attached with their patients,

2020, it has dropped to just 8.7 per cent.

they create additional lucrative attack

Does that indicate that insiders are no

surfaces.

the

wrong

(and

longer committing malicious actions with

• An organisation is sending out a mass

the access granted to them to accomplish

mailing (paper documents) and the

their jobs? Well, we wouldn’t go quite that

envelopes with the addresses become

far. However, it will be interesting to see if

out of sync with the contents of the

this continues as a trend when next year’s

envelope. If sampling is not done

data comes in.

periodically throughout the mailing

Another change that goes along with decreased insider misuse breaches is the corresponding drop in multiple actor breaches.

The

patients’ sensitive information. When thinking of the healthcare vertical,

typically been the leader in this type

one naturally thinks of medical data.

of breach—which usually occurs when

And, unsurprisingly, this is the industry

external

combine

in which that type of data is the most

forces to abscond with data that is then

commonly breached. However, we also see

used for financial fraud. The multiple actor

quite a lot of both personal data (which

breaches last year were at 4 per cent,

can be anything from basic demographic

and this year we see a drop to 1 per cent.

information

The 2019 DBIR reported a first in that

elements) and credentials stolen in these

the Healthcare vertical had Internal actor

attacks. The second most common pattern

breaches (59 per cent) exceeding those

for healthcare is the web applications

perpetrated by External actors (42 per

attack. As more and more organisations

cent). This year external actor breaches

open patient portals and create new and

are slightly more common at 51 per cent,

innovative ways of interacting with their

while breaches perpetrated by internal

patients, they create additional lucrative

internal

sector

NSYNC, then it’s bye, bye, bye to your

has

and

healthcare

process to ensure that they remain

actors

other

covered

data

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HEALTH-IT

attack surfaces. Finally, we see a good deal of everything else pattern, which is not unlike a lost and found for attacks that do not fit the criteria of any other attack pattern. It is within this pattern that the business email compromise resides. If youâ&#x20AC;&#x2122;re not familiar with this attack, it is typically a phishing attack to leverage a pretext (an

Security Controls to provide you with

services and ports should be exposed to

a way to translate DBIR data into your

your systems, and limit access to those.

security efforts. Here are the top controls that our data suggest will be worthwhile for most organisations.

Boundary Defense: Go beyond firewalls to consider things like network monitoring, proxies and multifactor authentication.

Continuous

Vulnerability

Management:

Use this method to find and remediate

Data Protection: Control access to sensitive

things like code-based vulnerabilities; also

information by maintaining an inventory

great for finding misconfigurations.

sensitive

information,

encrypting

sensitive data and limiting access to

invented scenario to give a reason for

Secure Configuration: Ensure and verify

the victim to do what the attacker wants)

that systems are configured with only the

to successfully transfer money (by wire

services and access needed to achieve

Account

transfer, gift cards, or any other means).

their function.

accounts across the organization to keep

Although these are common attack types across the dataset, it is a good reminder to healthcare organisations that it isnâ&#x20AC;&#x2122;t only patient medical data that is being targeted.

and

Web

Browser

Protection:

authorised cloud and email providers. Monitoring:

Lockdown browsers and email clients to

Use of multifactor authentication also fits

give your users a fighting chance when

in this category.

facing the Wild West that we call the

Implement a security awareness and

Internet.

This year weâ&#x20AC;&#x2122;ve aligned our findings with

Limitation and Control of Network Ports,

both

the Center for Internet Security Critical

Protocols and Services): Understand what

accidental breaches.

December 2020

user

bad guys from using stolen credentials.

Recommended best practices

Lockdown

training programme: Educate your users, on

malicious

attackers

and

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December 2020