IndiaMedToday Oct 2020

OCTOBER 2020, VOLUME 4 ISSUE 10 `200 INDIA MED TODAY

VACCINE CONVERSATION WE SHOULD HAVE Public perception of vaccines threatens vaccination programmes worldwide.

Understanding this may lead to better acceptance of vaccines including COVID-19 vaccine

AUGUST2020

AI IN HEALTHCARE Winning Strategy

APPROACH Behavioural Economics & Healthcare

OPERATIONS What Do Hospitals Need

INTERVIEW Dr Madiha Derouazi CEO, Amal Therapeutics

WMIT, Global Medical Industry Convergence Cluster W

onju Medical Industry Techno Valley (WMIT) was founded in 2003, by a spontaneous help and close cooperation between local government and universities as a non-profit organization.

WMIT established customized “MEDISTRY� provision system for Korean medical manufacturers, which currently includes comprehensive support for multilateral analyses on preceding technologies, mechanical and instrumental design, pilot production, safety and reliability tests to secure conformity to international standards and activities for making inroads to global market for corporations to have global competitiveness.

As a way of making inroads to Indian market, member companies of WMIT, NEODR (www.neodr.net), MIONE (www.mione.co.kr),

YUWONMEDITECH (yuwonmeditech.com), FORU (en.for-u.co.kr), HAHOMEDI (hahomedi.com) are herewith presenting their grand products.

GMES(Gangwon Medical Equipment Show),

one of the biggest medical B2B event hosted by WMIT is usually held every September in Korea.

Approximately 100 Korean medical manufactures and 200 overseas clients from all over the world invited by WMIT with financial support are participating in GMES. However as covid-19, we will deliver the GMES 2020 as a virtual show on October 15-16, 2020.

Tel: +82. 33. 760. 6100 / Email: gmes@wmit.or.kr, www.wmit.or.kr For more information on the show, please visit GMES website (http://gmes.wmit.or.kr/)

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3

EDIT NOTE www.indiamedtoday.com

October 2020 EDITORIAL Editor Neelam Kachhap editorial@ indiamedtoday.com

BOARD OF ADVISORS Dr Alexander Thomas Dr Girdhar Gyani Dr Prem Kumar Nair Dr Bhabatosh Biswas Ramesh Kannan

Welcome to the latest edition of IndiaMedToday.

CONSULTING EDITOR

Our cover this month examines the difference in perception

Dr Libert Anil Gomes

on vaccine and its effects on disease control. We analyse the

Dr Alok Roy

ART & PRODUCTION WepApp Logic Shylesh

Winning with Vaccines

Dr Salil Choudhary

recently published largest global vaccine confidence survey that throws light on the country wise differences in vaccine

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opinion. With COVID-19 vaccine hope, it is important to understand public attitudes towards vaccines. Our only hope to address this pandemic can be ensured if we figure out a response to decline in vaccine confidence. It is our best chance to enhance the acceptance of this new life-saving vaccine.

We also look at the progress of cancer vaccines clinical trials, in conversation with Dr Madiha Derouazi, CEO, Amal Therapeutic.

In another, first-hand narratives from frontline workers we look at what keeps you going when healthcare workers test Covid-positive.

Our lead story looks at the usability of behavioural economics in healthcare and how it can be used to enhance patient compliance.

We also examine how hospitals and other healthcare providers can execute a winning AI strategy. We also share with you thought leadership article from Cdr, Navneet Bali.

Do write back and let us know your thoughts.

OFFICE 301, Grazia, 1st main, 2nd Cross, Lingrajpuram, Bangalore 560084 www.indiamedtoday.com IndiaMedToday expressly disclaims liability for errors and omissions in this publication. While we try to keep the information timely and accurate, we make no guarantees. The views and opinions expressed in the magazine do not necessarily reflect the official policy or position of IndiaMedToday or the publication. Information on IndiaMedToday should not be used as a substitute for professional healthcare advice.

Readers are advised to always seek specialist advice before acting on information contained in this publication. Never disregard professional medicaladvice or delay in seeking it because of something you have read on IndiaMedToday. No part of this publication or any part of the contents thereof may be reproduced, stored in a retrieval system or transmitted in any form without the permission of the publishers in writing.

Printed and published by M Neelam Kachhap, 301, Grazia, 1st main,

Editor M Neelam Kachhap

2nd Cross, Lingrajpuram, Bangalore 560084 on behalf of Neelam Publishing (OPC) Private Limited, Printed at Supriya Print Art 143, Pragati Industrial Estate, N M Joshi Marg, Lower Parel West, Mumbai - 400011. and published at 301, Grazia, 1st main, 2nd Cross, Lingrajpuram, Bangalore 560084.

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5

OCTOBER 2020

CONTENTS

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ccording to several reports and studies, people with cardiovascular diseases and their relatable risk factors are more vulnerable to severe forms of coronavirus infection. It is important to emphasize on making sustainable proactive, dietary and lifestyle modifications for better heart health. Atleast 80% of premature deaths from heart diseases can be avoided by controlling risk factors such as tobacco use, unhealthy diet and physical inactivity as per the

experts. Consuming a well-balanced diet is one of the simplest, most effective ways to keep the nutrition value high and to live

Linkedin

a heart-healthy life.

Dr Aziz Kothawala - Cardiologist, Saifee Hospital, Mumbai

23 26 Behavioural Economics & Healthcare

World Heart Day

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OPERATIONS

AI IN HEALTHCARE

What Do Hospitals Need

Winning Strategy

Coronary artery diseases accounts for 25 per cent of all the deaths in India itself. This is a staggering number and the alarming rate at which the young population is succumbing to these coronary diseases is a huge cause of concern. Today, people below the age of 40 constitute 20 per cent of the angioplasty performed by Manipal Hospitals Jayanagar and one of the significant factors contributing to this alarming rise is the lifestyle changes and depreciating quality of life. This could cause major financial ramifications.

Cardiovascular diseases (CVDs) have now become the leading

Dr K P Srihari Das, Senior Interventional Cardiologist, Manipal

Dr Dilip Kumar, Senior Consultant Interventional Cardiologist and

Hospitals, Bangalore

Device Specialist Medica Superspecialty Hospital, Kolkata

PM Modi's renewed focus on 'AtmaNirbhar Bharat' and 'Vocal for

The prevalence of heart diseases is on a rise in India. Higher level

In the case of the current pandemic COVID-19, the virus mainly

of stress, lack of mental health awareness, sedentary lifestyle,

attacks the lungs. However, at times the virus can also cause

lack of exercise and increased consumption of unhealthy food

your body to produce an overactive immune response which can

all contribute to elevated levels of cholesterol. As there are no

lead to increased inflammation in the entire body. It can also

substantial symptoms, a thorough check up of cholesterol levels

indirectly affect the heart by making present heart conditions

on a regular basis is of utmost importance to keep a check on your

worse. As per recent research conducted by the University of

health. Lifestyle modifications such as regular exercise, proper

Frankford in Germany, more than half of the patients that were

diet, timely diagnosis and treatment can help an individual to

studied who had COVID-19 were found to have constant cardiac

maintain optimal cholesterol levels.

inflammation. Although, more research is required to analyse the long-term effects of the current COVID-19 virus on the heart, steps to safeguard health must remain a priority.

UPFRONT

17 34 COVER STORY

Vaccine Conversation We Should Have 6

October 2020

OPINION

To Doctors, From Doctor

03 Market Connect 04 Editorial 07 Letters 08 News roundup 34 Drive

cause of mortality in India. A quarter of all mortality is attributable to CVD. Ischemic heart disease and stroke are the predominant causes and are responsible for >80% of CVD deaths. Soon India is going to become the cardiovascular capital of the world.

Besides the advancements in the treatment of coronary artery disease in last two decades the growing burden of this disease suggests that prevention is the only option to deal with it.

Dr Anita Suryanarayanan, Vice President, Lister Metropolis, Chennai

Dr Sanjeev Kanoria, Founder, Suasth Hospital, Mumbai

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NEWS ROUNDUP AiMeD Applauds Secy DoP Dr PD Vaghela’s Initiatives Association of Indian Medical Device Industry (AiMeD), an umbrella association of Indian manufacturers of medical devices, covering all types of medical devices held a farewell meeting of SecyDoP,Dr. PD Vaghela set to retire on 30th Sep, 2020 as Secretary in the Department of Pharmaceuticals, Ministry of Chemicals and Fertilizers, for his great contribution towards betterment of the Indian Medical Device industry. IAS officer Dr PD Vaghela will now serve as TRAI chief for three years.

Calling Dr PD Vaghela a positive change agent in the one year that he headed as SecyDoP, Rajiv Nath, Forum Coordinator AiMeD, representing the interest of over 1200 medical device manufacturers highlighted the key initiatives led by Dr.Vaghela.

Dr. Vaghela initiated a five per cent surcharge in the budget as import duty protection to protect the beleaguered domestic manufacturing while creating a corpus for public healthcare. He did not allow price caps of stents and knee implants to be removed as sought by the

USA as that would have been detrimental to consumers and domestic manufacturers.

Under his leadership DoP introduced a scheme for four Medical Devices Parks & PLI scheme as a make in India enablers under the Govt.’s Atmanirbhar campaign; the PLI Scheme is reportedly being revised to enable wider acceptability.

GeneStore France Launches rRT PCR Kit

GeneStore France, a global leader in the healthcare diagnostic and research sector launched rRT PCR kit for the detection of SARS CoV2. Head quartered in Provence France, GeneStore is an enterprise driven genomics company with a global footprint. With two manufacturing facilities based in France and India, GeneStore can deliver over 2 million tests kits per month from its facility in India.

The rRT PCR Kit is also the most affordable test kit globally priced at INR 199. Additionally, the rRT PCR Kit detects SARS CoV2 in under 1 hour delivering a 100 per cent accurate result with an exceptional sensitivity and specificity. The kit was launched in India in July 2020 and is already being used to screen 40 per cent of clinical samples being screened by

private diagnostic laboratories in India.

success in performing angioplasty through

Alvarez & Marsal Named Administrators of UAE’s NMC Healthcare

the thumb, enabling patients to go back

Restructuring consultancy Alvarez & Marsal has said that it had been appointed as administrator of a group of operating businesses related to NMC Healthcare by the Abu Dhabi Global Market Courts.

box approach or distal radial angiography

NMC Health is the largest private health care provider in the UAE, operating more than 200 facilities including hospitals, clinics and pharmacies.

approach

Its implosion this year amid allegations of fraud and the disclosure of more than $4 billion in hidden debt has left some UAE and overseas lenders with heavy losses and prompted legal battles to try and recover money owed.

artery would be available for bypass

Thumb Angioplasty Reduces Hospital Stay

A leading cardiologist has shown

home the same day of hospitalisation.

Dr

Srinivasa

Interventional

Prasad

BV,

Cardiologist,

Senior Fortis

Hospital, Bengaluru said, “The procedure of angiography or angioplasty remains the same but when it is performed through the thumb artery, it is referred to as a snuff medically. The benefit of choosing this route over the traditional approach is, it is less time consuming and patient-friendly.”

Advantages

over

include

the

traditional

faster

recovery,

negligible bleeding, and Zero percent chance of blood transfusion. Also, another distinct advantage is uninjured radial graft, for those patients who need bypass surgery.

Dr

Prasad says that “With shorter

haemostasis and faster recovery, patients can be discharged on the same day after an elective angioplasty (stenting). This is of major help to most of the patients, particularly in this COVID times, for reason – shorter hospital stay means a lesser chance of acquiring COVID through unsuspected people around.”

SII Will Produce 100 Mil Doses of Covid Vaccine A further collaboration among the Serum Institute of India (SII), the world’s largest vaccine manufacturer by volume, Gavi and the Bill & Melinda Gates Foundation will accelerate the manufacture and delivery of up to 100 million doses of safe and effective COVID-19 vaccines for India and low- and middle-income countries (LMICs) as part of the Gavi COVAX AMC, a mechanism within the COVAX Facility.

This brings the total number of vaccine doses to be covered by the partnership between SII, Gavi, and the Gates Foundation to an aggregate of up to 200 million doses, following the initial agreement for up to 100 million doses announced in August. The arrangement again provides an option to secure additional doses if the vaccines pillar of the Access to COVID-19 Tools (ACT) Accelerator sees a need for it.

The collaboration will provide upfront capital to SII to help it increase manufacturing capacity now so that, once a vaccine, or vaccines, gains regulatory approval and WHO Prequalification, doses

AiMeD Delegates presenting a memento of gratitude to DoP Secy Dr Vaghela

8

October 2020

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9

NEWS ROUNDUP can be distributed at scale to LMICs as part of the Gavi COVAX AMC mechanism as early as the first half of 2021.

in tackling the unprecedented pandemic

through scientific rigour and innovation.

AliveCor said, “AliveCor’s expansion into

To

related

India is pivotal to our mission of providing

“The collaboration further bolsters up our fight against COVID-19! Through the avid support of Gavi and the Bill & Melinda Gates Foundation, we will now manufacture and deliver up to an additional 100 million doses of immunogenic and safe-proven future COVID-19 vaccines to India and low- and middle-income countries in 2021,” said Adar Poonawalla, CEO of Serum Institute of India. “At this stage, It is important for governments, global health and financial institutions in the public and private sector to come together in ensuring that no one is left behind in the road to recovery. This association is In line with our efforts to see that the future vaccines reaches the remotest part of the world providing full immunization coverage in a bid to contain the spread of the pandemic.”

information the exclusive portal will be

remote, medical-grade heart care to those

helpful in creating awareness among the

who need it most. We are committed to

masses. I hope all queries of common

innovating digital health services in India

people

development

by offering patients the ability to take

process will be addressed through this

control of their own heart health from the

portal and I am confident it will become

comfort of home.”

the most visited portal in times to come.”

The vaccine portal consists of all the

most common arrhythmias or irregular

information regarding the Indian efforts

heartbeat—atrial

towards

bradycardia,

The funding will help accelerate the manufacturing by SII for candidate vaccines licensed from AstraZeneca and Novavax, which will be available for procurement if they are successful in attaining full licensure and WHO Prequalification. The vaccines will have a ceiling price of US$3 per dose, a price enabled by investments made by partners such as the Coalition for Epidemic Preparedness Innovations (CEPI), the Bill & Melinda Gates Foundation and SII.

Dedicated Vaccine Portal and National Clinical Registry of COVID-19 launched

Dr Harsh Vardhan, Union Minister for Health & Family Welfare, Government of India launched the vaccine portal for COVID-19 and National Clinical Registry for COVID-19 today developed

by ICMR. Dr Balram Bhargava, Director General, ICMR and other dignitaries from ICMR were present at the inauguration ceremony.

Releasing two web portals, Dr Vardhan, said “ICMR has always been in the forefront of health research in the country and is now leading the country

10

October 2020

disseminate

on

the

vaccine

the

vaccine

vaccine

development

against

Priya Abani, Chief Executive Officer,

KardiaMobile 6L can detect the three

and

fibrillation tachycardia,

(AFib), which

various diseases including the most recent

require regular monitoring and a healthy

COVID-19. Interested people can visit the

lifestyle the company said. AliveCor’s

website

https://vaccine.icmr.org.in

innovative technology gives patients the

to get the latest information on vaccine

ability to record a medical-grade ECG in

development.

just 30 seconds, with no hospital visits

AliveCor Launches Six-lead, Personal ECG Device in India

and complete peace of mind. The device

on

is small enough to fit in a pocket, allowing users to check in on their heart anytime, anywhere right from their smartphone.

In a country like India where over 70 per

California based AliveCor, personal

electrocardiogram

(ECG)

technology

pioneer, launched a personal ECG device, KardiaMobile

6L

in

India.

Owing

to

cent of the population owns a smartphone, this technology comes as a big boost to make heart care accessible, affordable and convenient.

deliver affordable and convenient heart

Bajaj Finserv Launches HealthTech Venture

care to over 260 million heart patients and

those at risk, without visiting a hospital.

into healthcare, with the launch of Bajaj

the accessibility challenges to quality healthcare in the country and COVID related infection fears, the portable and technology-enabled ECG device will help

Bajaj Finserv announced its foray

Finserv Health and the Aarogya Care app, to address the financial needs of consumers in an increasingly phy-gital world, said Sanjiv Bajaj, Chairman & MD, Bajaj Finserv.

Devang Mody, CEO, Bajaj Finserv Health mentioned that they are using deep technology, AI and ML algorithms to provide tailored experiences and value to both customers as well as partners.

leading to the approval of the novel

Bajaj Finserv Health with the Aarogya Care app aims to provide preventive, personalised, prepaid health care packages to consumers, integrating various complementary components of the health ecosystem, to provide ease of access to quality and affordable healthcare, anytime, anywhere.

Dr

Shekhar

complimented

the

C

Mande,

CSIR-IGIB

DG-CSIR team

of

scientists and students, TATA Sons and DCGI for the exemplary work and collaboration carried out during the current pandemic diagnostic kit and paving the path for further innovations towards making India self-reliant.

BLK Hospital Doctors First to Remove

Ruptured Hydatid Cyst using Cryoprobe In a first-ever recorded medical procedure of its kind, doctors at BLK Hospital removed a ruptured Hydatid cyst from the right lung of a 45-year-old woman from Srinagar, without conducting an open chest surgery. The cyst, formed by the larvae

The app will also reportedly enable the customer to receive and maintain health records digitally, which would be integrated with the National Health ID.

of tapeworms, was excised piecemeal by

Tata CRISPR, LowCost Covid-19 test Launched

spit blood while coughing. She underwent

The Tata CRISPR (Clustered Regularly Interspaced Short Palindromic Repeats) test called FELUDA, powered by CSIR-IGIB (Institute of Genomics and Integrative Biology), received regulatory approvals from the Drug Controller General of India (DCGI) for commercial launch.

Commenting on the development, Girish Krishnamurthy, CEO, TATA Medical and Diagnostics, said, “The approval for the Tata CRISPR test for COVID-19 will give a boost to the country’s efforts in fighting the global pandemic. The commercialization of the Tata CRISPR test reflects the tremendous R&D talent in the country, which can collaborate to transform India’s contributions to the global healthcare and scientific research world.”

The test developed as per ICMR guidelines is said to have high quality benchmarks with 96 per cent sensitivity and 98 per cent specificity for detecting the novel coronavirus. This test uses an indigenously developed, cutting-edge CRISPR technology for detection of the genomic sequence of SARS-CoV-2 virus.

CRISPR is a genome editing technology to diagnosing diseases.

freezing it, using a cryoprobe.

The patient showed initial symptoms

and discomfort in July this year when she a CT scan of the chest which revealed 43 X 35mm cyst (equivalent to a size of tennis ball) in superior segment of lower lobe of right lung. The patient followed the CT scan with a bronchoscopy procedure thereafter

in

Srinagar.

However,

her

condition deteriorated, and she went into respiratory distress. She was unable to lie down and had not slept for close to two months. She had severe difficulty in breathing; she went to hospital in Kashmir where she was advised to rush to Delhi for emergency treatment.

Dr Sandeep Nayar HOD, Chest &

Respiratory Diseases, at BLK Hospital, said “Usually, the most common form of treatment of cystic echinococcosis is open surgical removal of the cyst, combined with chemotherapy. We froze the ruptured cyst and removed it from the lung through the mouth without opening the chest. The entire procedure took around 45 minutes.

If we had opted for surgery, we may have experienced

complications,

especially

during these unprecedented times, so it was best avoided. This is the world’s first such procedure of its kind. The patient got instant relief after the procedure and will be on follow up de-worming medication for the next three months.”

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11

NEWS ROUNDUP Obesity 70 Percent More Prone to Contracting Severe COVID-19

The Associated Chambers of Commerce and Industry of India (ASSOCHAM), one of the apex trade associations of India concluded the sixth edition of the ‘Illness to Wellness’ series themed ‘Lifestyle Behaviour during COVID-19’. The event saw an illustrious panel of clinical nutritionists hold an active dialogue on a variety of lifestyle-related ailments like insomnia, obesity, diabetes and others being faced by citizens. Ritika Samaddar, RD, Regional Head, Department of Clinical Nutrition & Dietetics, Max Super Speciality Hospital, said, “Obesity is the new disease that we need to fight. During this time, we have noticed the people who are obese, are the ones who are getting the severity of the COVID-19. The mortality rate is high only in these people.

It is very important for us to understand that no longer can obesity be restricted to a cosmetic problem or something that has to do with your looks but to see it as

12

October 2020

a medical issue. The severity means they often end up in ventilators from which it is very difficult for them to recover, so it is high time we realise how important it is to be healthy. If you are healthy, your immunity is high so your incidence of any kind of infection would be much less. The public should consider obesity as a disease and take all precautions like dietary, lifestyle or medical management to control it.”

“The pandemic catalyzed an imperative

Healthcare Leaders Congregate at APACMed, First Hybrid Conference

an equal priority. A healthy population

The Asia Pacific Medical Technology Association (APACMed) held the firstever hybrid virtual forum – Redefining Healthcare Agility, for 130 world class leaders from over 30 countries to share insights on how they are transforming the healthcare industry.

discerning populations.”

Delivering the keynote address at the virtual forum, Dr Preetha Reddy, Vice Chairperson, Apollo Hospitals Group & President NATHEALTH said,

of up to 50 people, along with virtual

and urgency to weave in, an all-new agility

into

healthcare,

which

must

redefine accessibility, affordability and accountability of care delivery. Hardwiring a culture of collaboration and commitment to

harnessing

emerging

technologies

can enable healthcare to bridge gaps in infrastructure and resources. Also, beyond COVID-19, innovations to manage the growing prevalence of NCDs must be is the smartest way to beat the disease and it is here that MedTech will play an important role, be it medical devices, in-vitro

diagnostics

or

digital

health

solutions, creative models across the value chain must evolve to meet the needs of

The APACMed Annual MedTech Forum

brings more than 1,000 delegates together every year, making it one of the largest yearly forums in Asia Pacific. Owing to the pandemic, the 6th edition of the conference included on-site attendance attendance of over 1000 delegates, thus becoming the first ever hybrid conference with a global reach to be hosted in the

medical technology arena. The conference witnessed the participation of global and regional leaders, serving as the perfect setting for discussing collaboration and innovation opportunities in Asia.

very slow yet complete recovery. Multiple

Aster CMI Doctors Help 5-Year-Old Recover from Snakebite

unpredictable. But to the child’s resilience

A 5-year-old boy, who had slipped into a coma and complete paralysis due to a deadly snake bite and was fighting between life and death was given a new lease of life through the efforts of doctors at Aster CMI hospital and with the funds raised by a crowd-funding platform.

Breakthrough AI Tool Can Screen for COVID-19 Based on Cough Sounds

Explaining the treatment and the complexity of the case, Dr Chetan Ginigeri, Consultant, Paediatrics and Paediatrics Intensive Care Unit, Aster CMI Hospital, said, “As he is a young child, the venom transfer and fast heartbeat causes rapid spread of venom. Children bitten

by Krait manifest with breathlessness and respiratory paralysis very fast. By the time the child presented to us – he was very sick, and was in coma with complete paralysis. He required complete respiratory and other organ support along with nutritional rehabilitation to allow a

teams including Pediatric ICU, respiratory therapists, physiotherapy and Nutritionists played a key role in this recovery. COVID pandemic situation made the fundraising and luck, he did not have any major complications

and

the

crowdfunding

campaign was well supported. It was very difficult for us to ensure his survival but we are glad that with our conscious effort we were able to save his life.”

In what could be a real breakthrough

for more efficient, effective COVID-19 testing, the AI tool can even identify asymptomatic individuals – those who have the infection but without a cough or any obvious symptoms. The results are instantaneous and the tool works on a basic smartphone. It does not require an app, special device or trained personnel.

Commenting on this breakthrough,

Dr. Rahul Panicker, Chief Research and Innovation Officer, Wadhwani Institute for Artificial Intelligence, said, “Testing for

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13

NEWS ROUNDUP COVID-19 has been a major challenge since the start of the pandemic. This prompted us to think about how we could use AI to develop a non-invasive COVID-19 testing tool that was affordable and accessible to a large population. After months of hard work, we are proud to present our patented Cough against Covid AI tool that can identify both symptomatic and asymptomatic individuals. We believe it will help health care and civic authorities speed up testing and also focus their resources better, by filtering out patients with Covid-19 – like symptoms but without the infection. We will continue to work towards making it accessible to those who need it most. We also plan to share our research widely so that people around the world can benefit from the tool.”

led by Dr Govindaraj AB, Director – Institute

MRI Cartilage Mapping Guides Treatment Planning In Cartilage Lesions For The Young

MGM Healthcare, a multi-specialty quaternary care hospital in the heart of the city, announced a successful Cartilage Defect Repair Surgery performed on a young patient with Osteo Chondral defect,

of Orthopaedics and his team of specialists including Dr Shriram Krishnamoorthy, Dr J Jagdeesan and Dr Vijayakumar Sohanlal.

patients.

as against Germany which has 29.2 and

patient health outcomes through quality

qIn a paper entitled “Challenges in

Canada which has 12.9. “These resources

care relative to expenditures.

the delivery of critical care in India during

are likely to be further limited in smaller

the COVID-19 pandemic” published in The

cities, towns and districts,” says Dr Bala.

Preetha Reddy, President – Nathealth &

the

partnership,

Commenting on the success of the

Journal of Intensive Care Society recently,

the authors highlight the unprecedented

availability of beds having oxygen supply

this surgery is commendable considering

said, “The covid-19 pandemic has been

demand that the COVID-19 pandemic has

with one estimate putting it at 120,000

highlighting the fault lines even in the

placed on the healthcare system with the

beds in the whole of the country. Demand for ventilators is also bound to increase and currently the number varies between 15,000 to 48,000. “We also need more doctors and nurses with ICU training”, argue the authors.

most advanced nations and underlined

the

complexity

patient’s

long

of and

the

problem.

complicated

The case

history including the previous surgery made it difficult for us to identify the

consequent need to boost critical care preparedness in the country.

problem with ease and narrow down on

the procedure to fix the condition. We

billion and the majority living in rural and

had to keep in mind that the patient is

remote regions, critical care and public

32 years old which is a very young age

health capacity in India face enormous

to consider major surgical procedures such

pressure,” says Dr Bharath Kumar, honorary

as knee replacement which could make it

research fellow, The George Institute India

difficult for the patient in the long run.”

and one of the main authors of the paper.

Critical Care Preparedness in India Needs a Booster Shot

With the anticipated increase in the

number of COVID-19 cases in India, there is a need for a coordinated effort by public health organizations and the professional societies to ensure adequate delivery of intensive care to critically ill COVID-19

“With a population exceeding 1.3

There is also a huge shortage of

and resources are scarce and unevenly

NATHEALTH and APACMED Join Hands to Advance Medical Technology For Universal Health Coverage In India

distributed,” he adds.

“Even if less than 5% of patients

require critical care services, this will still rapidly overwhelm the healthcare system in a country, where intensive care services

Chairperson,

Apollo

Hospitals

the acute need for a robust mechanism for UHC.

EVA IVF Launches Fertility Centre in Hyderabad

EVA IVF launches its first fertility

clinic in Hyderabad to provide quality care, right treatment plan and support to patients. The centre offers complete fertility care for both men and women.

With

leading

fertility

specialists,

the

clinic offers all fertility services like male and female fertility evaluation, IUI, IVF,

UNSDGs and SDG 3 is a critical goal, that

Hysteroscopy, Laparoscopy and advanced

preparedness of India for the pandemic

impact

advancing

techniques such as PICSI (Physiological

and the associated challenges, Dr Bala

medical technology is pivotal to achieving

Intra-Cytoplamsic Sperm Injection) and

Venkatesh of the George Institute and

Universal Health Coverage (UHC) in India.

ICSI.

a co-author of the paper said India has

In keeping with the above, the industry

only 2.3 ICU beds per 100,000 population

body, NATHEALTH – Healthcare Federation

exceptional

of India, renowned as the credible voice

protocols and policies, advanced medical

of the health sector of India and the Asia

infrastructure, OT, IUI and IVF labs and

Pacific Medical Technology Association

personalized care for its patients. EVA

(APACMed), the regional association of

IVF clinic is a dedicated fertility centre

medical technology in the Asia Pacific today

with highly skilled clinicians and qualified

signed a Memorandum of Understanding

doctors

(MoU) to harness the role of the medical

medicine,

technology industry in India, in relation to

fertility enhancing surgery, embryology

AB-PMJAY and to ensure that it optimally

& andrology. EVA IVF, headquartered in

engages

policymakers,

Hyderabad, aims to create its remarkable

helping shape polices leading to achieving

presence across the country and plans to

UHC in India.

expand its business soon.

Highlighting

the

critical

care

is

all

committed

others.

with

to

Further,

relevant

The goal of this strategic partnership

scales and increases the concerted efforts by both organizations. Both NATHEALTH and APACMed would work through a joint working group in formulating a work plan in relation to Universal Healthcare in India, that would synergize and complement the Patient with Dr Govindaraj AB and his team of doctors at MGM Healthcare

Vice

meeting

India

streamlines all innovations ensuring that it

October 2020

about

surgery Dr Govindaraj said, “The success of

is to enable a seamless pathway that

14

speaking

efforts of the government to maximize

The

new

centre

comprises

standard

experienced

of

in

reproductive

of

processes,

reproductive endocrinology,

Speaking at the launch, Dr Aishwarya

Nupur, Director, EVA IVF, said, “We are extremely happy and proud to launch our first fertility centre in Hyderabad. EVA IVF clinic is an effort to help our patients receive requisite quality care & treatment .

We help couples embrace their parenthood.

The global Pandemic has been a challenge for everyone, the fertility centre follows proper safety measures and guidelines.”

www.indiamedtoday.com

15

COVERSTORY

Vaccine Conversation We Should Have Public perception of vaccines threatens vaccination programmes worldwide.

Understanding this may lead to better acceptance of vaccines including COVID-19 vaccine

T

he world is waiting to get back to its axis. After being displaced by the most unprecedented healthcare challenge in decades, the wait for near-normalcy life is getting impatient. The Covid-19 vaccine is the only beacon of hope for many to get back to life without fear of infection.

However, with growing concern on Covid and varied political and religious views regarding the pandemic management, there is a lot of conflicting and confusing opinions about Covid vaccines. Public perceptions and the understanding of what people think about vaccine could help vaccine acceptance, and possible and end to the current pandemic.

M Neelam Kachhap

Understanding Vaccine Confidence

The Covid-19 vaccine is the only beacon of hope for many to get back to life without fear of infection.

16 17

October 2020 September2020

A group of scientists have reviewed the inputs of 250 thousand people across the globe on how they felt about the vaccine. Recently, Prof. Heidi Larson, Director, Vaccine Confidence Project, and colleagues at the London School of Hygiene and Tropical Medicine, UK, have published a paper in The Lancet on the findings from surveys on vaccine confidence conducted over five years. The study found that the public confidence in vaccines varies widely between countries and regions

around the world. The authors found signs that public trust may be improving in parts of Europe, but several countries experiencing political instability and religious extremism are seeing growing scepticism that vaccines are safe, and the spread of misinformation online is threatening vaccination programmes worldwide.

The new research maps global trends in vaccine confidence across 149 countries for a period of five years between 20152019, is based on data from over 284,000 adults (aged 18 years and older) surveyed about their views on whether vaccines are important, safe and effective.

The study was funded by the European Commission, Wellcome Trust and EPSRC. It was conducted by researchers at London School of Hygiene & Tropical Medicine, London, UK; Imperial College London, UK; University of Washington, USA; and University of Antwerp, Belgium.

Understanding Public Trust Understanding vaccine confidence and the reasons why people may not want a vaccine, is critical to ensuring vaccine uptake, and will be especially important if a COVID-19 vaccine becomes available.

Although existing data systems are able to measure the number of people vaccinated,

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17 18

COVERSTORY

Figure 1 Global trends in perceptions towards the safety of vaccines in November, 2015, and November, 2018 Figure shows model-based estimates of the percentage of respondents strongly agreeing that vaccines are safe (panels A, B), important for children to have (panels C, D) and effective (panels E, F) in November, 2015, and November, 2018. No data were available for countries in grey. they often don’t routinely capture levels of vaccine confidence.

Public

trust

in

immunisation

is

an

increasingly important global health issue, with WHO declaring vaccine hesitancy as one of the top ten threats to global health in 2019. Declining confidence can result in vaccine delays or refusals, which is contributing to a rising number of vaccine preventable disease outbreaks including measles, polio and meningitis worldwide.

“It is vital with new and emerging disease threats such as the COVID-19 pandemic, that we regularly monitor public attitudes to quickly identify countries and groups with declining confidence, so we can help guide where we need to build trust to optimise uptake of new life-saving

“One of the main threats to the resilience of vaccination programmes globally is the rapid and global spread of Declining confidence can result misinformation. When there is a large drop in vaccination coverage, it in vaccine delays or refusals, is often because there's an unproven which is contributing to a rising vaccine safety scare seeding doubt number of vaccine preventable and distrust. Sometimes there is a genuine small risk that gets rapidly disease outbreaks including spread and amplified to appear measles, polio and meningitis to be a much larger risk. There are worldwide. also cases where vaccine debates have been purposefully polarised, exploiting the doubting public and system weaknesses for political purposes, while waning vaccine confidence in other places may be influenced by a general distrust in government and scientific elites,” she adds.

vaccines,” says Professor Heidi Larson,

Vaccine Confidence Project

London school of Hygiene & Tropical

Although, immunisation coverage is reported across the world, no comparable

Medicine, UK, who led the research.

18

October 2020

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19

global estimates and monitoring of vaccine confidence are available. The Vaccine Confidence Project (VCP) was founded a decade ago to help plug the gap, providing a systematic approach to monitoring public attitudes to vaccines and to inform policymakers of the changing trends and determinants of vaccine confidence around the world.

are safe in Nov 2018, to 30 per cent in Dec

How the Study was Done

2015 rising to 3 percent in 2019,

Researchers analysed data from 290 nationally representative surveys conducted between September 2015 and December 2019—combining previously published data from nearly 250,000 survey responses with 50,000 additional interviews from 2019. They modelled data to estimate trends in public perceptions about the safety and effectiveness of vaccines, and the importance of vaccinating children. They also studied the relationship between vaccine uptake in each country and demographics like age, sex, religious beliefs, etc., socioeconomic factors like income, education and source of trust (eg, family, friends, health professionals). In fact, estimates of vaccine confidence for some countries shows wide confidence intervals reflecting lower numbers of recent data. “For these countries, the estimates are a weighting of the countries’ overall trend and the trend of the whole continent,” authors said.

Philippines in 2017 led to a dramatic drop in public confidence in vaccine safety and impacted the uptake of routine vaccines.

This caused the Philippines to drop out of the top 10 countries. Imagine, they had the highest overall vaccine confidence in 2015 which fell to ranking no higher than 70th in 2019.

in their safety or effectiveness, is most

In South Korea, online mobilisation efforts against childhood immunisation by communities such as ANAKI (Korean abbreviation of ‘raising children without medication’), have been identified as key barrier to vaccination.

necessarily dismiss the importance of

generally understand the value of

The analysis also suggests that overall

Indonesia has witnessed one of the largest falls in public trust worldwide between 2015 and 2019. The authors say negative attitudes may have been partly triggered

by Muslim leaders questioning the safety of the measles, mumps, and rubella (MMR) vaccine, and issuing a fatwa (religious ruling) claiming that the vaccine was haram (forbidden) and contained ingredients derived from pigs, as well as local healers promoting natural alternatives to vaccines.

confidence in vaccines—including safety,

Believing in Vaccines

who agreed that it is important for children

The authors believe that confidence in the importance of vaccines, rather than

to be vaccinated, while Hong Kong (36 per

2019. Interestingly, in the UK, confidence in vaccine safety rose from 47 per cent in May 2018 to around 52 per cent in Nov 2019.

Hesitancy Hotspots In contrast, six countries (Afghanistan

More recent changes in vaccine safety perceptions were evaluated for the EU, where a higher frequency of surveys has been conducted per country, on average, compared with the rest of the world.

2 per cent of those surveyed strongly disagreeing

vaccines

are

safe

in

Azerbaijan

2

percent-17

percent,

Indonesia

1

percent-3

percent,

Nigeria 1 percent-2 percent, Pakistan 2 percent-4 percent, and Serbia 4 percent-7 per cent) have witnessed substantial

increases

in

people

strongly disagreeing vaccines are safe. This means that they are not just being less convinced, but are actively against vaccines. The researchers describe it as a "worrying trend”, with negative attitudes mirroring trends in political instability and religious extremism in these six countries.

effectiveness,

and

importance—fell

in

Indonesia, the Philippines, Pakistan, and

strongly linked with vaccine uptake. By December 2019, the majority of European countries

were

displaying

increased

levels of confidence in the importance of vaccination than in their safety and effectiveness, the study says.

“Our findings suggest that people do not vaccinating their children even if they have doubts about how safe vaccines are, ”says co-lead author Clarissa Simas, London School of Hygiene & Tropical Medicine, UK. “The public seem to vaccines, but the scientific and public health community needs to do much better at building public trust in the safety of vaccination, particularly with the hope of a COVID-19 vaccine,” she adds.

Interestingly, the study found that in

The authors believe that confidence in the importance of vaccines, rather than in their safety or effectiveness, is most strongly linked with vaccine uptake.

2019, Iraq (95 percent), Liberia (93 percent), and Senegal (92 percent) had the highest proportion of respondents

cent), Russia (34 percent) and Albania (26

South Korea between November 2015 and December 2019. For example, risks of a dengue vaccine (Dengvaxia) in the

More recent changes in vaccine safety perceptions were evaluated for the EU, where a higher frequency of surveys has been conducted per country, on average, compared with the rest of the world.

Feedback from Europe The study found that across the European Union recent significant losses in confidence in vaccine safety were detected in Poland (a dip from 64 per cent strongly agreeing vaccines are safe in Nov 2018 to 53 per cent by Dec 2019), reflecting the growing impact of a highly organised local anti-vaccine movement.

However, confidence in vaccine safety is increasing in several countries, including Finland, France, Italy and Ireland as well as the UK, the study showed. In France, where confidence in vaccines has been persistently low, there has been a marked rise in confidence, from 22 per cent of those surveyed strongly agreeing vaccines

20

October 2020

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21

COVERSTORY

APPROACH

per cent) reported the lowest proportion strongly agreeing on the importance of vaccines.

vaccines.

The study also found that being male or less educated were linked with a lower chance of vaccine uptake. The study also found that people who trusted healthcare workers for medical or health advice, rather than family, friends, and other non-medical sources were more likely to take vaccine. Researchers also found that people from minority religious groups or those refusing to provide their religious belief were less likely to take vaccine.

School of Public Health, USA, says that

Balancing the Perspective These results should be seen in totality and not from a skewed sense as the study had some important limitations. One of the limitations was the lack of consistency between survey responses that meant vaccination beliefs were pooled into extreme categories of “strongly agree” or “strongly disagree”, potentially masking key information.

The researchers have also said that the vaccination status was based on parental recall, and that the findings do not reveal whether attitudes were related to specific

Behavioural Economics & Healthcare

Sharing his views in another article, Dr Daniel Salmon, John Hopkins Bloomberg most vaccine scares are not supported by scientific evidence. “Vaccines have a remarkable safety record, based on

Can we change patient compliance with behavioural economics

rigorous processes of phased randomised controlled

trials

and

on

licensure

requirements, which have ensured that the benefits of vaccination outweigh the risks. Situations such as Dengvaxia are

Throughout

exceedingly rare,” he says. Dr Salmon was not involved in the study.

He further says that global investment in vaccine safety and communication infrastructure is much needed. “Without substantial global investment in active vaccine safety surveillance, continuous monitoring of public perceptions, and development

of

rapid

and

flexible

communication strategies, there is a risk of

Vaibhav Dixit, Indian Institute of Foreign Trade, Delhi

SARS-CoV-2 vaccines never reaching their potential due to a continued inability to quickly and effectively respond to public vaccine safety concerns, real or otherwise.

With every crisis comes opportunity; it should not be ignored,” he concludes.

Reference Mapping global trends in vaccine confidence and investigating barriers to vaccine uptake: a large-scale retrospective temporal modelling study A de Figueiredo, C Simas, E Karafillakis, P Paterson, H Larson, 2020

the 20th century, there have been substantial advances in the development of public health and it led to a notable rise in the life expectancy of humans across the globe. Many notable economists have agreed that healthcare plays an integral part in the economic development of the nation and hence it has been a focal point of many economic policies of the developed and developing world. But the recent pandemic has revealed, rather more starkly that there exist significant differences amongst countries and even states within a nation, in the deliverability of healthcare services.

Economists have long confounded with the belief that people are rational and therefore if the government will increase the healthcare expenditure and more services will be available at cheaper

“It doesn't matter how beautiful your theory is, it doesn't matter how smart you are. If it doesn't agree with experiment, it's wrong.”

-

Richard Feynman. rates, the overall acceptance rate for these services will increase and that will lead to an improvement in the overall public health of the nation. And this model has worked to a certain extent but recent research shows that merely the availability of resources does not ensure that people are going to utilise them most efficiently. An example can be offered in the case of the US, which spends about 17.7 percent of its GDP on healthcare, and where (at the time of writing this article) the total number of corona positive cases

22

October 2020

has crossed 6.8 million, with fatality rate closing in on 2,00,000. Whereas, on the other hand, a country like Cuba has handled the crisis much more effectively. Hence, recent events have forced economists to reconsider their approach towards the policies related to healthcare.

Healthcare Policy Paralysis We need to understand that human beings are far removed from the image of profit maximising creatures which a large part of economic literature has envisaged us.

There are indeed certain shortcomings in the formation of healthcare policy by governments and multilateral organisations and it is also important to assess the elements human decision making in these approaches. Nobel Prize-winning economists such as Daniel Kahneman and Richard Thaler have shown that our decisions are often plagued by our inherent biases and beliefs, as opposed to being the product of a rationally optimal framework. It proved to be a very important observation because the limit to the psychological ability of people to process the information (although recognised by policymakers), never formed a major part of the actual policymaking process, leading to sub-optimal outcomes. For Eg, according to a study by JPAL, in Haryana, only 52 percent of children aged between 12 to 23 months have been immunised, even though immunisation is proven to be a highly cost-effective measure of improving child survival, etc. This is not merely the result of illiteracy because numerous campaigns were launched by the government and NGOs which have informed people regarding the veracity and viability of these drugs. These results point to the presence of some invisible barriers, which prevent people from utilising these services.

www.indiamedtoday.com

23

APPROACH What is Behavioural Economics?

Behavioural Economics is the combination of insights from psychology, economics, sociology and the environment of individuals, that helps us to gain a comprehensive understanding of these barriers present in the human mind. It argues that the human mind is divided into two selves: a myopic doer and a farsighted planner. And this short-sighted self is not concerned about the future, which makes her actions unpredictable because they are mostly guided by emotions or are simply the consequences of the individual’s immediate surroundings.

Behavioural Economists practitioners assert that we can exploit these shortcomings of myopic human nature to “nudge” them towards a better decision.

Engaging Patients These interventions can prove to be highly effective in positively reinforcing the behaviour of patients to improve their engagement with healthcare services. One such great measure was adopted by the UK in 1998 where they restricted the sale of paracetamol tablets to a limited quantity from one shop, which was previously available freely. Paracetamol overdose had been a major cause of suicides worldwide.

Although people can still buy the tablets from different shops, the introduction of such a small barrier led to a 43% reduction in suicide rates. Social Norms can also play a major role in modifying the behaviour of individuals. Arghyam, an NGO working to improve sanitation facilities in rural Karnataka, nudged the male members of the family to fulfil the needs of the females by constructing toilets, proved to be a success. Making the individuals aware of the actions of their community members can trigger the “herd behaviour” instinct, wherein people give preference to the widely followed practice instead of relying on their understanding, termed as “failing conventionally” by John Maynard Keynes. In England, the Chief Medical Officer gave the social norm feedback to certain doctors who were overprescribing antibiotics to their patients as compared to other doctors. It reduced their prescription by 3.3 per cent over the next six months.

While designing these nudges, there are certain principles which the practitioners

24

October 2020

people towards these advanced scientific

lottery, and the people are only eligible

Reference

breakthroughs of human civilisation. In the

to win the lottery if they take their

1.

words of Dr Richard Thaler ‘people aren’t

medicines on time. Feedbacks were given

Thaler and Shefrin 1981, Shefrin and Thaler 1988.

need to adhere to. The focus of these interventions should be towards prevention as compared to curing the diseases. Also, it is shown by various economists that the focus should be on improving the habits of individuals, and therefore the incentives or checks should be placed accordingly. By increasing the frequency of these interventions, we can make the people more conscious of their decisions and thereby try to alter the psychological inertia to their advantage. A major criticism against behavioural economics is that it considers a paternalistic approach towards policy making and there is undue denigration about the people’s ability to make decisions for themselves. But, psychologists have shown that the ability to make the right choice is inversely proportional to the available choices7.

Thus, by incorporating the choices as habits amongst people we can relieve them of the burden. Dr Amartya Sen said, “Sustainable Reasoning can exist without undertaking explicit scrutiny on every occasion.”

dumb, the world is hard’. Hence, it is time

to patients regularly regarding the actual

to bring human beings at the epicentre of

win and the possibility of winning if the

2.

our efforts and try to make things easier

people adhered to their medications. The

Toilets and the Indian Man (LiveMint, 2014).

for us.

experiment proved limited in increasing

4.

Examples from Literature

the intake of chronic medications amongst

Path dependence in corporate contracting: increasing returns, herd behavior and cognitive biases. (Kahan and Klausner, 1996)

5.

John Maynard Keynes, The General Theory of Employment, Interest and Money. (1936)

6.

Public Health England.

English surveillance programme for antimicrobial utilisation and resistance (ESPAUR). London: PHE, 2014.

7.

Paradox of Choice, Barry Schwartz (2004).

8.

The Idea of Justice, Amartya Sen (2009)

9.

Improving Immunization Coverage Through Incentives, Reminders, and Social Networks in India, JPAL (Ongoing Study).

Behavioural Economics can open a new set of opportunities for improvement in public health and also increasing the confidence of

In this trial, the researchers monitored

This again points to the importance of

the adherence of patients by installing a

social norms in nudging the behaviour of

monitoring system that is linked with a

citizens positively.

•

Conditional

economic

incentives

to improve HIV treatment adherence: literature

review

and

theoretical

the people with very low adherence and hence it has huge implications in modern healthcare engagement programmes.

•

considerations In this study the researchers have argued

Screening For Diabetes In Ramadan -

A Pilot Study

economic

During the season of Ramadan, an NGO and

incentives (such as contingent payment,

Hamad Medical Cooperation conducted

etc) have been unsuccessful in sustaining

many pre-diabetes tests in Qatar with the

the long term adherence of HIV patients

help of IMAMS (leaders of the religious

to

have

community) which proved to be highly

presented the case for the behavioural

effective in identifying the presence of

interventions such as self-determination

type 2 diabetes amongst the population

theory and motivational interviewing in

and also helped them to be aware of

internalising the motivation of adherence

the possible symptoms of the disease.

amongst patients, which they have argued

The conduct of test during Ramadan was

is more sustainable as compared to some

most successful because the community

external financial incentive.

was most receptive of such procedures

the

•

traditional

antiretroviral

conditional

therapy.

They

Randomised trial of lottery-based

incentives to improve warfarin adherence

during that time and the help of religious leaders ensured that they understood the importance of these medical procedures.

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25

OPERATIONS

What Do Hospitals Need Wide area of investment amid COVID-19 pandemic is a scintilla of hope

Commander Navneet Bali, Regional Director, Northern India, Narayana Health

The ongoing Covid pandemic has affected almost every area of human life.

As far as the healthcare is concerned, the entire scenario can actually be divided into the pre-Covid and post-Covid era, presently we are somewhere in between and fighting this unprecedented war imposed upon us. The sudden outbreak of pandemic was unfortunate, at present we have crossed the 50 lakh cases mark. But now the need of the hour is to rise above the situation and resolve the issues. It is apparent that the issue is no more merely about the infection spread; rather it is a call for strategic reforms. The unprecedented restrictions due to lockdown and the economic crisis has been a double whammy for all of us. Consequently, the impact is visible in almost every area of life. Especially our hospitals that is at the forefront of this entire scenario where our respected doctors, staff and other healthcare workers are working 24x7.

Our hospitals are prime units of healthcare system, whether it is about rising need of more beds or Covid proof units for patients other than Covid, our hospitals had to work day and night amid these unparalleled changes. Along with right treatment, hospitals are fulfilling everyday need of beds for Covid patients and the need to make our hospitals entirely infection proof and make sure other procedures or treatments don’t suffer. It will surely need a wide research and investment by both public and private units. Following the concept of “atmanirbhar bharat” or the spirit of self reliance, it will be apposite if our hospitals are well equipped and more investments are invited to get this done.

As per Government of India, now we have created the capacity of manufacturing two lakh PPE kits per day, which is also increasing each day. These PPE kits are primarily used by our respected doctors and healthcare workers in hospitals. In the same way, there are areas which significantly need more investment and expansion. Some of them are as listed below.

26

October 2020

Oncology, critical care services needs to burgeon Prior to COVID-19 pandemic, cardiac diseases were already one of the major killer diseases. Moreover, cancer patterns in India are also alarming. WHO suggests that one in ten Indians will develop cancer in their lifetime and one in 15 will die of the disease. Especially cancers in women need major attention. Cervical cancer is the second most common cancer in India. In a wide range of cancers, access to treatment has already been a bigger challenge faced by our entire healthcare system. Apart from influx of infected patients due to COVID-19 pandemic, cancer patients already on chemotherapy or other related therapies have highly suffered. The treatment procedures of other diseases also suffered to a major extent. Primarily, cardiac patients, cancer patients on cancer-related therapies, neurological patients and those who need urgent treatment had to bear the brunt of this pandemic situation.

seeking behaviour is listed below.

Hence, we need to widen this area well.

Hence, it is a right time to increase investments in oncology treatment and critical care units more than before. We all are aware that when it comes to cancer early diagnosis is the key but even before this Covid outbreak people were losing their lives due to lack of treatment at the right time. Covid may leave us sooner or later but this scenario may put other treatment processes at bigger risks than before. It is pivotal to widen the entire gamut of approach. Let’s think beyond for better future.

•

•

Future of Hospitals

encouraged.

Amid Covid pandemic it was also advised to visit hospitals only in case of critical condition and be in touch with concerned doctors thereby visiting hospital for sure if he suggests. However, the rising number of infected cases made people quite sceptical due to which some of them did not report to the hospital in the fear of catching infection. Also online consultations took a new turn. Some of the shift in treatment

•

A large section now prefers to get

Online consultation should be in

service at home than to visit hospitals as

more organised form with online digital

much as possible. Hence, services at the

platforms. More and more apps should be

home should be encouraged. Along with

introduced. A number of start ups can be

patient’s convenience it will bring in more

invited in this regard.

profit to the healthcare and satisfaction of •

the patients.

•

Medical devices industry can be

expanded. Hand sanitizers, basic hygiene have emerged as new more basic concerns in life. Hence, manufacture of PPE kits, air purifiers, ventilators, sanitisers should be

Unlike

people

are

already

suffering

from

other critical diseases are now more careful and more people are becoming health conscious, they are extra cautious about their basic well-being. Apart from treatments, diseases and cure keys to increase immunity, longer and healthy life

before,

Patients

Our hospitals need more investments, for the cause government and private players together should come forward for better healthcare and services.

are

being

discussed.

Rather,

the

more

future seems more fitness centric and our

concerned about mental health as well.

hospitals should offer its visitors a wide

Major healthcare issues lead to a number

range of options in this regard.

of critical diseases. Also people have suffered so much of negativity with

This pandemic is unfortunate but still one

everyday witnessing the number of cases,

need to look at the brighter side of the

living in confined spaces for more than four

story and work for it; the economic crisis

months in this pandemic, now a section of

country facing today can surely be dealt

them is more aware about mental health.

with this step.

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27

AI IN HEALTHCARE

Winning Strategy Are you actively implementing or have plans to execute an AI strategy, read this Our DNA is Artificial

Intelligence (AI). We are having a fresh look at legacy systems being used in the radiology space and rethinking how AI can better the experience. In radiology and imaging space the stakeholders are the patient, imaging experts (radiologists) and referring physicians. The idea is to ensure how AI can enhance the experience for all concerned in multiples of “x”.

Dr Amit Kharat, Co-founder, DeepTek, Pune

AI Versus Smart Solutions AI is a blanket term and is not appropriate as it does not do justice to its actual workings. The appropriate word must be smart solutions though it sounds less glamorous. A smart solution can use AI or simple rule based engines and clinical decision support matrices to enhance the user experience and yet produce marvelous and rewarding outputs. These smart solutions may machine learning and its subsets such as deep learning at its core. All in all this makes a complete end to end solution for radiology. Such smart radiology solutions principally can make things efficient, economical and also be a strong enabler.

Point of Impact Smart Solutions in radiology departments can be deployed at appointment scheduling, process of patient scanning, scan result interpretation (prescreening and triage), workflow augmentation and result delivery through notifications. At our company, we have a strategy to manage the entire cycle of the patient experience using cutting edge solutions making it a win-win situation for all participating stakeholders into an engaging experience.

Our strength is in understanding these basic nuances which can be an irritating form factor, identify and eliminate or minimise these challenges.

Plan To have the right AI strategy we have to step back to take a bird's eye view into the

28

October 2020

working within a radiology department.

The AI strategy process is something we started two and half years ago where we identified use cases during the inception phase of DeepTek. The number of use cases are substantial, however, those which have lasting impact on society, those which can bring in substantial gains in improving report turnaround times and those which improve the quality of work for physicians and imaging experts gets priority. Use cases also get divided as per the geography and modality.

Deployment Strategy Deploying AI for the workflow and image analysis is complex. This also needs to be smoothly integrated in the radiology workflow. Aim of the activity is to reduce bottlenecks and workflow congestions. If AI has increased the number of clicks or added additional dashboard then it's not going to be easily accepted in workflows.

Currently a lot of time and effort of floor managers is gone in rationalising resources and human experts in the radiology department which ultimately results in valuable time getting wasted.

Workflow automation and combining it with radiology medical image analysis, and downstream process integration could result in substantial time savings.

AI strategy and use cases To bring automation in radiology medical image analysis requires us to dive deeper in the use cases for AI in the radiology department. Let's take a simple example of X-ray chest and see how complex it can get. It starts with a simple task of finding a normal versus abnormal X-ray and then it can move further to detection or more complex disease process such as TB and COVID-19 pattern or we can still dive deeper to more complex problem solving such as detection of 20+ more lung pathologies like pleural effusion, consolidation, mass, nodule, cardiomegaly

and it does not stop here. We can further analyse to assess skeletal abnormality in the X-ray chest such as scoliosis, fracture and as the journey continues we can go to understanding subtle nuances like quality of the chest radiology, motion blur and image centering. As you can see, developing a precise and complete X-ray chest suite is itself quite a long and exhaustive task and it cannot be possible without deep domain knowledge and high-quality annotations. Of course we should not forget that the same pathology can have multiple differentials and we need to be more careful while annotating and creating a list of differentials.

Finally all these findings need strong feedback and self learning through actual modifications being brought around by radiologists as this feedback can establish the dynamism of the algorithm. However,

to run such complex chest solutions have humongous cost implications and hence implementations must be carefully planned and executed.

In conclusion As you can see every organ and modality in medical imaging has its own unique set of challenges and opportunities to better healthcare. While executing an AI strategy, one needs to ask the following questions.

•

Is the solution being implemented really improving workflows or is it complicating it?

•

Medical radiology and imaging automation therefore is not a simple exercise of a custom model deployment but much more complex and needs a lot of out-of-box thinking to make things work and enhance the experience for users.

Is the solution empowering experts and not frustrating them?

•

Does the solution ensure significant saving

in

time,

costs

and

is

it

minimising errors?

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29

INTERVIEW

‘Cancer vaccines will not replace surgery or chemo but could give long-lasting immunity’

Why have previous attempts to create a cancer vaccine failed?

I think immunology is one of the parts of life science, which has evolved the most over the past 10 years. So the people that were developing cancer vaccines 15 years ago had a dream to cure cancer with a vaccine, but we know now that it will not.

The vaccine will never work alone. It will not replace surgery or chemotherapy.

However, maybe after chemo and surgery, you can educate the immune system to recognise the cancer and have long-lasting immunity against the cancer, reducing the

Dr Madiha Derouazi, CEO, Amal Therapeutics

risk of relapse.

Also, we were lacking some key knowledge

Recent advances are bringing cancer vaccines much closer to reality, giving patients another weapon in their arsenal of cancer treatments, says Dr Madiha Derouazi, CEO of Amal Therapeutics and one of three winners of the 2020 EU Prize for Women Innovators, in conversation with Ian Le Guillou.

in the immune suppressive mechanisms that the cancer cells have developed – how they escape the immune system.To fight against that, we have checkpoint inhibitor drugs, which over the last four or five years have completely changed the landscape of cancer treatment.

Arming our immune system

to

fight cancer has been a long-standing dream for scientists and doctors. However, many cancers have tricks that allow them to hide from the immune system and suppress our immune defences. To unleash our immune system we have to tackle both of these tricks.

Around 1891, a surgeon called Dr Coley

have what is suppressing the immune

noticed that when patients have cancer and

system. So if you want to win, you have

also a bacterial infection at the same time,

to address both sides of the balance -

the tumour was shrinking. He developed a

promoting with the vaccine and removing

cocktail of bacteria that he administered to

the

patients to treat the cancer, and sometimes

inhibitor.

promoting the immune system and you

over

there were quite impressive results. This drug, called Coley’s toxins, was on the

of

market until after the Second World War

revolution

in

immunotherapy

immunology drugs

known

as

checkpoint inhibitors that reawaken the

(when changes in FDA regulations required

immune system. These drugs can have

clinical trials for the drug to be approved

remarkable results in a minority of cases,

for use).

leading to long-lasting remission.

Your immune system spontaneously, or

To work more broadly, we must also train

with some stimulation, can recognise

the immune system to recognise the cancer.

the cancer cells as a threat and attack

This is where vaccines could soon help us

them. But the immune cells are not fully

to target some of the most hard-to-treat

activated, so you need to give them a little

cancers, says Dr Derouazi, whose company

help.

is currently running trials of a therapeutic

How does your vaccine help the immune system to recognise the cancer?

vaccine in people with colorectal cancer.

Vaccines are getting a lot of public attention at the moment in the battle against Covid-19.

Most people are familiar with the idea of vaccinating against infectious diseases, but not

October 2020

It's always a balance. You have what is

the past decade led to the creation

A

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against cancer. How would a cancer vaccine work?

Each

type

of

vaccine

platform

has

advantages and disadvantages. Vaccines using proteins are easier to manufacture than viruses. But proteins do not produce the immune response that you want.

suppression

with

the

checkpoint

Five years ago, cancer vaccines were

Dr Madiha Derouazi, CEO, Amal Therapeutics

standalone,

now

it’s

always

as

a

combination and that’s very important.

For a cancer vaccine you want to have cytotoxic T-cells (which kill cancer cells) and not necessarily antibodies. To achieve that, the protein has to be delivered in a certain way; to improve that I have added a cell-penetrating peptide (to deliver) the antigens.

(prompt the immune system to) target a

The other aspect is that you need to have the so-called ‘danger signal’ in order to get the immune system activated. So we could find some protein sequence which provides the danger signal and fuse it to the same protein. We end up with a chimeric protein where we have pieces assembled that keep the advantages that we will need to achieve a good immune response.

who is compatible with you. We would like

can improve?’, ‘what have we learned?’

We chose colorectal cancer because in

We're trying to have antigens which can

and building on this knowledge.

2015, for the first time in immunotherapy,

lot of different cells in the tumour - not all the tumour cells express the same antigen.

Also,

we

are

addressing

the

genetic

heterogeneity of human beings. So that's why, for example, when you have to get a new organ, you have to find somebody

You are currently testing a vaccine for colorectal cancer using your ‘chimeric protein’ approach. What stage is the vaccine currently at?

to have a vaccine which addresses this

It’s in phase 1b clinical trial (for side

genetic heterogeneity and could work in

effects and dosage in humans), where

Europe, Japan or the US, where the people

it’s being tested in two populations of

are genetically very different.

metastatic

It's innovative, but it's not like I had the idea of the century when I woke up one morning. It has matured over 12 years of research in that space and thinking ‘what

Within different

colorectal

colorectal

cancer

cancer,

populations

based

patients.

you

have

on

their

genetic background or based on where they are in the standard of care treatment.

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31

INTERVIEW we had a genetic marker which allowed you to say if a colorectal cancer patient will respond to (the checkpoint inhibitor drug) anti-PD1. This is seen in about 4-5% of metastatic patients, and the remaining patients will not respond to this treatment.

I was thinking that cancer vaccines should be used in patients where anti-PD1 is not working. It is not working for a reason and that could be addressed by the vaccine.

A combination of a vaccine and antiPD1 could get those patients to respond.

So for colorectal cancer we had a clear differentiation (genetic) marker.

At the beginning, this (trial) was planned for 32 patients, but this number will increase as soon as we see a signal (results that indicate the vaccine is effective).

For a first-in-human trial, the primary endpoint is always safety, and then the secondary endpoints are clinical outcomes.

You’ll have the vaccine response in four or five months, but the clinical outcome takes

OPINION a little bit longer – six to twelve months.

I’m very grateful to the patients who enrol in the trial because they not only get the treatment, but they also come a few times to give us some blood samples so we can follow the immune response.

a

lot

more

cautious

in

how

Ask me again next year! Honestly, we are much closer, because already in 2020, I have seen two scientific publications on cancer vaccines which, for the first time,

Why do you think your vaccine approach will be successful?

I’m

It’s an impossible question to answer, but when will we have a cancer vaccine available?

have really promising results.

I

To Doctors, From Doctor What keeps you going if you get Covid

I really believe that in the next five years, this will become a reality.

communicate about it. I get a lot of letters from patients requesting to be included

On 23 September Dr Derouazi was awarded

in our trial or to get the vaccine under

a €100,000 EU Women Innovators prize

compassionate use, and it’s very sad.

I don’t want to sell dreams to cancer patients; I don’t want to oversell it.

in recognition of her work. Her fellow winners, also awarded €100,000, were Maria Fátima Lucas, co-founder and CEO of Zymvol Biomodeling, and Aranzazu

Where I think we are differentiating

Martínez

ourselves is that we are really trying to

Director of It Will Be. Josefien Groot, co-

build up our technology platforms and

founder and CEO of Qlayers was named

clinical strategies on how the others have

‘Rising Innovator’ and awarded €50,000.

failed and what we have learned from

This was originally published in Horizon,

their trials.

the EU Research and Innovation magazine.

co-founder

and

Managing

Dr Kamna Kakkar, Senior Resident, Department of Pulmonary and Critical Care, PGIMS, Rohtak

As a resident doctor

working in

Covid ICUs in a tertiary care hospital in India, I am seeing COVID-19 pandemic from the worst end of the spectrum. A sudden drop in oxygen saturation, a bout of severe breathlessness and suddenly, the patient needs ICU care. I've seen an 80-year-old man survive while a 30-year-old succumbs on the adjacent bed, despite the best efforts. In the last six months, we realised there are a few things that work and a few that don't in fighting

About boosting immunity

Covid.

There is no product in the market that can claim to be an effective immunity booster for Covid. In fact, using certain herbs and spices for an extended period of time has been shown to affect kidneys and liver adversely, ultimately making you more vulnerable to Covid! For boosting immunity, just handle your co-morbidities in advance. Control your diseases before the diseases control you! Control your blood sugar levels if you are diabetic.

Control your blood pressure if you are hypertensive. Don't miss your medications (if you have been doing that). Consult your doctor if you've forgotten what

About testing When in doubt, do not hesitate to get tested. When struck by fever or a bit of sore throat, please do not ignore the symptoms. I know it's inconvenient to get tested and even more inconvenient to test Covid positive. I know there's a stigma.

I know there's job loss associated with absenteeism. But, do you know, doctors lose precious amount of time in testing you for multiple diseases when you're wheeled-in with critical breathing issues in an emergency room? If you have 'Covid'

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October 2020

already as a diagnosis, all our efforts go into treating you as a Covid patient only and not a MI/dengue/ malaria/ typhoid/ scrub typhus patient because patients of all these diseases may present with difficulty in breathing. So, don't wait for your health to suddenly deteriorate- get tested even when the disease seems mild and symptoms tolerable because you can never predict how Covid may affect your body.

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OPINION medications you were on. Eat a healthy balanced diet. Quit smoking- now is the ideal time. Having your diseases in check makes sure your body is ready to face any ailment, even the worst bout of Covid. This also helps sail smoothly out of ICUs too.

About danger signs in Covid As more and more people are being isolated at home itself, one needs to be aware of important danger signs/warning signals of Covid that require immediate hospitalisation of the patient. If the face of the home isolated patient appears pale or a shade darker than usual, if lips appear bluish, if the patient appears to be gasping for breaths, is difficult to arouse or has trouble staying awake, if he/she has pain in the chest, if they haven't been able to eat or drink anything- inform and rush the patient to a Covid dedicated hospital immediately. The patient may have some of these warning signs, if not all. The elderly, people with serious comorbodities, the disabled are more vulnerable populations- keep an eye on them. Read more about these danger signs- knowledge is power.

your hands. If you use sanitizers, make sure it's 70 percent alcohol or else it fails against Covid. Also, ensure you moisturise your hands too as alcohol and frequent handwashing can really dry out your skin.

Gloves, Not needed unless your hands are allergic to frequent washing. Masks, Yes, 100 percent yes!

There are websites like cdc. gov and who.int, which can be trusted and consulted for scientific information by general public.

About keeping abreast with information In this pandemic, we must learn to mistrust stray anecdotes and trust only proper research. There has been a pandemic of misinformation that has run parallel to the Covid pandemic. Any news that seems path-breaking and overtly sensational isn't necessarily true. Infact, mostly it will be debunked as false. Science works quietly. Your RT-PCR and antigen tests are science. Ventilators and oxygen therapy are science. Trust science and science only.

Anything that cannot be backed by peer reviewed research isn't science - always remember that.

About experimental therapies There's a hue and cry around with people rushing for costly experimental drugs, exotic therapies and what not. There have been incidents of people self-medicating themselves too. Do not believe any whatsapp forwards that claim to say to have found a 'miracle drug'. There is no 'cure' for Covid so far. What seems to work in complicated Covid cases is intensive care, oxygen therapy and management of co-morbidities. There are drugs that work to reduce inflammation (like steroids) but they too need tailored dosage that varies from patient to patient. Trust your doctorthey have been trained to handle this. Do not pester them to try drugs you've read about on social media.

About stuff to keep at home: Keep a thermometer and learn how to use it.

That's the only gadget anyone should keep at home. Pulse oximeter is needed only when suggested. Also, to clean your house, you don't need any special chemicals. Just use your regular soap and water to keep floors clean, wipe door handles, taps and other frequently touched surfaces. Most importantly, use soap and water to wash

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October 2020