The National Sample Survey Office’s 75th round data indicates that close to 60% of all hospitalizations in India are handled by the private sector. And while for the average patient, the hospital is the face of what healthcare represents, in reality, it is the last in a long chain of participants. Pharmaceutical companies, diagnostic firms, medical equipment manufacturers, and suppliers form a large and integral part of the country’s healthcare infrastructure. Many of these private sector companies have thrown their R&D budgets behind developing vaccines for Covid-19, drugs, diagnostic equipment, lab instruments – all of which are key for implementing testing and treatment programs as we battle the virus.
As the country moves towards opening up more and lockdowns become more local in nature – there is a multi-prong approach being taken towards recovery. Operations are being scaled up in firms that work across the spectrum – diagnostic firms are releasing more efficient and speedy tests, pharma companies are testing more drugs and hospitals are looking at effective management.
Those that get infected finally are affected by bed availability, access to drugs and the care the hospital provides. While drugs like Remidisvir and Tocilizumab still remain in short supply, Gautam Khanna,CEO, P.D. Hinduja Hospital & Medical Research Centre says the rest of the issues are now under control, “ As far as bed availability is concerned, there is no panic situation. Compared to a few months ago, things are much better now. What happens sometimes is that if a person finds out they’re infected, they rush to a hospital to find a bed. We have helplines that are working effectively. So if you call, you’ll know whether you even need to get hospitalized and if yes, which hospital you need to go to.”
The health care machinery is working both on the treatment and tools to access them for smooth implementation. In the area of testing, private labs like SRL diagnostics with a network across 700 Indian cities are offering the RT-PCR, antibody and antigen testing. The foundation for the fight against Covid-19 remains testing and effective treatment as the vaccine is not the silver bullet many are making it out to be.
Even though the news of encouraging vaccine trials is heartening, Zydus – the global pharmaceutical company that has received permission to begin human clinical trials in India for its Covid-19 vaccine (ZyCoV-D), believes it will be a phased solution. “The clinical trial is an adaptive Phase I/II study so both can happen in parallel and in about two and a half months we can get some meaningful results. For us or any other firm, even if the trial is successful, there will be a challenge in producing a large amount in a small period of time. We’re already looking at potential sites and technologies to produce at a large scale. However, the vaccine and immunization program will be controlled and prioritized as per risk. Assuming that multiple vaccines come out at the same time, even then we’re looking at a 6 month to one year period for a meaningful solution through vaccination,” says Dr. Sharvil Patel, MD, Cadila Healthcare.
The city of Mumbai has already relaxed testing norms, allowing anybody who wishes to get tested to do so without a doctor’s prescription. Industry insiders are hopeful that the rest of the country will follow suit. But in order to implement this – everything that’s required, testing kits, reliable labs and necessary equipment need to be available.
Thermo Fisher Scientific, which has played a pivotal role in responding to Covid-19 globally by making its cryogenic electron microscope available to researchers, developing collection kits that maintain sample integrity and real-time RT-PCR tests which are considered the gold standard for Covid testing, is working with several private and government agencies to provide continuous support.
Emphasizing the importance that healthcare infrastructure plays in the current scenario, Amit Chopra, Managing Director – India and the Middle East, Thermo Fisher Scientific says, “Containing the spread of COVID-19 requires comprehensive testing infrastructure and capability enhancement. In India, the government has taken several initiatives by setting -up virology laboratories within states, districts and zones, and authorizing private labs to accelerate the testing infrastructure and capabilities in the country. The Indian Council of Medical Research (ICMR) has approved over 1000 testing laboratories- that includes both private and government laboratories to rapidly respond to the evolving situation. The efforts to build a robust testing infrastructure for COVID-19 is a crucial differentiator and hence there is an immense need for laboratories to quickly upgrade their existing facilities for sample extraction, PCR set up and analysis, apart from safe and efficient handling of samples.”
Private firms are intensifying their efforts on every front to recover from the pandemic. Terumo Corporation which is global leader in medical technology, is spearheading the convalescence plasma treatment in India by supplying clinical data, supporting cases and working with key opinion leaders. The company’s Mirasol Pathogen Reduction Technology has shown efficacy against SARS-CoV-2 which causes Covid-19 and is awaiting addition to the Covid-19 formulary by the National Blood Transfusion Council (NBTC). The firm has also made a $2.5mn contribution to the WHO Covid-19 Response Fund and donated to the PM Cares Fund.
Probir Das, Regional Representative APAC, Terumo Corporation and Chairman & MD, Terumo Asia Holding believes that there are a few areas that are key to fight Covid-19. “First, of course, is the need for massive diagnosis and testing. You have to break the chain of transmission. Then, you have to strengthen health mechanisms to minimize complications and deaths. Also, healthcare workers have to be protected, when they are at work and when they go back home, they must have societal support. In addition to that, a steady supply chain has to be maintained for medical equipment, PPE and diagnostic kits. In every country, elective cases have to be managed effectively and patients who’re suffering from non-Covid cases must be encouraged to seek treatment. And lastly, the most vulnerable groups have to be protected and there has to be trust between the private and public healthcare organizations that are both working towards the same goal,” he says.
While in the areas of drug management, vaccine development and medical and diagnostic equipment, healthcare organizations have scaled up to the new level of requirements arising in the country; one area that continues to pose a challenge is the testing laboratories. While India is now doing close to 2 lac tests per day, which a significant increase from the level we were at earlier, it still amounts to eleven thousand tests per million. And all these tests are being carried out by 1200 labs approved by the government, a majority of which belong to the public sector. The regulations and requirements to undertake Covid-19 testing are stringent for private labs, which could slow down the process of increasing the testing infrastructure for the private sector.
SRL Diagnostics, which is the largest private network of diagnostic laboratories in the country with close to 400 labs and 1400 collection centres, says it is hoping to iron out a few issues going ahead. “In March, across all our labs we were doing a few hundred tests. Now, we’ve expanded our capacity 7-8 times. We have put in extra machines, extra manpower. From here, if we have to expand, the tests will have to be priced right. Nobody is saying they should be at Rs. 4500 but the states will have to reach a consensus on the right amount. It’ll have to be a fair price that accommodates the costs that private labs are incurring on transportation, additional manpower for the data entry work and of course the machines and equipment. This is a pandemic, and costs will be kept to the lowest possible, but private labs should be able to cover their costs also. Secondly, the regulations to do Covid-19 tests for private labs are very stringent and if the government would like to increase overall infrastructure, it could re-assess those,” says Arindam Haldar, CEO, SRL Diagnostics.
It has been given access to medical facilities that has been a top priority when it comes to Covid-19 care. The government has thus regulated the number of beds private sector hospitals assign for Covid-19 and the price at which they do so. Similarly, for testing labs, the prices for tests have been capped by the state governments. At hospitals, the government has also put in auditors to check patient bills. While all these steps to aid the average citizen are welcome, the financial health of these organizations must also be considered because if they need to continue to function well and scale, they cannot be struggling to cover costs. And it is amply clear, that the private sector is playing a critical role in the fight against Covid-19.
