Why India’s research focus on diagnostics can revolutionise public health

The United Nations Children’s Fund (UNICEF) recently reported that Nepal is currently facing a double burden of non-communicable diseases (NCDs) and communicable diseases, with rising trends of NCDs. This situation will add great pressure to already fragile health systems and pose a major challenge to the country’s development unless urgent action is taken. While the primary health care approach offers a common platform to effectively address NCDs through preventive and curative interventions, its potential is not fully tapped in Nepal.

The data on NCDs in India also paints a sobering picture, akin to a reality check after binge-watching too many health documentaries. These diseases, like cancer, stroke, heart disease, and the like, account for a staggering 62 per cent of total deaths, with preventable premature deaths constituting 48 per cent of this mortality, a stat that screams “preventable tragedy” in bold letters. Despite these alarming statistics, the R&D systems in place are about as sturdy as a house of cards in a windstorm when it comes to addressing this crisis effectively.

Similarly, in Ghana, NCDs have taken the lead in the death race, accounting for 45 per cent of all deaths and leaving communicable diseases in the rearview mirror. However, the capacity to address NCDs in primary health care (PHC) is as limited as a flip phone in a smartphone world. In response to this challenge, Ghana stepped up its game by being selected as one of five countries for the NCD Flagship Initiative (2020-2024), aiming to turn the tide by strengthening PHC and improving NCD services in health facilities.

In low and middle income countries like Nepal, Ghana, and India, where over three-quarters of NCD deaths occur, mapping the patient journey for NCDs is as crucial as following a treasure map for buried gold. This journey includes early diagnosis, risk assessment, treatment planning, and access to palliative care, all of which are as essential as Wi-Fi in today’s digital age. Currently, only a meager 15 per cent of all research is directly focused on diagnostics, a figure that stands out like a lone wolf in a herd, starkly contrasting with the pressing need for accurate and early diagnosis of diseases, particularly in the context of cancer.

One of the primary reasons for this disparity is the historical neglect of NCDs, especially in regions outside Europe and North America. The focus has often been on infectious diseases, leaving NCDs sidelined like the forgotten middle child, despite their growing impact on global health.

In response to the increasing prevalence of non-communicable diseases (NCDs), India initiated the National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases, and Stroke (NPCDCS) in 2010, aiming to encompass all districts across the country. The program was designed to concentrate on preventing, screening, diagnosing, and managing hypertension, diabetes, cardiovascular disease, and cancer. However, the implementation of the program at the state level has encountered difficulties due to inadequacies in the monitoring system, interruptions in drug supply, inconsistent access to diagnostic tools, and insufficient financial planning. 

But there is potential. The first step is to develop and strengthen early detection and diagnosis capacity in primary care systems. Secondly, we have to build a proficient public health workforce at both the state and district levels to oversee, assess, and interpret program data effectively. Thirdly, educate and empower community-level health workers with basic tools and training to facilitate early diagnosis. Fourth, we have to identify key obstacles and implement evidence-based strategies to overcome those challenges. And finally, it needs to be understood that a one-size-fits-all approach will not work, and that research and development should always keep up with new developments.

India’s leadership in diagnostic research and development can have a ripple effect across the global south. Many countries in this region face similar healthcare challenges and can benefit immensely from India’s expertise and experience. By sharing knowledge, best practices, and technology, India can catalyse progress in addressing NCDs on a broader scale, contributing to improved population health outcomes and healthcare systems across the global south.

The National Research Foundation (NRF) can play a pivotal role in driving forward the agenda of prioritising diagnostics in healthcare research and development. As a central agency dedicated to funding and promoting scientific research, the NRF can allocate resources specifically towards initiatives focused on advancing diagnostic technologies for non-communicable diseases. This could involve funding collaborative projects between academic institutions, research organisations, and industry partners to accelerate the development of innovative diagnostic tools and techniques.

In 2022, A*STAR’s Genome Institute of Singapore (GIS), in collaboration with the National University Cancer Institute, Singapore (NCIS) and National Cancer Centre Singapore (NCCS), secured the prestigious Open Fund-Large Collaborative Grant (OF-LCG) supported by the National Research Foundation, Singapore (NRF) and administered by the National Medical Research Council (NMRC), like winning an Oscar for healthcare innovation. Their goal is to enhance early diagnosis and survival rates for nasopharyngeal cancer (NPC), commonly known as nose cancer, a mission as bold as a space exploration. NPC is the second most prevalent cancer in adult males aged 40 to 49 in Singapore, predominantly affecting individuals of Chinese descent from Southern China, as well as Malay and indigenous Southeast Asian populations, like a stealthy ninja targeting specific groups.

India has a unique opportunity to redefine the narrative around public health by pivoting towards diagnostics. By investing in research and development that prioritises early detection and intervention, India can lead the way in combating the silent epidemic of non-communicable diseases, setting a precedent for the world to follow.