The Jiofication of genomic diagnostics

In a wide-ranging discussion on the future of genomics and cancer diagnostics in India, senior leaders from Strand Life Sciences outlined their long-term vision, regulatory challenges and the evolving market dynamics shaping precision medicine in the country.

In 2000, four scientists from Bangalore’s Indian Institute of Sciences set up Strand Lifesciences. Combining bioinformatics with genomics, their mission was to take genomic insights from the lab to researchers and ultimately patients.

Their initial suite of products and services, using AI to decipher omics data, included providing bioinformatics services to improve success rate in drug discovery and diagnostics genomics.

Besides being India’s first academic spin-off, Strand was the first bioinformatics genomics company in India and among the first in the world. The company created the first Indian made genomic analysis software to receive over 20,000 citations in peer reviewed literature.

Co-founder Dr Vijay Chandru, recalls the many firsts for Strand, calling it India’s first AI company. “Back in 2000, it was actually the first use of machine learning and AI in a substantive way in the country. In those days, people never talked about AI, we called it data science and data analytics,” he reminisces.

The team built machine learning tools and NLP systems as early as 2000, including an engine that parsed 20 million PubMed articles to form the knowledge graphs still used in its interpretation stack.

Strand reportedly conducted and published India’s first large scale studies of inherited cancer risk and diagnosing neurological disorders. It was also the first in India to introduce an non-invasive early cancer detection test based on epigenetics.

Its 32,000 sq. ft genomics centre was India’s first College of American Pathologists (CAP)-accredited laboratory for genome sequencing in India, with over 75,000 tests completed, and capacity to process hundreds of thousands of tests annually.

The Jiofication of genomics

25 years later, Strand is driven by the same mission, but at a significantly higher scale. Turbo-charged by investor Reliance Industries Limited (RIL) in 2021 and now a subsidiary of Reliance Industries, the management team, led by CEO Dr Ramesh Hariharan, ((second from right in the founders’ photo, the youngest of the four co-founders), is now working to mainstream genomics testing, by making it even more accessible and affordable.

Though the team has managed to bring down the costs of genomic tests, Dr Hariharan chuckles and mentions that they are still a long way from RIL Chairman Mukesh Ambani’s directive to bring it down to Rs 999/-.

Our chairman’s vision is that we really need to create impact with AI, leverage the power of AI and bring it to the common man.

Predictably, Nilesh Modi, Director, Strand Lifesciences, an RIL veteran, calls the Chairman’s brief “a Jiofication of genomics”, harking back to the RIL group’s business strategy of aggressively disrupting every sector they choose to enter: from textiles to retail to telecom.

Modi refers to the various parts of RIL’s plan to build an overall healthcare ecosystem, saying, “Our chairman’s vision is that we really need to create impact with AI, leverage the power of AI and bring it to the common man.”

Key components are the patient-facing health app, JioHealthHub, the Jio Clinic platform for clinicians with over 22,000 doctors, and the CareXpert hospital information system—now deployed across more than 500 hospitals in India, the Middle East, and Nepal. RIL’s acquisition of Karkinos Healthcare in December 2024, to boost affordable cancer care, is another part of the RIL healthcare ecosystem.

But can the same playbook apply to genomic diagnostics? While AI-driven bioinformatics can cut short turnaround time (TAT) time and increase throughput, running many samples at the same time, will customers trust that the results are accurate? Will patients believe Dr Hariharan’s assurance that the ‘human in the loop’ protocol ensures accuracy and continuous oversight?

Trust at scale

Over the years, Strand seems to have built trust and addressed these concerns, with referrals from approximately 2500 clinicians and hospitals across India and ~10 other countries. The company counts several global genomics companies as clients, ranging from Abbvie, Sanofi, Takeda, etc, with more than 500 completed projects. Their early cancer detection programme and tests were built in collaboration with global leaders like University of Chicago and Johns Hopkins University.

Strand’s expertise in genomics is a vital part of RIL’s healthcare play. One major expertise area is deploying precision medicine to help oncologists modify treatment throughout a patient’s journey. Giving more details, Dr Hariharan pinpoints a growing area of clinical research: monitoring cancer patients post surgery, when Strand’s tests can detect residual tumour DNA fragments. This helps clinicians decide if the cancer has truly been eradicated and then take calls on escalating or de-escalating therapy.

In reproductive health, Strand’s non-invasive prenatal screening tests detect and prevent genetic disorders like Down’s Syndrome. On the preventive health and wellness side, Strand’s products offer patients precision nutrition, with microbiome- informed precision pre & probiotics for skin and gut issues as well as aging/organ health monitoring. Soon, genomic tests could be added to the annual check ups.

The case for blood-based non-invasive screening

Quoting studies that show that 750,000 cases of cancer can be averted and 250,000 deaths prevented by assessing all adult women for inherited risk of breast and ovarian cancer, Dr Hariharan points out that health economic analysis and modelling shows that screening and catching cancers early is viable and is both life-saving and cost-saving.

But he also highlights the drawbacks of current screening methods, especially radiation-based tests. Repeated radiation-based screening tests like mammograms for breast cancer, colonoscopies for colorectal cancer, or low-dose CT scans for lung cancer expose patients to too much radiation and this may be more harmful over a period of time.

He thus makes the case for a shift to blood-based non-invasive screening methods that can look for multiple cancer types simultaneously and reduce the number of people undergoing radiation based-tests to the minimum.

The leadership team revealed that Strand is conducting multiple clinical studies—including a national, multicentre blinded study currently underway, based on samples from hospitals across the country —to validate that its test helps more than it harms. Results are expected mid-next year, alongside additional trials across different risk categories.

Revving up for the next phase

Four years after becoming part of the RIL group, Strand seems ready for the next pivot: scaling up its genomics testing presence, leveraging RIL’s scale to bring down prices and penetrate the market beyond metro towns. Strand’s genomics centre today performs 40,000–50,000 tests annually, with capacity for several hundred thousand.

The leadership disclosed three new releases. Firstly, Strandomics v2, will use AI and speed up, by four times, the process of reading complex clinical descriptions in prescriptions and map them to the appropriate genes described in the medical literature.

The second release, CytoRx AI, will help Strand answer questions raised by pharma partners faster and better, reducing the cost of drug development by three times. This tool works by assembling the relevant single cell datasets to answer a given drug response question, using LLMs.

And lastly, but possibly the most ambitious launch, CancerSpot v2, is a multi-cancer early detection blood test. This version expands from the previous version’s 10 to 14 cancer types, using evidence from approximately 1700 samples.

Prioritising high sensitivity and specificity, the test aims to reduce the number of invasive tests needed for guideline adherence (reduces colonoscopies 10-fold, reduces low-dose CT exposure for heavy smokers 20-fold) and as per Strand’s leadership team, provides the first viable option for screening non-smokers for lung cancer.

Health economic analysis and modelling shows that screening and catching cancers early is viable and is both life-saving and cost-saving. 

The genomics testing opportunity

Strand is part of India’s competitive and expanding genomic testing market. A Grand View Research report estimates the global genetic testing market size at USD 14.25 billion in 2025, anticipated to reach USD 39.25 billion by 2030, growing at a CAGR of 22.5% from 2025 to 2030. While North America was the largest market in 2024, Asia Pacific is pegged as the fastest growing market.

The big names in global genomics are Natera and Illumina, whereas within India, Strand/RIL competes with genomic-focused players like MedGenome and MapmyGenome as well as players like Agilus Diagnostics, Metropolis Healthcare, Dr Lal PathLabs, Mahajan Imaging & Labs, and Redcliffe Labs, which have seen their genomic testing revenues rise over time.

As per the Grand View Research report, the genetic testing market in Asia Pacific is expected to experience the fastest CAGR of 25.7% during the forecast period. Based on technology, the next generation sequencing segment led the market with the largest revenue share of 49.3% in 2024. Based on application, the health and wellness-predisposition/risk/tendency segment led the market with the largest revenue share at 52.3% in 2024.

The report posits that the growing prevalence of chronic and genetic diseases, along with the rising demand for personalized medicine, is fueling the need for genetic testing services. Governments in several countries are also supporting the market by funding genomics research and integrating genetic testing into public health programmes. Furthermore, the increasing adoption of direct-to-consumer genetic testing and the expansion of healthcare access in emerging economies are contributing to the overall market growth in the Asia Pacific region.

A Nexdigm report values India’s genomic testing market at USD 550 million, based on 2024 data, as per industry projections, which estimate a CAGR of 18 % through 2030, potentially elevating market size to approximately USD 2,066 million.

In terms of market potential, the Strand leadership believes that genomic testing could apply to every Indian above age 45–50. While market size is not the constraint, they caution that building infrastructure and a supportive ecosystem takes time, patient capital and supportive government initiatives.

While global genomic testing companies offer single high-value tests costing ₹2.5–3 lakh, the RIL-Strand leadership stresses the need for affordability and scale in India. With RIL as a partner, the aim seems to be to ensure advanced genomic testing reaches far beyond the top 2–5% of the population, presently concentrated in major metros.

A double edge sword?

While genomic testing could reduce healthcare costs by early detection, it raises other concerns. Health data privacy and the implications of genomic testing on health and life insurance need further clarity, as insurers could misuse test results to refuse insurance cover.

The Strand leadership team strongly recommends that India should evolve towards developing its own version of the US GINA Act, referring to the Genetic Information Nondiscrimination Act (GINA) of 2008.

The GINA Act prohibits genetic discrimination in health insurance and employment. It prevents health insurers from using genetic information to determine eligibility or premiums and prohibits employers from using it in hiring, firing, or other employment-related decisions.

In contrast, the Insurance Regulatory and Development Authority of India (IRDA) had a clause excluding genetic disorders. It was only in March 2018 that the Delhi High Court took this up, while examining the case of a patient whose insurance claim was denied as he had been diagnosed with hypertrophic obstructive cardiomyopathy, a disease that could be classified as a genetic disorder.

As per media reports, the Delhi High Court rejected the claim that insurance was not payable because it was a genetic disease, holding that the term genetic disorder is vague and should not be used as the ground for exclusion of insurance claims.

Thus as of April 2025, health insurance policies in India are required to cover genetic disorders. However, while genetic disorders can no longer be universally excluded, analysts are concerned that the implementation and vague wording will allow insurance companies to deny payment. In the US too, the GINA Act has a major loophole: GINA’s protections are limited to health insurance, but does not cover life, disability, or long-term care insurance.

As awareness about the advantages of genomic tests rises, insurance coverage will be a major driver to spur greater acceptance. The Strand leadership suggests that instead of excluding genomic testing, insurers should reimburse the costs of the tests. Their argument is persuasive: genetic tests enable early detection, thereby significantly reducing long term healthcare costs and improving outcomes, allowing patients and clinicians to “manage the disease rather than treat it.”

Strand LIfesciences was India’s first AI company. Back in 2000, it was actually the first use of machine learning and AI in a substantive way in the country. In those days, people never talked about AI, we called it data science and data analytics

Correcting the genetic spelling errors

While AI is the engine driving genomic testing, the Strand leadership ensures that a human is in the driver’s seat. The ‘human-in-the-loop’ model both in the lab as well as in clinical settings would be essential to build customer trust. As genomic tests become more mainstream, companies like Strand will need to ensure that sufficient trained counsellors are also in the loop, to explain the results and implications of genomic tests.

Giving examples from his own life, Dr Hariharan discovered he was color blind after a genetic test. In his book, Genomic Quirks: The Search for Spelling Errors, he starts with his relatively less serious genetic condition, and goes on to analyse more serious consequences of spelling errors in genes: a baby detected with eye cancer, infants suddenly dying, misplaced organs, a family coping with sudden vision loss. The book brings out how scientists hunt for clues to correlate clinical observations with genetic spelling errors, all in the hope that genomics will advance to one allowing the correction of these errors.

Will the scientific credentials Strand of Lifesciences, backed by RIL’s reach and expertise in price compression, succeed in taking genomic diagnostics to the masses? And will India’s laws on health insurance protect patients’ genomic data, while reaping the benefits of better health outcomes?

 

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