India and Zika: Help Wanted

Though India would face enormous challenges in coping with a potential Zika outbreak, creative public-private partnerships could prevent a public health disaster.

Views from inside Bharat Biotech, a research company headquartered in Hyderabad that has already created the first two candidates for possible Zika vaccines.
Views from inside Bharat Biotech, a research company headquartered in Hyderabad that has already created the first two candidates for possible Zika vaccines. Photo from Bharat Biotech Media Library

With 2 million km² of tropics and subtropics, India provides an ideal breeding ground for tropical mosquitoes that bear disease. For that reason, the country has a long history with the mosquito-borne Zika virus, with the earliest recorded case dating back to the 1950s. But in spite of this head start on an infectious disease that now threatens to bloom into a global epidemic, India may be particularly vulnerable to an outbreak.

Dr. Pranatharthi Chandrasekar, Chief of the Division of Infectious Disease at Wayne State University’s School of Medicine in Detroit, Michigan, insists India faces big challenges in dealing with a potential Zika outbreak. “Even in the U.S., we have a hard time preparing for any outbreaks,” he says. “You can imagine it’s far worse in India.” Chandrasekar, who received his early training in India in the 1960s and 1970s, notes that although infectious disease is the leading cause of death in India, the first post-graduate medical fellowship program in the specialty was created just last year. “There are less than 25 subspecialists trained for the entire population,” he notes.

Pranatharthi H. Chandrasekar, M.D. Courtesy of Wayne State University
“Private companies have a role in dealing with disease outbreak,” says Pranatharthi H. Chandrasekar, M.D.
Photo courtesy of Wayne State University

Chandrasekar adds that extreme wealth inequality exacerbates the healthcare inattention to infectious disease. “Government hospitals that tend to serve the poor have limited resources,” he says, “while private hospitals, which target a wealthier population, do not make this sort of issue a priority.” In addition, about 80 percent of Indians have no health insurance, according to India’s Central Bureau of Health Intelligence, which means they must pay out of pocket even at government hospitals that often provide inadequate care. Fourteen percent of the population has government healthcare insurance, which covers much of the cost of treatment, but only at government hospitals. Only 6% of the population has private health insurance, often employer-provided and relatively comprehensive, providing access to private hospitals without incurring large out-of-pocket costs. This lopsided coverage picture means that many and perhaps most Zika patients in India are likely to either avoid care, or receive inadequate care that is financially devastating.

Chandrasekar calls for collaboration between central and state governments and a range of public institutions in order to come up with an effective plan to gather resources for a Zika outbreak. “Private companies have a role in dealing with disease outbreak, too,” he says. “Pharmaceutical companies could be very involved.”

Fortunately, India is also a breeding ground for international business cooperation, which Chandrasekar hails as one of the solutions for a possible Zika outbreak. India is the world’s fastest-growing economy, and as it reworks its structures of governance, regulations are slowly making the marketplace more accessible to foreign companies, especially as it relates to healthcare. Foreign institutions have significant opportunities for moving into the Indian market, where they can not only find markets but address public health needs. The Indian biotech sector is currently valued at US$7 billion in 2015 and is estimated to reach US$11.6 billion in 2017. One Indian biotech company, Bharat Biotech, headquartered in Hyderabad, has already created the first two candidates for possible Zika vaccines. Partnerships would help Indian companies access both knowledge and international funding that would be critical to combatting an outbreak.

Also helpful are strategic partnerships between Indian hospitals and academic medical centers in countries with more advanced healthcare systems. Such collaborations can help the country develop a new generation of infectious disease subspecialists and tackle more basic access to care. U.S.’s Johns Hopkins Medicine, for instance, signed a 10-year affiliation with India’s HCL Healthcare in 2014 to “collaborate on outpatient family and specialty care knowledge transfer, training and education projects, and clinical services.” The U.S.’s MD Anderson Cancer Center has an academic partnership with the Tata Memorial Centre, in Mumbai. These AMCs are utilizing their experience running financially sustainable operations which also serve as hubs for training and mission-based work.

Chandrasekar, who chaired the Annual Infectious Diseases Symposium at Wayne State University in 2015, says that the time to act is now. “If India wants to address this public health crisis, they need to stop burying their heads in the sand.”


— Alissa Zimmer

Alissa Zimmer is a writer and social media consultant for GHCi.



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