BW Healthcare February 2023 Issue

     Sajjan Singh Yadav, Additional Secretary Ministry of Finance on the value in Indian Pharma February 2023 | Rs 300 | RNI WE NEED A VERY STRONG BIOTECH REVOLUTION IN INDIA SANJEEV NAVANGUL MD & CEO, Bharat Serums and Vaccines Dr Sangita Reddy Joint MD, Apollo Hospitals Jasdeep Singh Group CEO, CARE Hospitals Group Gautam Khanna CEO, PD Hinduja Hospital Santy Sajan Group COO, Paras Healthcare Bullish On India's Health Infrastructure

6 B W EDUCATION FEBRUARY 2023 WWW.BWHEALTHCAREWORLD.COM OPEN YOURSELF TO A NEW ERA OF SUBSCRIBE NOW & GET BUSINESS INTELLIGENCE! Returns... All-time high consumer sentiment pushes festive spending back on course Special Double Issue www.businessworld.in RNI NO. 39847/81 I 22 OCTOBER 2022 Splurge Season www.businessworld.in RNI NO. 39847/81 I 03 DECEMBER 2022 The National Logistics Policy (NLP) seeks to transform India’s logistics sector into an `ek\^iXk\[#Zfjk$\øZ`\ekXe[ sustainable ecosystem ON A FASTER TRAJECTORY Apoorva Ranjan Sharma Co-founder, Venture Catalysts Group (See Interview) RS 150 LOGISTICS: HAL TEJAS www.businessworld.in RNI NO. 39847/81 I 05 NOVEMBER 2022 RS 150 MAKE IN INDIA THE EARLY TRAILBLAZERS CUTTING-EDGE STARTUPS ARE THE BRIGHT SPARKS IN INDIA’S EMERGING DEFENCE INDUSTRIAL COMPLEX STARTUPS@DEFENCE M.K. STALIN, CM, Tamil Nadu RISHAD DADACHANJI, MD, Dadachanji INSIDE Group KAIRUS DADACHANJI, Chairman, Dadachanji Group www.businessworld.in INDIA’S TOP BSCHOOLS The Most Denitive Ranking of the top business management institutions RS 150 HR heads on what B-schools must factor in Illustrious B-school alumni share takeaways & lessons learned Been There, Done That Industry Expectations BUILDING BLOCKS OF THE FUTURE SUBSCRIBER’S COPY NOT FOR RESALE I RNI NO. 39847/81 I 19 NOVEMBER 2022 Special Double Issue www.businessworld.in RS 150 Festive Sparkle Returns RNI NO. 39847/81 I 22 OCTOBER 2022 LUXURY Thoughtful Spotlight: Beauty entrepreneur Katrina Kaif on the growth of her brand Kay Beauty and sectoral trends RECOVERY THE YEAR OF As India’s advances towards it’s $5 trillion mark, a look at what 2023 will mean for various sectors www.businessworld.in SUBSCRIBER’S COPY NOT FOR RESALE I RNI NO. 39847/81 I 31 DECEMBER 2022 INSIDE: IBLF Delhi Chapter Economy Education Agriculture Aviation Manufacturing Finance RS 150 BW Disrupt 40 under 40 Winner VINEETA SINGH Co-founder and CEO, SUGAR Cosmetics www.businessworld.in SUBSCRIBER’S COPY NOT FOR RESALE I RNI NO. 39847/81 I 17 DECEMBER 2022 RS 150 Young entrepreneurs like SUGAR Cosmetics’ Vineeta Singh are breaking barriers to create new-age brands that also have the potential to shine on the global stage THE ENTREPRENEURSHIP ISSUE POWER OF PM Modi sets a target to make India a developed nation by 2047 as he unveils his ‘Panch Pran’ blueprint. BW Businessworld comes up with ‘Five Pledges’ that will add momentum to the drive SUBSCRIBER’S COPY NOT FOR RESALE I RNI NO. 39847/81 I 24 SEPTEMBER 2022 RS 150 Leader India Inc. Will Miss Cyrus Mistry 1968-2022 www.businessworld.in 1 YEAR SUBSCRIPTION @ Rs. 3,900 Rs. 2,899 2 YEARS SUBSCRIPTION @ Rs. 7,800 Rs. 5,599 3 YEARS SUBSCRIPTION @ Rs. 11,700 Rs. 8,199 THINK BUSINESS. THINK BW BUSINESSWORLD. To subscribe, please visit subscribe.businessworld.in or scan the QR Code

     February 2023 | Rs 300 | RNI LEADERS OF TOMORROW Arun Singhvi BW Healthcare World honors industry leaders who are redefining healthcare Dr Nikita Sobti Dr Sunl G Kini Dr Sita Rajan Dr Sonal Dixit Gurjeet Singh Anand K Dr Mahesh Mayalarappa Dr Naveen Kumar Arya Sanjeev Vashishth Tarun Gupta Dr Arjun Dang Yuvraj Singh Ravjot Arora

4 BW H E A LT H CA R E FEBRUARY 2023 WWW.BWHEALTHCAREWORLD.COM ON THE RIGHT PATH EDITOR-IN-CHIEF’S NOTE Last year the Budget allocated INR 86,200 cr to the Ministry of Health and Family Welfare, which was a 16.5 per cent increase when compared to FY 2020-21. This year, all eyes will be on specific areas namely, GST reforms, allocation to medical education, and infrastructure in Tier2 and Tier 3 cities. With Covid rearing its head again, and numbers increasing in China, the world is readying its healthcare systems for any possible outbreak. Here in India too, healthcare facilities are reviewing their systems to guard against any eventualities. The latest figures suggest India has administered over 220 crore vaccine doses, and approximately 95 crore people are double vaccinated and over 22 crore people have taken the booster dose. Post pandemic revamping of hospital infrastructure has seen healthcare providers becoming self-dependent on oxygen support, driving digital strength, and creating better monitoring systems to better predict and control the next outbreak. We bring you voices of leaders from across the sector on how the healthcare sector has applied the learning from the pandemic to infrastructure, processes, and most of all to delivering care. Technology has been a key driver for a significant part of reform that has taken place in the healthcare sector. 2023 will see a number of innovations and technology being used to improve care that is being delivered.We look at how 5G will revolutionise healthcare systems. With the help of 5G we will be able to focus on delivering preventive care, it will create a customer-centric environment that will provide services at reasonable prices. Not just this, it will also help pharma companies enhance their drug delivery business. In this issue, we spotlight a conversation with Sanjiv Navangul, MD & CEO, Bharat Serums and Vaccines who stresses on how we need a strong biotech revolution in India. We have a feature on BW Healthcare World Excellence Awards, which brought together leaders from the domain who have redefined the practice with expertise, empathy, innovation and foresight. The list looks at unique business ideas and the people powering them. While each one may not have built a billion-dollar business, but they are all committed to serve the nation by working towards providing the gift of good health to the citizens. Read all about them in the pages ahead. In addition, we have our regular columns, articles by experts in the domain and features on various aspects of healthcare. Happy Reading. “The test of our progress is not whether we add more to the abundance of those who have much; it is whether we provide enough for those who have too little.” Franklin D. Roosevelt [email protected] ANNURAG BATRA

WWW.BWHEALTHCAREWORLD.COM BW H E A LT H CA R E FEEBRUARY 202 3 5 Technology will impact healthcare in a big way FROM THE CEO’s D E S K Dear Reader, I believe there are three pillars that define the success of the healthcare industry. These pillars are accessibility, quality and affordability. The learning from the emergency situation in the recent past led to innovations in all spheres of healthcare in 2022. I have had the good fortune to speak with the healthcare industry thought leaders in the past one year and I can sense the acceptance of technology advancement that will truly impact the sector in a big way this year. I am so pleased to observe the focus on saving healthcare records, technology advancement in connected healthcare leading to increased accessibility, articifial intelligence that promises to lead to diagnostic services in under-served areas as well as even more advanced robotic surgeries, quality remote monitoring offering continuity of care beyond hospitals, increased attention on R&D by the pharmaceutical sector, emerging focus on Ayush and mental health as well as acceptance of the new disruptive healthcare delivery models. It is with pride that I observe India becoming not just a destination for affordable care, but also a destination that offers quaility care. From the time we used to rush overseas for quality healthcare to receiving foreign patients in India, we have certainly come a long way. India prides itself as a producer of some of the best doctors as well as world-class engineers, a promising combination for health tech advancement. Keeping in mind how India handled the medical crises during the recent pandemic and how we responded with innovations, all eyes should be on India for its contribution to healthcare and health technology in the coming times. BW Healthcare World team will continue to be the voice of the healthcare industry as its partner and platform for sharing news, reports, presenting thought leaders’ opinions and industry trends. Do share your views and feedback on how we could improve. Happy reading. Harbinder Narula CEO, BW Healthcare World & BW Wellbeing World

6 BW HE ALTHCARE FEBRUARY 2023 WWW.BWHEALTHCAREWORLD.COM BW Businessworld does not accept responsibility for returning unsolicited manuscripts and photographs. All unsolicited material should be accompanied by self-addressed envelopes and sufficient postage. Published and printed by Annurag Batra for and on behalf of the owners, BW Businessworld Media Private Limited. Published at 74-75 Amrit Chamber Scindia house CP New Delhi 110001, and printed at Infinity Advertising Services Private Limited. Editor : Annurag Batra. © Reproduction in whole or in part without written permission of the publisher is prohibited. All rights reserved. R.N.I.No. 39847/81 BW Businessworld Media Private Limited EDITORIAL OFFICES BW Businessworld Media Pvt. Ltd. 74-75, Scindia House, Connaught Place, New Delhi-110001 Phone: 9818063325 ADVERTISEMENT/CIRCULATION / SUBSCRIPTION ENQUIRIES BW Businessworld Media Pvt. Ltd. 74-75, Scindia House, Connaught Place, New Delhi-110001 Phone: 9818063325 SUBSCRIPTION SERVICE Vinod Kumar +91 9810961195, [email protected], [email protected] Subscription rates: ONE YEAR - Rs 2,899 TWO YEARS - Rs 5,599 THREE YEARS - Rs 8,199 HUMAN RESOURCES: Namrata Tripathi ([email protected]) LEGAL ADVISOR: Sudhir Mishra (Trust Legal) FEBRUARY 2023 GROUP CHAIRMAN & EDITOR-IN-CHIEF: Dr. ANNURAG BATRA CEO, BW COMMUNITIES Bhuvanesh Khanna CEO & CHIEF INNOVATION OFFICER Hoshie Ghaswalla (CEO-BW Engage) GROUP EDITORIAL DIRECTOR Noor Fathima Warsia BW HEALTHCARE WORLD: Smridhi Sharma, Shivam Tyagi, Bhupendra Paintola EDITORIAL TEAM Sr. Associate Editors: Ashish Sinha, Jyotsna Sharma, Meha Mathur Sr. Correspondents: Rohit Chintapali, Deep Majumdar, Correspondents: Abhishek Sharma, Arjun Yadav, Aparajitha Nair; Trainee Journalists: Sneha Patro DESK TEAM Deputy Editor: Mukul Rai Associate Editors: Madhumita Chakraborty; Smita Kulshreshth ART TEAM Art Directors: Dinesh Banduni, Shiv Kumar, Shivaji Sengupta Assistant Art Director: Rajinder Kumar Infographics & Data Visualiser: Arun Kumar Assistant Images Editor: Sanjay Jakhmola PHOTO TEAM Sr. Photo Researcher: Kamal Kumar BW ONLINE: Assistant Editor: Poonam Singh VIDEO EDITORIAL TEAM Video Team: Anurag Giri, Pappu Kumar Singh, Sunny Kumar Paswan Sr. Cameraperson: Ratneshwar Kumar Singh BW APPLAUSE & EVERYTHING EXPERIENTIAL: Ruhail Amin BW AUTO WORLD: Utkarsh Agarwal BW ESG & BW CFO WORLD: Urvi Shrivastav BW CIO WORLD: Ratnadeep Chaudhary BW DISRUPT: Resham Suhail BW EDUCATION: Vasudha Mukherjee, Upasana BW HOTELIER: Editor: Saurabh Tankha Editorial Lead: Bulbul Dhawan Operations Controller: Ajith Kumar LR Editorial Lead: Krishnendra Joshi, Kaustubh Mehta BW MARKETING WORLD: Soumya Sehgal BW PEOPLE: Sugandh Bahl BW WELLBEING: Kavi Bhandari, Sneha Sinha VC WORLD: Anisha Aditya GROUP EDITORIAL HEAD: Vishal Thapar (BW Defence, BW Securityworld & BW Policeworld) BW POLICE WORLD: Ujjawala Nayudu DIRECTOR: Prasar Sharma GROUP SR. VICE PRESIDENT - STRATEGY, OPERATIONS & MARKETING Tanvie Ahuja ([email protected]) CEO, BW HEALTHCARE WORLD & BW WELLBEING WORLD: Harbinder Narula DIRECTOR, ADVERTISING & REVENUE: Aparna Sengupta DIRECTOR, PROJECTS & COMMUNITIES: Talees Rizvi SR. VICE PRESIDENT : Deepika Gosain VICE PRESIDENT STRATEGIC PROJECTS: Uday Laroia MARKETING & DESIGN TEAM: Prerna Singh Rathore, Kartikay Koomar, Mohd. Salman Ali, Moksha Khimasiya, Shweta Boyal, Alka Rawat, Arti Chhipa, Sunny Anand Asst Manager - Design: Kuldeep Kumar EVENTS TEAM: Rekha Rawat, Tarun Ahuja, Devika Kundu Sengupta, Preksha Jain, Akash Kumar Pandey, Preeti Kushwaha, Mohd. Arshad Reza, Sneha Sinha, Ashish Kumar, Nandni Sharma, Nivish Singh, Mahek Surti, Reeti Gupta, Atul Joshi, Mir Salika, Preeti Tandon, Biren Singho, Abhishek Verma, Neeraj Verma, Prashant Kumar, Mayank Kumar SALES TEAM NORTH: Ravi Khatri, Anjeet Trivedi, Rajeev Chauhan, Amit Bhasin, Somyajit Sengupta, Cynthia Majhi, Priyanshi Khandelwal, Sajjad Mohammad WEST: Kiran Dedhia, Nilesh Argekar SOUTH: C S Rajaraman BW COMMUNITIES BUSINESS LEADS Priya Saraf (BW Education), Gareema Ahuja (BW LegalWorld), Chetan Mehra (BW Disrupt), Surendra Agarwal (BW Auto world) CIRCULATION TEAM General Manager - Circulation, Subscription & Sales: Vinod Kumar ([email protected]) NORTH-EAST: Shiv Singh, Mukhtadir Malik, Kamlesh Prasad WEST: Arvind Patil, Gorakshanath Sanap SOUTH: Sarvothama Nayak K, Anup Kumar FINANCE TEAM Ankit Kumar, Ishwar Sharma, Shrikant Sharma, Vijay Jangra IT SUPPORT: Brijender Wahal ADMIN SUPPORT: EA to Chairman & Editor-in-Chief: Durga Krishnamurthy Sanya Kapoor ([email protected])

8 BW HE ALTHCARE FEBRUARY 2023 WWW.BWHEALTHCAREWORLD.COM FEBRUARY 2023 CONT ENTS 12 Dr. Sandeep Shah Executive Director, Neuberg Diagnostics on Future of Genomics – 18 Muralidhara Hosahalli Global Head Medical and Life Sciences, L&T Technology Services on Medical Devices in 2023 24 Gerald Jaideep CEO, Medvarsity on Medical Education 44 Namit Chugh Investment Lead, W Health Ventures on AI in Healthcare 51 Pranav Poddar Director, Syenergy Environics on Effect of5GonHealth 52 Srinath Sridharan Corporate Advisor on Healthcare Trends in 2023 74 Raheel Shah Director, BDR Pharmaceuticals on AI in Drug Discovery 76 Anupam Gupta VP Data Science, Optum Global Solutions on Data Interoperability 78 Dr. Vaibhav Kapoor Co-Founder, Pristyn Care on Elective Surgeries of Tomorrow 10 Health Bulletin Columns: Cover Package: 80 Sanjay Jain President, India Operations, Amneal Pharmaceuticals on Quality Healthcare 82 Neeraj Balani Managing Director, Indian Subcontinent, International SOS on Climate Change 86 Srinivas Iyengar VP & Head of Health and Life Sciences, Happiest Minds Technologies on AI in Mental Health 94 Himalayan Siddhaa Akshar on Spiritual Vision 26 We need a strong biotech revolution in India Sanjeev Navangul, MD & CEO, Bharat Serum and Vaccines 30 Gearing Up for Future Shockwaves With Covid numbers increasing in China, the world is readying its healthcare systems for any possible outbreak. Here in India too, healthcare facilities are reviewing their systems to guard against any eventualities.

WWW.BWHEALTHCAREWORLD.COM BW HE ALTHCARE FEEBRUARY 202 3 9 The pages in BW Businessworld that are labelled BWi or Promotions contain sponsored content. They are entirely generated by an advertiser or the marketing department of BW Businessworld. Also, the inserts being distributed along with some copies of the magazine are advertorials /advertisements.These pages should not be confused with BW Businessworld’s editorial content. TOTAL NO. OF PAGES INCLUDING COVER 100 Cover design by SHIVAJI SENGUPTA CONT ENTS Spotlight: 22 Healthcare Market in 2023 Unprecedented Healthcare Growth In 2022, Tenable Trajectory Ahead 36 HealthTech in 2023 46 5G in Healthcare 90 Wellness Technologies Special Package: 56 BW Healthcare World Excellence Summit & Awards In Conversation: 14 Krishnan Ramachandran on Health Insurance 34 Sandeep Budhiraja on India’s Covid Preparedness 42 Mandeep Singh on Robotics Last Word: 98 Sajjan Singh Yadav Additional Secretary, Ministry of Finance on Value in Indian Pharma

10 BW HE ALTHCARE FEBRUARY 2023 WWW.BWHEALTHCAREWORLD.COM “India has the potential to be a global leader in research” Stable Outlook for Hospitals In FY23 Following an outbreak in neighbouring China, the minister reviewed the availability of essential medicines in the country. The Union Health Minister emphasised the necessity of joint participation and cooperation between public and private research centres for enhancing the scope and output of medical research. The Minister said that India has demonstrated its capacity to be a global leader in research. It is evident from the fact that within a month of the release of the first Covid-19 vaccines in the world, India rolled out its own indigenous Covid-19 vaccine, he added. Moreover, supplying medicines to 150 countries was also achieved without compromising quality and hiking the price of medicine. By Bhupendra Paintola By Kavi Bhandari JOTTINGS The pharmaceutical corporations were tasked with keeping a careful eye on the state of the worldwide supply chain by Mandaviya. Additionally, close monitoring of production of crucial drugs and availability of active APIs (active pharmaceutical ingredients) were also requested. Pharma companies were instructed to make sure that all medications, including Covid medications, were not only adequately stocked but also accessible throughout the supply chain up to the retail level. “India’s pharmaceutical industry is robust, resilient and responsive. It is due to their strength that we could not only meet our down demand during the pandemic, but also be in a position to supply medicines to 150 countries,” said Mansukh Mandaviya. With an aggregate bed occupancy of 64 per cent, the hospital industry is expected to witness dependable growth majorly backed by demand for elective surgeries, medical tourism and organised players improving their market share, stated credit rating agency ICRA (Investment and Credit Rating Agency ). According to Mythri Macherla, Assistant Vice President and Sector Head, ICRA, the average revenue per occupied bed (ARPOB) is likely to grow 8-10 per cent for the ICRA sample set of companies. While most capacities are expected to be set up in metro cities, some large players are entering into operations and management contracts to diversify their presence in unexplored markets on an asset-light basis. Despite high input cost inflation, improving operating leverage, supported by the increasing scale of operations and continued cost optimisation measures, are expected to support a healthy OPM (Older People’s Medicine) of around 20-22 per cent in FY2023 and FY2024 as per ICRA. ICRA maintained its stable outlook for the industry, citing rise in non-communicable lifestyle diseases, growing per capita spend on healthcare, awareness, and increasing health insurance.

Fastest Hip Replacement Surgery WWW.BWHEALTHCAREWORLD.COM BW HE ALTHCARE FEEBRUARY 202 3 11 India’s Infant Mortality Rate Improves By 3.89% The infant mortality rate is an important indicator reflecting the health status of the community and indicates the development of different societies. Approximately 6,700 newborns die every day, as per World Health Organisation. In this aspect, India has improved much in past years. As per the United Nations (UN) latest data, the current infant morBy Shivam Tyagi tality rate of India in 2023 has declined by 3.89 per cent from 2022. Infant mortality rate is counted by the number of deaths of infants for every 1,000 live births. Therefore, according to the data, the current number of deaths is 26.6 per 1,000 live births. In 2022 and 2021, these numbers were calculated to be 27.6 and 28.7 deaths respectively. The reasons behind child mortality can be many, either an infectious A team of clinical experts at Fortis Escorts Hospital, Okhla have conducted the hip-ball replacement surgery on an octogenarian patient in 15 minutes 35 seconds. The hospital has claimed the feat to be the fastest hip replacement surgery on the planet, stating it to be the shortest known duration for such a surgery globally. The surgery was performed on an 86-year-old woman, Sumitra Sharma who hails from Bihar’s Gaya district. Her left hip was fractured. The woman was brought to the hospital in the national capital three days after the incident, and was previously treated for cardiac arrest and breast cancer. The hospital informed that the woman was also on double blood thinners. A team of doctors performed angiography on Sumitra before her surgery and included heparin to her blood thinners. “The patient needed swift surgery. Our team, led by Dr Kaushal Kant Mishra, performed a hip-ball replacement surgery in 15 minutes 35 seconds, which is the shortBy Sneha Patro disease, birth defects, pregnancy complications, or sudden infant death syndrome. Almost 10 million child deaths could be averted in countries at risk of missing the SDG (sustainable development goals) target on under-five mortality accelerated progress to achieve it by 2030. If swift action is not taken, dozens of countries will fall short of meeting the SDG mortality targets by 2030 and tens of millions of families will suffer the loss of a child or young person in the coming years, the report said. est duration for such surgery known so far globally,” the hospital said. The hospital stated that the surgery took three minutes less than the previous record two years ago, also set by Mishra and his team.

12 BW HE ALTHCARE FEBRUARY 2023 WWW.BWHEALTHCAREWORLD.COM Genomics is the study of an organism’s complete set of genetic material or genome. By analysing an individual’s genomic data, doctors can detect the presence of diseases at an early stage, when treatment is most likely to be effective COLUMN By Dr Sandeep Shah By studying the DNA sequences of individuals, researchers can identify genetic variations associated with specific conditions. This knowledge is used to develop new diagnostic tools, treatments, and strategies for preventing and managing diseases. TARGETED/PERSONALISED MEDICINE Your actual potential can be found through spirituality. The goal of spirituality is to widen your mind to possibilities that go beyond your current knowledge and perspective. You will master both identifying your objectives and goals as well as the means of achieving them through this spiritual training process and methodology. The darkness in winter is deeper and makes it the perfect time to find yourself. Here are a few techniques you can employ to grow yourself spiritually. For example, targeted therapy for cancer is a major area where genomics has a major impact. Identifying specific genetic markers in cancer cells makes it possible to create targeted therapies that are much more effective than traditional chemotherapy. These therapies, which can take the form of oral pills or injections, are designed to attack specific cancer cells while leaving healthy cells unharmed. This has led to significant improvements in treating several types of cancer, including breast, lung, and colorectal cancer. In some cases, these therapies have even put cancer into remission, providing hope to patients and their families who may have previously thought there were no treatment options. PHARMACOGENOMICS Another area where genomics is expected to GENOMICS AND ITS IMPACT ON THE FUTURE OF HEALTHCARE DR SANDEEP SHAH Executive Director, Neuberg Diagnostics

WWW.BWHEALTHCAREWORLD.COM BW HE ALTHCARE FEEBRUARY 202 3 13 have a significant impact is the development of new drugs and therapies. By understanding the genomic basis of diseases, researchers can design more targeted and effective treatments. This could lead to personalised medicines that are more effective in treating specific conditions. Pharmacogenomics is revolutionising the way we approach medicine. By understanding how an individual’s genetics can affect their response to certain drugs, we can tailor treatment plans to their specific needs. This personalised approach has the potential to improve efficacy, reduce side effects, and prevent adverse drug reactions. Genomics is also expected to play a role in the early detection and diagnosis of diseases. By analysing an individual’s genomic data, doctors can detect the presence of diseases at an early stage, when treatment is most likely to be effective. Overall, pharmacogenomics can significantly improve how we are prescribed medications, which are already being used worldwide in clinical settings. NUTRIGENOMICS Nutrigenomics is an emerging field that studies the relationship between genetics and nutrition. By understanding how genetics can influence an individual’s response to certain foods and nutrients, nutrigenomics aims to provide personalised dietary recommendations that optimise health and prevent disease. One of the key areas of nutrigenomics is the study of how genetics can influence an individual’s risk of developing certain nutritional disorders. For example, some individuals may have a genetic predisposition to nutrient deficiencies, such as a lack of vitamin B12 or iron. By identifying these genetic risk factors, nutrigenomics can help prevent these deficiencies’ development. Nutrigenomics also has the potential to help individuals with rare diseases. For example, some genetic disorders, such as phenylketonuria (PKU), require specific dietary management to prevent serious health complications. By understanding the genetic basis of these disorders, nutrigenomics can help to develop more effective nutritional treatments. TREATMENT OF RARE DISEASES Helping to diagnose and treat rare diseases is another major benefit of genomics. These diseases, which affect a small percentage of the population, are often difficult to diagnose due to their rarity and lack of knowledge about their underlying causes. However, with the advent of genomics, it is becoming increasingly possible to diagnose and treat these conditions accurately. More rare diseases are being diagnosed every year thanks to the increasing affordability of genomics. This is particularly exciting news for patients with rare diseases and their families, who often struggle to find a diagnosis and appropriate treatment due to the lack of knowledge about their condition. With the emergence of new variants and the ongoing threat of the virus, it’s more important than ever to have a plan to tackle this ongoing crisis. Covid-19 has brought the world to its knees and has exposed the importance of being prepared for pandemics. And one company that is leading the way in Covid-19 preparedness is Neuberg Diagnostics. Neuberg Diagnostics is at the forefront of genomics and healthcare by offering advanced genetic testing and analysis services. Their stateof-the-art technology allows for accurate and efficient diagnosis of genetic diseases and the identification of personalised treatment options. With Neuberg Diagnostics, we can unlock the full potential of genomics in healthcare and pave the way for a brighter and healthier future for all. Genomics is the key to unlocking the future of healthcare. Understanding an individual’s genetic makeup can tailor treatment and prevention strategies to their specific needs. This personalised approach to medicine has the potential to improve outcomes, reduce side effects, and lower healthcare costs. With the rapid advancements in genomics, we are on the cusp of a new era of healthcare where the possibilities are endless.

14 BW HE ALTHCARE FEBRUARY 2023 WWW.BWHEALTHCAREWORLD.COM TRUST BETWEEN HOSPITALS & INSURERS CAN COME FROM SUNLIGHT: KRISHNAN RAMACHANDRAN In an exclusive conversation with Shivam Tyagi, BW Healthcare World, Krishnan Ramachandran, MD and CEO of Niva Bupa Health Insurance speaks on the growth of health insurance sector in the year 2022, outlook for 2023, finding the missing middle, trust deficit between hospitals and insurers and bringing on more services under the standard health insurance policies Q&A How do you think the health insurance industry has evolved over the last couple of years, and specifically, how do you think 2022 was? The last two years have been simultaneously the most challenging and exciting for the health insurance industry. Challenging due to Covid and exciting owing to the permanent shift in awareness of the need of health insurance products. Many parts of insurance have been about push, but the one that I think is increasingly consumer-driven and is pulled is health insurance. So we have seen that trajectory play out more so for health insurance and certainly for our company in 2022. 2022 has been a year where the industry has seen unprecedented growth, as an example, in FY 21- 22, we actually grew 60 percent as a company. And in FY 22-23 it does look like that we will grow roughly by 45 per cent as a company. 2022 By Shivam Tyagi

WWW.BWHEALTHCAREWORLD.COM BW HE ALTHCARE FEEBRUARY 202 3 15 has also been the year where health insurance firmly entrenched itself as the largest growing segment in non life and the largest you know, in terms of growth as well as in terms of size. So in terms of size, it is 35 to 37 per cent of the whole non life industry. And it continues to be the fastest growing segment. What do you think 2023 will look like when we see growth in the industry? Today we are in a position to service more than 60 per cent of our policyholders entirely digitally I do personally think that we will continue to see high growth rates in the health insurance industry. And many of the trends that were accelerated by Covid will be sustained specifically in the health insurance industry and in the context of Niva Bupa. One of them is awareness. I think, permanency around awareness and shifts in consumer demand for health insurance are getting more and more established. Number two is the trend around embracing technology. For example, we have permanently moved to a hybrid method of working as an insurance company and also technology to do with the distribution or servicing. We expect that by the time we close 2022, more than 15 per cent of our claims will be auto adjudicated meaning without human touch and this is great for customer experience because it eliminates the friction and the waiting and the associated anxiety. Today we are in a position to service more than 60 per cent of our policyholders entirely digitally. Today, more than 50 per cent of our policies get issued with zero human touch entirely digitally, and more than 85 per cent get renewed without human touch entirely digitally. So I think the secular trend around technology adoption will continue as we move ahead. What are the ways by which we can find the missing middle, the population which does not have any health insurance cover?

16 BW HE ALTHCARE FEBRUARY 2023 WWW.BWHEALTHCAREWORLD.COM Q&A So the missing middle exists as it is not yet into the fold of private health insurance and is not yet taken care of by the government. Estimates vary, but the NITI Aayog report suggests that could be as large as 300 million Indians, and I think four things need to be done at the country level, to find the missing middle. First is to create more awareness. I think this segment is still not aware of the willingness to pay a risk premium for protection. Second, is affordability. I think on the private side, we do need to come up with products that are more affordable to this segment. Third, is assurance. I still think our perception is more framed by the few claims that get rejected as opposed to the vast majority of claims that get paid. As an example, the industry settled 25-26,000 crores worth of claims on account of Covid. But how much of this is known by the public in the country? How much of this has been captured by the media? Because that’s how trust builds and this missing middle is at a point where they still perhaps don’t trust that health insurance will work for them when it needs to. And I think the answer is it does. And we need to get this story out. And the last one, which is the fourth A, is about access. I think while we have a massive access as an industry, especially through banks, taken together for example, as a company, we have access to distribute through more than 40,000 bank branches. Getting the banks to distribute more, getting other methods of distribution and increasing access in general so that we are able to get these products to these customers. There’s a trust deficit that exists between health insurance compa- nies and hospitals. Why do you think this exists in the first place, and how do you think we can exclude it? I think trust between hospitals and insurers can come from sunlight, what I mean by sunlight is dramatically higher levels of transparency between both of us, right, so today, for example, on tariffs it’s important to have transparency. From a customer standpoint, if he is going to get treated in hospital ABC, what is the likely cost outgo in many situations, patients, and we don’t necessarily have a fix on that. So transparency should be around costs. Second is, medicine is art and science. So let’s bring more science into medicine specifically when it comes to protocols. I think the healthcare industry must submit itself to say that look, if it’s, for example, Covid, this is the protocol for treatment. These are the care pathways, and this is what we are going to follow. So then there’s a basis for dialogue between hospitals and insurers. Today that basis does not exist for most part. As an example the WHO has standards around dengue, when should one get admitted? What are the conditions? For example, platelet count, fever, etc, for admission? We find that many hospitals don’t submit themselves to these protocols. So I believe the second aspect to improving trust between hospitals and insurance is to have more transparency and practice of evidence based medicine protocols and so on and so forth. And the last one I will point out is technology. I think from our side, we are very committed to using technology as an industry. We need the hospital industry to reciprocate. And I do know that in time they will. What are the checkboxes for health insurance companies to include OPD services, home healthcare services or robotic surgeries under a standard umbrella policy? I think, to your point on bringing on board more services. In my mind, a critical aspect is the GST. I think one of the single most important reasons why outpatient products have not been launched at scale in our country is the fact that we have 18 per cent GST on insurance and healthcare is GST exempt. So when I go out there to build an outpatient product, I am straightaway working against 18 per cent. It has been an important ask from us that we should bring this 18 per cent GST down. So that we are able to ensure that health insurance is affordable in general, but specifically that we are able to cover more and more of the services that you described under health insurance. The second important aspect is, for many of these outpatient services, it is high frequency but low value in terms of transactions. Today with healthcare being as fragmented as it is and with technology adoption in healthcare being relatively lower in general . I think it’s extremely important for us to have underlying technology in order to deal with high frequency and low value transactions in a way that is administratively efficient. So we do need work around technology for us to be able to meaningfully offer the range of outpatient services that you refer to. As an example, the INDUSTRY SETTLED 25-26,000 CRORES worth of claims on account of COVID

18 BW HE ALTHCARE FEBRUARY 2023 WWW.BWHEALTHCAREWORLD.COM MEDICAL DEVICESIN 2023 Driven by the emergence of engineering data analytics and AIenabled patient monitoring, we are also witnessing an expansion of Digital Front Doors (DFD). A DFD involves ensuring optimal patient care across all key healthcare delivery touchpoints, from early health warnings to the actual process and subsequent recovery By Muralidhara Hosahalli YEAR AHEAD MURALIDHARA HOSAHALLI Global Head LTTS 2 022 was an eventful year. As we emerged on the other side of the pandemic, global medical devices OEMs and manufacturers found themselves on the frontiers of the impossible - disruption had become a new way of life. This trend was reflected in the continued growth of revenues and valuations, especially with the US and European public medtech companies continuing their robust 2021 trajectory. The landscape was defined further with software and AI/ML-enabled solutions finding ever-widening adoption for transforming patient care mechanisms, across medical facilities worldwide. Wearable technologies continued to grow on the back on this emerging trend, with adoptions ranging from real-time health monitoring to the detection of common diseases like the flu. In response to the unprecedented challenges of the past couple of years, supply chains for global medical devices became more resilient and regulatory compliance received heighted attention across geographies. Reliability is defining the worldwide outlook for the revitalised medical devices landscape, with a focus on ensuring greater agility, enhanced cybersecurity, and an optimal performance matrix that delivers a truly transformative care experience. Should these trends and the emerging onground reality be any indication, 2023, by all parameters, promises to be an exciting year. It could redefine our entire outlook of the future, marking the rise of a whole new paradigm for medical devices manufacturers worldwide.

WWW.BWHEALTHCAREWORLD.COM BW HE ALTHCARE FEEBRUARY 202 3 19 and data privacy continue to be an area of concern. 2. Immersive technologies: Newage participants are redefining the global medical devices landscape by leveraging the possibilities of immersive technologies. Virtual Reality (VR), Augmented Reality (AR), and Extended Reality (XR) solutions are helping improve product design paradigms, while streamlining existing rehabilitation and engagement pathways. 3. Internet of Medical Things (IoMT): Connected medical devices are transforming global healthcare delivery. As I write this, we are witnessing the emergence of an expansive network that allows patients to relay their medical data to hospitals, enables doctors to perform diagnosis and share their prescription with the intended recipients, and facilitates round-the-clock monitoring by care givers for those in need. IoMT is therefore not only helping unlock significant transformations of care delivery, but is also unveiling new avenues for ensuring a transformative experience along the entire healthcare spectrum. 4. Medical Artificial Intelligence: The future clearly belongs to the growing adoption and deepening of solutions that leverage AI and ML. Medical device manufacturers and OEMs worldwide are among the pioneers in this direction, leveraging AI/ML-enabled offerings to unlock value from the massive patient data streams now made available through the expansion of the wearables ecosystem and the emergence of the IoMT. 5. Cybersecurity: With growing risks, the need for effective defensive mechanisms, from a device onwards to a network level, has come to the fore. This is being addressed by several specialised entrants to the domain, who today offer solutions that prevent data breaches, and protect against intended malfunctions. 6. 5G: The emergence of 5G connectivity could prove to be a game changer for the global medical devices industry by enabling reliable and robust connectivity between devices and the healthcare infrastructure through higher bandwidth availability and ultra-low latency. Driven by the emergence of engineering data analytics and AI-enabled patient monitoring, we are also witnessing an expansion of Digital Front Doors(DFD). A DFD involves ensuring optimal patient care across all key healthcare delivery touchpoints, from early health warnings to the actual process and subsequent recovery. I feel that the New Year would witness significant traction around the following key focus areas: 1. Wearables: As the global semiconductor chip shortages are addressed, we would witness a marked acceleration in the wearables revolution. These devices can be used both at a personal and at a clinical level.By collecting real-time data on user health and vitals for delivering better healthcare and control, these non-invasive devices are already transforming healthcare delivery paradigms, improving overall wellbeing, and improving prognosis efficiency for medical emergencies. With several new entrants unveiling their range of offerings around ECG monitors, smart glasses, and bio patches 5G connectivity could prove to be a game changer for the global medical devices industry by enabling reliable and robust connectivity between devices and the healthcare infrastructure through higher bandwidth availability and ultra-low latency (to name but a few), it is no surprise that existing OEMs and manufacturers are focusing on revitalising their offerings with even more advanced and smarter solutions.The rate of transformation is further strengthened by the renewed interest on new-age minimally invasive devices and equipment for delivering better outcomes with the least trauma. However, we should not overlook the fact that while wearables today are helping drive better health outcomes, risks around data accuracy, right data access,

22 BW HE ALTHCARE FEBRUARY 2023 WWW.BWHEALTHCAREWORLD.COM Unprecedented Healthcare In 2022, Tenable Trajectory Ahead Healthcare industry pundits opine that the sector grew by 25 to 26 per cent in the year 2022 over the base year 2021 powered by the return of the pre-pandemic footfalls and post-pandemic attitudes YEAH AHEAD The post-pandemic financial year of 2022 has seen normalcy return to the shores of healthcare institutions, the big and small hospitals chains alike witnessed an upsurge of patients tapping the doors with health issues which were overshadowed by the Covid-19 pandemic in the previous financial year of 2021, leading to a flat line growth trajectory in FY21. The healthcare industry pundits opine that the sector grew by 25 to 26 per cent in the year 2022 over the base year 2021 powered by the return of the prepandemic footfalls and post-pandemic attitudes. The organised players in the healthcare sector saw dramatic growth owing to several factors that underpin this growth story beginning with the comeback of elective surgeries, a change in consumer behaviour leading to better health insurance coverage, rising burden of diseases and consumers choosing premium and branded healthcare institutions and services over nursing homes and smaller healthcare setups. The sector experts put it this way that the “buyer is already aware”, meaning By Shivam Tyagi the healthcare consumers are making an informed choice and selecting facilities not by price but by value, understanding that the latter brings better outcomes. The market maestros believe that increasing penetration of health insurance and consumers buying policies with bigger premiums coupled with the pandemic’s lesson that health comes before wealth is driving this informed change in behaviour among the people. Describing the four growth factors mentioned above, Kaustav Ganguli, Managing Director, Alvarez & Marsal said that in the year 2022, corporate healthcare players subsuming the large corporate hospital chains, either pan-India or regional ones, experienced an unprecedented growth year when compared with the growth trajectory of the last three to four years or even the decade before with improved returns profile and unit economics standing as a testament to their growth story. “Consumers opting for higher or new insurance coverage during the pandemic and subscribing to premium healthcare services in hospitals resulted in faster value growth. This growth was further enhanced by improved case mix specialisation. In summary, improvements in both speciality mix and channel mix had a positive impact on break-out growth of ARPOB (average revenue per operating bed) and topline of organised hospital chains,” stated Ganguli. However not all was rosy in healthcare in 2022 said the experts, as healthtech remained a mixed story, unable to fully deliver on the impetus provided by the pandemic with only a few bright segments such as the online diagnostics firms and digital pharmacies showing their metal while the others still trying to find their place in the healthtech market. 2023, A YEAR OF DEPENDABLE GROWTH 2023 is being vouched as a tenable year by the industry pundits seeing a growth rate of roughly 13 to 14 per cent over the financial year 2022, the growth would not be comparable to the previous year as 2022 had

WWW.BWHEALTHCAREWORLD.COM BW HE ALTHCARE FEEBRUARY 202 3 23 a lower base year effect with the sector utilising the one-time effect of several growth factors. Growing with pre-pandemic levels, healthcare in 2023 is set to witness greater action in the consolidation space with the mergers and acquisitions activities extending with full force into the upcoming financial year. Pan-India healthcare chains as well as the private equity investment chains are expected to gain considerable ground. “Large corporate chains are not only considering other chains as acquisition opportunities but also going after stand-alone mid-market hospital targets across town tiers with a threshold level of revenue, EBITDA and infrastructure. Corporate multi-specialty service providers as well as the corporate single specialty groups will continue to grow at the expense of the smaller, stand-alone hospital segment or the nursing home segment making the space more and more organised,” explained Ganguli. Another tailwind expected in the year 2023 is the international medical value tourism bouncing back, adding value as well volumes for the organised corporate sector. The medical value tourism remained silent for the most part of FY2022 due to restricted travel across borders but with the travel opening up coupled with government’s Heal In India initiative, the sector is expected to render huge gains to the industry. Union Minister for Health and Family Welfare, Mansukh Mandaviya has hinted that India will be prioritising health during its G20 Presidency tenure in 2023. “India will prioritise health emergency prevention, preparedness and response to strengthen cooperation in the pharmaceutical sector with focus on availability and access to safe, effective, quality and affordable medical countermeasures,” stated Mandaviya in his ministerial address in Bali recently. Mandaviya added that the nation will also focus on digital health innovation and solutions to aid universal health coverage while improving healthcare service delivery for the Health Working Groups during its G20 Presidency. EVOLVING WITH ROBOTICS & AI Technology is set to advance at a faster pace in 2023 with the healthcare sector evolving with data, robotics and AI, enumerating this Jasdeep Singh, Group Chief Executive Officer, CARE Hospitals Group, stated that data-driven decision-making and healthcare automation will help in improving the quality of care and clinical productivity. Whereas metaverse in healthcare will also play a major role with the immersive experience that the metaverse provides, paving the way for inclusive management and support in digital transformations. Foreseeing the trends of this year Dr K. Hari Prasad, President, Apollo Hospitals said, “2023 will redefine healthcare with a preventive and wellness-oriented approach. The year will see an upgradation of medical facilities in Tier-2 and Tier-3 cities along with upskilling of the healthcare workforce. And advances in innovation will empower us with the tools to ‘heal before there is a need to heal’ while AI-enabled clinical modules will guide the choice of the most suitable treatment.” Technology playing the catalyst in the growth story of 2023 is set to continue to shift care away from hospitals, driving preventive as well as predictive healthcare and pushing for a more decentralised healthcare model. The new-age technologies will boost operational and financial efficiencies of healthcare institutions by fostering better clinical outcomes adding to seamless growth across the healthcare value chain. 2023 will redefine healthcare with a preventive and wellness-oriented approach. The year will see an upgradation of medical facilities in Tier-2 and Tier-3 cities along with upskilling of the healthcare workforce Large corporate c h a i n s a r e n o t o n l y considering other chains as acquisition opportunities but also going after standalone mid-market hospital targets across town tiers with a threshold level of revenue, EBITDA and infrastructure DR K. HARI PRASAD President, Apollo Hospitals KAUSTAV GANGULI MD, Alvarez & Marsal

24 BW HE ALTHCARE FEBRUARY 2023 WWW.BWHEALTHCAREWORLD.COM MEDICAL EDUCATION IN THE YEAR 2023 Medical education in India has been undergoing tremendous changes in the past decade. The country boasts of the largest number of medical colleges in the world with over 90,000 MBBS graduates in 595 medical colleges of Modern Medicine (Allopathy) and 53,000 graduates in another 733 AYUSH medical colleges produced every year YEAH AHEAD The demand-supply mismatch of healthcare resources and disparity in methods adopted to impart education in the country is leading to a dearth of affordable and quality healthcare education.Despite these challenges, India is leading the way for digital health transformation to create a resilient healthcare system. Certain radical changes have opened opportunities to improve the medical education system in the country to match up with the healthcare needs and global academic standards. 2023 is about strengthening the learning approaches with an emphasis on all-around development and a renewed focus on developing patient-centric competencies. NEW-AGE DIGITAL TRENDS Digitalisation in the healthcare industry is made possible by technological advancements like electronic health records, online appointments, telemedicine, SaMD (Software as a Medical Device), and AI-powered medical devices. Computer-aided instruction is aiding students in easily visualising complex procedures for excellent By Gerald Jaideep accessibility. New trends in teaching and assessment methods including Google Forms to collect students’ answers, YouTube as a streaming platform in medical education, and choose your own adventure (CYOA) as a story-telling technique are turning out to be extremely useful for medical teachers to adopt in the education field. AUGMENTED REALITY (AR)/ VIRTUAL REALITY (VR) The healthcare industry is increasingly utilising the potential of AugGERALD JAIDEEP CEO, Medvarsity

WWW.BWHEALTHCAREWORLD.COM BW HE ALTHCARE FEEBRUARY 202 3 25 mented Reality (AR)/Virtual Reality (VR) to help practitioners gain practical experience to perform specific critical care procedures, anatomy learning, social skills learning, and medical training. The global market of gamified education, estimated at $840 billion in 2020 is growing at a CAGR of 36 per cent and is expected to reach $2,317 billion by 2026. Equipment called Hololens from Microsoft is actively providing a unique experience of seeing a real patient and acquiring related medical information, including images and charts. Health practitioners can virtually inspect highly realistic 3D models of bones, organs, blood vessels, and muscles. A wide range of medical procedures can now be simulated for nurses, surgeons, and ICU workers, which enables a risk-free and practical experience that results in reduced skill deficiency. HYBRID OR BLENDED LEARNING Blended learning refers to the systematic integration of online and offline learning to facilitate critical, creative, and complex thinking skills. In this process, students study before class and then apply their knowledge in classroom discussion and through a practical operation According to research conducted by the award-winning educational The global market of gamified education, estimated at $840 bn in 2020 is growing at a CAGR of 36 per cent and is expected to reach $2,317 bn by 2026 designer and author Eric B Bauman, it was concluded that blended learning was significantly more effective for acquiring relevant knowledge, enhancing studentcentered learning, and improving clinical practice. Blended learning may address deficiencies in clinical skills, make up for limited time and space, and ensure learning efficiency and quality. By adopting advanced tech solutions, healthcare institutions can significantly improve staff experience, enhance patient care, and allow better and faster diagnosis. In 2023, digital technologies will help understand the needs and behaviors of the industry and are poised to serve as a knowledge pool for future practitioners. BOOKS, JOURNALS, AND CASE STUDIES Medical practitioners often require regular access to information to stay abreast with the latest pharmaceutical innovations, drug discoveries, and research. Surprisingly, there are about 6 million new articles published every year and students are always under pressure to learn novel treatment guidelines to help enhance their medical practice. In 2023, there are novel methods that are being put to use to rapidly access a vast amount of valid information. Now, it is possible to access the world’s best and most up-todate health information for travelers by dialing a single number. A list of universally-renowned publishers are now providing healthcare professionals access to credible research books and journals covering specialties such as Cardiology, Critical Care, Endocrinology, Internal Medicine and other medical specialities. EMPOWERMENT IN THE MEDICAL FRATERNITY VIA UPSKILLING In the current times, education is no longer limited to four walls of a classroom and there are rapid advancements and breakthroughs in technology. There is a growing need to develop and provide leadership education and development experiences for equipping medical practitioners with the right knowledge to become clinical leaders and improve patient care. The health information infrastructure must enable providers to connect, combine, analyse, and share health and social data for highly personalised care. To create a future-ready workforce, the current biopharma, Medtech, and other healthcare stakeholders must be able to maximise the operational value of digital technologies in 2023. Upskilling will lead to better outcomes and will drive stakeholder awareness, adoption, engagement, and growth.

26 BW HE ALTHCARE FEBRUARY 2023 WWW.BWHEALTHCAREWORLD.COM INDIA NEEDS A STRONG BIOTECH REVOLUTION In an exclusive conversation with BW Healthcare World, Sanjiv Navangul, MD & CEO, Bharat Serums and Vaccines spoke about the awaited advancements in medical research & patented products in Indian Pharma COVER STORY

WWW.BWHEALTHCAREWORLD.COM BW HE ALTHCARE FEEBRUARY 202 3 27 By Team BW The pandemic pushed innovation in the pharmaceutical industry to ad - dress the huge demand for medicines. India continued to supply medicines to over 200 countries, living up to its reputation as the ‘pharmacy of the world’ during the pandemic. India is the third largest producer of medicines by volume, and 14th by value. With a fleet of 3,000 domestic drug companies and 10,500 manufacturing units, the country enjoys a crucial place in the global pharmaceutical sector. Indian generics and vaccine exports is often called a soft power, as India is the biggest supplier of generic medicines and vaccines, holding 20 per cent of the generics supply globally and delivering over 60 per cent of the world’s vaccines. On the growth spectrum, as per the Indian Economic Survey 2021, the pharmaceutical sector in 2021 stood at US$ 42 billion, which is now set to touch US$ 64 billion dollars by 2024, and is expected to reach US$ 130 billion by 2030. Whereas the bio - tech industry valued at US$ 70.2 billion in 2020 is expected to reach US$ 150 billion by 2030. SANJIV NAVANGUL MD & CEO, Bharat Serums and Vaccines

28 BW HE ALTHCARE FEBRUARY 2023 WWW.BWHEALTHCAREWORLD.COM The pharmaceutical sector in 2021 stood at US$ 42 billion, which is now set to touch US$ 64 billion by 2024, and is expected to reach US$ 130 billion by 2030. Whereas the biotech industry valued at US$ 70.2 billion in 2020 is expected to reach US$ 150 billion by 2030. THE PANDEMIC STORY Sanjiv Navangul, MD & CEO, Bharat Serums and Vaccines, speaking on the company’s experience during the pandemic, said, “The first few days were probably the same for everyone. We only had 48 hours to get used to the lockdown story. At the same time, we heard from the government that pharmaceutical companies could not stop working. The greater problem was to persuade workers to come back to the factory against their village sarpanch’s will. Hence, we developed social communication skills to tell them that they are doing what soldiers do at the border i.e., saving people’s lives. As the disease progressed, we realised that we had a greater purpose to serve as a company.” He said that the company increased manufacturing capacity from 5 lakh to 24 lakh vials through simple changes and creative means and the ministry also acknowledged their efforts. “While tackling the pandemic problems, there was a transformation in employee perceptions of the company that we are an important company, we mean something to society and we do contribute to India. For us, the psychological transformation was more significant than business transformation,” Navangul added. THE NEXT BIG THING IN R&D While explaining the importance of research and development, Navangul said, “Today, we can manage a certain lifestyle, and let’s say a certain lifespan, thanks to the chemistry drug revolution and the research and development revolution that occurred in the last 40 to 50 years.” Talking about the future of R&D, he stated that the future is going to be customised medicines and more cure than treatment. He also said, “There are serious research projects taking place. The only place where research peaked earlier was in anti-infectives, and therefore, we saw a lot of success in infection rates. But then we also gave birth to antimicrobial resistance with this.” Underlining the pharma success story, he stated that India did a great job in chemistry by ensuring that it built a lot of manufacturing capacity, a lot of quality management skills, and a lot of export management skills at a low cost. “Moreover, one-third of tablets consumed in the US or Europe are manufactured by Indian companies, which reflects what we have accomplished,” Navangul added. Talking about places where we lag in pharma, Navangul said, “Can we not go up the value chain? Even with the above accomplishments, we are currently at only 2 per cent of the value. It might be 10 per cent of the volume, but we are only 2 per cent of the value. On the other hand, the whole biologics revolution, or the new wave of R&D that is happening, is imperative.” Citing an example, he said, “Consider Merck’s Keytruda, which has US$ 5.4 billion in quarterly sales, that’s about US$ 22 billion a year. India’s pharmaceutical exports are worth US$ 25 billion, or US$ 27 billion. So, one drug by one company is equal to India’s exports. And therefore, for changing this, we need very strong biotech companies in India.” For upscaling India’s share in global valuation, Navangul said, “We need to make a good ecosystem, we need to build more R&D. Can we work on labs? Can we work on the product development of biologics? Can we work on the different methods of manufacturing COVER STORY

WWW.BWHEALTHCAREWORLD.COM BW HE ALTHCARE FEEBRUARY 202 3 29 INVESTING IN PATENTED PRODUCTS “When market access was available through the easier path, we never took the difficult path. So, it’s a question of choosing which of the two roads to take at what time. The financial incentive was greater on one road than on the other. But the work was harder, and the investment was higher. At some stage, we did not have the money as companies, but now we have reasonable money. I think we cannot make the excuse that we did not have the resources anymore,” he added. Talking about the current scenario Navangul said that we are no more in a phase with limited resources, skills, scientists, ecosystem, government participation. “Today, we have a good ecosystem and connectivity around the world. We have a good pool of scientists, who understand a lot about biology. We have companies that have money to invest. And we have a government that has become very supportive of R&D. This, if well-channeled, can provide us a perfect storm to deliver the new wave of patented products in India,” Navangul added. and therefore looking at different IP ways of biologics? Can we look at doing our own cell lines? Can we look at monoclonal bodies you know, to see that we start building a very customised treatment programme for different kinds of diseases, which are difficult to treat. So, each pharmaceutical company will have to ensure that we participate in the biotech revolution now, and really make something for India so that we don’t remain 2 per cent of the value, but at least 10 per cent of the value by 2030.” THE BIOTECHNOLOGY OPPORTUNITY Speaking on the opportunities that lie ahead in biotechnology, Navangul mentioned, “Take the simple case of the top 10 drugs in the world. I think seven or eight are biologics. And each of the top ten drugs costs more than US$ 10 billion. So, we have a global market now of about US$ 1 trillion. Generics account for roughly US$ 150 billion of that trillion dollars, while patented products account for US$ 850 billion. So, when it comes to biologics, the opportunity is huge.” “Each pharmaceutical company will have to ensure that we participate in the biotech revolution now, and really make something for India so that we don’t remain 2 per cent of the value, but at least 10 per cent of the value by 2030”

30 BW HE ALTHCARE FEBRUARY 2023 WWW.BWHEALTHCAREWORLD.COM INDIAN HOSPITALS GEARING UP FOR FUTURE SHOCK WAVES A 2022 study published in the scientific journal ‘Proceedings of the National Academy of Sciences’ has indicated that recurrence of an extreme event like the Covid -19 pandemic has significantly tripled over the last 400 years COVER PACKAGE

WWW.BWHEALTHCAREWORLD.COM BW HE ALTHCARE FEEBRUARY 202 3 31 The Indian healthcare industry has tided over many shock waves of the Covid -19 virus at regular intervals in the last 2 to 3 years, the Delta variant which struck the country unguarded in April-May 2021 was the most devastating in terms of people succumbing to the virus. The healthcare infrastructure of the country was completely overwhelmed and cries of families demanding oxygen support for their loved ones were heard in every corner of the country. As per the Health Ministry’s data 5,30,726 people have died due to the virus since the pandemic first struck India while unofficial estimates put this number 10x high. Globally the worst of the Covid-19 pandemic is still not over and is being seen in China. Experts contend that Beijing is presently witnessing a peak in its Covid tally, facing a state of helplessness with overflowing hospitals and crematoriums and pharmacies being stripped of key medicines. As per WHO, Omicron sublineages BA.5.2 and BF.7 are driving the caseload accounting for 97.5 per cent of all local infections in the land of the red dragon. Currently India stands well guarded with over 220 crore vaccine doses administered with over 95 crore people doubly vaccinated and over 22 crore people taking the booster dose. With its active Covid cases tally at 2,149 as of 15 January 2023, while the recovery rate stands at 98.8 per cent. Medical experts believe the various sublineages of the Omicron variant waves perhaps have not caused such havoc in India but the possibility of a serious outbreak like the Delta wave cannot be ruled out. “It’s unlikely to have a major wave By Shivam Tyagi with minor variants of what already is in circulation like the Omicron variants such as XBB 1.5, BA 2.75, BA.5 or the original XBB variant, as in the last 10 months there have been only minor waves in India such as the Kerala upsurge in September last year which have been effectively controlled. But it’s biologically plausible that an all new version could appear,” said Dr Rajeev Jayadevan, Co-Chairman, National IMA Covid Task Force. Dr Jayadevan further said that a new wave could come up with new Covid variants from anywhere in the world including India, or another possibility could be the Omicron mutating further and escaping the immunity of the Indian population. HOSPITALS ALARMED Amid a global rise in Covid cases in December 2022, safety drills were conducted across India to check whether hospitals are ready to deal with any sudden surge in the number of cases. Hospitals are equipping themselves having learned I b e l i e ve m o s t hospitals have got their act together, in terms of usage of appropriate medications and it may have taken us three to four months to start planning during the first wave but god forbid if there is another pandemic, we will be up and ready in 15 days DR SANGITA REDDY Joint MD, Apollo Hospitals

32 BW HE ALTHCARE FEBRUARY 2023 WWW.BWHEALTHCAREWORLD.COM O u r G u r u g r a m hospital unit inaugurated an oxygen plant which was set up along with global food major Cargill. This move came in view of the rising Covid cases, fearing another wave of Covid-19. In order to handle situations like this, all members of our staff have also been trained from the past of shortage of beds, oxygen, medicines and other medical facilities and are putting in place the resources to fight another outbreak. “I believe most hospitals have got their act together, in terms of usage of appropriate medications, we created the treatment protocol or the redbook with 72 updates over the last two-and-a-half years. This was shared with more than 3,000 nursing homes, so it may have taken us three and four months to start planning during the first wave but god forbid if there is another pandemic, we will be up and ready in 15 days,” said Dr Sangita Reddy, Joint MD, Apollo Hospitals. Jasdeep Singh, Group Chief Executive Officer, CARE Hospitals said that the importance of public health has now been accepted by both the government and private players. “They have implemented various measures, such as improving the infrastructure and availability of Intensive Care Units (ICUs) and High Dependency Units (HDUs), ensuring the availability and use of Personal Protective Equipment (PPE) for healthcare workers, and DR SANTY SAJAN Group COO, Paras Healthcare implementing strict infection control protocols to prevent the spread of the virus,” said Singh. Speaking on the role of the frontline responders Dr Sharad Kumar Agarwal, National Chairman, IMA Hospital Board of India, stated that doctors are always on the battlefield leading the country’s attack, “Within IMA we keep organising various medical education programmes with doctors on the latest developments around the world and in the last three years we have done hundreds of seminars to better discuss the developments of the virus, its variants and planning roadmaps accordingly,” stated Dr Agarwal. REVAMPING INFRASTRUCTURE The post pandemic revamping of hospital infrastructure has seen strides in healthcare providers becoming self dependent on oxygen support, driving digital strength , and are creating better monitoring systems to better predict and control the next outbreak. “Our Gurugram hospital unit inaugurated an oxygen plant which was set up along with global food major Cargill. This move came in view of the rising Covid cases, fearing another wave of Covid-19. In order to handle situations like this, all members of our staff have also been trained, said Dr Santy Sajan, Group COO, Paras Healthcare. Enumerating on the need of driving digital strength to better deal with outbreaks Dr Reddy said that Apollo currently has 14 million people on Apollo 24x7 with 6,000 doctors catering on the platform, ready to video consult if the patients cannot reach them physically. She further said “Our diagnostic team has over 800 phlebotomists, who can go to a home and pick up samples and take them to the nearest labs.” Indian private hospitals are also building better surveillance systems, Gautam Khanna, CEO, PD COVER PACKAGE

WWW.BWHEALTHCAREWORLD.COM BW HE ALTHCARE FEEBRUARY 202 3 33 We are establishing effective surveillance and response systems to track and respond to new cases of Covid-19 while also implementing new policies and procedures to support the mental health and wellbeing of staff and patients during an outbreak Investing in research a n d d e ve l o p i n g n e w treatments and technologies can help to address future p a n d e m i c s i n c l u d i n g developing new vaccines, better combinations of drugs, rapid diagnostic tests and point-of-care treatments support the mental health and wellbeing of staff and patients.” ROADMAP FOR FUTURE PANDEMICS A 2022 study published in the scientific journal ‘Proceedings of the National Academy of Sciences’ has indicated that recurrence of an extreme event like the Covid-19 pandemic has significantly tripled over the last 400 years. The study said that there is over a 2.5 per cent chance of an extreme event such as the Covid-19 pandemic happening every year. The research further implies that the chances of experiencing an extreme event like this in one’s lifetime have increased to 76 per cent. Singh believes investing in research and developing new treatments and technologies can help to address future pandemics including developing new vaccines, better combinations of drugs, rapid diagnostic tests and point-of-care treatments. Khanna stated that increasing investment in healthcare services, potentially by raising the percentage of GDP spent on healthcare to about 3 per cent and recruiting, training, and better engaging with healthcare workers, through targeted policies and incentives could also be a boon in dealing with future pandemics. “We also need to improve the supply chain manageGAUTAM KHANNA CEO, PD Hinduja Hospital & Medical Research Centre JASDEEP SINGH Group CEO, CARE Hospitals ment and logistics to ensure that essential supplies and equipment are available when needed,” he added. But we do not know what we do not know, said Dr Reddy adding that the next pandemic can attack in a completely different way, “this one was a respiratory, if the next one is different in the methodology, then we will have to relearn the treatment modalities,” she said. Industry experts opine that India from hereon needs to take a multifaceted approach to build a formidable healthcare ecosystem which will not only focus on treatment and prevention but also on proactive education, better hygiene standards, better surveillance and better monitoring mechanisms and the whole society’s involvement in these initiatives at large. Hinduja Hospital and MRC said, “We are establishing effective surveillance and response systems to track and respond to new cases of Covid-19 while also implementing new policies and procedures to

34 BW HE ALTHCARE FEBRUARY 2023 WWW.BWHEALTHCAREWORLD.COM NEW COVID WAVE– IS INDIA PREPARED? In an exclusive interaction with BW Healthcare World, Dr Sandeep Budhiraja, Group Medical Director, Max Healthcare & Senior Director, Institute of Internal Medicine speaks on how India is preparing for the new variant that has gripped China INTERVIEW DR SANDEEP BUDHIRAJA Group Medical Director, Max Healthcare & Senior Director, Institute of Internal Medicine

WWW.BWHEALTHCAREWORLD.COM BW HE ALTHCARE FEEBRUARY 202 3 35 By Team BW THE CURRENT SCENARIO “There have been a lot of changes in the past two-and-a-half years when it comes to Covid-19, in terms of a first experience of the world with the pandemic, and everyone from people to healthcare professionals have learnt a lot in the last twoand- a-half years,” said Dr Budhiraja. He said they were not aware about the category of the virus, how it replicates, how it transmits between people, possible treatments, prevention, vaccinations, diagnosing it, characterising the genomic sequence etc. He also mentioned that clinical protocols have changed which was a learning experience and now they know how to treat patients, how to prevent the spread of this disease, awareness of genetics on a large scale and how vaccine platforms were there but mankind never had the courage to use those for actual therapeutic interventions or vaccinations, science has made great progress and even healthcare professionals have learnt the basics of infection control. THE ROADMAP AHEAD He went on to say that this pandemic showed that how the world at large had forgotten what a pandemic could actually do, and how to deal with it as the world was busy focusing on lifestyle and communicable diseases. “Since November 2021 the variant on the planet has been Omicron and all the other names we are hearing about are sub-variants of Omicron or lineages of Omicron,” he stated. He also said that India is vaccinated and prepared for any disease like this and our bodies are prepared for any mutants in the future. The number of hospitalisations and death rates have significantly decreased as compared to the first two years of the pandemic. China he feels cannot be compared to the rest of the world as they have a zero-Covid policy, their vaccine efficacy hasn’t been so good, the elderly population haven’t been vaccinated so they are non-immune to the virus. PREVENTION IS BETTER THAN CURE “One needs to understand that although people have become fearless of the disease, we need to be aware and adopt a rational, guarded approach, as it is extremely important. Prevention is key. We need to apply our common sense to take safety measures, as news is making us aware of a high rate of Covid cases and deaths. We need to abide by certain rules and regulations, for example, wearing masks in crowded areas,” he explained. He also mentioned that there can be long-term consequences of Covid such as mental fogging, lack of concentration, fatigue, loss of hair due to the Long Covid Syndrome or post Covid, where people who have even had a mild Covid infection can be affected by this. He strongly suggested that testing should be still done even if mild symptoms of Covid might arise, so that the person infected doesn’t infect others and recovers well in isolation. “People have become unwell, but not at a higher rate as before. All international travellers have to be tested as per the government’s containment policies. Timely testing will be a dynamic process,” he added. THE VACCINATION SITUATION Moving on he also suggested that the real results of vaccines can be quite beneficial. He added, “When we talk about elderly people getting vaccinated as they are more vulnerable to the disease and mortality rate is higher, the decision is right and is critical.” From a layman’s perspective vaccinations are still very important as without them the severity of the disease is much higher. He also said that we are well prepared to face the disease, as a nation. Lab processes being in order, mock drills happening and proper infrastructure being set up, patient education etc. are ensuring that we are ready. Many of the processes were stopped earlier as the numbers of Covid infected people dropped. This led to complacency but we need to gear up for another wave. Our preventive preparation is holistic in nature, but we still need to live with awareness, following all government (state and Central) policies and rules and regulations. One needs to understand that although people have become fearless of the disease, we need to be aware and adopt a rational, guarded approach, as it is extremely important. Prevention is key. We need to apply our common sense to take safety measures, as news is making us aware of a high rate of Covid cases and deaths. We need to abide by certain rules and regulations, for example, wearing masks in crowded areas

36 BW HE ALTHCARE FEBRUARY 2023 WWW.BWHEALTHCAREWORLD.COM ADVANCES IN TECH HEALTHCARE AI TO DATA SECURITY As per a 2021 report by RSBA Advisors, the healthtech industry was valued at USD 1.9 billion in 2020 and is now poised to touch USD 5 billion by the year 2023 growing at a CAGR of 39 per cent. The report expects the sector has the potential to grow to a USD 50 billion industry in the coming 10 to 12 years The Covid-19 pandemic tested the deep waters of the Indian healthcare system while laying open its operational and structural weaknesses though there were a few silver linings, one such silver lining was providing the impetus to the growing healthtech industry. Experts say that the pandemic has expedited healthtech adoption which would have taken 4 to 5 years in a non -Covid scenario. The pandemic accelerated the use of technology among the patients as well as providers leading to a top line growth for the healthtech industry in the last few years. As per a 2021 report by RSBA Advisors, the healthtech industry was valued at USD 1.9 billion in 2020 and is now poised to touch USD By Shivam Tyagi IN-DEPTH 5 billion by the year 2023 growing at a CAGR of 39 per cent. The report expects the sector has the potential to grow to a USD 50 billion industry in the coming 10 to 12 years. According to the research, the healthtech sector accounts for less than 1 per cent of the overall healthcare industry implying that the sector has an imminent opportunity to scale its growth. As per me-

WWW.BWHEALTHCAREWORLD.COM BW HE ALTHCARE FEEBRUARY 202 3 37 dia reports the industry currently employs around 5,000 startups and has 6 unicorns of valuation above USD 1 billion. 2022 saw two startups wearing the unicorn hat, the online pharmacy Tata 1MG and the molecular diagnostics firm Molbio Diagnostics aided by investments from Tata Digital and Temasek respectively. The other unicorns in the healthtech space include Innovaccer, Pharmeasy, Pristyn Care and CureFit. Speaking on the investments Gaurav Bagga, Head of Product & Engineering, Pristyn Care stated that “Between 2014 and March 2020, Indian healthtech startups secured funding of USD 2.3 billion across 459 transactions which reflects that technology is ready to strengthen the healthcare ecosystem of India.” But the ride after the pandemic induced impetus has not been as fruitful as the sector experts would have expected, industry punBetween 2 0 1 4 a n d March 2020, Indian healthtech startups secured funding of USD 2.3 billion across 459 transactions which reflects that technology is ready to strengthen the healthcare ecosystem of India GAURAV BAGGA Head of Product & Engineering, Pristyn Care

38 BW HE ALTHCARE FEBRUARY 2023 WWW.BWHEALTHCAREWORLD.COM A major contributor to inefficiencies and inaccessibility in healthcare delivery is the lack of quality manpower. We cannot significantly augment trained resources availability quickly. This is where AI has a role to play, to automate the screening which till date has been the purview of humans DR TATHAGATO RAI DASTIDAR Founder & CEO, SigTuple IN-DEPTH dits opine that healthtech remained a mixed story in 2022 as the footfall of patients returned to the hospitals rather than getting consultations online, affecting the telemedicine segment. However, experts saw bright spots in segments like the online diagnostic services as well as the online pharmacy services pumping hope into the sector. “The addressable opportunity for the healthtech start-ups is significant; however, their ability to capitalise on this opportunity will be contingent on whether they are fundamentally solving key issues through tech interventions in the healthcare value chain,” stated Kaustav Ganguli, MD, Alvarez & Marsal. LEVERAGING AI & DATA Innovation in technology is driving the healthtech segment and artificial intelligence and data are playing the catalysts in this driving force. According to the Fifteenth Finance Commission report, India has one doctor for 1,511 patients against the WHO norm of 1 doctor for 1,000 patients. Experts say this puts extra onus on AI and technology to enhance healthcare accessibility and its delivery. “A major contributor to inefficiencies and inaccessibility in healthcare delivery is the lack of quality manpower. We cannot significantly augment trained resources availability quickly. This is where AI has a role to play, to automate the screening which till date has been the purview of humans,” says Dr Tathagato Rai Dastidar, Founder & CEO, SigTuple. Tech experts say that AI aids in the early detection of diseases, and consequently early treatment, because AI can flag abnormalities just as well as a human can. In fact, far more accurately, since unlike humans, AI does not suffer from fatigue. Sriram Natarajan, Director & CEO, Molbio Diagnostics explains that AI and Machine learning (ML) tools have started playing a big role in image analysis for reporting Xrays, CT scans, MRI scans etc. and are likely to become the cornerstone for all health interventions. “There will be more focus on data acquisition, storage, processing and analysis. Automated data exchange will enable enhanced patient experience, and patient and disease management through more innovations and next-generation tools. AI, ML and IoT will continue to propel the healthcare segment for the benefit of all,” Natarajan adds. According to a World Economic Forum report India’s expenditure on AI is estimated to touch roughly USD 11.78 billion by 2025 and is expected to contribute USD 1 trillion to the country’s economy by 2035. India’s AI spend rose by over 109 per cent in 2018, totaling to USD 665 million. In recent years, artificial intel-

WWW.BWHEALTHCAREWORLD.COM BW HE ALTHCARE FEEBRUARY 202 3 39 There will be more focus on data acquisition, storage, processing and a n a l y s i s . A u t o m a t e d d a t a e x c h a n g e w i l l enable enhanced patient experience, and patient and disease management through more innovations and next-generation tools. AI, ML and IoT will continue to propel the healthcare segment for the benefit of all SRIRAM NATARAJAN Director & CEO, Molbio Diagnostics ligence, data and the Internet of Medical Things have rapidly expanded from simple devices designed to track vital signs such as heart rate and blood oxygen levels to smart watches that are capable of even complex scans such as ECGs, smart textiles that can track your blood pressure and also predict the risk of heart attacks, enumerates Bagga. Bagga further says that a growing emphasis is being placed on developing digital wearable devices that are capable of detecting signs of mental illnesses with the use of physical indicators such as sleep patterns, activity levels and heart rate to detect when a person may be at the risk of depression. Data is the fodder for artificial intelligence, thus data experts opine that data will retain its primary role of being the main driver of building a quality healthcare infrastructure. Experts say that a centralised repository of healthcare records or EHR (Electronic Health Records) is the need of the hour which will aid doctors in accessing all the health records of patients assisting in better clinical outcomes. CONCERNS: DATA SECURITY & PRIVACY The government is pushing hard to create EHR and ABHA IDs (Ayushman Bharat Health Accounts) under the Ayushman Bharat Digital Mission (ABDM) scheme, claiming that over 8 crore health records have been digitally linked. The concerns around data security and privacy are now more prominent than ever. As the cybersecurity attack on the premier health institute AIIMS which houses health data of top politicians and other influential personalities became a flashpoint in November 2022, leading experts to ponder whether going digital without building the required framework to deal with such contingencies is really the way forward. The Indian healthcare sector faced nearly 1.9 million cyber attacks between January and November 2022, as per a research by a cybersecurity think tank CyberPeace Foundation. In another report AI company CloudSEK in 2022 said that India was the second most hit country in terms of cyber attacks after the USA. The concern is reflected in the registries of healthcare facilities under the ABDM scheme, as per the ABDM data, of the total 1,93,667 healthcare facility registries, only 45,772 are private facilities, while the rest are government health facilities for whom the registration is mandatory. Cyber experts highlight that the country’s healthcare facilities need investments for building formidable firewalls to sustain such cyber attacks in future. “Due to cost constraints, most health institutions do not spend enough on updated hardware and software and also because modern hardware requires constant configuring and checking,” says Arvind Tiwary, Chair, Cybersecurity Working Group, IET Future Tech Panel. Experts also believe that digital literacy has now become the need of the hour as more personal and sensitive information is being stored and transmitted digitally. “It is essential that individuals who handle sensitive data, such as patient data, are proficient in using digital tools and technologies securely and responsibly,” says Rajusiva Arunachalam, Vice President, Technology, Omega Healthcare. Arunachalam adds that it is also important for individuals handling sensitive data to be aware of the ethical and legal implications.

40 BW HE ALTHCARE FEBRUARY 2023 WWW.BWHEALTHCAREWORLD.COM IN-DEPTH The addressable o p p o r t u n i t y fo r t h e healthtech startups is significant; however, their ability to capitalise on this opportunity will be contingent on whether they are fundamentally solving key issues through tech interventions in the healthcare value chain KAUSTAV GANGULI MD, Alvarez & Marsal This includes understanding and respecting privacy rights and being aware of the potential consequences of mishandling or improperly accessing sensitive data. HEALTHTECH’S OUTLOOK IN 2023 The healthtech industry is one of the fastest growing segments of healthcare with thousands of startups offering innovative products and healthcare services. However the sector also faces a few challenges of its own. One of them is securing adequate funding in the startups. The challenge that the sector is currently facing is making sure that funding is being funnelled to the correct places and equally distributed to help push the industry forward, explains Bagga. Whereas experts also believe that few of the healthtech start-ups do not solve fundamental business problems and as such do not have strong reasons to sustain their business. “Some of these healthtech start-ups’ paths to profitability are unclear. This is because the models do not have strong unit economics supported by a strong proposition,” says Ganguli. In 2023, industry pundits expect that online pharmacies will continue to shine in the healthtech space especially as they show greater efficiencies in sourcing and supply chain and demonstrate their trajectory towards profitability. Further, Ganguli believes that patient sourcing, in-patient pathways and post-discharge engagement will improve significantly for leading players, thanks to effective digital interventions. Point of Care digital diagnostics will continue to decentralise testing to patient homes. Leading care providers will adopt such technologies to expand patient engagement to settings outside the hospital. B2B interactions will become more streamlined and data-driven in the healthtech industry, adopting best practices from pharmaceutical and FMCG industries, explains Ganguli.

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42 BW HE ALTHCARE FEBRUARY 2023 WWW.BWHEALTHCAREWORLD.COM “INDIA AT AN INFLECTION POINT IN ROBOTIC SURGERIES” Intuitive Surgical dominates the market share in India with about 100 surgical robots deployed across the country, BW Healthcare World spoke with the Vice President and Country GM, Mandeep Singh Kumar on various aspects related to cost, health insurance, innovation, trends, and future plans of the company in India Q&A How do you think robotic surgery has evolved over the last couple of years and what are the trends that you are witnessing currently in the country? From the point of view of interest, it has continued to increase among the Indian surgeons who are really passionate about robotic-assisted surgery and wanting to learn new skill sets, with the hospitals looking at providing the latest advanced technology and better outcomes to their patients. Similar interest has also been seen in the government setups. While the interest has always been there, in the last five years, we have seen a big acceleration of that. This is majorly because of the connect that Indian surgeons have with their counterparts abroad, and the exposure they have to the quality of work that has been done outside. The number of clinical publications that have been coming out has also led to multiplying the interest manifold, both in large private hospital chains like Apollo, Max, and Manipal etc., and also in government teaching and referral institutions like AIIMS and Safdarjung. To support this, we are also getting clinical publications, consensus statements on different therapy areas published out of India. There’s a whole surgical community and robotic-surgery associations invested in showcasing the benefits and value of RAS. When surgical communities, academic societies and teaching institutions start supporting the technology, that’s where the real acceleration happens. I think that is the inflection point and I see that the pace of adoption will only increase from here on. Are there any plans to relook at the price bracket for By Shivam Tyagi da Vinci surgical systems in the Indian market, with emerging players enter- ing the market, and the price-based volatility of the Indian market taken into account? We see the value of our technology in terms of the benefit it provides. As we grow, expand and make technological advancements, which help us reduce costs, like our extended use programme where we increase the shelf-life of the instruments. We also have different models of procurement for hospitals, ranging from paper use to leasing. We will offer those kind of benefits. We don’t look at price in isolation, or in relation only to competition. To summarise, we see our products from a point of view of the value it provides, and will continue to invest a lot in technological advancement. And, whatever that technology advancement and R&D yields in terms of benefits and cost, we will be willing and happy to share that with our customers. But not only from a customer or a competitive standpoint. Because ultimately our goal is to deliver the best technology in the hands of the surgeons, so that they can generate world-class clinical outcomes. We have about close to 30,000 peer to peer-reviewed papers, which talk about the clinical outcomes that we produce.

WWW.BWHEALTHCAREWORLD.COM BW HE ALTHCARE FEEBRUARY 202 3 43 When it comes to insurance companies although IRDAI has already specified this and allowed this to be a part of standard policies, do you think there is a lag there? There is a lag for sure. The IRDAI circular was a positive step. But it didn’t start getting implemented the same way by every insurance company. And if you were to look at various insurance companies, some provided supplements, others were co-paying. But over the last couple of years, this has changed, as we have been working with some of the larger standalone health insurance companies, showcasing the value of RAS by sharing required dossiers with them. And today, I’m happy to say that most of the large insurance companies have robotics fully insured without gaps or ceilings in a couple of their policies if not all. Ultimately our goal is to deliver the best technology in the hands of the surgeons, so that they can generate world-class clinical outcomes. We have about close to 30,000 peer to peerreviewed papers, which talk about the clinical outcomes that we produce the system to us and take the new fourth-generation system against credit, or they move the third-generation system to a smaller unit just to introduce that unit to robotics and buy the latest technology in their newer centres. What are your future plans in India? We have two key products that are in the pipeline, one is the Single Port, in that you need to work through the body only with one orifice or you can also use an actual natural body orifice so it would be a totally scarless surgery. And the second is, a product which uses robotic technology for lung cancer detection. So it’s a product called Ion for lung cancer diagnostics. Because the most important thing in lung cancer is to draw the right sample to do better diagnostics and given that India has a high incidence of lung cancer this product could be very relevant. Do you feel there is a challenge in updating the old da Vinci surgical systems as some doctors say that they are facing issues with older versions of the robot? Not exactly. I think what they are trying to tell you is that if they have an old technology, they may not have certain feature sets, which the latest technology offers. To that extent, they are true because some of the latest upgrades have come only in fourth-generation systems. But that is true for any and every technology. For instance, if somebody is on a third-generation system, then they don’t have a boom mounting for the four arms of a robot. They will not have the same convenience of doing a multi-quadrant surgery. To address this, we work with some of our hospitals to upgrade existing third-generation programmes. Either they return

44 BW HE ALTHCARE FEBRUARY 2023 WWW.BWHEALTHCAREWORLD.COM AI is Transforming Healthcare in India The World Economic Forum recently hailed AI in healthcare as India’s trillion-dollar opportunity. The need for artificial intelligence (AI) arose when the volume of available data surpassed human ability to comprehend it using human cognition alone in required time YEAH AHEAD There was an increasing need to automate repetitive tasks or supplement subjective guesswork with databacked decision making. Coincidentally, healthcare has been burdened with many repetitive admin tasks such as manual counting in diagnostics and is laden with subjectivity in care protocols. If an AI were to predict which sector needs AI the most, healthcare would be one of the top picks! Good AI needs great datasets to learn from. With India’s 1.3B population and the increasing digital penetration (600M+ smartphone users), quality datasets have increasingly been available for research in India and to Indian developers. Further digitization of the healthcare systems with the advent of the Ayushman Bharat Digital Mission (ABDM) – which has already created more than NAMIT CHUGH Investment Lead, W Health Ventures 200M+ Health IDs – will hopefully bring more real-world data for research and development. In addition to this, India’s technology and engineering talent is making the best of this resource to create AI solutions in India, use India as a sandbox and then export this to the world. DIAGNOSTICS: Efficient, affordable and accurate radiology screenings Diagnostics in India is riddled with challenges – limited supply side talent, lack of standardization and quality protocols, etc. leading to severe misdiagnosis which is a leading cause of avoidable mortality and economic burden. We have seen AI bringing in efficiency in existing diagnostics processes by increasing throughput of radiologists and improving the quality of diagnosis by reducing human error. For instance, Niramai is working towards creating predictive models for diagnosing life-threatening conditions like cancer using newer biomarkers. It uses AI to enable early detection of breast cancer so that patients can get By Namit Chugh

WWW.BWHEALTHCAREWORLD.COM BW HE ALTHCARE FEEBRUARY 202 3 45 timely medical intervention. Carpl, on the other hand, is helping doctors identify the right AI model by creating a “playstore” that hosts, compares and helps deploy multiple AI radiology solutions from the world. MENTAL HEALTH: Triaging patients through AI care While perception is slowly changing, mental health is still a taboo in India. This is compounded by the lack of access to quality mental health professionals. Emotionally intelligent AI chatbots are enabling on-demand therapy and clinically backed interventions. When patients are feeling depressed, anxious, stressed or just overwhelmed, they can reach out immediately and feel heard. Artificial Intelligence and ML tools are also using this data to identify patterns, bring in psychiatrists and psychologists in dire cases and improve mental health outcomes. One such company isWysa. Through its AI powered chatbots blended with support from professional experts, it is helping users manage various mental health conditions using clinically validated interventions. Further digitization of the healthcare systems with the advent of the Ayushman Bharat Digital Mission (ABDM) – which has already created more than 200 m Health IDs – will hopefully bring more real-world data for research and development FERTILITY: Egg, sperm and embryo grading for higher success in IVF There are nearly 40 million infertile couples in India. The process of seeking fertility treatment, especially for women, is a painful one. There are multiple decision points in the process (which procedure to choose, what dosage of medicines for preparing the eggs, when and how many to retrieve, which embryos to be selected, when to do the embryo transfer etc.). IVF particularly involves the process of identifying the best quality sperm first and embryo later that should be used for a successful pregnancy. This process is manual today – thus prone to human error and limited scalability which has plateaued its global success rate to 30-40%. Multiple companies are using computer vision (to ensure machine-based screening of all available eggs/sperms/embryos) and machine learning (to predict which sperm/embryo would have higher chances of success) models to bring scientific rigour to the process and make it error-free and scalable. Indian experts are working with global innovators to create in-house solutions for developing and testing such machine learning models. While we are seeing many disruptive uses of AI in healthcare already, we have only scratched the surface. As data quality and technology infrastructure strengthens AI solutions, we will see unprecedented automation in multiple tasks for patients and providers which will eventually simplify healthcare . We will also see providers acting upon critical insights based on the patient’s unique genetic, psychological and health parameters that make healthcare truly personalized. As is rightly pointed out by the World Economic Forum, the next phase of maturity in this industry will come from responsibly foreseeing concerns like bias, ethics and privacy in the datasets we use to build out these AI models. Trust is a key pillar in healthcare and we strongly believe that the adoption of AI in healthcare will be closely linked to our ability to create privacy respecting, secure, unbiased and regulated AI solutions. Wysa, for example, was recognized as one of the only two mental health solutions that respected data privacy by an independent analysis by the Mozilla Foundation. We at W Health are excited about the future of healthcare technology where AI solutions from India become a part of the routine care journey across the world.

46 BW HE ALTHCARE FEBRUARY 2023 WWW.BWHEALTHCAREWORLD.COM IMPACT OF 5G ON HEALTHCARE Remote monitoring, real-time medical imaging, remote surgery, and medical data management will be possible in the healthcare segment once 5G comes into play. These methods will help doctors visualise their patients’ conditions better, eliminate guesswork and provide faster, more accurate diagnoses By Bhupendra Paintola YEAR AHEAD

WWW.BWHEALTHCAREWORLD.COM BW HE ALTHCARE FEEBRUARY 202 3 47 A remarkable opportunity to build an integrated ecosystem for new opportunities in healthcare and other industries has been made possible by digital innovations such as the continued development of telehealth, the creation of fifth generation wireless networks (5G), artificial intelligence (AI) techniques such as machine learning and deep learning, big data and supercomputing, the Internet of Things (IoT), and digital security capabilities such as blockchain. The 5G networks have an extremely low latency of less than one millisecond (ms) of delay in comparison to about 70 milliseconds of lag on the 4G network. Moreover, the data transmission speed of 5G is about 100-fold higher than the current 10 megabits per second on 4G, as it uses higher-frequency millimetre waves compared to existing networks. 5G may save the global healthcare sector, as a whole, some $94 billion in costs by 2030 With the introduction of 5G, healthcare has evolved to become more data-oriented and is no longer only a system for the supply of care or services. Patient applications, particularly those used outside of traditional hospital facilities, are the area of the healthcare sector that offers operators of 5G the most potential. The expansion of telemedicine, online consultations, health monitoring, remote surgeries, and similar applications are a few use cases that support this. DEMOCRATISATION OF HEALTHCARE 5G healthcare models are deemed to transform healthcare into a more customer-centric environment, with a focus on providing patient care and services at reasonable prices, instilling customers at the epicentre of the ecosystem where every stakeholder is affected. Moreover, it will also bring a paraRemote monitoring, real-time medical imaging, remote surgery, and medical data management will be possible in the health care segment once 5G comes into play. These methods will help doctors visualise their patients’ conditions better, eliminate guesswork, and provide faster, more accurate diagnoses. In use cases, such as connected ambulances, emergency medical technicians (EMT) will be equipped to share a patient’s symptoms, vitals, and medical records between doctors and the ambulance staff using 4K video calls to provide treatment PEEYUSH VAISH Partner and Telecom sector leader, Deloitte India digm shift in people’s approach to healthcare, with people opting for preventive healthcare against the conventional necessity-based approach towards it. This will be possible with the synergy of data and artificial intelligence (AI) enabled by the widespread use of 5G technology in India.

48 BW HE ALTHCARE FEBRUARY 2023 WWW.BWHEALTHCAREWORLD.COM STARTUPS & PATENT FILINGS 5G may enable a surge in IP licencing agreements. The trend in patent application filings shows an increase from 9,000 in 2012 to around 25,000 in 2020. COST REDUCTION AND ACCESSIBILITY The global pandemic has made our current healthcare system’s sclerosis clear. The influx of patients with Covid-19 at various emergency rooms and intensive care units around the nation was overwhelming. As potential clients for elective and other less urgent procedures cancel their appointments, other practice areas are either barren or haemorrhaging money. According to a projection by STL Partners’, 5G may save the global healthcare sector as a whole, some $94 billion in costs by 2030. However, the real value goes beyond money because it has the potential to significantly enhance health outcomes. 5G will actually give a boost to innovation as well as patent filings. So the primary area of innovation will be the things that were not possible before because of the limitations of data. Startups, because they are very agile by nature, understand the new trends in the industry. Hence, they represent speed in innovation. This is only possible with startups, as a lot of times, bigger companies tend to have a longer planning style, like a strategy planning cycle. So it would take them six months or two quarters just to decide whether to do this or not, whereas startups will begin working on a solution within the next five days. So, you can expect a lot of patents to come from medical device and telemedicine companies, specifically in the health tech system, which is connected by nature GAURAV PARCHANI, Co-Founder & CTO, Dozee Co-Founder & CTO of Dozee Given the approximately $1 trillion rise in healthcare spending in the US during the previous 20 years. The new ecosystem prioritises bringing affordable, high-quality healthcare to all people. 5G will enable always-on device connectivity, enable telemedicine solutions, and improve data sharing between patients, carers, and insurers in the healthcare insurance sector, taking connected healthcare to a new level. Increased data availability will result in more accurate health and life insurance statistics, which will lower rates and support a more individualised, proactive, and predictive approach to health insurance where clients are encouraged to maintain a healthy lifestyle. LEVERAGING THE PHARMA INDUSTRY Pharma businesses are already delivering their products globally thanks to the use of 5G in the healthcare industry. Pharmaceutical manufacturing is, unsurprisingly, highly regulated due to strict quality requirements and patient safety concerns. Industry standards and standard operating procedures are also motivated by this. However, the requirements of the new pharma reality cannot be met by the current pharma IT infrastructures, which can still be decades old. 5G standardisation promises to develop a globally uniform networking infrastructure for the enhanced industrial internet and Internet of Things (IoT) services. End-to-end digitalised pharmaceutical solutions can be implemented on the basis of these capabilities. Additionally, if AI develops further, it is anticipated to play a 5G may enable a surge in IP licencing agreements. The trend in patent application filings shows an increase from 9,000 in 2012 to around 25,000 in 2020 YEAR AHEAD

WWW.BWHEALTHCAREWORLD.COM BW HE ALTHCARE FEEBRUARY 202 3 49 bigger role in R&D, notably in the life sciences. Hence, 5G will also incentivise pharma and tech companies to enhance the drug discovery process. REVOLUTIONISE PRODUCT DISTRIBUTION The distribution of healthcare has never been limited to delivery. It involves safely and effectively delivering the appropriate medications to the appropriate patients at the appropriate times. The logistics specialists handle this. 5G can assist pharmaceutical products in moving through the supply chain using edge computing and blockchain technologies and can also help track and verify them. A 5G-enabled blockchain-based supply network for the pharmaceutical business also provides encrypted contracts and channels for communication, as well as built-in security checks at every link in the chain of custody. ROLE OF GOVERNMENT/ POLICY MAKERS In order for the 5G industry to reach its full potential, the government must play a key role in providing secure services.The security of 5G is crucial because it may virtually enable sensors and other devices to communicate and make decisions without the need for human intervention. The government will need to release radio spectrum that is currently reserved for other uses, such as radar and satellite systems. More generally, the disruption caused by 5G will force governments to regulate companies and government institutions. With 5G, the use of augmented and artificial intelligence will be possible, but regulations to distinguish between decisions at the discretion of people and those that should be left to computers may be necessary, especially in a healthcare context. Some healthcare services could undergo a revolution thanks to 5G, such as the ability to early diagnose serious diseases with remote analysis of vital signs recorded by body-worn devices, although this too would require regulation on the usage of such information. ENERGY EFFICIENCY With its high speed and bandwidth, 5G is capable of transmitting information like prescriptions, diagnostic test results, medical imaging, and other medical reports almost instantly. It can enable high-quality video interactions too. All of this functionality growth occurs even as 5G, with its low power requirements, lowers the energy use of every connected device. But because 5G broadcasts at higher frequencies, signal degradation poses a bigger problem, necessitating the need for several “base stations” (approximately every 250 m). However, such a deployment offers a rare chance to bring all those technologies locally, in real time, to the point of care. CYBER ATTACKS AND DATA SECURITY When we move to the cloud, many aspects become cloud enabled and cloud connected. This leaves processes open to 5G will enable always-on device connectivity, enable telemedicine solutions, and improve data sharing between patients, carers, and insurers in the healthcare insurance sector, taking connected healthcare to a new level cyber-attacks, which is where two things can happen. The first is obviously data security and all of the data. And second, more importantly, is the private information of the patients. “Cyber attacks have no direct relationship to 5G, but they have a lot of indirect relation, because with 5G, a lot of new solutions are emerging, and a lot of people who were not in healthcare are coming into healthcare.” So, for them to understand healthcare regulations, it is very important. We have the first draft of the privacy or data privacy policy that was released some time ago. And more and more things will be built over it. We will also draw inspiration from the European data protection regulations, GDPR, and the American data protection regulations (HIPAA). Our own guidelines that were released recently are being worked upon right now as the first draft,” said Gaurav Parchani, Co-Founder & CTO of Dozee. All in all, 5G is set to transform the way the healthcare sector works.

50 BW HE ALTHCARE FEBRUARY 2023 WWW.BWHEALTHCAREWORLD.COM 5G SPECTRUM AND HEALTH There is a flip side to all the promising projections of ushering in 5G, for its impact on human health can be quite hazardous YEAH AHEAD S ince the 1980s the evolution of telecommunications has come a long way. Every generation has its forte. People went berserk when they could communicate with the entire world at the snap of a finger. It all started with 1G with the ability to do voice calls. With 2G we could do voice calls and messages, 3G came with the added advantage of video calling, and then came 4G which skyrocketed the internet speed, gave us the vision for a Digital world and a world where the Internet of things (IoT) and 100 times faster connectivity will be possible with 5G. DIGITALIZATION AND 5G Digital transformation across all sectors is enabling an economic revolution. It is well documented that an economic boost for any nation is directly proportional to its rate of digitalization in its business activities. 5G is touted to be the most important enabler to By Pranav Poddar PRANAV PODDAR Director, Syenergy Environics Ltd