Medical Innovation and Disease Burden: Conflicting Priorities and the Social Divide in India

228 Pages·2021·7.328 MB·English

by  Sobin George

Medical Innovation and Disease Burden
Striking the right balance between public health priorities and medical innovation
is a critical policy challenge for India, given their mutually conflicting nature and
interests. On the one hand, the country has an expanding health industry with
a strong presence of domestic and multinational private firms. The sector, with
enormous state facilitation, could effectively position itself as the future engine
of economic growth by rearranging itself to the new intellectual property and
trade regimes. On the other hand, India has a huge burden of diseases implicated
by a gamut of public health problems, including the uneven distribution of
demographic and epidemiological transition, threat of new infectious diseases
like COVID-19, increasing privatisation of healthcare, inadequately regulated
pharmaceutical market, low affordability of life-saving medicines and, most
importantly, escalating out-of-pocket healthcare expenditure coupled with poor
financial risk protection. All these make the Indian healthscape not only diverse
but also exceedingly complex. Given these, the central question that the book
addresses is whether medical innovation in India is sensitive to public health
needs and priorities. The book unearths a number of overriding issues related to
responsiveness and equity in India’s health innovation and highlights the need for
a responsible innovation framework for India that balances the priorities of public
health and industry goals.
Sobin George teaches at the Institute for Social and Economic Change,
Bengaluru. His areas of research and writings are marginalities, social gradients of
health, medical industry and labour rights.

Medical Innovation and Disease Burden
Conflicting Priorities and the Social Divide
in India
Sobin George
University Printing House, Cambridge CB2 8BS, United Kingdom
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Information on this title: www.cambridge.org/9781108832304
© Sobin George 2021
This publication is in copyright. Subject to statutory exception
and to the provisions of relevant collective licensing agreements,
no reproduction of any part may take place without the written
permission of Cambridge University Press.
First published 2021
Printed in India
A catalogue record for this publication is available from the British Library
Library of Congress Cataloging-in-Publication Data
Names: George, Sobin, author.
Title: Medical innovation and disease burden : conflicting priorities and
the social divide in India / Sobin George.
Description: Cambridge, United Kingdom ; New York, NY : Cambridge
University Press, 2021. | Includes bibliographical references and index.
Identifiers: LCCN 2020049872 (print) | LCCN 2020049873 (ebook) | ISBN
9781108832304 (hardback) | ISBN 9781108935838 (ebook)
Subjects: LCSH: Public health--India. | Medical care--India. |
Equality--Health aspects--India. | Health services accessibility--India.
| Medical innovations--India.
Classification: LCC RA529 .G46 2021 (print) | LCC RA529 (ebook) | DDC
362.10954--dc23
LC record available at https://lccn.loc.gov/2020049872
LC ebook record available at https://lccn.loc.gov/2020049873
ISBN 978-1-108-83230-4 Hardback
Cambridge University Press has no responsibility for the persistence or accuracy
of URLs for external or third-party internet websites referred to in this publication,
and does not guarantee that any content on such websites is, or will remain,
accurate or appropriate.
Contents
List of Tables vii
List of Figures xi
Acknowledgements xiii
List of Abbreviations xv
Introduction 1
1. Medical Innovation and Its Institutional Co-production in India 18
2. The Disease Focus of Health Research and Development 57
3. Drug Development and Responsiveness to Disease Burden 102
4. Affordability and the Social Divide 136
5. The Puzzle of Responsive and Responsible Medical Innovation 175
References 189
Index 205

Tables
1.1 Income, sales, R&D, export and import in Indian
pharmaceutical sector (all) (INR million) 20
1.2 Income, sales, R&D, export and import,
government enterprises (INR million) 21
1.3 Income, sales, R&D, export and import, Indian
private enterprises 22
1.4 Income, sales, R&D, export and import, major
13 Indian private companies (INR million) 23
1.5 Income, sales, R&D, export and import, all foreign
MNCs in Indian pharmaceutical sector (INR million) 24
1.6 Indian biotechnology industry, revenue of various
sub-segments (INR crore) 28
1.7 Income, sales, R&D, export and import, major
biopharma companies (INR million) 29
1.8 Income, sales, R&D, export and import, major
biopharma government enterprises (INR million) 31
1.9 Income, sales, R&D, export and import, major Indian
private sector biopharma (INR million) 33
1.10 Income, sales, R&D, export and import, major
biopharma MNCs (INR million) 34
1.11 Market size, production, import and export of
medical devices, India (USD million) 37
1A.1 Ongoing clinical trials by Indian pharmaceutical
companies by disease focus by type of hospital 50
1A.2 Ongoing clinical trials by global pharmaceutical
companies operating in India by disease focus by
type of hospital 51
1A.3 Ongoing clinical trials by research institutes (Indian
and foreign) by disease focus by type of hospital 53
viii Tables
1A.4 Ongoing clinical trials by research institutes cum hospitals
(Indian and foreign) by disease focus by type of hospital 55
1A.5 Ongoing clinical trials by government funding agencies
(Indian and foreign) by disease focus by type of hospital 56
2.1 Number of new drugs approved for marketing between
2000 and 2017 across disease conditions – 1 61
2.2 Number of new drugs approved for marketing between
2000 and 2017 across disease conditions – 2 64
2.3 Vaccine R&D pipelines of selected biopharmaceutical
firms in India 66
2.4 Therapeutic R&D pipelines of selected biopharmaceutical
firms in India 67
2.5 Research focus of selected biopharmaceutical start-ups in India 70
2.6 Medical technology requirement by disease/conditions
in the Global South 77
2.7 Product and disease focus of selected medical device
and technology firms in India 81
2A.1 Number of new drugs approved for marketing in India
from 2000 to 2017 by indication 89
2A.2 Major biopharmaceutical companies in India and their
product focus (as of February 2019) 91
3.1 Gender-wise distribution of causes of death 104
3.2 Causes of death, India: 0–4 age group 104
3.3 Causes of death, India: 5–14 age group 105
3.4 Causes of death, India: 15–29 age group 106
3.5 Causes of death, India: 30–49 age group 107
3.6 Causes of death, India: 50–59 age group 108
3.7 Causes of death, India: 60–69 age group 109
3.8 Causes of death, India: 70-plus age group 109
3.9 Deaths due to communicable, maternal, perinatal
and nutritional conditions 111
3.10 Deaths due to non-communicable diseases 112
3.11 Deaths due to cardiovascular diseases 113
3.12 Deaths due to respiratory diseases 114
3.13 Deaths due to malignant neoplasms (cancer) 114
3.14 Deaths due to digestive diseases 117
3.15 Deaths due to genitourinary diseases 117
3.16 Deaths due to neurological conditions 118
3.17 Percentage distribution of reported morbidity in
India by gender and sector 121
3.18 Contribution of disease categories to total deaths by
age groups in states grouped by epidemiological
transition level (ETL), 2016 122