Ensuring India remains the leader in vaccines and pharmaceuticals in the face of attack on it by China and the “Big Pharma” is of vital importance for the health and economic security of India. This pandemic has pushed the health of the nation to the geopolitical centre stage and health workers into frontline warriors. Self-sufficiency in vaccines, medicines, diagnostic kits, medical-surgical disposables and equipment is as important if not more than self-sufficiency in armaments to protect us from bioweapons of our enemies both state and non-state actors who do not respect any international law and have no hesitation to commit crimes against humanity. They first attack us with bioweapons and then deny us essential supplies especially those required for manufacture of drugs and vaccines. Then in a charade of helping us they sell us defective medical supplies at exorbitant rates and profit from our misery while using the media to mock us and dent our self-confidence hoping to subjugate us. Health industry has vast applications far beyond what is obvious and is a source of strategic, geopolitical and soft power heft.
STRATEGIC IMPORTANCE OF PHARMACEUTICALS AND VACCINES: India is the world’s pharmacy and main supplier of low-priced, high quality drugs and vaccines to World Health Organization and nations around the world, both poor and rich, developed and under developed. The Indian pharmaceutical industry has had a major role in facilitating containment of HIV/AIDS worldwide with supply of affordable generic antiretroviral (ARV) drugs. Refusal to share patents on vaccines and their constituents and profiteering by big pharma companies has become a major problem. Serum Institute of India had to plead with the US government to lift the ban on essential ingredients of the Covishield vaccine. During the second wave of Covid-19 in India essential drug prices shot up due to profiteering by Chinese suppliers of API (Active Pharmaceutical Ingredient) and pharmaceutical intermediates required for the production of these drugs. India was self-sufficient in producing its own API and intermediates till the 1990s. In the last two decades, import of cheap Chinese APIs and intermediates has led to closure of many Indian factories.
STRATEGIC IMPORTANCE OF MEDICAL AND LABORATORY CONSUMABLES AND EQUIPMENT: The initial shortage of masks, Personal Protective Equipment (PPE) and diagnostic kits brought home to the Indian government the importance of medical consumables such as gloves, syringes, needles, wound dressings, sutures, catheters, tubes, infusion sets, IV cannulas etc., and also laboratory supplies, surgical instruments and implants, ventilators, defibrillators, infant incubator, fiberoptic endoscopes and electromedical appliances. India currently imports approximately 80% of its requirement of medical devices especially from China and there is an urgent need for self-reliance in these.
STRATEGIC INTERDEPENDENCE: Messaging apps, social media, telemedicine, video conference and digital payment platforms used in the management of this pandemic demonstrated the importance of smart phones, reliable broadband telecommunication networks and software. Managing surges in demand showed the crucial need for logistics, energy, food and water supply and waste disposal facilities. Nuclear medicine and brachytherapy are dependent on nuclear reactors for isotopes, radiation therapy equipment on nuclear sciences, cryotherapy on cryotechnology, and nanomedicine on nanotechnology. Various medical equipment, their sensors, electronics and materials are based on technologies and materials developed in aerospace, defence, nuclear sciences, electronics, telecommunication, artificial intelligence and other strategically important fields of research. Often profits from the sale of medical equipment have funded research and development in these allied sciences.
MEDICAL TECHNOLOGY APPLICATIONS IN OTHER STRATEGIC FIELDS: Endoscopes are used in locating, extracting entrapped persons in a disaster site and for equipment maintenance and security investigations. Ultrasound, CT, MR scanners have found use in forensic science, security and customs screening, archaeology, non-destructive testing of products and structures to detect invisible flaws and stress fractures. Sensors and monitors developed for the health industry have had wide applications elsewhere including in aerospace cockpits.
SPACE, HIGH ALTITUDE, POLAR, DEEP SEA, DEEP MINES OUTREACH: Mental and physical fitness research and training, special medical equipment, protective suits, designer foods, water, medical, oxygen and sanitary special supplies, have made it possible to explore Antarctica from Bharati Antarctic research station; survive on Siachen Glacier and Himalayan heights; explore deep sea beds; operate long submersions in a nuclear submarine; protect personnel and researchers in deep mines, nuclear facilities and other hazardous industries and environment and now to send Indians to space. Health industry helps sportspersons, pilots, astronauts, police and defence personnel in harsh conditions. It empowers us to explore new frontiers and push the envelopes of human survival.
GEOPOLITICAL IMPORTANCE OF DISASTER AND MEDICAL RELIEF: India has a long history of providing medical relief in war and disaster zones like the evacuation from Kuwait during the 1990-91 Gulf war, from Libyan Civil War in 2011, after Brussels bomb blast on 22 March 2016. On 31 January and 1 February 2020, Air India evacuated 637 Indians and 7 Maldivians from Wuhan and on 27 February 2020 evacuated 119 Indians and 5 foreign nationals from the Diamond Princess cruise ship, docked off Yokohama, in Japan. On 26 February 2020, an Indian Air Force C-17 aircraft carried 15 tonnes of medical assistance including masks, gloves and other medical equipment to Wuhan and brought back 76 Indians and 36 foreign nationals. India responded within 15 minutes of the April 2015 earthquake in Nepal under Operation Maitri and the Indian Armed Forces evacuated 5,188 persons, including nearly 785 foreign tourists. During the Yemen crisis in 2015, 4,640 Indian citizens and 960 foreign nationals of 41 countries were evacuated under Operation Raahat; and 1,764 Indians, 112 Sri Lankans, 64 Nepalese and 7 Lebanese nationals were evacuated during the Lebanon war in 2006 under Operation Sukoon by the Indian Navy. Tajikistan air bases were recently used for evacuation from Afghanistan and providing relief. Under the Vaccine-Maitri program, India is providing Covid-19 vaccines to many nations. The ability to provide medical and disaster relief to any part of the world expands and strengthens Indian logistics and geopolitical power.
INDIAN HEALTH INDUSTRY AND DIASPORA AS SOFT POWER: President Trump’s appeal to PM Modi to release emergency stocks of hydroxychloroquine; WHO and many nations’ request to India for vaccines and essential medicines are an obvious proof of Indian soft power through the health industry. Dr Michael Ryan, Executive Director, WHO Health Emergencies said a year ago that that India led the world in eradicating two silent killers, smallpox and polio, and that India will show the world how to control Covid-19, as India is playing a leading role in the development of a potential vaccine candidate and also producing potential anti-Covid drugs. On 21 April this year at a European Commission (EC) meeting in Brussels, German Chancellor Angela Merkel lamented that they “allowed” India to become a major pharmaceutical producer in the world. These statements by world leaders are ample proof of Indian pharmaceutical soft power. Indian doctors, nurses, technicians and health workers form the backbone of the national health service of many nations around the world. This highly respected diaspora is another source of Indian soft power.
BENEFITS OF MEDICAL TOURISM: Large health facilities and health work force scalable during an emergency, development of hospitality and leisure tourism facilities, foreign exchange earnings, export of Indian drugs, multiple sources of financial returns, gratitude of many nationals, experience and research data of managing various races and nationals are some of the many benefits of medical tourism. It also expands our soft power.
HEALTH INDUSTRY ROUTE TO MULTI TRILLION ECONOMY: This pandemic has demonstrated the financial, strategic and geopolitical growth and prospects of the health industry, especially pharmaceuticals; medical, laboratory, housekeeping and sanitary consumables; health related software, data storage and management; medical equipment like ventilators, ICU facilities, oxygen supply equipment and logistics. Since most of these are imported; to grow to a $5 trillion or bigger economy, there is nothing better than firing up the health and its allied industries including medical electronics and biomedical sciences.
HEALTH NEEDED TO BECOME SUPERPOWER: Green revolution provided us with food security. To ensure the security of our nation a major effort is in progress to achieve self-reliance in defence production. Moves are afoot to secure strategic supplies like manufacturing of semiconductors, electronics, telecommunication equipment and solar cells. Similarly, to protect our health and economy we need to be self-sufficient in health supplies. In a health emergency like a pandemic or a bio war we should not be held to ransom by denial of technology or supplies. We should produce health supplies at a global scale and export them so that we are able to fund research and development of cutting edge technologies.
Dr P.S. Venkatesh Rao is Consultant Endocrine, Breast & Laparoscopic Surgeon.