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India’s work on health tools, financial inclusion can be global goods: Gates Foundation CEO Mark Suzman

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Better surveillance methods and public education are critical to manage multiple Covid-19 variants, CEO of the Gates Foundation, Mark Suzman, told Vasudha Venugopal in an interview. He spoke about his ongoing India visit — his first after Covid-19 pandemic struck, the impact of the Ukraine war and food shortages on foreign aid, India’s digital health initiatives, and the government’s handling of Covid-19.

How does a country like India prepare itself for different Covid-19 variants?

Nobody is sure if there is an end to Covid-19. What we have seen is the evolution and spread of various Covid-19 variants. But now we do have the tools, therapeutics and vaccines to deal with the pandemic in a responsible way. So we have to keep our guard up. The world is at a stage of managing to live with Covid-19 rather than looking for the end of Covid-19. Only better surveillance can track multiple variants. There were some challenges with respect to testing in the beginning but there was a network in place shortly thereafter. Covid-19 has been a global challenge and it needs a global response. So whatever tools India puts in place — and the country has good infrastructure — it needs global support to track these everyday variants that come out, so that we can respond collectively.

What is your assessment of the way the government handled the pandemic, particularly the second wave?

Overall, it has been impressive to see how India has managed the crisis. I have been doing a series of meetings for the last few days with our partners that we worked with during that time, from the ICMR to the health department. Just look at the numbers. Over 1.9 billion vaccine doses were administered in India and all of them were manufactured here, and there was a pioneering digital global tool Cowin to track the vaccination, which itself is valuable for future interventions. Covid-19 no doubt has been a devastating blow to families not just in India but everywhere, but some tools used by India have been an impressive model nationally and globally. Also, India’s national vaccination numbers are comparable to the best.

This is a certain vaccine fatigue in people even as the cases are rising. How does a country like India handle that?

My boss Bill Gates has just written a book on how to avoid the next pandemic. When we look back and see dislocations and economic damage, it is self-evident that the world should be making big investments in research and development, but we haven’t seen that coming. That is partly a reflection of a global exhaustion with the pandemic and the perception that “we want to get back to normal”. But the reality is that being able to operate in what is really a new normal when Covid-19 will continue to circulate is to act responsibly. There is no easy solution, but to keep supporting public information and public education.

What are the Gates foundation’s priorities for India?

We have been in India for almost two decades. When we started the focus was on HIV; since then, we expanded to a range of other areas, mainly reducing child and maternal mortality, working with national and state governments closely, particularly in UP and Bihar. In fact, I am travelling to UP. One of our efforts will be to continue working in this area to prevent ‘under five’ mortality. India has enjoyed significant improvements in this area. I was talking at AIIMS about the leadership of Dr Raj Bhan who helped to develop the rotavirus vaccine. We had supported the development of this vaccine that was cost-effective, with an investment of 65 million dollars, working with Indian authorities. The vaccine has saved many, many lives in India and worldwide. Our priorities will continue to remain the health space from the highest level of research and development, by working with companies such as Serum Institute, Bharat Biotech and other Indian manufacturers in private and public sector. In fact, we provided some bridge loans and financing to SII when they developed their original vaccine, using AstraZeneca vaccine transfer, even before there was a regulatory approval. Apart from sanitation, agriculture development, strengthening primary healthcare is also a priority and we are working with the UP government. The purpose of my visit is also to track those programmes that did not stop during Covid-19, but since all our attention was on the pandemic, it is time to take stock. Other priorities include Tuberculosis and Lymphatic Filariasis (LF).

There are a lot of challenges countries of the world are facing — Covid-19, Ukraine war, food shortages, oil prices, inflation. Do you see this affecting foreign aid to developing countries, including India? Some NGOs have said it is becoming difficult for them to get clearances. Do you have similar experiences?

We are concerned about pressures on foreign aid globally. You must have seen the most recent numbers from the World Food Programme of people facing the food crises, which is from the whole of Africa to Afghanistan to Yemen. These are really humanitarian needs, but even during these times, huge amounts of money, particularly from European donors, shifted perhaps appropriately to support Ukrainian refugees. While the intent is good, our strong view is that it should not be at the expense of traditional global aid into investments such as the Global Fund to defeat HIV, TB and malaria. Global Fund is arguably the most successful health innovation in the 21st century and has saved millions of lives. It is coming due for replenishment in a few months and we are very concerned that some of the resources might not be available to do proven, accountable, life-saving interventions in malaria or providing antiretroviral therapy (ART) treatment of people infected with HIV. India is a country with a lot of resources and it has been investing them. We have been working as a thought-partner fully aligned with the government, sharing our expertise and experiences. It has been a positive set of meetings for us.

How do you see India’s Unified Health Interface (UHI) open network designed to enable digital health service delivery like teleconsultations?

One of my meetings this time was also at the Ministry of External Affairs, something I don’t traditionally do as frequently. It was to talk about, apart from India’s model of vaccine manufacturing and distribution and health tools, the wider reforms that can be made through digital identity and Aadhaar, payment systems and UPI, and how they have driven down costs for the customers, the lakhs of bank accounts that have been created. While these are helping Indians in need, we think they can be global public goods. And we want to see if we can work in India with partners in India and share the best practices with other countries, especially Africa where we work a lot. One of the meetings I had was with experts who work across different aspects of digital tools that range from financial inclusion to Ayushman Bharat and it’s impressive how India is coming up with such innovative, cost-effective measures. One of the silver linings of the Covid-19 crisis is the acceleration of the development of digital tools. It will be interesting to see how digital health wallets and health stacks built on digital vaccine can be used beyond Covid-19 vaccination, to track regular vaccination, Ayushman Bharat insurance payments, ante-natal and postnatal visits, and it could become a sub comprehensive set of efficient medical records, apart from enabling telemedicine. We are still at the very early stage. There will be gaps and challenges. What India has now is a proven scale of a robust, digital backbone that has the potential to be built on. It is the most encouraging experiment that we have seen that is capable of reaching the poorest. I expect India to be at the forefront of digital health tools in the next two or three years.

NFHS data has pointed to several realities in the country — anaemia, lifestyle diseases, obesity, hypertension are on the rise. What are the areas of health that India needs to look into?

The data is a mixed bag but we can’t underestimate how powerful and positive key indicators on maternal and infant mortality are. The neonatal mortality figures for us showed significant improvement. It is difficult to do a full attribution and contribution but those improvements have been because of improved health systems. The data showed that in the last five years there has been a significant increase in facility-based births, but the facility has to be equipped with good health tools and health workers. Primary health care units are critical because they provide the primary interface for people with their healthcare providers. Now you have the Ayushman Bharat that provides some level of tertiary insurance. There have been some improvements in nutrition but it is not uniform throughout. What is needed is focused targeting of pregnant women and efforts that can go till the panchayat level, and historically data has shown that these improvements take time. As with regard to non-communicable diseases, the foundation doesn’t yet work on them because one has to choose one’s priority areas, and we go for the most neglected ones. There is a lot of research money in the US on the study of NCDs.

Credits – Source – https://economictimes.indiatimes.com/industry/healthcare/biotech/healthcare/indias-work-on-health-tools-financial-inclusion-can-be-global-goods-gates-foundation-ceo-mark-suzman/articleshow/92090836.cms

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