Dissecting India’s Healthtech
India's healthtech startups were growing rapidly even before the pandemic, but Covid-19 has ushered in a new age. This series dives into the trends, startups business models emerging in the wake of Covid-19.
In early May, a study published in the European Heart Journal said that while Covid-19 and the SARS CoV-2 virus infects a wide age group, it is predominantly seen in elderly individuals, especially men and those with cardiovascular disease. The study found that men have higher levels of the angiotensin-converting enzyme 2 (ACE2) in the blood, which helps the virus infect cells faster, thereby leaving men more vulnerable to the coronavirus.
The study was part of a diverse range of gene-centric research from across the world. Never before have the medical scientists of the world come together to fight something as one. But research takes time and scientific breakthroughs are much a result of trial and error as it is of brilliant minds.
“Because it is the first time [Covid-19], I think there have been a lot of missteps from everyone. A lot of resources have been drained out at all ends. I hope we can really take the learnings, document for the future and relook at the power centres,” says Anu Acharya.
The Mapmygenome cofounder recalls that even as India was only reading about the disease in January and February when the first cases were reported, the company decided to enter the preparation stage. “We told the team that we need to start preparing for and analysing our data to help our customers understand how to prevent themselves and build immunity from this virus,” added Acharya.
Three months down the line, it is among the handful of the private testing laboratories in India that have received approval from the Indian Council For Medical Research (ICMR) for Covid-19 testing. In April, it launched an extension of its flagship product Genomepatri, the “Genomepatri Immunity Report”, with a focus on Covid-19.
For Acharya, who has been in the DNA and genetics testing industry for over two decades now, this was a crucial opportunity to prove Mapmygenome’s capabilities and scale.
Covid-19 changed everything for Mapmygenome. Medical technology became the centre of attention across the country and everyone had their eye on where the cure for Covid-19 would come from. Did the answer lie in genetics, many wondered. “The company has become very different. We’re suddenly seeing walk-in patients, we are getting hospital samples, and collaborating with different governments and researchers worldwide. So challenges are definitely different now,” says Acharya.
First Step: Going Back To The ‘Core Theory’
When the pandemic hit, the problem was not only with the data gaps in tackling the novel coronavirus but also to bring in the required capabilities, set up the infrastructure, assess the cost components and change the daily processes that too amid lockdown. Like most other companies, Mapmygenome also went back to the basics and reassessed its core proposition in search of new innovations for the world in crisis.
Before Mapmygenome, Acharya had run the global genomics company Ocimum Biosolutions for 13 years. However, she realised that there was inequality in the genetic and genomic data points, as globally the Indian gene data represented less than 2% of the available data and only effective for 20% of the population. Now, in a country like India, where government spending on healthcare is less than 2%, it is important to focus on prevention to reduce overall costs. This is something that other gene-centric healthtech startups have also pointed out.
In addition to Mapmygenome, Indian genetic tech startups such as 4BaseCare, MedGenome, Strand Life Sciences, Onco, Positive Bioscience, HaystackAnalytics, as well as global companies such as Novogene, Ambry Genetics, Invitae, and CeGat among others are working in this budding field within the broader healthtech ecosystem.
Investors are also eyeing genetic tech innovation. Bengaluru-based MedGenome raised $55 Mn from LeapFrog Investments, Sequoia Capital and Sofina in April 2020. It said the funding would be used towards expanding its clinical genomic testing in Tier 2 and 3 cities and smaller towns. It will also invest in accelerating its drug discovery programmes.
Besides providing gene-based medical reports and exposing risks in the long run, the big part of the effort is to build a genome data bank that can one day be used to provide advanced treatments faster and detect diseases such as cancer at an earlier stage. The gaps in the Indian market and gene data pertaining to Indian population set the base for the launch of Mapmygenome in 2012.
By combining genetic health profiles with an overall health history and genetic counselling, the startup is looking to bring actionable steps to individuals and their physicians based on genetic history. Its patented data analysis algorithm brings genomics assessment of 200+ conditions, personal gene panel tests, molecular diagnostics, brain wellness solutions, TB diagnostic kits, and DNA forensics.
“With a simple swab of saliva, we can give anyone a complete profile of their genetic predisposition to health and lifestyle. While the genetic component does not change, factors like environment, habits, and lifestyle can be modified to mitigate any genetic risks. Combined with genetic counselling and/or nutritional counselling, these tests have the potential to change your lifestyle and save on healthcare expenses, ” she added.
With uncertainties crawling around coronavirus treatments and precautions, Mapmygenome thus decided to stick to its core theory to spread awareness and treat the problem at its roots by helping people understand their immunity levels in a best possible manner.
Second Step: Building On The Core
Mapmygenome already had a suite of products in personal genomics testing and diagnostics of critical ailments, developed over the course of eight years. Once an individual books a test through the website, they receive a consultation call to explain the procedure and the test process. After the payments are done, a testing kit is sent to the patient for collection of a saliva sample. It takes anywhere between six to eight weeks for the full gene panel report to be generated.
The new challenge was to build something that would help them fight against Covid-19. For example, how the disease might impact the immunity of a person depending on their genetic tests.
“There are no drugs specific to the treatment of Covid-19. But there are a lot of experimental drugs in the market. We also had with us the genomics data of our existing user base and more than 200+ ailments they are already suffering from. This gave us the starting point,” says Acharya.
The Mapmygenome team thus started documenting the warning signs for their existing user base. Reports were generated to tell them if they are allergic to any of the available antiviral drugs being used in Covid-19 treatment, as well as precautionary measures for those with critical ailments. This research then became the base to standardise and curate the Genomepatri Immunity report.
Launched in April this year, Genomepatri Immunity predicts an individual’s genetic risk for Covid, the severity of infection, the risk for associated comorbidities, and factors that affect immunity. The company also recently partnered with Apollo Clinic to offer DNA Health tests.
The company’s existing Genomepatri customers were given a free Covid-19 immunity and risk panel report, which tested for genetic predisposition for infections, side-effects and immunity-associated diseases, as well as nutrient deficiencies that may impact immunity adversely.
Besides Mapmygenome, Mumbai-based HaystackAnalytics is also working to trace the transmission of coronavirus in India by sequencing the genome of the coronavirus, which will aid in vaccine creation and blocking transmission. Founder Anirvan Chatterjee told Inc42 in an earlier interaction that the startup is using DNA fingerprinting to trace the recent common ancestor of the virus. “Theoretically, we can draw the entire trace of the virus back to Wuhan. This means that the transmission chain can be drawn out.”
Rationalising Costs For India
With the increased number of cases in the country, the government has put up a cap on the testing prices to INR 2,400 (on center sample collection) and INR 3,000 (the home sample collection). However, as Acharya highlighted, there were a lot of costs at the end of laboratories that have been ignored by the authorities.
To their credit, the government could not have let the private sector set the price, but that impact is felt by companies. At Mapmygenome, the team size had to be increased by almost 30% with increased expenses for personal protective equipment for the team, reagents, R&D costs, testing kits and more.
In this regard, the INR 53 Lakh grant Mapmygenome received from the Action Covid-19 Team has gone a long way towards enabling the startup’s PCR sample pooling to reduce the cost of testing by 60%-80%. The objective is to reduce the strain on the system by pooling and testing a higher number of samples through a reverse transcription-polymerase chain reaction (RT-PCR) technique.
Besides the Covid-19 focussed immunity report, Mapmygenome’s existing range of tests includes DNA-based ethnicity analysis to comprehensive genomic assessments for nutrition profiles, cardio-respiratory fitness, muscle strength, body composition, dietary restrictions and noninvasive personal genomics tests — ranging from INR 5,999 to INR 15,000. The personal genomics test that assesses inherited and acquired genomic health risks for 100+ conditions is delivered in combination with genomic counselling through experts.
One might think the costs are high, however, these reports help users save a lot on the amount of time and expenses on future health diagnosis and expenses. And it’s also never just about one disease as gene panel tests reveal the whole spectrum of risks. The test only needs to be conducted one in most lifetimes, but given the pace of change in DNA technology, there could be more tests that come up in the near future, which would involve further costs.
In the wake of the pandemic, Mapmygenome extended its testing facility as a private laboratory for Covid-19 testing. “We had a lot of pieces already together as we were already developing TB testing kits. So we already had a lot of biosafety elements, RT-PCR kits, cDNA synthesis kits, mixes, enzymes, reagents and more,” claims the founder.
According to Acharya, the biggest efforts were in using technology for integrating and automating workflows such as pipetting the samples into test tubes or vials and RNA extraction to offset the increased costs as far as possible. One of the key challenges was the effective use of collection kits.
“We are dealing with a live virus here. To safely transport the collection kit, we attenuate the virus at room temperature to reduce the risk of contamination. Also, we made sure that the sample doesn’t degrade even if it’s not processed upto a month. Still, I would say we are in the process of making it much more efficient than we are, but we have definitely achieved some success here,” Acharya says.
Is Gene Editing The Answer To Covid-19?
Covid-19 is enabling digital transformation and accelerating innovation across the globe. The global gene editing market is projected to reach $11.2 Bn in 2025 from $5.1 Bn in 2020, at a CAGR of 17%, as per MarketsAndMarkets.
The world’s most popular gene-editing technology CRISPR has found application in Covid-19 diagnostics as well. Researchers have found that using CRISPR, the viral genome can be attacked and its viral payload concentration can be reduced in a test solution by 90%. Another option could involve finding the right sequence to edit in the human genome to develop resistance to the virus, but this is mired in the quicksand of ethical and legal considerations.
When it comes to Mapmygenome’s future and the potential for gene editing in the Indian market, Acharya believes that at the moment it is a long shot. “For a country like India, today it is more important to face a new normal that has crumbled the wall between private healthcare and public health. We need regulations that promote efficacy while supporting inclusivity,” she added,
History has taught us the importance of public consensus for progress and Covid-19 has shown how masses can come to a consensus, mandating to prioritise prevention over individual rights. Confidence has to be built not only among individuals but also in the medical community and among healthcare providers. Doctors also need to be enabled to read into gene tests and suggest advanced solutions.
“We had to deal with issues like paucity of data. Building up our bioinformatics capabilities was the key factor behind our right algorithm and the reports for patients. And we continue to make it better. This is all we can count on while dealing with Covid-19 as well in the coming months.”