Innovation in TB Diagnostics: The Indian Challenge

Dr. Madhukar Pai of McGill and Dr. John Kenneth of St. John’s Research Institute put together a fascinating conference last week with a simple objective: can we come up with low-cost yet accurate diagnostic tools for turberculosis (TB)?

What’s the problem? India accounts for 22% of all TB cases in the world, and for 25% of the Multi Drug Resistant (MDR) cases. We have a national programme to detect and cure TB that has done well – the whole country has been covered by both diagnostic and curative efforts, and we have met the Millennium Development Goals in this area – yet, case detection has plateaued around 72%, and treatment success rate at around 87%. There are still 280,000 deaths every year due to TB. And undetected and untreated patients spread the disease rapidly to others.

The primary diagnostic tool used for TB – a sputum smear test – is more than a hundred years old, needs skilled manpower, takes several hours to give results, and has limitations with respect to accuracy. New technology in the form of molecular imaging is now available – e.g. Xpert MTB/RIF, a molecular imaging platform developed by the Foundation for Innovative New Diagnostics (FIND – a Geneva-based non-profit) and Cepheid, a Silicon Valley technology company – detects TB accurately and tests for drug resistance at the same time. Yet Xpert’s “discounted” $17,000 price tag for the equipment, and $17 price tag for the cartridge make it an unlikely candidate for rapid diffusion across India and the rest of the developing world.

The Challenge? To create a low-cost, accurate, high-quality, reliable, easy-to-use test to diagnose TB. Though a FIND-study reports a global market size in excess of $ 1 Billion, a quick estimate by a McKinsey & Co. consultant indicates that the size of the addressable market is $75-100 million. Any test developed has to displace the 1.5 million serological tests of doubtful utility conducted by the private sector in India.

Given the size of the market, this may not be attractive for a large diagnostic company. But wouldn’t this be a great learning opportunity for India? Can’t we put our biotechnology, pharma, statistics, and instrumentation students to work on creating alternate TB diagnostics? The spin-offs in terms of experience, learning and creation of expertise would far out-strip the costs involved.

A problem is that we don’t have the organizational and institutional structures or programmes that could make this happen. Nor are our national implementation programmes geared up to provide support to such development. Even if we were to come up with such a diagnostic, we don’t have a public procurement policy that would rapidly diffuse it across the country. And even before that, a big challenge is to follow the rigour and discipline needed to test and validate the diagnostic. We desperately need to build these capabilities if we are to graduate to a higher level of innovation in the biopharma sector. (The usual barriers to innovation exist as well – see my presentation at the conference at https://docs.google.com/viewer?a=v&pid=explorer&chrome=true&srcid=0B_JQN9Y6fQRsNTZmMDBjMjktMmVmOC00NWJjLTllN2YtODVkYjRhZDNiODNk&hl=en_US )

The good news is that we have a growing set of highly capable entrepreneurs in this area. Speaking to some of them at the TB Diagnostics conference, I realized that they are raring to go. Particularly impressive were Dhananjaya Dendukuri of Achira Labs, Anu Acharya of Ocimum and Ravi Kumar of Xcyton Diagnostics. Can we provide the support required to let them flower and bloom?

Focus on Innovation: What it means for CIOs

With Indian companies enhancing their focus on innovation, CIOs face new challenges in supporting innovation initiatives. In this article specially written for CTO Forum, I have outlined what CIOs need to do....

FJ2SI video on Youtube

Here's a short video on how India can move From Jugaad to Systematic Innovation....

Going Beyond Jugaad: article in Outlook Business magazine

Happy to share with you an article that I wrote for the 5th Anniversary issue of Outlook Business magazine.

In this article, I have argued that while Jugaad may be a good starting point, Indian companies need to go beyond Jugaad if India is to build strong innovation capabilities.


Look forward to comments and feedback.

Two Manifestos on Innovation: Great Ideas, but who will bell the cat?

Inclusive growth and similar slogans are not just the preserve of the Indian government. The innovation community, or at least some influential parts of it, is asserting the importance of focusing innovation efforts on the problems that matter such as poverty, health, nutrition and shelter.


“Innovation, Sustainability, Development: A New Manifesto” (ISD) is the title of a thoughtful document emerging from the joint efforts of two institutions with strong credentials – the Institute of Development Studies (IDS) at Sussex, and the Science Policy Research Unit (SPRU) at the University of Sussex. IDS has produced excellent work in the past on core development issues such as irrigation and corruption. SPRU is the arguably the world’s pre-eminent think-tank on Science Policy and Innovation.

At the heart of ISD’s manifesto is the fact that modern science and technology may have great achievements to its credit, but millions of people are poor and malnourished and suffer from myriad health problems. Obviously, there is something wrong with the priorities of innovation if the most talented innovators focus their attention on the next iPod or iPad rather than solving these humanitarian problems. The trajectory of innovation is controlled by commercial interests (read “large corporations”) rather than the interests of people. The ISD manifesto calls for a change in Direction, Diversity and Distribution of Innovation-related activities. Diversity refers to the need for experimentation with a portfolio of options, and using the local knowledge of people rather than depending on centralized, top-down solutions. Above all, the ISD manifesto calls for a change in the politics of innovation – who makes decisions, when and where.

The ISD manifesto is available at http://anewmanifesto.org/wp-content/uploads/steps-manifesto_small-file.pdf

“Knowedge Swaraj: An Indian Manifesto on Science & Technology” (KS) is the outcome of the work of two Indian groups – Knowledge in Civil Society (KICS) and the Centre for Knowledge, Culture and Innovation Studies at the University of Hyderabad. KS builds on a strong Indian tradition of decentralized innovation in the Gandhian movement, and the efforts of movements such as the KSSP and PPST in recent decades, to argue that knowledge needs to be more participative and democratic, community knowledge is valuable, and that the public should be involved in important strategic choices regarding science and technology. The focus is again on inclusiveness and changing the politics of innovation decision-making.

The KS manifesto is available at http://kicsforum.net/kics/kicsmatters/Knowledge-swaraj-an-Indian-S&T-manifesto.pdf

Both ISD and KS emphasise the importance of these cultural and political changes in any effort to avert an ecological disaster. They imply that centralised technology decisions driven primarily by commercial interests and ignoring people are likely to result in even bigger ecological disasters than what we have seen so far.

It’s interesting to note that there is a certain coalescence between how very diverse groups are thinking. Even management gurus are moving in a similar direction. After the original “Bottom of the Pyramid” (BoP) formulation was criticized for seeing the poor as consumers rather than full participants in the development process, we now have BoP co-founder Stuart Hart advocating BoP 2.0 – a BoP innovation process which is socially embedded and evolves ground-up. Vijay Govindarajan, who was only a short time ago Professor-in-Residence and adviser to GE CEO Jeff Immelt, is now running contests for low-cost housing solutions. Innovation for the poor is certainly in fashion!

The other major movement that has embraced innovation for social needs is Social Entrepreneurship. From almost nowhere, this has become a buzzword of current discourse. Of course, its focus on scale, and the possibility of combining doing good and doing well would seem to come in conflict with the ideas of diversity and distribution in the ISD manifesto, but the idea of social entrepreneurship has certainly attracted youth all over the world.

The main problem with both the ISD and KS manifestos is the absence of a pathway to achieve their noble goals. The ISD manifesto at least discusses this issue, but the Strategic Innovation Fora and Global Innovation Council it proposes seem to be mired in the same straitjacketing that ails current political systems. Current “democratic” political systems in many countries have been captured by powerful interests and the legitimacy of movements outside these systems is questioned by the people who have captured these systems (witness the way in which the Indian political class has closed ranks against the civil society organizations in the matter of the Lok Pal bill).

Frankly, I can’t see how either of these manifestos will make much headway without a revolution, or at least an attempt at one. To bring these on to the agenda, we need new equivalents of the Greens parties in Europe. If the politics of innovation is to change, innovation will have to become a subject of politics.

In Praise of the Indian PhD

In a recent column in Eductech magazine, I pointed out that we have some outstanding scholars and thinkers who did their PhDs in India. Is it possible that our doctoral programs permit an independence of thinking that is not possible in more structured systems? Check out this link to find out more...

What I learnt at the EIRMA conference

I had the privilege of speaking at the Annual Conference of the European Industrial Research Management Association (EIRMA) held at Cannes last week (May 26-27, 2011). EIRMA (http://www.eirma.org/) is a forum for heads of R&D of about 120 leading companies in Europe to share ideas and best practices on the management of research and development in a corporate context. EIRMA was founded in 1966 and has been a vibrant arena for debating the changing role of corporate R&D.


EIRMA prides itself on providing a good environment for networking and informal exchanges. This year’s conference maintained that tradition, but there were several good “formal” talks as well.

I found Stephen Aguilar-Millan of the European Futures Observatory the most interesting, probably because he was the most provocative. He believes the next industry/technology wave will be focused on scarcity and sustainability. The last wave, information and communication technology is now mature, and we shouldn’t expect to see that as the locus of innovation for long (a sober thought for the Indian IT industry!). According to Stephen, there is no inevitability about China becoming the world’s largest economy – trouble on the west, negative demographics, raw material shortages, and high inflation could derail the China growth story.

Dorothea Seabode of Philips made an impassioned plea for sustainability-driven innovation. She drew on the WWF Living Planet report and the WBCSD Vision 2050 to make a strong case for such a push. I was impressed by the level of integration of sustainability into the Philips corporate agenda. Starting as a part of the Management Agenda, it is today very much a part of the company’s operational framework. For example, their EcoVision 5 sets a target of improving energy efficiency by 50% by 2015.

Another useful perspective was from Werner Frohling, Chief Intellectual Property Counsel for Volvo. He gave an excellent summary of the evolution of the intellectual property system in Europe, and identified today’s key challenges – 1. The Chinese Patent Tsunami – a huge growth in patenting by local inventors in China in Mandarin. These patents will constitute prior art in all patent domains in the future, and companies that don’t keep track may come up against barriers to IP protection even in their own home markets! 2. A clear mismatch between the high growth fields of business such as services and the areas of patentability that are more oriented to a product-dominated world. 3. The shortening life cycle of products, but long lead times for patent grants leading to another mismatch between innovation and protection.

A few interesting statistics from the talk by the Head of Centro Richerche Fiat: automobile design and development lead times have come down from 48 months to just 15-18 months; in 2010, a car typically had 15,000+ parts, and its average price per Kg was comparable to that of a hamburger; Fiat has a huge open innovation network, and works with as many as 400 university partners. He made the counter-intuitive point that the use of electric cars in China may make the environment worse rather than better because of the poor environmental performance of coal-based power plants in that country (according to his data, the same would be true in India as well!).

The talk by Matthias Kaiserwerth, head of IBM Research’s Zurich Lab raised interesting questions about whether machine intelligence could soon surpass human intelligence and thus change the innovation landscape altogether. He referred to the rapid improvement of robots – IBM’s Watson can even play a complex game like Jeopardy successfully. Machine intelligence is no longer based on programming, but is today driven by learning.

We visited the Sophia Antipolis Science Park, one of the oldest (proposed in 1960) and most successful in Europe. I was impressed by its ability to keep some core principles (easy access; low-profile architecture that merges with the environs) invariant while changing on others (some land is now being used for different purposes such as shopping and low-tech employment so as to meet the needs of the larger community). The founder and visionary of the park was a French senator!

As you will notice, the activities at EIRMA had a lot of variety and food for thought. It would be useful to have a similar organization in India, but with a broader scope of innovation management rather than R&D management!