THE Department of Health Research (DHR), a wing of the Ministry of Health and Family Welfare, has proposed a national health research policy. The department has been in existence for almost two decades, but it has woken up only now to the fact that India lacks a dedicated policy on health research.
As per the R&D data released in July, the Indian Council of Medical Research (ICMR), the flagship agency for health research in the country, receives just 3.3% of the national R&D funding, while defence and space get 32% and 15%, respectively. India’s expenditure on R&D itself is abysmally low — 0.84% of GDP compared to China’s 2.58%.
Among the obvious goals of the new health research policy is to increase the expenditure on biomedical and health R&D. The target is to increase health research investment as a share of GDP from the current 0.024% to 0.072% by 2037 and 0.15% by 2047. While it may appear to be a big jump, it is far too low compared to India’s current and projected disease burden as well as emerging health challenges. Moreover, the timelines for the proposed increase are too far away, targets are non-binding and without any budgetary support in the pipeline.
How the proposed increase will be achieved is more problematic. The policy says, “Public investment shall rise progressively, complemented by responsible private, philanthropic and non-governmental investment.” This formally opens the doors for private investment in health research.
The nature of private investment that the government wants to encourage should cause greater concern. The policy says that Corporate Social Responsibility (CSR) money from private companies will be allowed to be used for R&D projects in public institutions, and the DHR will formulate necessary policies to facilitate such funding.
The approach is different from existing public-private partnerships for drug or vaccine development involving pharma companies and public institutions under specific projects such as the development of Covid-19 vaccines. If CSR funds are allowed from any company — be it pharma or otherwise — or a philanthropic organisation promoted by a company, it may lead to biased research or a hidden agenda like manufacturing “scientific doubt” in contentious topics like environmental health (impacts of air pollution, tobacco, alcohol), occupational health, food safety and climate change.
It is ironic that on the one hand, the government has stifled field research studies by some of the leading health NGOs and public health institutes in the name of foreign contribution regulations, and on the other hand, it is opening the doors for the industry and also foreign foundations to conduct health research. For domestic researchers, scientific collaboration with foreign researchers would still need a permit from a screening committee of the health ministry.
The whole approach seems to be to centralise and bureaucratise health research at all levels. The policy talks of a National Health Research Agenda that will set the priorities at the macro level and a three-tier governance architecture to implement the agenda. At the top would be the National Health Research Stewardship Committee to provide overarching strategic direction. It will be headed by the Principal Scientific Adviser and include several bureaucrats (secretaries of scientific departments) as members. At the second tier will be the DHR, acting as the central nodal implementing agency, and the third tier would be the ICMR, tasked with scientific and technical execution.
The proposed governance system undermines the role of states, ignoring the fact that public health is primarily a State subject and ‘Medical Education and Research’ is in the Concurrent list of the Constitution. By authorising the central stewardship committee to set the health research agenda, states will be reduced to mere implementers. “States and Union Territories will support alignment with local health needs and translation into programmes, service delivery and public health action,” the policy says.
The policy marks another important shift — allowing Ayurveda and other systems of medicine to get access to the research kitty meant for modern medicine in the guise of promoting “integrative health”. This is despite such systems having dedicated research funding from the Ayush Ministry and mechanisms operated by it. This is bound to give rise to “validation science”, wherein traditional remedies like cow urine could be subjected to modern research so that they could be “scientifically validated.” This is already happening through projects funded by other research agencies like the Department of Science and Technology.
India is not only a geographically and culturally diverse country but also has myriad health needs as well as disparities in access to health systems. Health indicators and challenges of Kerala, for example, are completely different from those of Bihar or Odisha. Instead of making states implement a “top-down” agenda, states should be guided and helped to build and develop their own health research infrastructure based on their priorities and needs.
Health research is not just about testing new technologies or developing new vaccines and drugs. Its outcomes are supposed to guide health policies and budgets. Much of it is about ways to improve the functioning of health systems and healthcare delivery to achieve better outcomes. Health research is a continuous and dynamic process, closely linked with social and economic factors. For instance, health problems of many marginalised groups and communities like urban poor and tribal people are often understudied. A large number of medical colleges have been opened in recent years. They need to be oriented to conduct research on health topics in their respective regions.
The idea of developing a dedicated health research policy addresses a long-felt need. However, the direction the policy is seeking to take — a centralised approach to developing a research agenda, giving the private sector a prominent role and integration of traditional medicine in the modern health research agenda — is rather unhealthy.