You are right, Dinesh. India desperately needed this success story. For multiple reasons: patient population at large, entrepreneurs in this field, VCs, and biomed professionals. This company had attracted some of the best MD pathologists from the best teaching hospitals. Imagine the message it'd send - don't take risk, don't try to do something new.

Seema Singh

Thanks, Deepak. You are right, Mitra was the best bet Indian VCs had. My biggest disappointment here is for patients. I know how doctors make stabs in the dark for drug combinations and patients lose out on precious early months. Life sciences is extremely tough to crack. But if you back a good team, it can also be very capital efficient, unlike many internet cos that burn so much capital to build a biz which hardly reaches profitability.

Seema Singh

Ajay, all that you read here doesn't make for a story according to you? :) These are all exclusive details. The reveal (or no reveal) lies in all the questions I ask here. But the most revealing part is the fact the CEO left the company and within a month starts another company to work on the same tech.

Seema Singh

Thanks, Subash. Yes, a well-characterised reference panel provided by ICMR would go a long way in standardising diagnostics development. Even the NEJM paper on the US experience, quoted in the story, recommends that. Much time was lost in the early days because companies did not get samples to optimise their kits. Access to samples is also key in this, which ICMR and NIV have totally undermined in this epidemic.

Seema Singh

Totally, Srikanth. Nobody questions the intent here but the way it's executed, including some of NHA's other requirements, it's hard to understand why they are rushing like this. Looking at some of the plans they have lined up for the next few weeks, it's truly transposing fintech methods on healthcare. Healthcare is not as transactional as fintech. Period. There are so many stakeholders, you can't do without their buy-in. Today I see the Indian Medical Association has sent a 9-page opinion on the NDHM ecosystem. This is what it says in nutshell: "NDHB document published by Government of India, comprises of an ambitious plan to bring a digital ecosystem comprising of digital health network under NATIONAL DIGITAL HEALTH MISSION. We do not favour the content of the NDHB document, its roll out plan and the administrative mechanism. Our opinion is based on the following contentions..." This is the group that should have been convinced first because it's their adoption of the process flow in an EMR/EHR that decides the success of digitisation in any hospital.

Seema Singh

Nikhil, this story is free to read. Anyone can sign up for free and read. Please feel free to share it widely. As for publishing this on any other platform, I'm afraid we don't do that. We'd like people to read The Ken stories only on our platform.

Seema Singh

Adithya, it's not contradictory. It means, relatively speaking, Airtel would not spend too much on migrating 2G users to 4G because it'd still be a big bet whether these users would move to a higher plan (or whether Airtel would be able to sell enough services) with a subsidised 4G smartphone. On the other hand, given the sheer size of this user base, it'd continue to run its 2G network as long as it can. I'm sure they'd have done their math too - what is the tipping point where shutting down 2G and losing out on those users would be offset by 4G users.

Seema Singh

Mahesh, I have no gripe. My job is to report and initiate or contribute to public discourses. To your point on the market share, which a few other readers have incorrectly raised too, Indian vaccine makers don't have a signifiant market share. The global vaccine market in 2020 is about $35-38 billion. Indian vaccine makers, if you add their total vaccine earnings, together gross less than $1.5B in annual revenue. So that's nowhere close to any significant market share. As I have said before, none of these companies sell in any regulated market, most supply to governments or Aid agencies. It's not about aping the rich countries at all. It's about building your base. Think about it- other than Zydus no one has a vaccine candidate of their. It's all US collaboration. Why? As for finding funds, not sure how much VC investment in life "sciences" you follow in India. There's no risk capital available because there's no e-comm or edtech like exit in this sector. It's a slow burn, long gestation sector. There's been a dearth of great startups, but there's been a greater dearth of risk capital for life sciences. I've followed this sector for very long and hence say this with some conviction. Plus, vaccine manufacturing is complex (not like generics).

Seema Singh

Harsh, agreed. These are two separate issues, but yet they are related. All these companies have grown because of plugging into the global Aid supply chain. They've remained small (relative to their age), almost like a cottage industry. If this pandemic can give them some size and scale, it's good for both India and these companies because there's a resurgence in vaccines. Both for preventive and therapeutic use. And who knows what bug will nature throw at us next. What most of these companies produce are generic vaccines, tried & tested but old technology. It's time they upped their game. But for that you need a strong balance sheet. Which is why I published their revenue and profit numbers. There's no reason they should go on the generic drugs path of Indian pharma and only dabble in old technology and patent-expired products. I know for sure that Bharat has a novel Zika vaccine candidate, discovered and patented months before the outbreak in Brazil. The vaccine couldn't move beyond a point because there was no R&D support and ICMR was even suspicious that Bharat worked on a Zika vaccine when there was no outbreak. Innovation doesn't happen in that manner. Anyhow, that was a long answer to why we need to demand transparency and quality but also support industry to move up the value chain.

Seema Singh

Abhijeet, that'd be a tactical and shortsighted approach. To use fiat instead of helping build infrastructure for long term. All Indian vaccine makers put together constitute the biggest suppliers, but to the international aid agencies like WHO, UNICEF and GAVI. They are not the largest sellers in the private market globally. (They just don't have the muscle to build a private market. MNCs dominate that.) The govt has no business to disrupt the supply to these aid agencies which are for regular immunisation programmes. Even if GOI did, they'd only get some capacity. World over, vaccine companies are adding capacity, they are not substituting. Advance purchase orders will help these companies build capacity and infrastructure.

Seema Singh

Well, we are talking a new telco here, not any hypothetical startup. You think a new telco can buy spectrum license, set up all the infra and do this all over again? I don't think so, nor does anyone in the telecom industry or TRAI or DOT for that matter. Let TRAI or TDSAT come and say this is incorrect, and I'll correct it. Till then we'll wait for another telco, or as you say, any startup to do it all over again. Moreover, there's an element of interpretation in my statement. I am surprised why you are failing to see that.

Seema Singh

Pls refer to Point 9.4 in the TTO -- "The Authority is also of the view that there is no need to further restrict the time period of promotional offer from existing stipulation of 90 days. Currently, while the offer period is restricted to 90 days, there is no restriction on the period of benefit to consumers. Regulatory Principles applicable for regular tariff offers are equally applicable to promotional offers as well."

Seema Singh