Can India leverage data to conquer cancer?
Add this to Indias strength of a large number of well-characterised and annotated cancer tissue samples, and exceptional clinical and scientific professionals hungry to solve pressing issues. India can not only compete, but also surpass developing economies in detecting and curing diseases such as cancer. In the game of skills and scale, India will win, but we need to start today for that to happen. Large genome-sequencing projects in developed economies, like the US, have been expensive. The largest share of the money in these projects is spent on expensive chemicals, instruments and salaries for expert scientific manpower. India needs to do what it did with mobile telephones by leapfrogging from 2G to 4G and bypassing, largely, the 3G network. Similarly, developing inexpensive sequencing instruments and producing reagents indigenously will push the pricing of whole-genome sequencing from nearly a lakh per sample pair to 5,000-10,000. A couple of years ago, no one could think of using RT-PCR instruments in hospitals in small towns and at the district level. Covid-19 changed that. Similarly, suppose we can push the burden of early detection to district-level hospitals. The burden on specialised tertiary cancer hospitals can then be reduced and they can focus on cases requiring expert advice from clinical cancer specialists. Once the genome sequence information is available, it will push the challenge from the experimental clinical labs to data science labs. The petabytes of data generated from such large genome sequencing experiments, along with well-annotated clinical information and longitudinal follow-up data, will make India compete in the space of genomic data science more effectively. Indias information technology and data science strength will help crunch this data to identify markers for early diagnosis and treatment follow-up. This will aid precision medicine at district-level hospitals for the early detection of cancer. We can do that by sequencing 15,000 to 20,000 tumour tissues representing the top five cancers in India. Large cancer genomics projects are designed to understand the genetic make-up of individual patients cancer tissues by cataloguing all genetic changes and, therefore, help us identify the disease early by using those as markers. Let us suppose India can turn cancer from a medical problem to a data problem at the discovery stage. In that case, it can leverage the power of information and data science to conquer cancer. This is not to suggest lessening the efforts on the clinical management and treatment of the disease, but to leverage data by pushing a large chunk of Indias public exchequers funding towards detecting cancer early rather than treating patients with late-stage disease. Cancer is primarily a genetic disease, and the vast majority of the cases in India are preventable as these are linked to a single risk factor  tobacco. Therefore, grassroots awareness drives and educational programmes, along with aggressive regulation on selling and distributing tobacco products, will bring the cases down significantly. However, implementing any solution in a democratic, large, and heterogeneous county like India is complex. Even after rigorous implementation, thousands of cases will need better diagnosis, prognosis, and treatment. Going by the numbers alone, it does not look good for India. However, numbers only tell part of the story, as I shall describe with one example, in developing innovative solutions to conquer cancer. Out of the total R&D expenditure in India, nearly 70% is in the private sector, and space and defence. To be more specific, the total budget of the governments three flagship departments (science and technology, biotechnology, and scientific and industrial research) is around 14,700 crore or approximately $2 billion for 2021-22. Altogether, it is 25 times less than what NIH plans to spend in the coming year. Comparing science funding between the United States (US) and India is a non-starter. Indias gross expenditure on research and development (R&D) is roughly 1.25 lakh crore or less than $20 billion, and accounts for 0.65% of its Gross Domestic Product. This covers all the fields and is less than 40% of the proposed budget of the US NIH that looks at health alone. I am going to argue that India can, and will. While doing this, I acknowledge that much of Indias promise lies on paper, and we need to act fast to realise our true potential. Let us start with the basics. The announcement, welcomed by the scientific community, includes the formation of a quasi-independent entity called the Advanced Research Projects Agency-Health (ARPA-H) with a planned $6.5 billion investment. The idea is to make innovation in treating deadly diseases such as cancer by funding out-of-the-box transformational ideas with little or no administrative processes and peer review. A recent announcement by the Joe Biden administration to boost science funding has been widely noticed, including in India. The National Institutes of Health (NIH), the largest biomedical funder globally, is one of the biggest beneficiaries of the announcement with a planned budget of a whopping $51 billion that dwarfs the scale of any biomedical science-related funding elsewhere. A recent announcement by the Joe Biden administration to boost science funding has been widely noticed, including in India. The National Institutes of Health (NIH), the largest biomedical funder globally, is one of the biggest beneficiaries of the announcement with a planned budget of a whopping $51 billion that dwarfs the scale of any biomedical science-related funding elsewhere. The announcement, welcomed by the scientific community, includes the formation of a quasi-independent entity called the Advanced Research Projects Agency-Health (ARPA-H) with a planned $6.5 billion investment. The idea is to make innovation in treating deadly diseases such as cancer by funding out-of-the-box transformational ideas with little or no administrative processes and peer review. I am going to argue that India can, and will. While doing this, I acknowledge that much of Indias promise lies on paper, and we need to act fast to realise our true potential. Let us start with the basics. Comparing science funding between the United States (US) and India is a non-starter. Indias gross expenditure on research and development (R&D) is roughly 1.25 lakh crore or less than $20 billion, and accounts for 0.65% of its Gross Domestic Product. This covers all the fields and is less than 40% of the proposed budget of the US NIH that looks at health alone. Out of the total R&D expenditure in India, nearly 70% is in the private sector, and space and defence. To be more specific, the total budget of the governments three flagship departments (science and technology, biotechnology, and scientific and industrial research) is around 14,700 crore or approximately $2 billion for 2021-22. Altogether, it is 25 times less than what NIH plans to spend in the coming year. Going by the numbers alone, it does not look good for India. However, numbers only tell part of the story, as I shall describe with one example, in developing innovative solutions to conquer cancer. Also Read | US Covid deaths at 600,000 equal to 2019 cancer toll in America  Cancer is primarily a genetic disease, and the vast majority of the cases in India are preventable as these are linked to a single risk factor  tobacco. Therefore, grassroots awareness drives and educational programmes, along with aggressive regulation on selling and distributing tobacco products, will bring the cases down significantly. However, implementing any solution in a democratic, large, and heterogeneous county like India is complex. Even after rigorous implementation, thousands of cases will need better diagnosis, prognosis, and treatment. Let us suppose India can turn cancer from a medical problem to a data problem at the discovery stage. In that case, it can leverage the power of information and data science to conquer cancer. This is not to suggest lessening the efforts on the clinical management and treatment of the disease, but to leverage data by pushing a large chunk of Indias public exchequers funding towards detecting cancer early rather than treating patients with late-stage disease. We can do that by sequencing 15,000 to 20,000 tumour tissues representing the top five cancers in India. Large cancer genomics projects are designed to understand the genetic make-up of individual patients cancer tissues by cataloguing all genetic changes and, therefore, help us identify the disease early by using those as markers. Once the genome sequence information is available, it will push the challenge from the experimental clinical labs to data science labs. The petabytes of data generated from such large genome sequencing experiments, along with well-annotated clinical information and longitudinal follow-up data, will make India compete in the space of genomic data science more effectively. Indias information technology and data science strength will help crunch this data to identify markers for early diagnosis and treatment follow-up. This will aid precision medicine at district-level hospitals for the early detection of cancer. A couple of years ago, no one could think of using RT-PCR instruments in hospitals in small towns and at the district level. Covid-19 changed that. Similarly, suppose we can push the burden of early detection to district-level hospitals. The burden on specialised tertiary cancer hospitals can then be reduced and they can focus on cases requiring expert advice from clinical cancer specialists. Also Read | Google CEO Sundar Pichai announces 113 crore Covid grant for India  Large genome-sequencing projects in developed economies, like the US, have been expensive. The largest share of the money in these projects is spent on expensive chemicals, instruments and salaries for expert scientific manpower. India needs to do what it did with mobile telephones by leapfrogging from 2G to 4G and bypassing, largely, the 3G network. Similarly, developing inexpensive sequencing instruments and producing reagents indigenously will push the pricing of whole-genome sequencing from nearly a lakh per sample pair to 5,000-10,000. Add this to Indias strength of a large number of well-characterised and annotated cancer tissue samples, and exceptional clinical and scientific professionals hungry to solve pressing issues. India can not only compete, but also surpass developing economies in detecting and curing diseases such as cancer. In the game of skills and scale, India will win, but we need to start today for that to happen. Binay Panda is a genome scientist and professor, Biotechnology and Systems Medicine, Jawaharlal Nehru University, New Delhi. The views expressed are personal