As the novel coronavirus started to make its way through India in 2020, Anu Acharya, chief executive of Mapmygenome, a genome sequencing start-up in Hyderabad in southern India, had a proposal for her clients: a Covid-19 risk and immunity report.

Based on their genes, the report would tell them how likely they were to get the virus, how severe it would be and what amount of helpful vitamins to take if they wanted to boost their immune systems.

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“One thing everyone is trying to understand is why is Covid-19 affecting some people more than others,” says Ms Acharya. “A lot can be explained by your genetics as well as what you’ve done to mitigate risks.”

Genetic vs environmental factors 

The complex interplay between human and pathogen genomes plays a massive role in whether outbreaks become pandemics, and many companies around the world are trying to understand that interplay with Sars-Cov-2 — the virus behind Covid-19.

India has stood out because despite having the second highest number of infections in the world — with the number of cases having crossed 10.65 million and 153,000 deaths in a country of 1.35 billion with a stressed healthcare system — the pandemic has not been as severe as was initially feared. It is currently reporting under 20,000 new cases per day.

However, it is clear that the extent of the pandemic in India is not really known. In a research paper that Ms Acharya co-authored, researchers surveilled for Covid-19 infection in the southern state of Karnataka in both rural and urban areas between June 15 and August 29. Using RT-PCR genetic testing, they found that approximately 31.5 million residents of the state had been infected — 96.4 times the publicly reported 327,076 cases as of August 29, suggesting that the epidemic was growing rapidly during August.

“Our findings provide new evidence that the Covid-19 epidemic in India has affected rural areas almost as severely as urban areas,” the authors wrote.

Such real-time RT-PCR tests have not been the standard of care in most parts of the world, although Covid-19 has “shifted the timeline by  five to 10 years”, says Sumit Jamuar, chief executive of Global Gene Corp, a genome sequencing firm based in Mumbai, which has its R&D labs there as well as in Cambridge in the UK. 

For instance, the first clinical case of Covid-19 was identified in December 2019; the first genome was sequenced in January 2020 and the first vaccine trial started shortly after in February. The first vaccine was approved in record time in December 2020. The speed of that development is even more stark when compared to the path of the Ebola virus. The world had its first clinical case in 1976, its first genome was sequenced in 1993, its vaccines went on trial in 2003 and 2015, and a vaccine was finally approved in 2019.

“If I knew what risks you had, I can ward off some of those risks,” says Mr Jamuar. “That’s the paradigm that we’re moving toward, fundamentally.”

Research bias

While those links may already have been established for some diseases in the West, that information is based on a data pool where about 78 per cent of the genes are of a white, European ancestry. India, which makes up 20 per cent of the world’s population (and that includes 4500 of the world’s 10,000 ethnic groups), contributes barely 2% of the genomic data, says Mr Jamuar. His firm is trying to fill that gap and is working with some hospitals and labs in the country to collect data from volunteers to study their DNA for both rare and common genetic disorders to ultimately make drugs to treat them. 

“The opportunity in genomic and life sciences is like the IT opportunity” at the turn of the century in 1999 in India, which saw several IT services firms leap to the global stage, he says.  

Vedam Ramprasad, chief executive of MedGenome, a genomics and clinical data-driven diagnostics and drug discovery research firm in Bangalore, says genome sequencing around Covid-19 is just the tip of the iceberg of the opportunity in India.

The company has traditionally been working to develop diagnosis of rare diseases for reproductive tests including the non-invasive prenatal testing as well as in oncology to ascertain whether patients will respond to certain drugs. 

In 2020, it made a foray into infectious disease, testing for infections of the eye, brain (meningitis and encephalitis) and bloodstream — efforts that got a boost with Covid-19. By July, the company had realised that India needed its own products to tackle pandemics instead of just depending on imports. It took the company a month to design and complete internal validations for a strip-based antibody testing kit. MedGenome, which has raised about $130m so far, is now awaiting government approval to be able to launch the product in market.

“The opportunity is huge,” says Mr Ramprasad adding that their kit can be easily modified to test for other viral pathogens.

MedGenome is also tackling other problems in this part of the world, including coming up with a risk score to analyse whether a person is prone to heart attacks — South Asians are at four times the risk of that than Caucasians, says Mr Ramprasad — and it also has developed a proprietary test to carry out surveillance of tuberculosis (TB). This covers where infection is coming from, how is it traveling and what drugs it might be resistant to. All this information has helped drive down costs, and time, for treating TB, he says. 

“Market opportunity is important,” says Mr Ramprasad. And while the past year has more than provided it, the government can really give that a bigger boost if it can help create the ecosystem, like it did to test for Covid-19 he says.