“Creation of National Blood Authority can address many challenges”

Founded to help diagnose and prevent diseases by bringing appropriate technologies into India, Bengaluru based Hemogenomics has been primarily focusing on the safety in blood transfusions, including preventing the spread of HIV and Hepatitis through infected blood.

In an exclusive interaction with the BioVoice, Mr Sumit Bagaria, Managing Director and CEO of Hemogenomics shared details about his organization’s on the ground activities. Mr Bagaria who is also the founder of the Indian Foundation for Safe Blood shared insights on the importance of Individual Donor-Nucleic Acid Testing (ID-NAT), challenges in healthcare settings, need for policy changes and much more.

Which priority activities of Hemogenomics are adding value to the healthcare community? What are your immediate focus areas?

Hemogenomics was born out of a devastating incident that happened in my family. My brother was diagnosed with Hepatitis C, which was traced back to blood transfusion following a road mishap. While on a trip to the USA for his treatment, I learnt about the existence of a highly sensitive blood screening technique called Individual Donor-Nucleic Acid Testing (ID-NAT) which could have prevented this infection. I realized the kind of impact this technique could make in the Indian blood banking sector, which was still relying on conventional techniques for blood screening.

For the past 17 years, Hemogenomics has focussed on blood screening for deadly Transfusion Transmitted Infections (TTIs) – HIV, Hepatitis B and Hepatitis C. India has more than 3000 licensed blood banks and over 11 million units of blood are collected annually. However, the varying standards of traditional serology-based screening techniques (mostly ELISA and rapid tests) are not sensitive enough to detect early-stage infections.  It is evident from the recent media reports of TTIs in Tamil Nadu and Kerala, that detecting early-stage infections is still a challenge. Our priority is to prevent such infections through ID-NAT-  the most sensitive, commercially available screening technology which has been adopted all over Asia and many parts of the world.

We believe that safe blood is every patient’s right and our immediate focus lies in innovating consolidation testing across the country through centralized ID-NAT screening model. At present, there are over 40 installations across the country, many of which are catering to an additional 50 consolidation sites. Hospitals across major cities like Delhi, Mumbai, Pune, and Guwahati have adopted this model successfully.

How is Hemogenomics making a difference to the lives of the common man?

Blood does not recognize gender, race, religion or economic status. After my brother acquired Hepatitis C, I got to know that Mr Amitabh Bachchan had also contracted Hepatitis B through infected blood. This made me realize that this could happen to anyone, irrespective of economic status.  Apart from causing significant health complications like AIDS in the case of HIV, and Liver Cancer in the case of Hepatitis, TTIs can lead to social stigma, ostracization, and a life-long financial burden. In certain cases, it may also compel the affected person to take extreme steps of ending one’s life.

Based on published data, on an average, ID-NAT detects at least 1 additional infected blood unit in every 1200 units, which test negative by conventional techniques. This estimated 1 /1200 blood units, is termed as a NAT yield. That means, in the absence of ID-NAT, infected blood units can evade even the most stringent screening process and end up in the safe blood inventory.

Till now, we have screened over 4 million blood units with ID-NAT. With an average national NAT yield of 1/1200, we have interdicted more than 3300 infections (NAT yields) which could have been transmitted into innocent patients.  Considering the fact that blood units are further separated into 3 components, we can proudly say that we have saved close to 10,000 lives from getting TTIs. Needless to say, apart from the patients themselves, ID-NAT has positively impacted their families by saving them from trauma and financial burden. The kind of impact that ID-NAT is making to society, gives me an immense sense of pride and achievement.

Hemogenomics tries to make safe blood available to all patients, especially the common man. We have worked hard to make safe blood available across different types of hospitals and blood banks. While corporate hospitals like Medanta, Apollo, Gangaram, Artemis, Fortis Escorts, FMRI, etc. in NCR; KDAH, Hinduja and Reliance H. N. etc. in Mumbai; and many more across India make sure that their patients get the safest blood possible, ID-NAT is also available at Government hospitals like AIIMS Delhi, Jodhpur and Rishikesh, PGI Chandigarh, RML and Armed Forces Transfusion Centre in Delhi, RNT in Udaipur, Sree Chitra Tirunal Institute of Medical Sciences and Technology in Trivandrum, JN Medical College (AMU) in Aligarh, JN Hospital in Bhilai, blood banks under Government of Karnataka, etc. The common man also has access to safe blood at CMC Vellore, Narayana Hrudalaya in Bangalore and R N Tagore Hospital in Kolkata, Amrita Institute of Medical Sciences in Kochi, HIHT in Dehradun, MGM in Jaipur, Marwari Hospital in Guwahati and also through Rotary blood banks in Delhi and Thane, Lifeline Blood Bank in Nagpur and Arpan Blood Bank in Nashik.

Hemogenomics provides free or subsidized NAT kits for Thalassemia patients and those from the economically weaker sections of the society in many places across the country, and our endeavour is that nobody should be denied access to safe blood for lack of money.

Safe blood access is now available across most parts of India to both the old and the young, patients who are delivering babies or those suffering from dengue, multi-transfused patients with Thalassemia, Haemophilia or Cancer, and those undergoing surgery or the ones who have lost blood due to an accident.

Isn’t there a need for more awareness about a technique like NAT (Nucleic Acid Testing) in India? What is being done in this regard?

There is definitely a need for more awareness about NAT. While the developed world mandated NAT in the early 90s, it is still an optional screening test in India.  Hemogenomics introduced ID-NAT in India in 2006. However, in spite of the high prevalence and incidence rate of TTIs, the need for mandating this technique has still not been acknowledged fully.

We have been using a multi-directional approach to create awareness amongst not only Transfusion Medicine practitioners but also the end users like surgeons who often are unaware of the safety standards of the blood being used for transfusion.

Apart from that, we also strive to reach out to the authorities who are responsible for providing adequate funds required for ensuring blood safety. These include people in the Government- both at the center and the state level. Many times, we have seen that people in NACO, NBTC (National Blood Transfusion Council) and the State Blood Transfusion Councils (SBTC) understand the need for NAT. However, it is a challenge to convince policymakers, who realize the gravity of the situation only when they come across media reports about incidents of TTIs. Such incidents also grab the attention of the common man and make them question the standards of blood safety in the country. However, our approach towards creating awareness amongst the common man is calibrated and constructive as we do not want to create fear.

Taking into account the high prevalence and incident rate of TTIs in India, it is absolutely necessary to implement the most sensitive screening technology. The fact that ID-NAT tests every individual blood unit for infection and can effectively detect very low viral load infections makes it a “must have” technique for screening blood. In certain countries where the prevalence of TTIs is very low, a compromised format of NAT is used, where at a time, many blood samples are pooled together and tested as one sample. The pool size may range anywhere between 6 to 96, which results in dilution of low viral load samples, thus compromising the sensitivity. This, in turn, may lead to a TTI. Most countries with a high prevalence of HIV or Hepatitis (like India) have shifted from pooled testing to ID-NAT, in order to maintain higher blood safety standards.

What are the elusive challenges before the healthcare sector in India and possible solutions?

The biggest challenge in the Indian healthcare sector is the inadequacy of healthcare professionals and healthcare facilities, especially in rural and remote locations. This is compounded by the fact that a large population cannot afford even basic healthcare facilities. Low affordability in turn, results in the adoption of technologies at the lowest denominator. The federal nature of our country, where health is a state subject, also causes differences in healthcare facilities and delivery models in the government sector.

I think the new health schemes under Ayushman Bharat and further efforts to strengthen primary healthcare, if executed properly, will be a game changer, in terms of accessibility and affordability.

If we look at blood banking, we have a highly fragmented system with over 3000 blood banks of different sizes, levels of manpower or technology and therefore differences in the quality of the blood issued. In addition to that, we have a deficit of 2-3 million units of blood. Also, we do not have a national level body that can promote regular and repeat voluntary blood donation. Although a PIL in the Supreme Court in 1996 led to significant improvements in the blood banking sector, and currently the mandatory licensing norms have improved the standards significantly, the minimum standards may not be good enough for patients who require safe blood.

Creation of a National Blood Authority, fewer blood banks and adoption of better screening techniques like ID-NAT may address most of the current challenges.

Would you like to share a few positive experiences from your journey so far?

Our journey so far has been challenging, yet incredible. There have been many incidents which have made me believe that the path we took was completely worth it. Way back in 2004, when we were trying to establish the need for NAT in India, with the help of Indraprastha Apollo Hospital, we facilitated an evaluation study. This was in collaboration with 8 major blood banks across the country. Through this study, we gave the Transfusion Medicine fraternity a whole new perspective about the scenario of blood safety in the country. This led to the commencement of the first routine ID-NAT testing in India in 2006, which was a dream come true experience for me after putting efforts for 4 long years.

Our goal has always been to cater to a large section of the society which comprises of people from all economic backgrounds. We saw ourselves one step closer to this goal when AIIMS Delhi started routine ID-NAT testing in 2009. When we were about to install our equipment for the first time at AIIMS, I was asked “Why AIIMS? NAT is for corporate hospitals”, to which my response was that the common man who comes to AIIMS, sometimes from as far as thousands of kilometers away, deserves safe blood as much as the tycoon getting operated in a corporate hospital. AIIMS Delhi started ID-NAT in 2009, and that day, I had tears in my eyes.

Through the years, we have been successful in impacting millions of lives through ID-NAT. But with every new hospital or blood bank that joins us in our journey, I get the same sense of pride and satisfaction. As almost 7% of India’s blood is being tested by ID-NAT, it gives us immense satisfaction to think of the number of lives that we save on an everyday basis. At Hemogenomics, we believe that success is not measured by the annual turnover but by the number of lives impacted!

Also, being invited to be a part of the International Society of Blood Transfusion (ISBT) Working Party for TTIs; being invited as a speaker at AIIMS Delhi, PGI Chandigarh, Bio Korea Seoul; getting awards and accolades from suppliers, associations and organizations – all make you proud and happy.

What are the long term goals of Hemogenomics? Please share your future outlook.

At Hemogenomics, we believe that safe blood should not be limited only to patients who have access to premium hospitals in cities. Safe blood is every patient’s right and our mission is to come up with more innovative models which can cater to smaller blood banks, irrespective of the location.

We were the pioneers of NAT testing in India and going forward, we aim to bring more innovative and patient-centric technologies to serve our country. The thought of introducing NAT in India came from the unfortunate incident that happened in my family. Through the years, I have witnessed close friends and family members who could not survive Cancer as they were not diagnosed at the right time. We wish to venture into the arena of Cancer screening, by identifying appropriate and affordable technologies for early detection.