Pharmaceutical, Medical Innovation

AFP/NICOLAS ASFOURI

In this file photo taken on April 29, 2020, an engineer looks at monkey kidney cells as he makes a test on an experimental vaccine for the COVID-19 coronavirus inside the Cells Culture Room laboratory at the Sinovac Biotech facilities in Beijing. - Sinovac Biotech is conducting one of the five clinical trials of potential vaccines that have been authorised in China.

The world is in a state of chaos these days due to the Covid-19 pandemic. It can be said that not a single country has escaped it, and all are fighting against this invisible enemy called the coronavirus.

But unfortunately, the actions of each country seem to not be well orchestrated. The World Health Organization (WHO) also seems uncertain. For example, there are doubts about what China, the first country affected by the outbreak, has disclosed in termse of data and information. Countries are competing over medical devices such as masks and gloves, and especially ventilators, because everyone needs the equipment while supply is limited. There is even competition among states in the United States. And there are still many other problems.

Also read : Post-Coronavirus Awakening

What the world has done relatively uniformly is to restrict social interaction. This is certainly a positive, because the measure plays a major role in breaking the chain of the virus’ transmission. Moreover, many countries have made a variety of efforts to develop vaccines and find medicines for Covid-19. According to the latest news, six countries have so far trialed Covid-19 vaccines in humans: the US, China, Russia, the UK, Germany, and Australia. We get the impression that this is a race to lead in vaccine development. All these efforts are certainly good or the sake of humanity. However, we must also remember that it takes a long time to reach any promising results.

What about Indonesia?

The Covid-19 outbreak has been occurring in this country for two and a half months, starting from the announcement of the first two cases in early March. However, as has happened in other countries, our healthcare system has been overwhelmed. A bitter reality has come to light amidst the commotion because there are no weapons for fighting this war.

The outbreak has opened our eyes to the fact that Indonesia imports most of its medical supplies and raw materials for producing medicines (more than 90 percent). This means that our pharmaceutical and medical equipment industries are highly dependent on foreign countries. Reportedly, this has been occurring for a long time and has been a concern for certain people. However, because this has emerged while we have an urgent need for pharmaceuticals and medical equipment, it has opened our eyes wide and suddenly. This bitter reality has emerged when all our attention is focused on competing with and even fighting other countries to procure medicines and medical equipment.

Also read : Post-Covid-19 Indonesia

This is very disturbing, of course, because the high dependence of our pharmaceutical and medical equipment industries on foreign countries shows that our health security is fragile. It appears that we do not have sovereignty in health.

It should be noted that around 94 percent of our medical equipment in 2019 were imported at a value of around Rp 26 trillion. Most of the imported equipment is high-tech, such as infusion pumps and ventilators, high-flow oxygen devices, digital and portable surgical equipment, electronic health equipment, and reagents and laboratory equipment.

Meanwhile, our pharmaceutical industry procured 95 percent of its raw materials from abroad. Most were imported from China (60 percent) and India (30 percent). The combined import value of pharmaceutical raw materials reached US$2.7 billion last year, or more than Rp 40 trillion.

Also read : Coronavirus and Economic Resilience

Although Indonesia also exports medicines and medical equipment, their value and variety are less competitive than imports. Some of the medicines and medical equipment we export also use raw materials from abroad. We are mere seamstresses and assemblers here. This means that value-added is enjoyed abroad.

The question is, is there an opportunity for us to significantly reduce our imports of pharmaceutical materials and medical equipment?

Kompas/AGUS SUSANTO

Health worker wear personal protective equipment (PPE) in the Covid-19 rapid test at a community health center (Puskesmas) Duren Sawit Sub-district, East Jakarta, Tuesday (28/4/2020). Large-scale social restrictions or PSBB in DKI Jakarta are considered to have a positive impact.

It turns out that the answer is quite encouraging. This outbreak has also opened our eyes to the potential of local industry and innovation in producing the same drugs and medical devices that have been imported. This is a blessing in disguise.

When the Covid-19 outbreak emerged in Indonesia, the Research and Technology Ministry/National Research and Innovation Agency (BRIN) formed a consortium of non-ministerial government agencies (LPNK) under its coordination. The consortium includes the Indonesian Institute of Sciences (LIPI), the Agency for the Assessment and Application of Technology (BPPT), the National Nuclear Energy Agency (Batan), the National Institute of Aeronautics and Space (Lapan), and the Eijkman Institute for Molecular Biology, as well as universities, hospitals, SOEs, and private companies. Its aim is to assist the national Covid-19 task force established by the government in tackling this outbreak.

The consortium supports the task force on three general fronts: First, assist the Health Ministry in polymerase chain reaction (PCR) testing, also called swab testing. This is crucial because it its highly accurate in determining whether a person is infected with Covid-19 or not. The Eijkman Institute and LIPI have key roles in this.

Also read : Coronavirus Triangle

Second, we are developing medical device prototypes. Aside from producing personal protective equipment (PPE), the consortium has also demonstrated an ability to produce portable ventilators and test kits in just 1.5 months. The capacity to innovate has existed for a long time, but did not receive attention until the outbreak occurred.

For example, the Bandung Institute of Technology (ITB) and University of Indonesia (UI) have been able to make ventilators; and likewise the BPPT. The three prototypes are being tested by the Health Ministry\'s Health Facilities Testing Center. If they pass, PT LEN and a private company are ready to produce the BPPT ventilators at a capacity of 200 ventilators per week. The latest news is encouraging: four innovations have passed the Health Ministry’s medical device tests and clinical trials. This certainly is very meaningful at a critical time like now.

Meanwhile, two types of Covid-19 test kits are ready for production. A team consisting of the BPPT, Bio Farma, and a start-up company is ready to start producing up to 50,000 polymerase chain reaction (PCR) test kits per week. Its advantage over imported kits is that these PCR test kits were developed from a local virus strain. Meanwhile, a team consisting of the BPPT, Gadjah Mada University (UGM), and one private company started producing around 100,000 rapid test kits in early May 2020 to support the widespread testing that is badly needed in Covid-19 prevention and control.

Also read : Winning Against Covid-19

Kompas/Bahana Patria Gupta

Simple and Low Cost Prototype Mechanical Ventilator made by the Sepuluh November Technology Institute at the ITS Robotics Building, Surabaya, East Java, Tuesday (7/4/2020).

To summarize, PCR test kits, non-PCR diagnostic test kits, ventilators, and biosafety level (BSL) 2mobile laboratories are all under development for mass production in the near future.

Third are innovations related to treating Covid-19. The consortium is working develop vaccines, serums, supplements, and Covid-19 drugs. It takes time to develop a vaccine, but we must continue to pursue this to our utmost as a nation. Even if other countries develop one first, we must still be able to produce our own vaccine prototypes. In the end, we must be able to produce vaccines ourselves to meet the needs of hundreds of millions of Indonesians.

In order to reduce deaths from Covid-19, the Eijkman Institute, in collaboration with the Indonesian Red Cross (PMI), plans to extract convalescent plasma from recovered patients and give it to patients with severe infections. It is expected that the antibodies from recovered patients can help sick patients fight the virus. This can be done immediately once the standard operational procedure (SOP) and the national protocols are ready. Eijkman has also begun research on designing candidate antigens for vaccine development. As for the serum, we can produce it ourselves once we have obtained a viral isolate (a culture of the isolated virus).

With regard to supplements and drugs, the consortium is testing various drugs made from domestically available ingredients. These include quinine and other herbal and medicinal plants that are widely found in this country, such as red ginger, sambiloto (green chireta) and other empon-empon (medicinal herbs).

KOMPAS/RIZA FATHONI

A researcher works at the Eijkman Institute for Molecular Biology after the inauguration of the facility on Thursday (26/4/2018). The center is equipped with the latest genetic sequence devices, which makes Indonesia an international-level laboratory. The center focuses on the research to identify infectious and genetic diseases, develop diagnostic test devices and study new medicines or vaccines for infection.

Momentum for strengthening the industry

From these various efforts coordinated by the Research and Technology Ministry/BRIN, it has been discovered that this country possesses the ability to produce medical devices and pharmaceutical raw materials. Local innovations have very promising potential. Therefore, the momentum from the hard work done to overcome this outbreak should also be used to strengthen the domestic industry, especially in medical equipment and medicines. This is a big opportunity for us to reduce imports and replace them with domestic products.

Of course, what the Research and Technology Ministry/BRIN and the abovementioned institutions have produced are still prototypes of medical devices and medicines. The involvement of business and industry is needed for production on a large scale. No less important for these innovations is badly needed downstream support from regulators and end-users, namely ministries and related institutions.

The path has been carved by forming the consortium, which also includes state-owned enterprises and the private sector. If the consortium’s efforts are proven effective in supporting Covid-19 prevention and control, support for strengthening the domestic industry will surely flow profusely from various parties. Thus, these various local innovations can head towards mass production.

KOMPAS/BNPB

Bambang PS Brodjonegoro

Wise people say that there is wisdom in failure. Opportunities arise from problems. The Covid-19 outbreak has opened an opportunity for us to seize the chance to become more independent in our need for medicines and medical equipment. This is not about just reducing imports to maintain our foreign exchange, and offers something more crucial: to reduce the high dependence of our health sector on foreign countries, to develop health security and to encourage domestic innovations in health and medicine.

Bambang P.S. Brodjonegoro, Research and Technology Minister, Chairman of the National Research and Innovation Agency.