Hey folks, Kamayani here.
I'll tell you why I'm writing this before I tell you what it's about.
Every issue so far I've asked where India stands against the world in a new industry, and the answer has always been some version of "behind, but catching up."
On Sept 19, we hosted The Next Gene Bioscience Summit in Gurugram, where I spent a day listening to geneticists and doctors, and it's the first industry where I don't think that's the answer.
David Sinclair, the Harvard geneticist and probably the best-known longevity researcher in the world, told the room that this industry is going to be bigger than AI, because once people have food, clothing and shelter, what they want is time. It's an enormous claim but it got me thinking about something more immediate: what does the future of bioscience look like when you build it around India?
In 2009, a geneticist in Hyderabad called Dr Kumaraswamy Thangaraj published a paper on a small deletion in a heart gene that about 4% of people in the Indian subcontinent carry.
It raises the risk of heart failure later in life, it is about 33,000 years old, and it has been found nowhere outside South and Southeast Asia.
Thangaraj was on our stage that day, and the line he used was that the human genome cannot be considered understood until India's genome has been. India has about 4,600 distinct communities, most of which have married within themselves for close to two thousand years, so we carry variants that nobody else does.
The part I found hard to believe is how little of it has been studied. For context, South Asians are a quarter of the world's population and less than 2% of the participants in global genome-wide association studies.
So the dataset that medicine runs on is missing a quarter of the world, and only that quarter can fill it in.
The rest of the world has already started building these datasets.
The UK has 500,000 whole genomes in the UK Biobank, linked to years of health, lifestyle, imaging and biomarker data. The US NIH's All of Us programme now has data from more than 747,000 participants, including over 535,000 whole-genome sequences linked to electronic health records.
Iceland went in the opposite direction: small country, unusually deep data. deCODE has genetic and medical data from more than 160,000 Icelanders, covering more than half the adult population, alongside genealogies going back more than 1,000 years.
That combination has allowed researchers to connect very rare genetic variants to diseases and other traits in ways that are difficult to do anywhere else. In August, deCODE published the first Icelandic pangenome and found a previously undetected variant associated with Parkinson's disease.
China is building population-scale references too. A Chinese pangenome project covering 36 ethnic groups found 5.9 million small variants and 34,223 variants that were not in the first human pangenome reference.
For twenty years, biology worked with something called the reference genome: essentially one standard sequence against which other people were compared. But there is no single genome that represents humanity.
The new approach is the pangenome, built from many populations and designed to capture the variation between them. The first human pangenome reference already added 119 million base pairs that weren't present in previous references.
This matters because the missing pieces aren't just interesting from a scientific point of view. They can change what we know about disease.
And that is where I think genomics is heading.
Not just bigger databases, but better ones: genomes linked to medical records, family histories, environmental exposure, lifestyle and increasingly detailed measurements of what is happening inside the body.
The goal is to move from treating the average patient to understanding why this particular person gets a disease, responds to a drug, ages differently or carries a risk that another person doesn't.
The countries building these datasets now will have something more valuable than a collection of DNA samples.
They will have a map of their own biology.
Which brings me home.
The government's Genome India project sequenced 10,000 people from 83 communities and opened the data to researchers last year.
Yes, it's a start, but it's a fiftieth of what a country a twentieth our size has already done.
We also have promising companies in this space:
MedGenome in Bengaluru worked with Massachusetts General Hospital to build a heart-disease risk score tuned to South Asian genetics instead of European data, and validated it on Indian patients, because a score trained on the wrong population can tell an Indian they're fine when they're not.
In 2024, IIT Bombay and Tata Memorial Centre launched NexCAR19, India's first homegrown cancer therapy that re-engineers a patient's own immune cells, at around ₹40 lakh against roughly $400,000-plus for the American versions.
And Sangita Reddy, who helps run Apollo Hospitals, told us Apollo has 40 million patient records and a plan to sequence a million people linked to their health histories.
The gap I see isn't talent. It's the bridge between biology and scale.
The second gap is translation. We have become reasonably good at producing promising science. The harder part is taking something that works in a lab and getting it through validation, regulation, manufacturing and into a hospital at a price India can afford.
NexCAR19 is a good example of what that can look like when the pieces come together. But we need hundreds more such journeys, across diagnostics, therapeutics, agriculture and industrial biology.
And then there is the people gap.
The person who makes Indian biotech work won't necessarily be the scientist who discovers the next gene or the engineer who builds the next sequencing machine. It will often be the person in between: someone who understands enough biology to work with scientists, enough technology to see what is possible, and enough business and operations to turn it into something that can be used.
Those are the people I think India needs a lot more of.
Because the opportunity isn't just to study India's biology. It's to build an industry around it.
The way I'd think about bioscience in India is that for the next decade it is less a laboratory problem than a measurement problem, because the science mostly exists and the Indian data, the tests that make it usable here and the people who can explain a result to a family mostly don't.
The headline job, finding the mutation, will go to a small number of scientists.
The far bigger opening is everything around it, from the person who turns a genome into an affordable test to the one who builds the Indian version of a risk score that was only ever tested on Europeans.
The people already doing this look a lot like you.
Dr. Nickhil Jakatdar came from chips, Anuradha Acharya started her first company in her twenties, and her advice on stage was that fundamentals come first and there are no shortcuts, not even for the AI folks.
