Why India lags in making cancer treatment affordable | Mumbai news

Imagine your body could be taught to fight cancer the way sniffer dogs are trained to detect explosives. Normally, the immune system does this job. But when it fails, is when cancer happens. This is a clever enemy. It disguises itself as part of the body, slipping past the immune defences and goes unnoticed. Now, CAR T-cell therapy is like fitting the immune system with high-tech goggles so it can spot the enemy. Doctors take a few of your immune cells, reprogram them in a lab to recognize cancer, and send them back into your bloodstream.

These newly trained cells now act like heat-seeking missiles, tracking down and destroying only cancer cells. Unlike chemotherapy, which attacks everything in its path, this therapy targets only the disease. The idea is as audacious as it is elegant.

But audacity does not come cheap. Seven years after it was thought up, the therapy still costs as much as a two-bedroom flat in Mumbai. The price tag in the United States hovers around $373,000 per treatment. It is, for all practical purposes, the privilege of the wealthy. How are we to make sense of it then?

Dr. Ravi Nayar, former dean of St. John’s Medical College, Bangalore, offers some perspective: “The question is not whether India can afford it, but whether we should aspire to afford,” he asserts. This is no longer an argument about economic feasibility, but about intent. Because, as he puts it, “desire precedes all actions.” And that, in essence, is the real challenge India faces. If we can aspire to buy Jaguar cars, why not life-saving drugs?

India, which supplies affordable generic medicines to the world, should have been among the first to crack the affordability puzzle. But for a long time, nothing happened. The United States approved its first CAR T-cell therapy in 2017. China rolled out its own by 2021. But India neither had an approved therapy nor the means to make one. Patients who could afford it had to fly abroad, paying ₹3 or 4 crores for a treatment that might or might not work.

The silence, however, did not mean nothing was brewing. Startups have been at work to crack the problem. By way of example, at a lab at IIT Bombay, a small team was working on what would become India’s first CAR T-cell therapy. ImmunoACT, an IIT Bombay spin-off, partnered with Tata Memorial Centre to develop NexCAR19. It was approved in 2023. At ₹50 lakh, this isn’t cheap. But it is a fraction of what it costs in the West.

The question now is not whether India can make CAR T-cell therapy, but whether it can make it cheap enough for the masses. Again, perspective helps. Dialysis, for instance, costs around ₹4 lakh a year. A kidney transplant costs anywhere between ₹10 and ₹15 lakh. These are expensive, but not entirely out of reach. If CAR T-cell therapy can be brought down to those levels, it could change cancer treatment forever.

IIT Bombay’s role in NexCAR19 proves that the capability exists. But to scale this up, more hospitals, research labs, and private companies need to work together. Without that, this will remain an expensive boutique treatment, available to those who can afford to burn through their life savings.

Siddhartha Mukherjee, the oncologist and Pulitzer Prize-winning writer, has been watching this space closely. Through his ventures, Vor Biopharma and Myeloid Therapeutics, he has been exploring ways to make cell therapy more accessible. He has also been working to bring this expertise to India. If CAR T-cell therapy is to become affordable, it will take a mix of science, economics, and sheer political will.

Dr. Nayar is pragmatic about how this must happen. “The only hope for mankind is for AI and startups to crack the price to ensure the scale of sales required to reduce the price,” he says. The race is not just for India. The implications of making CAR T-cell therapy affordable extend far beyond national borders. “The world is at an inflection point,” he added.

Cancer is an expensive disease. For many Indian families, a diagnosis is the beginning of financial ruin. Land gets sold. Loans get taken. Every last rupee is poured into treatments that offer no guarantees. If CAR T-cell therapy becomes affordable, that equation changes. It is not just another expensive drug. It could mean the end of chemotherapy, the end of cancer treatment as we know it.

India may have been late to this race, but the race is still open. The science is here. The talent is here. If India leads the way, it will not just be treating cancer. It will be setting the terms for the future of medicine.