India’s genomics moment has arrived; act now

This article is authored by Dr. GSK Velu, healthtech entrepreneur and CMD, Maxivision, Neuberg and Trivitron.

For decades, diagnostics in India has meant biochemistry, pathology and imaging. Today, a profound shift is underway. Genomics--once confined to a few research labs and elite cancer centres - is rapidly moving to everyday clinical practice. Technology is maturing, sequencing costs are falling, turnaround times are improving and clinicians are beginning to see how genetic insights can transform decisions at the bedside. Today, we are at a unique inflection point. If we get this right, genomics can unlock one of the most significant paradigm of the nation’s health infrastructure. India must now decide how fast and how equitably it wants to scale this momentum.

Genomics (Roman Ivashchenko/PantherMedia/IMAGO)

In my experience, I have never seen the following three forces coming together to create a once-in-a-generation window.

• India’s unique genetic diversity: India is one of the most culturally and genetically diverse countries on the globe, with roughly 5000 genetically distinct, socio-lingual population. This diversity is a scientific goldmine which can help reveal rare disease risks, drug-response patterns and genetic risks that western datasets will never capture. Yet Indians remain significantly under-represented in global genomic repositories. Building indigenous datasets is therefore urgent; without locally calibrated data, our risk scores and treatment algorithms will always be “imported”, not truly Indian.
• Escalating NCD burden: Cardiovascular disease, diabetes, cancer and respiratory disorders now dominate India's health profile and are striking at younger ages. It is time to move beyond only depending on doctors, hospitals and cathlabs to tackle this growing burden. We need earlier risk identification, better targeting of therapies and sharper ability to segregate high and low risk patients. Pharmacogenomics can change the game and enable this shift from reactive care to predictive care.
• Favourable technology and cost trends: Tests like BRCA1/2, non-invasive prenatal testing (NIPT) and multi-gene cancer panels – once priced out of reach – are now routinely available in tier 1 and emerging markets. Sequencing that once took weeks now takes days. Panels for oncology, cardiology, prenatal care and rare diseases are increasingly accessible. Most importantly, consumer awareness is rising, aided by clinician advocacy. Public projects like the Genome India initiative have already built foundational reference panels and identified millions of previously undocumented variants.

In India, I have witnessed three waves of diagnostics:

• Diagnostics 1.0 was an age of standalone lab testing.
• Diagnostics 2.0 brought in high-end imaging, automated platforms and highly integrated labs with broader access.
• The next decade will be defined by Diagnostics 3.0 - where radiology, pathology, genomics and AI will work in unison. This is not futuristic thinking; it is visible in advanced tertiary centres and in emerging integrated diagnostics models across the country.

Emerging fields like proteomics, big data analytics AI, genomics gain traction when positioned as part of routine medical care in complex diagnoses like newborn screening, prenatal testing, oncology, cardiology, transplant medicine, etc.

The technology is only the starting point; capability and infrastructure building are what drives mainstream adoption. If India wants to lead in precision medicine, three urgent actions must guide the next five to ten years.

• Build distributed, interoperable genomics capacity: India needs a tiered, interconnected network of genomics-enabled labs that seamlessly connect government, private and academic programs. This would entail upgrading national and state reference labs with next-generation sequencers, quality systems and trained bioinformaticians. Public–private collaboration for variant surveillance, AMR tracking, high-risk pregnancy programmes and population-scale screening should be encouraged. Genomics must be linked to the National Digital Health Mission so reports flow into electronic health records to enable clinical decision-support tools and registries.

Just as we once argued that India cannot be dependent on medical device imports, and must build a self-reliant med-tech ecosystem; we now need the same zest to reduce import dependency on genomic reagents, platforms and software. A genomic equivalent of “Make in India” is essential if affordability and sustainability are to be achieved.

• Equip clinicians, not just laboratories: Sequencing is of now good, if the clinicians fail to read them meticulously. Trained clinicians will deliver good clinical outcomes across oncology, cardiology, neurology, neonatology and primary care basis their interpretation of genetic findings.

We need to embed genomics into undergraduate and post graduate curricula across medicine, nursing and allied health. Establishing structured training and medical-education modules across disciplinary boards will help doctors discuss real cases. Clear, India-specific guidelines are also essential so that clinicians know when genomics is standard of care and when it remains experimental.

• Build, protect and ethically use Indian genomic datasets: India’s genomic diversity is both an asset as well a national responsibility. Data infrastructure must be created with guardrails - robust consent frameworks and ethical governance. Counselling must be strong, consent must be simplified and genomic discrimination must be proactively guarded against.

This will allow researchers, startups and industry to build India-specific risk models, pharmacogenomic tools and clinical-decision algorithms. We should encourage Indian representation in global reference panels that will help drive drug discovery, personalised treatment and population-health insights.

Above all, we must keep sight of the core triangle I have consistently argued for in digital health and diagnostics: Access, affordability and quality. If genomics scores on only one or two of these, it will not deliver what India needs.

The good news is that India already has the building blocks ready: a growing network of integrated diagnostics centres, high-quality clinical talent, a robust digital-health ecosystem and a thriving innovation economy. What we now require is to realise the urgency and strategically align ourselves to establish genomics as an essential capability for the next decade of Indian health care.

India’s genomics moment has indeed arrived. We have the science, technology and the business models. All we need is the right investments, policies and collaborations – and now one can stop India from becoming a global leader in precision medicine.

This article is authored by Dr. GSK Velu, healthtech entrepreneur and CMD, Maxivision, Neuberg and Trivitron.