Vision 2022: A Roadmap for Ayurveda by CII, Frost and Sullivan

Frost and Sullivan, a growth strategy consulting and research firm based in Bangalore, India along with the Confederation of Indian Industry (CII) that works towards the proper engagement of Indian industries to achieve national development have studied the mega pivot points and growth levers that will illustrate the potential of key Ayurveda industries in a report titled Vision 2022: Roadmap for Indian Ayurveda Industry.

Some of the key principles of the National Health Policy were equity, affordability, universality and patient-centred & quality of Care. India is home to more than one school of medicine that pays attention to health and wellness. A collaboration between modern medicine and Ayurveda is sure to help achieve the above objectives.

Ayurveda is a 5000 year old “scientific” lifestyle regime originated in India focused on the acquisition and maintenance of Swasthya or good health. Many Vaidyas of the past have worked towards providing Swasthya to all and for over centuries, this science has served billions of people. Today, this very science is trying to secure a strong footing in the same country it originated in and across the world. No matter the side effects and the possibilities of disease recurrence, modern medicine is the most sought out cure. Modern medicine is, no doubt, advanced especially in the field of surgery but comes with many limitations. The most obvious limitation is the occurrence of side effects post treatment. Secondly, pre and post-operative care requires a helping hand. All systems of medicine aim at patient relief which is why it is important that there must be a collaboration between scholars, experts, practitioners and scientists from both schools of medicine to bring in this dialogue. Dr Ashoka Vaidya in a recent webinar by CAAM spoke to Vaidya-Scientist Namyata Pathak-Gandhi and said, “Patient relief is the foundation for synergic medical practices”.

Both schools of medicine follow different epistemologies. Modern medicine focuses on the understanding of cell and molecular biology. Ayurveda is based on the Darshanas that help to understand the formation of the universe, the relationship between the body, mind and consciousness, tridoshas and the Panchamahabhutas. Last year, Professor Rama Jayasundar, the head of the department of NMR at the All-India Institute of Medical Sciences, New Delhi spoke on the difference between Ayurveda and Allopathy and why these matters, as a part of the lecture series organised by Vijnana Bharati.

Dr Vaidya pointed out the significance of taking the time to understand and respect the epistemologies of the two schools. “If you show the response and explain in terms of both epistemologies, it will strike a sympathetic chord of understanding”, said Dr Vaidya. It is critical that there is substantial and meaningful growth in the healthcare industry every year. The Ayurveda industry certainly needs a push to thrive and grow well.

Diseases can be divided in four stages: Pre-Acute, Acute, Emergency and Post-Acute. Pre-Acute involves preventative and curative; Acute stages involves alleviative, preventive and curative; Emergency involves management; Post-Acute involves preventative, curative and promotive. Pre-acute, acute and post-acute can be managed efficiently by Ayurveda. According to AyurVAID Hospitals, “Shifts in healthcare expenditures and disease profiles provide Ayurveda a golden opportunity to be positioned as the treatment of choice for non-emergency medical care”. Although modern medicine holds an upper hand at emergency care, Ayurveda is not less competent at the same. Dr Rama Jayasundar mentioned that Ayurveda dealt with emergency care during war times and thus was capable. Classical Ayurveda encompasses anatomy, physiology, pharmaceutics, diseases, causation-evolution and disease management.

The Ayurveda industry includes two sectors: Organised and Unorganised. Organised sectors include companies, hospitals, clinics, pharmacies, and Ayurvedic wellness centres. The unorganised centres include manufacturing product units, raw material cultivators, local Vaidyas, and small exporters.

The industry is of two types based on the market offerings: Products and services. Products include ethical, classical, over the counter products, personal/beauty care. Services include medical well-being, payor and medical tourism. The total market size is valued at $3 billion of which products cover 75% and the rest is services. Products such as Chyawanprash, Aloe Vera, Ashwagandha are very prominent on the global platform. Along with retail franchises, e-commerce is also bringing to the masses many Ayurvedic products.

Ayurveda and its products have various strengths and opportunities that must be harnessed to reserve its place as a mainstream healthcare system. Ayurveda with medical and experiential tourism can attract 1 billion people every year. Kerala Tourism has also introduced Green Leaf and Olive Leaf grading to Ayurvedic institutions to ensure the quality of service. Green leaf is provided to those that offer five-star facilities and Olive leaf to those who offer three-star facilities. This grading system provides credibility and assures those who visit the centres of the best service. Product development takes less time compared to pharma drugs.

Both CII and Frost & Sullivan have listed down the mega pivots and growth levers that can enable the Ayurveda industry to realise the vision of tripling the market by 2022.

Many traditional family-run hospitals, clinics offer curative services and these services- hospitalisation and other medical care services- are now being offered insurance coverages. Since February 2016, The Insurance Regulatory Development Authority of India has directed health insurance companies to extend cashless coverage to NABH accredited Ayurveda hospitals. There is also CGHS coverage for Ayurvedic medical care. Panchakarma and wellness centres are the most sought out services by people especially after undergoing Allopathic treatment. These Ayurveda Panchakarma  clinics and wellness centres have also been offered NABH accreditation since 2017.

The industry has to formulate the right policies and incentive framework. This includes signing MoU’s between academic institutions and hospitals/ research institutions, establishing the National Ayush Mission to increase the number of medicinal plants on farmer’s lands. It is also necessary to focus on essential herb cultivation since we are facing a shortage of resources. The Late PK Varier in conversation with CSP spoke about how Arya Vaidya Shala is cultivating medicinal herbs in an area of 300 acres to overcome the shortage in supply of medicinal herbs.

Cultivating and processing high quality drugs/ products is important. At the same time, maintaining the quality and ensuring safety of the products will allow trade across the country. This will also ensure a clear brand identity for Ayurveda to build awareness and market acceptance. It is important to create this brand identity because similar to Yoga, Ayurveda variants may emerge in the world that can dilute the quintessence of Ayurveda.

Setting up Ayurveda chairs in each country would help obtain MoU’s from promising markets that promote Indian herbal medicines. These include Belgium, Hungary, Trinidad & Tobago, USA. Ayurveda courses conducted in foreign universities must be accredited to ensure correct dissemination of knowledge of Ayurveda.

It is also critical to conform to International & Regulatory requirements to ensure uniformity in composition, taste, appearance for all Ayurveda drugs. Also critical to upgrade the Indian Pharmacopeia to streamline market access.

Researchers around the world are working to show the science involved in Ayurveda. They are also working to bring out evidence-based research to establish safety and efficacy of the drugs. Ancient Indians did not document their studies completely because the medium of knowledge transfer was via oral means. Medieval India did document their work but due to the various invasions, we have lost most of them. When modern medicine came into the scene, it was a challenge for Ayurveda to stand its ground. The current scenario is changing slowly with more and more hospitals and wellness centres gaining NABH accreditation. Focus must be laid on strengthening the  National Ayurveda clinical database. This will enable innovative research to generate more and the right evidence to establish the safety and efficacy of Ayurveda Chikitsa.

Dr Ashok Vaidya illustrated the concept of reverse pharmacology. This concept works from bedside to bench. He says clinical outcomes must be the starting point to incite research. Usually, researchers take into consideration a particular protein or gene or marker that is responsible for the disease and develop drugs that hinder its action. This is the bench to bedside concept. However, it must be taken into consideration how each of these proteins/genes/markers behave in each person. This is how Ayurveda achieves personalised medicine.

Ayurveda chikitsa can be of three types: Daiva - Vyapasraya, Yukti- Vyapasraya and Sattvavajaya. Daiva - Vyapasraya treatment is based on healing with divine power and remedies such as mantra, homa (fire rituals), Niyama (rigid living), prayaschita (confession) and Upavasa. Yukti- Vyapasraya is based on treatment with medicines, dietary  and lifestyle management. Sattvavajaya treatment to gain control over the mind and keep the mind and senses detached from unnecessary objects. This can be correlated with today’s psychiatry. Dr Ashok mentioned that it is important to focus on Daiva- Vyapasraya and Sattvavajaya also when treating patients. This is why Ayurveda is a way of life and not just medicine.

Ayurgenomics is also a promising field that integrates concepts in Ayurveda such as Prakriti, with modern genetics. It correlates the concepts of Vata, Pitta and Kapha with the genotype (gene expression) and phenotype (physical attributes). This field can provide better understanding of Ayurveda in terms of modern medicine.

Lastly, making use of digital platforms can greatly benefit Ayurveda in terms of awareness and connecting to the world with its products and services. With more than half the country immersed in technology, telemedicine can be a great initiative by the Government of India to extend quality expertise to people living across the nation, especially in rural areas and it will also help provide employment opportunities to many Vaidyas. AyuSoft was a software that was developed by the Centre for Development of Advanced Computing, Pune. This software supports Constitution (Physiological and Psychological) and Tissue Quality Assessment, Disease Diagnostics and Treatment, Diet and Lifestyle Advice, Patient Information Management System, Multimedia based Encyclopaedia, and Textual and Graphical Analytical reports (AyuSoft). With AyuSoft, one can have medical solutions based on traditional medicines at their fingertips. Moreover, health decisions are expected to be more informed, more accurate and quicker.

CII and Frost & Sullivan have put together a very comprehensive roadmap for Ayurveda. This comes at a time when the world is grappling with the pandemic and modern medicine is finding its hands full to deal with it. This is a great opportunity for Ayurveda experts to step in and make full use of it to gain that grounding Ayurveda almost lost a few decades ago.