- 20 hours ago
"Access to safe, timely surgery remains deeply unequal across the world. As robotics, connectivity, and real-time data make remote surgery increasingly feasible, the challenge is no longer just technical, but one of scale, safety, and equity.
Can these approaches truly expand access to care in underserved settings? What barriers still stand in the way and how can they be overcome? This session explores what it will take to move beyond experimentation and integrate remote surgery into health systems in a way that strengthens, rather than fragments, global care."
Can these approaches truly expand access to care in underserved settings? What barriers still stand in the way and how can they be overcome? This session explores what it will take to move beyond experimentation and integrate remote surgery into health systems in a way that strengthens, rather than fragments, global care."
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TechTranscript
00:19good morning thank you for being with us today I'm excited to dive right in I have two incredible
00:26speakers with me today for those of you that don't know me my name is Anna Rold and Luis Agasnap
00:32is
00:33head of innovation hub at World Health Organization and with me have also Dr. Jitendra Sharma the
00:39executive director of Kalam Institute for Health and Technology welcome to you all the theme today
00:47is beyond borders and whether remote surgery can democratize care so I wanted to begin with just a
00:55few little notes to to kind of set the tone about what this conversation is about today and the and
01:03really had a few thoughts but I'm going to just start with one and only one and that will be
01:08our
01:08kick-starting point and that was the number that made me stop in my tracks that number was nine out
01:15of ten people in low and middle income countries can't reach safe surgery when they need it and
01:22sounds like a very simple thing that technology should be able to democratize that's the big
01:27question and the promise of technology for a very long time so let me start with both of you and
01:32Luis you know you're the closest to me so I'll start with you first why has the World Health Organization
01:40focused on these digital technologies in the way it has right now and I know that you're leading
01:44an initiative so I'd love for you to just begin by explaining a little bit about that
01:50thank you so much Anna and pleasure to be here not least in company with my friend Jitendra
01:58so we are facing enormous health inequity in the world five billion people and more do not have
02:06access to health care and as you said in the area of surgical care we have close to nine out
02:13of ten
02:13people in low and middle income countries not having access to surgical care so that health
02:18inequity is something that requires urgent action at the same time there's a bit of a paradox because
02:24we don't lack innovation we don't lack technological breakthrough technology innovation it's it's actually
02:33abundant and piling up the problem is that we don't manage to scale it in the places where these
02:40technologies are needed the most and one area is digital technologies including AI including virtual
02:49care technologies and robotic tele-surgery is sort of there at the frontier end of that spectrum right
02:57now so innovations and technologies that won't scale in isolation you don't just bolt it on to a system
03:06actually you have to integrate it into a health system if you want it to really reach the patients
03:10who need it the most so therefore we have created a platform called the WHO digital innovation investment
03:17platform which is really focused on first of all starting with the demand of the public sector of
03:24populations what is it that people need and what is that the government wants to prioritize
03:29and then bridging to the investor community the innovator community and from there building stronger
03:38innovation ecosystems where those innovations can be embedded into health systems thank you for that
03:46and so I wanted to jump right to Jitendra Jitendra you have your microphone you're building this platform
03:54so tell me from your perspective what does that look like thank you for having us here and
04:00absolutely a delight to be discussing on this this topic robotics one out of every five exhibition
04:13stalls today outside has something to do with robotics but robotics is a is a technology platform
04:20now when you add on this tech platform application it becomes tele surgery and then when you add to that
04:31the access affordability and equity it becomes virtual care so these are packets of a continuum of care
04:43what we are doing is unpacking that and making it easier for everybody to to add value to this this
04:51continuum of care now if you were to use a robotic hand for sorting out potato chips in a factory
04:57you would need the same robotic arm whose specifications would differ from a medical robotic arm that you use that
05:06we use for um um um um cauterizing a blood vessel in the heart
05:12the specifications the specifications are different the requirements of biocompatibility are different the the physical characteristics are different the the
05:21physical characteristics are different but the platform is the same so what we are doing is taking
05:25taking robotics in its um taking robotics in its um most um unspecialized form unpacking it to create open source
05:35systems in our robotic accelerator that we have at amtz which is a very large medtech technopark
05:43also hosts the who collaborating center for health innovations we are unpacking what is common like the haptic drive the
05:51pressure sensors the uh feedback loops the
05:55electrical circuits the electrical circuits the material science we are unpacking that and allowing many enterprises innovators to actually take
06:04that open source knowledge and add specialization specific um characteristics making it suitable for medtech for healthcare
06:13and then the digital investment platform that lou innovation investment platform that louis my colleague spoke about adds to that
06:22specialized medical robotics the element of virtual care
06:27what tele-surgery is today is what telemedicine was 25 years ago
06:33covid actually disrupted the telemedicine space because virtual care became a necessity
06:38we don't want to be unprepared we don't want to be unprepared for any eventuality like that
06:42and therefore what who is doing is very important because it's not just allowing partners like us to unpack a
06:49very complex
06:51tech platform like robotics and add medical tech to it add virtual care to it allowing it to do surgeries
06:58in far off places like angola or bangladesh and many other sites
07:02but also bringing various stakeholders together because when you unpack such a complex platform
07:10you need to involve telecom which was not there in our operating room and hospitals earlier
07:15you need to bring in material science which was not there earlier and that aggregator of stakeholders
07:21the aggregation of stakeholders is the role that who plays and therefore um accelerates the impact that we can make
07:31so i'm i'm glad that you bring that up and actually one of the questions that i had thought about
07:36asking you louis
07:37was exactly what does look what does that look like in in reality what is who in the middle of
07:43this public
07:44private partnerships or as a multitude of stakeholder look like so i'd love to hear more about what does that
07:50mean in reality
07:53so it means uh connecting the types of stakeholders that are currently not actually having that
08:00conversation they need to have um we did a lot of research uh in the past year which led to
08:06the
08:06creation of this platform and what we saw was really a huge disconnect between the public health priorities
08:13and the supply so the demand side and the public sector and the supply of innovation um and many
08:20reasons for that we speak different languages in our different silos government and private sector speak
08:26different languages the investor community speaks a different language um and it's been interesting to
08:32actually convene that kind of conversation in our innovation hub in geneva and having uh listening to
08:39expertise from the investor community from the manufacturers from government and you can also see a
08:46light switch on when when the private sector hears governments capable leaders from all over the world
08:55speaking about wanting to leapfrog with new technologies
09:01angola for instance has uh invested in robots that are tele-enabled meaning this is robotic surgery
09:09which is already happening in many rich countries but these robots are also tele-enabled
09:14meaning the the surgeon can actually sit thousands kilometers thousands of kilometers away this is
09:20possible now still with a lot of safeguards and still with a capable surgeon on the bedside with the
09:26patient so we're not there yet uh but there's there's a lot of uh government leadership happening
09:33now of governments stepping into this space and i've also heard you know had conversations with ministers
09:39of health from uh the western pacific region who tell me that they see how uh their their private
09:47hospitals are investing in robots benefiting affluent patients whereas the public sector hospitals do not
09:55have these robots but these uh ministers want to invest now because they see a lot of potential in
10:02being able to reach patients with the expertise needed they also see and and i think this is
10:08important to note that maybe the far game is the actual telesurgery um there's still a lot of hurdles to
10:16to overcome before we get there but i think as an ecosystem we can but in the shorter run this
10:22is a
10:23strong vehicle for transfer of knowledge access to expertise tele-mentorship so not necessarily the
10:30remote surgeon doing the remote surgeon doing the surgery but assisting proctoring mentoring advising
10:37looking through the same digital uh interface um so that holds a lot of promise and that's also where
10:45we are now gathering the evidence base to um help develop guidance so that governments can make informed
10:53decisions in this space and i think again equity is at the core here because if who and if governments
10:59don't step into the space and act as a government steward these technologies will very quickly widen
11:07inequity and that's already happening but we need to narrow that gap and make sure that we can democratize
11:13access to life-saving technologies i mean that is the promise of technology across so many different
11:20sectors but what does that look in reality because you mentioned i have a quick follow-up question for you
11:25louise you mentioned hurdles what do these hurdles look like in reality
11:31i think you can um divide them into different categories of the economics of this we need to
11:39develop the public sector business case or the return on investment we need to know if it's actually
11:45good value for taxpayer money so that's gathering the evidence on the economic side on the economic side
11:52we also need to look at payment schemes how can this be embedded within universal health coverage i know
11:59some countries are already considering how to do that on the ethical and legal side there are hurdles to
12:07overcome in terms of the patient consent the liability issue who is liable if something goes wrong
12:17um what happens in the patient doctor relationship when the doctor sits thousands or hundreds kilometers
12:24away um so these are some of the areas there's also the whole infrastructure and sort of technological
12:32area the robots are probably the least the smallest problem we have because they're already quite
12:39advanced but what i find fascinating is that it's not just about as i said bolting on a technology in
12:45a system it's building the system connecting the building blocks of the system around the technology so that
12:52it can serve as many people as as possible and i just wanted to do one little pitch for for
12:59this scaling innovations in public health systems
13:02it's a new guidance and toolkit that we have uh just put out in who from the who innovation hub
13:09this is actually um describing and giving concrete guidance and tools for how governments can act as stewards
13:17in their country's innovation journey not as the ones deciding and controlling everything but actually as an enabler
13:25as a steward of the wider mission but aligning stakeholders within the country from the telecom industry to the
13:33startups and the research and development uh community to patients uh etc
13:41you mentioned governments and you mentioned this is a recurring theme by the way that the tech is not actually
13:47the problem it's all of the other things around so you've developed this ecosystem this partnership is quite
13:52fascinating for you jitendra what is um from your experience in in india what does that look like
13:59especially the government side yeah so i just add i would like to add one element of the hurdle story
14:05that louis mentioned
14:06there is also a regulatory hurdle because when you use a a telesurgery system remotely
14:15you also need to factor in the risks that come with it the risks of malfunctions of the machine
14:21the risks of malfunction of the telecom bandwidth i mean just imagine how many times our zoom call
14:29gets disconnected or um or there is a delay in relaying a video or audio what do we do at
14:37that time
14:37sometimes we log out and log in you can do that while operating on a patient so you cannot say
14:44wait
14:45please don't die we will get back in seven minutes for the telecom network to come back what we also
14:52don't realize that look at the hundreds thousands of people that are there in this expo city
14:59until about 6 a.m they were all living in hotels or residences so the telecom tower in those locations
15:05were overloaded at night and the telecom bandwidth is transmitted to towers that are within the city
15:12during the day that's how telecom industry manages its bandwidth all this would continue to happen as
15:20it is happening today when you start operating on a patient remotely also the safety of robotic systems
15:28on animals cadavers dead bodies they all need to go through the clinical pathway to get approved to be
15:35used on humans so there is an entire hurdle that we need to cross as a society as a tech
15:41community
15:41bringing regulatory bodies that regulate telecom fiber optics security data privacy and clinical
15:50medicine the certification of surgeons as a bunch of regulators and how to connect them and converge
15:58them to achieve what we want to achieve to bring equity to places which does not have surgery
16:04more than 1.3 percent of women who undergo childbirth goes through complications and a large number of
16:10them in many countries actually die for lack of surgeon for lack of blood products and if this solution
16:16has to touch their lives and save them and the babies that are coming into the world which is our
16:21future
16:22society then all these needs to converge to bring that equity so there are hurdles but these hurdles
16:29cannot be crossed by a single factor they need to be crossed by multiple agencies coming together
16:36led by an entity like who what governments do is then to take this toolkit which helps us scale innovation
16:47understand the complexities that this toolkit unpacks and use those tools to bring the intergovernmental
16:53regulators together as amtz what we are doing is trying to create test cases for that so we have a
17:02call for
17:02applications for tele-surgery and virtual care that would open up shortly um and and people who are
17:10attending viva tech and and your friends in this robotic and tele-surgery virtual care sector are most welcome
17:16to apply the world health innovation forum that we host uh with louis in in our techno park in visac
17:23city in india
17:24every year in december uh we would screen those calls and see how we as government and we as who
17:33collaborating
17:33center and we as who can help innovators cross how can we handheld them to cross these hurdles to make
17:42their idea into reality i've been thinking while the two of you have explained sort of uh how this
17:49partnership works about the general goal when you talk about equity and access and democratization i
17:56think about it in many different ways right from a perspective of the investor from perspective of the
18:02innovator from perspective of the government what are you trying to achieve as a common goal when you
18:08bring all these actors together and you draw a sort of a venn diagram and this is our sweet spot
18:13for all of
18:14them is it more quality care or is it in general access where there is none so the the ultimate
18:25goal is
18:25to democratize access to life-saving technologies uh but not for the sake of of technology but for the sake
18:33of of health equity so it's really more people having access to care that's very simple uh it's a very
18:40complex issue but that complexity can only be addressed through collaboration through drawing on
18:48the uh sick troll and the different interdisciplinary expertise that's in the ecosystem so it's really
18:56the collective intelligence but it's also convergence of interests and this is where it can get a little
19:05uh challenging sometimes because there are both perceived differences and conflicts of interest and
19:13there are real conflicts of interest but is there so part of this is also something we don't have the
19:18answer
19:19to now but hopefully we'll find is can we find that sweet spot where there is a triple win or
19:27a quadruple
19:28win among these different sectors um we all benefit from a world where there is greater equity better health
19:37for everyone we know it's good for economic productivity it's good for the labor force it's good for general
19:43happiness of a nation um and there are benefits also economically and i also sometimes say that frankly
19:53i mean our our goal is health for all it is bringing out and and helping our governments our member
20:01states
20:01close to 200 member states of who to deliver better care to their populations we provide guidance evidence
20:08convening power to make that happen um but uh getting there requires uh an ecosystem and and if we can
20:18actually address that gap of over five billion people not having access to care with technologies
20:27that's also a market and if i can just add to that uh with an example um you know there
20:35are less than 25
20:36entities in the world that make satellites but there are more than 50 000 entities now entrepreneurs
20:42enterprises that make drones right and yes drones can be misused but that's a pack that comes with every
20:50technology you can use it for good and you can use it for not so good robotics today telesurgery virtual
20:57care
20:57today is like those 10 15 people making satellites and what what louis and i am trying to do is
21:05bring together
21:06our institutions that we represent to convert that satellite kind of technology to a drone kind of
21:12technology to democratize not just democratizing it technologically which would require component supply
21:20chain which would require design testing validation but also uh democratizing by its application by
21:29disrupting the market space so that large number of entrepreneurs tech enablers can actually create these
21:35solutions which brings in the competitiveness to reduce the costs and when the cost comes down
21:41the demand picks up and that's true disruption of of a technology you know i've been thinking and again
21:49this is me being the fuzzy in the room not the techie but explain to me for example when i
21:55was thinking
21:55about the hurdles and the interoperability of this right you're thinking the technology is being developed
22:01over here and this is where you who plays such an interesting role right it makes the connections
22:08but in the on the tech side of things how much of it is tech and how much of it
22:14is know-how and and you
22:17know knowledge and expertise and you know when you have a doctor in so such and such country can that
22:24doctor
22:25lead lead in another country where there may be you know uh issues political issues for collaboration
22:32credentialing issues issues of credentialing the doctor that's another one yes so half of it is tech
22:39for sure because you have a huge amount of material science that comes in into telesurgery robotics
22:48detectors detectors sensors a lot of it is core tech but the other half is certainly a black box
22:55which includes software credentialing regulations training uh you don't train it is as good as a ferrari
23:04sitting in a garage it can do nothing so a half of it is tech and the other half ecosystem
23:12partners like all of us in this room
23:14need to come together to understand it and play a role what i know for sure is everyone in this
23:20room
23:20has a role to play in it whether it's software whether you are a chemical engineer whether you are a
23:25material
23:26science whether you are a testing or a validation agency whether you are a software developer we all
23:32have a role to play in it what louis has told earlier and represents the cause is that your skill
23:40ability
23:41resources if you choose to play a role in this will be used for an immense amount of greater good
23:47and
23:48not just a technology that blinks glamour but a technology that makes a difference yeah i think i
23:56can just add to that that if you look at this historically the reason why we right now see a
24:02convergence
24:03that is propelling this tele robotic telesurgery area forward it is part technological development and
24:12i'll come back to the the evolution there but it's also um i think a maturing or a realization of
24:20that
24:21need for an ecosystem to work together to achieve big things um there has been a drastic uh development
24:31and and pressure on multilateral organizations the whole notion of collaboration and in some areas
24:39that has you know been a negative pressure um it has led to layoffs reduction in funding to organizations
24:47like who but at the same time there's also been i think a uh revival of the appetite to actually
24:55collaborate um radically across sectors and i find that i sense that honestly in this robotic
25:02telesurgery virtual care area where there's a lot more sort of realization that we can actually
25:08achieve something really powerful here together uh just looking at it historically the first telesurgery
25:14happened uh surprisingly over 20 years ago 26 years ago 26 years ago correct it was called the
25:21Lindbergh one they call it Lindbergh one now um and it was at a huge course cost but it it
25:29was feasible
25:29and they wanted to prove the case and it was a surgery between the us and france uh it was
25:36extremely
25:37expensive because of the uh connectivity cost at the time the technology itself the robot itself was very
25:44expensive 20 years on uh different situation in terms of competition in the market prices are going
25:52down the maturity of connectivity fiber optic networks etc and now it's actually feasible and to date there
26:00have been i i've heard in conferences the number 1400 uh telesurgical operations happening worldwide and it's
26:33uh and it's uh it's uh it's that convergence of the political climate the uh economic situation
26:41the the affordability is is growing etc um and the networks are being built so that infrastructure
26:48element is extremely important uh and we're not yet there where it's like safe and you could just do it
26:55um so i think the first phase is really about transferring knowledge and using it as a mentorship uh
27:02vehicle and that is also very very important because one of the big bottlenecks and the reasons for this
27:08surgical care gap of you know so many people not having access to life-saving surgical care is a lack
27:18of health
27:19workforce millions of doctors and nurses are needed i've seen the number 11 million um uh don't quote me for
27:28this but it's we're up there and it's probably even higher so how are we going to address that gap
27:34and how
27:35we're going to build that capacity and the current models of you know experts flying in from abroad
27:41spending a week training and then you know people tell me those capacities don't stay they don't stick
27:48and many times people are trained and then they leave so there's a lot of brain drain in this area
27:53as
27:54well and what i hear from the case in angola is actually that the doctors and the surgeons there have
28:00gotten you know a revived uh professional pride and appetite because now they can see they can actually
28:06learn remotely and that's very exciting and if i can just add the resource package perspective to that
28:17if you look at the automotive market the private equity and venture capital space leaning on to
28:25automotive investments a majority of it is going on automation self-driving cars and not so much as
28:32as the traditional uh cars or or e-bikes um if you are in this space getting attached to robotics
28:41tele-surgery
28:42virtual care highly increases your ability to attract funding because venture caps and private equity firms are
28:50looking for exciting opportunities that gives a three x five x market cap in three to four years and this
28:57space is
28:57exactly that space in healthcare that if you align to increases the chances of your ability to generate funding so
29:05it's
29:06yes it's about equity but it's also about wealth creation it's also about entrepreneurship it's also about
29:13convergence and i think um that requires all of us to work uh uh together because individually it's too complex
29:22to
29:22to to to get sorted by one entity um and we only have like maybe less than a minute left
29:27so this is a fire
29:29rapid fire question for both of you um where are we in this timeline of success if you know we're
29:37on a 10
29:37year anniversary right now for viva tech what does the next 10 year look like for for this sector
29:48i think the the promise is huge uh no doubt about that we see an ai revolution as a whole
29:56new paradigm
29:57not just sort of the next development step within digitization it is it is a new paradigm
30:05um so promise is huge but the inequity risk is enormous as well uh there is a real risk that
30:14uh
30:15ai and virtual care technologies digital technologies become you know the the luxury of of of the few and
30:24we're here to make sure that we can spread the wealth we can spread the benefits of innovation and through
30:30vehicles of you know having governments embrace this other actors too because this is actually an
30:35ecosystem uh guidance and toolkit of how do we work across sectors so um that's that's the promise
30:42there um so i hope governments will seize it other uh players too and engage on our who digital innovation
30:49investment platform and work with me and jitendra to make it happen thank you and and uh last 26 years
30:56we have grown 3x next 10 years uh in the 20th anniversary of vivatech by then we would have
31:02grown at least 50x there might be uh um telesurgery screens happening all over the world with their
31:11display at vivatech pavilion so thank you there you go you both defined the sweet spot so hopefully
31:17we'll get there even faster with ai thank you all for your attention thank you to our speakers thank you
31:21thank you thank you
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