H.E. Klas Molin has been serving as the Ambassador of Sweden to India since 2017. Prior to this, he served as the Ambassador and Chief of Protocol at the Ministry for Foreign Affairs in Stockholm, Sweden.

He also held various positions at Ministry for Foreign Affairs in Stockholm. He earned his Masters of Arts in Law and Diplomacy from the Fletcher School of Law and Diplomacy (USA).

Q. What is the Swedish interest in India and your priority topics for the Indian health sector?

We have a very fruitful bilateral collaboration with India in the health sector, beginning with our development cooperation in areas such as mother- and child health, midwifery, and work against communicable diseases. Cooperation has now increased to mutually beneficial partnerships. For the past ten years, we have had a Memorandum of Understanding on Health between our countries and next year we are going to celebrate this with an India-Swedish Health Year.

Many collaborations of mutual interests are ongoing and being planned that focus in a wide range of areas like antimicrobial resistance, elderly care, pharmaceuticals, non-communicable diseases and digital innovations including artificial intelligence, where the emphasis will be on knowledge transfer, capacity building and skills training.

InnoBRIDGE Sweden 2019 : Report

Q. An MoU was signed during Prime Minister Modi’s visit to Sweden on 17th April 2018 at Stockholm on “India-Sweden Innovation Partnership for a Sustainable Future”. Can you share the progress with respect to healthcare?

We are in the process of putting out calls and setting up incubators which will encourage close collaboration between the innovators in Sweden and India. Solutions are only sustainable if both sides contribute and share a strong sense of ownership. Progress has already been made in laying the groundwork for such partnerships within the sectors of clean energy and smart cities, and we hope to launch initiatives targeted to healthcare during the coming year. The Embassy will be sure to keep you posted.

InnovatioCuris signed MoU with Swecare

Q. India and Sweden will complete 10 years of Partnership in Health Sector in 2019, any plans in store for 2019?

India and Sweden plan to commemorate the ten years completion of the MoU in 2019. We hope to enhance our collaborations in new areas with new stakeholders like the new AIIMS that have come up in some states. We also hope to have high-level visits from both sides to enhance policy dialogues and bilateral relations. Some of the collaborative partners are also developing new plans to strengthen their cooperation.

Q. What can Indian healthcare businesses gain from Swedish healthcare businesses?

Any suggestions on possible partnerships? It is not so much what the Indian healthcare system can gain, but rather, how can we join forces to overcome common challenges. Swedish businesses have been in India for many years. Within healthcare, we have AstraZeneca, who recently celebrated 40 years in India, and Getinge who has been investing in the Indian ecosystem for many years. Their focus, like many others, has been in building the capacity of their employees and the users of their products to increase efficiency. The businesses also bring with them lessons from Sweden so that we can help India leapfrog outdated technology. Sweden also ranks high in most innovation indexes – it can be argued that our relatively small size makes collaborations outside traditional silos necessary in order to succeed. Public actors, private companies, and institutions often work together in finding innovative solutions to serious healthcare challenges. We would like to work with India to build spaces for similar ecosystems across India.

Q. What are the common areas for healthcare research and ongoing partnerships for both sides to collaborate?

Under the MoU, there are extensive collaborations between public authorities and universities from both countries. For instance, the Swedish Public Health Agency, Medical Product Agency and Forte (the Swedish Research Council on Health, Working Life and Welfare) have an ongoing collaboration with their Indian counterparts. There are ongoing discussions on extending collaborations with new players like our National Board of Health and Welfare and E-Health Authority as well as between our medical universities such as Karolinska Institute, Uppsala University and the different AIIMS.

Through these collaborations, we hope to demonstrate best practices and technologies. We have research calls in different areas for example with EU in big data and artificial intelligence for monitoring health status and quality of life after cancer treatment, under JPIAMR call on diagnostics and surveillance 2019.

Innovation-the UNNATI way is an India-Sweden Innovators for strategic business development to address global challenges. It is an industry-supported initiative coordinated by Business Sweden in collaboration with AGNIi-Invest India and ATAL Innovation Mission, NITI Aayog.

Q. You have signed for skilling nurses on infection control, wound care and diagnostics with Govt of Maharashtra in 2016. What is your experience of the last two years?

I believe the overall experience has been good. Business Sweden will, however, be able to provide more information on this as they have been coordinating this activity.

Q. Anti-Microbial Resistance is an important issue right now. How do you propose the Swedish Govt. support in this area?

The Swedish Public Health Agency and the Indian National Centre for Disease Control have an ongoing collaboration with a focus on antimicrobial resistance. Additionally, the Indian Ministry of Health has proposed that Sweden collaborate closely with a new-AIIMS and its associated Health and Wellness Centres. AIIMS-Jodhpur has been suggested to us and we are currently considering the scope of such collaboration.

Q. Artificial Intelligence seems to be a focus area for Sweden in the Health Sector?

Do you see any collaboration in this field with Indian providers? This is a hot topic all over the world right now. I know India is well ahead in AI technology while Sweden has more long-term experience in extracting relevant information from vast amounts of data. Our patient registries have enabled us to have one of the highest cancer survival rates in the world and that is only one example. I believe we will see some collaborations in the coming year, especially as you are arranging a delegation to Sweden addressing this exact topic in May next year. I will follow this progress closely.

Q. What is your message for InnoHEALTH Magazine readers? How can we, as a platform, support India-Swedish collaboration?

I congratulate InnovatioCuris for collaborating with Swecare Foundation and Swedish Medtech in facilitating innovative and promising solutions for India. Sweden has a long tradition of developing innovations in healthcare. We also have a well-functioning public sector, together with extensive health data registries, biobanks and digital connectivity infrastructure, that provides great opportunities to develop innovative, demand-driven, competitive solutions for healthcare. Exciting opportunities abound in an environment dedicated to medical innovation, drug discovery and pharmaceutical commercialization. Sweden and India have lots to share and learn from each other!

Exclusive interview of Union Health and Family Welfare Minister Jagat Prakash Nadda

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Last year May 24-26, 2017 was big startup event Latitude 59 in Tallinn,Estonia. I attended the event and got a flavor of the startup scene and healthcare sector discussions were held. I aligned my visit to Estonia along with the visit of my meeting with CBHEALTHACCESS delegates, innovative healthcare companies from Finland, Sweden, Estonia and Latvia.

I could witness many startups and meet some friends. At any point in the premises of the conference there were over 1000 people and all engaged about future trends and opportunities. One way to know future is always by observing what problems best startups are engaged in solving. I could witness many biotech (genetics) based startup trying their hands on personalized medicine and new age diagnostics platform. Also, interesting was the cyber security companies.

One cyber security startup from Switzerland, OneVisage, that attracted my attention was working on 3D face scanning as authentication mechanism and looked promising for applications like online banking with your own face as your password. Estonia in general has made great advances in two areas, one that of e-governance including e-health and the other cyber security. Hence, it was no surprise for me to see both kind of startups flocking in conference and building upon the existing good work happening in that country. The other exciting thing to see was the countries collaborating and there were many international visitors including from India. Japanese and Finnish presence was quite visible.

There was also heavy promotion of e-residency program with some exciting announcements about easier account opening with a Finnish provider. It lured me also to try my hands on registering a company and post conference it took me only few minutes with the help of some local friends to register a company! Although, I am yet to make it fully functional, but that was already something for me.

The highlight for me was the healthcare session on the second day, which had a keynote by Nicky Hekster from IBM Watson. Nicky started by asking everyone in the room to standup and asked first those who have been to a hospital in last six months to sit down or someone in their close family. Next, he asked if they knew someone in friends/relatives who have been to the hospital. To my surprise there were only 2-3 people standing in the room  which had over hundreds of people. This was a master tactic to drive the point home, that healthcare matters to all.

Followed by the keynote was a panel discussion, which comprised of panelists from USA, Finland, Germany, Italy, Netherlands and Estonia. They were healthcare practitioners, investors, incubators, startups and large company representatives. The session was interesting and demonstrated that how international best practices sharing and collaboration is need of the hour cutting across all type of stakeholders. I really enjoyed my two days not just in the conference but also in after parties with loads of intellectual discussions. Look forward being there again next year!

Want to write for InnoHEALTH? send us your article at  magazine@innovatiocuris.com

Read all the issues of InnoHEALTH magazine:
InnoHEALTH Volume 1 Issue 1 (July to September 2016) – https://goo.gl/iWAwN2 
InnoHEALTH Volume 1 Issue 2 (October to December 2016) – https://goo.gl/4GGMJz 
InnoHEALTH Volume 2 Issue 2 (April to June 2017) – https://goo.gl/Nv3eev
InnoHEALTH Volume 2 Issue 4 (October to December 2017) – http://amzn.to/2B2UMLw

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Introduction

The famous Silicon Valley investor Marc Andreessen says, “software is eating the world”. By, which he means that increasingly we are bringing software into systems to increase efficiency, lower down the cost or time involved in the process. Interestingly, humans also do software writing and humans are prone to make mistakes. It is estimated by various experts that 1000 lines of code (KLoC) has approximately 15-50 bugs present. Bugs here mean mistakes made by the software programmer while writing the software code. Bugs often result in some kind of malfunction or wrong output. Some of these bugs can lead to exploit by a third party making the larger system vulnerable or as we call hackable. As long as humans will write software, bugs will be there.

In a typical software company as bugs are discovered, new code is written to fix these bugs. The new code might further result into new bugs hence the cycle continues. At the consumer end, we keep receiving software updates over the air, as we use our phone / laptops or other devices, which are many times an attempt of the software company to overcome the past mistakes.

A lone computer hacker or an organized crime group looks at these software updates (sometimes called patches) very curiously as for them this could be a chance of hitting the jackpot! They reverse engineer it and try to understand the bug, that the patch is trying to cover. Very often systems are not updated with latest updates. Leading to most system having a known vulnerability, which the hacker can take advantage after understanding it well. Hackers further can create a simple script (programming code snippet) to some sophisticated software, which can then take advantage of the vulnerable system. We often call such a program as malware, as it is built with bad intention.

Today, as we talk it has become from a hobby crime to organized crime! Software companies regularly receive communication from bounty hunters about exposing their critical software bugs and in exchange not to do so, hackers want to charge them bounty money. Some software companies have gone further and engaged these bounty hunters to reduce security risks in their software.

In some cases the hacker is not interested in the bounty money (hence they do not inform the software maker) but rather interested in exploiting the bug. Sometimes, the bug is not known to the software maker or anyone else in the world and can be converted into a lethal attack. Such attacks are known as a zero day attack! As prior knowledge of such a vulnerability does not exist. Hence, most software security solutions, like anti virus software do not work on them. Further selling the knowledge of exploit as lethal software is now called as a cyber weapon. Nation states are now engaged in buying or building such software to infect systems of enemy states. Hence, we have come very far in the business of software bugs, where the enemy could be a lone developer, an organized crime group or a Nation state.

How is software eating the health sector and the threats linked to it?

In the above section we discussed in general, how the exploitation of software is increasingly becoming a serious business. While, we have seen many examples in last 30 years from a hobby software programmer to Nation states taking advantage of the software driven vulnerabilities. We would like to share some examples closer to the health sector.

1. Malware affecting data systems

Hospital information systems and similar information systems as part of the healthcare delivery have become very commonplace and one of the core component of the system. As pointed out in the introductory section, organized crime groups are now looking to exploit software bugs for commercial purposes. One of the ingenious way that they have developed is a malware known as ransomware . Ransomware is a malicious computer program which when executed on a system encrypts the data with very strong encryption making it unusable for hospitals or any other care provider to access patient records or other vital information. It then demands a ransom inform of bitcoins (a crypto currency) in order for the victim to have the key to decrypt the vital information. In recent incidents of ransomware infection, some hospitals in USA have even demanded millions of dollars as ransom and some have even paid.

The mitigation strategy for countering ransomware for any organization would be a strong backup of data. Also, creating awareness among the employees on sources of malware and reducing the chances of accidental infection of the workplace systems.

The long-term solution of tackling such organized crime is a better international legal framework, which allows international prosecution and cooperation among law enforcement agencies.

2. Denial of service attacks on ehealth services

In 2007 there was a distributed denial of service attack that took place in Estonia. A statue of the Russian soldier was removed from the Tallinn Square, capital of the country. Which sparked a response from sympathizers from Russia and it brought down the Estonian economy for three days. Estonia being one of the most advance countries when it comes to take up of e governance services, ehealth being one of them. The entire attack costed less than 50,000 US dollars. That was the first Denial of service attack the world saw at the level of a nation state.

The basic premise behind such an attack is that you have a service (e-service) to be provided to citizens over Internet like their own health records for example. The provider would have some finite amount of bandwidth and computing power at the backend of the service correlating to the average load on the service. In a distributed denial of service attack, the attacker uses compromised computing devices (commonly known as a bot) to access the Internet service. The botnet, which is a collection of such bots could be having thousands or millions of such devices that simultaneously access the service. The service provider is not able to distinguish the normal traffic from the bot traffic and often the server crashes under the heavy load. For a normal user trying to access the service, the service is unavailable because of the finite resources of the server being exhausted by the bot traffic. Hence, it is called a denial of service attack.

Hence, when a city, state or a nation is considering providing an eservice to citizens it could witness such attacks. One strategy to mitigate such attacks is to have tracking of the server traffic for any anomalies and having redundancy available in the system. This is achieved many times by putting the service on a cloud, which can tolerate such traffic fluctuations.

3. Data leak and breaches

Many health systems or systems require some kind of authentication mechanism to log in to the system in order to access the service. Many a times these are text password based systems behind which, important patient profile or health records information is stored. The largest of the companies like that of Google, Microsoft etc have seen attacks where the attacker is able to leak the passwords of millions of their customers. Such scenarios result in massive breach of data privacy and compromise for customers.

Good security practices, proper encryption of data and regular updates of the system are some of the key considerations for avoiding such instances. Nowadays, two-factor authentication has become a standard practice for making the authentication systems more robust. However, still some user awareness is needed to opt for better security practices whenever possible.

4. Hacking medical devices and health system

If we look at the building blocks of the health systems, where information technology is deeply integrated. We have already covered the health information systems, eservices and patient interface of authentication into the services. However, increasingly we hear about Internet of Things (IoT) devices in the health sector domain. Which means the integration of Internet services into traditional medical devices or new age devices, which have also connectivity. For example, a thermometer which can send the temperature data to your phone or a stethoscope which can record the patient breathing sound and upload in a server for finding patterns of lung diseases. These are powerful use cases and provide great opportunity to clinicians and care providers, where they have greater computation power available to them and they are able to do more with less. However, these IoT devices are prone to the same kind of attacks as any other communication device or a software program. They can be compromised to show wrong values and totally messing up the diagnosis. There are already such instances. One such instance not related to health sector but important is of the Stuxnet. Stuxnet was designed for the SCADA systems of Iranian nuclear program by USA and Israel in order to delay their nuclear program.

5. Stealing identity information

As mentioned in the point 3, about data leaks and breaches at the system level. One problem, which can arise from such an attack, is a further more damaging attack that is stealing of identity information. In India, mobile phones to receive an sms message containing one time password is increasingly becoming a standard practise because of being cost effective, simple and secure. Any such application, which you may install on your phone, can also get access to the sms and other features of your phone. Meaning the incoming sms or calls can also be stolen by this application to complete the transaction on your behalf. As increasingly we have to prove ourselves using biometrics or passwords to online systems. It is possible for the attackers to steal these credentials and access our records without our knowledge. Hence, any third party applications that we install on our devices (especially phone) , we need to be very careful about the type of access control they have on our devices.

6. Implantable medical devices with communication interfaces:

In 2007, the former US Vice President, Dick Cheney’s implanted pacemaker’s wireless communication was disabled fearing a terrorist attack. This sounds like science fiction to many but incident has already happened ten years back! Many of the medical devices are built with a communication interface and it is quite normal for a typical pacemaker or other such devices to have a Bluetooth or a similar communication technology based interface for remote diagnosis and other purposes. While, the communication ability of such a device was planned for looking at the state of the pacemaker it was not designed with keeping security in mind. Hence, it is possible that someone can connect to a critical device like pacemaker and shuts it down remotely.

One more reason that such exploits are possible increasingly as computing is becoming cheaper. What seems strong security today might not be strong tomorrow. However, an implantable device might stay in the patient’s body for tens of years. Hence, we need to have a long-term view on the communication interfaces and their capabilities on such devices. We need to make considerations on control and information capabilities of these interfaces. Misuse of control capabilities can lead to even death and misuse of information capabilities can lead to breach of patient privacy.

Way forward: why Internet is the new breeding ground for crime?

The law of the land governs the Internet in every country and hence the legal regime globally is very fragmented. However, a user of Internet does not see any borders or walls and so is the criminal. They build their criminal businesses where they do not fear strict government action and often for paltry sums the user or the national law enforcement agencies do not pursue the criminal cases cross border.

On top of it newer crypto currencies like Bitcoins, makes it easy to make such transaction in an anonymous manner. Dark net marketplaces provide a breeding ground for criminals to conduct illegal transactions of billions of dollars without getting caught. So, the three important components, weak legal enforcement, anonymous currency and secret marketplaces are enabling the cyber crime to flourish. If we want to slow it down, we will need greater international collaboration among lawmakers and user awareness at all levels.

Reference:
(i) https://www.wsj.com/articles/SB10001424053111903480904576512250915629460
(ii) http://labs.sogeti.com/how-many-defects-are-too-many/
(iii) https://www.ted.com/talks/mikko_hypponen_fighting_viruses_defending_the_net/transcript?language=en
(iv) https://hackerone.com
(v) https://en.wikipedia.org/wiki/Zero-day_(computing)
(vi) https://en.wikipedia.org/wiki/Cyberweapon
(vii) https://en.wikipedia.org/wiki/Ransomware
(viii) https://en.wikipedia.org/wiki/Bitcoin
(ix) http://www.csoonline.com/article/3033160/security/ransomware-takes-hollywood-hospital-offline-36m-demanded-by-attackers.html
(x) https://www.theguardian.com/technology/2016/feb/17/los-angeles-hospital-hacked-ransom-bitcoin-hollywood-presbyterian-medical-center
(xi) http://innovatiocuris.com/looming-danger-of-ransomware/
(xii) http://www.bbc.com/news/technology-24608435

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Last November 2016, I got an opportunity to walk in the remote villages of Nagaland. The journey was organized by Prof Anil Gupta from IIM Ahmedabad, India. Prof Anil has been doing Shodh Yatra for last 19 years (a walk of approximately 150 kms to 200 kms to scout grass root innovators and cross-pollinate ideas). The hindi meaning of ‘Shodh’ is to research and ‘Yatra’ is journey. As, we in IC are constantly looking for inspiration and innovations, being part of the Shodh Yatra was an excellent opportunity to meet some innovators and see the country with a different point of view. A point of view which beliefs in the grassroot innovations, celebrating them and spreading them.

Essentially speaking the Yatra takes you through many small villages and in each village you repeat 4-5 activities. Celebrating the elders of the village and document the traditional learnings by asking questions. Organizing Idea and Bio Diversity competitions among young children and students. Also, engaging the village community and sharing innovations from other parts of the villages. One of the ways to put the experience of Shodh Yatra is in Prof Gupta’s word: “During the Yatra we can learn from four teachers: the teacher in nature, teachers within, teachers among peers and the teacher among common people”.

We met people who were 100 plus years old and villages of Nagaland were rich in biodiversity and very clean. All, my stereotypes were broken about remote and inaccessible parts of the country in a good way. The superiority of traditional knowledge in terms of knowing the medicinal use of plants by the communities was amazing. If such a task is taken up by communities to document traditional knowledge countrywide and further look at it through scientific methods. It can open up new avenues for the marginalized communities in terms of commercialization of traditional plants and medicine and also preserving the oral and tacit knowledge of the communities.

Most of us who live in cities have become distant from nature and the understanding of it. Such visits not just give you new eyes to look at what nature can offer us, but also the sense of community from the villagers, who are so giving in their nature. Some of them are constantly innovating and we need structures and methods to spread the good work.

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