Why Indonesian medical breakthroughs struggle to reach patients

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Jakarta (ANTARA) – Paulus Sudiharto had a working medical invention decades before he had a product on the market. His struggle reveals a stubborn gap in Indonesia’s health research: discovery is only the beginning.

In 1972, Paulus Sudiharto, a neurosurgeon at Gadjah Mada University, began developing a pump to drain excess fluid from babies’ heads. Four years later, the project was abandoned, unfinished.

While studying in the Netherlands, Sudiharto watched heart valves open to let blood pass, then close to stop it flowing backward. He saw a principle that might help patients with hydrocephalus.

Back in Indonesia in 1978, he completed a tube fitted with a crescent-shaped valve to keep cerebrospinal fluid moving in one direction. A small raised stop prevented the tube from being sucked into the skull.

The device worked. Doctors at Dr. Sardjito General Hospital in Yogyakarta implanted it in patients as young as 11 days and in adults. Its use gradually spread to Medan, Bangka and Batam.

It cost about Rp2 million, far below imports that could cost several times more. Patented in 2009, INA-Shunt reached commercial marketing only in 2016, 38 years after design completion.

A similar journey shaped Ika Dewi Ana, a dentistry professor at Gadjah Mada. Starting in 1999, she researched a carbonate-apatite bone substitute that helps damaged bone regenerate without removing healthy bone elsewhere.

Fifteen years later, Gama-CHA reached the market, with production involving Kimia Farma and university-linked Swayasa Prakarsa. The team, however, faced a regulatory obstacle unrelated to the science.

Regulators had no clear category for the material, which sat between a medicine and a medical device. Researchers therefore helped develop rules, learning licensing requirements, factory processes and commercial markets along the way.

Ika, who received the 2026 Achmad Bakrie Award in health, says a researcher’s work does not end when an innovation is successfully developed. Getting it into patients’ hands is part of the job.

Her experience echoes Sudiharto’s. Indonesian researchers can produce promising discoveries but often struggle with the next steps: clinical trials, marketing authorization, manufacturing partners and, perhaps most important, finding the first buyer.

Researchers call this stretch the “valley of death,” where prototypes lose momentum and become reports or exhibition pieces. Laboratories teach people to investigate and publish, but rarely prepare them for commercialization.

The barriers are not simply technical. Moving a medical invention forward requires capital, regulatory clarity, production capacity, quality assurance and a market willing to adopt something unfamiliar. A brilliant design cannot provide these alone.

When someone is waiting

Yet Indonesia’s notoriously long road from lab bench to hospital bedside can shrink dramatically when urgent demand aligns all stakeholders.

In March 2020, as the COVID-19 pandemic overwhelmed hospitals with severe ventilator shortages, Bandung Institute of Technology (ITB) electrical engineering lecturer Syarif Hidayat built an emergency breathing aid.

Within a single week, a cross-disciplinary engineering and medical team assembled to tackle the crisis.

With the university campus shuttered under strict social restrictions, the team worked inside a mosque room, backed by Salman Mosque ITB and crowdsourced public donations.

In less than a month, their portable ventilator, named Vent-I, passed rigorous Health Ministry safety tests and rolled out to overwhelmed hospitals across the archipelago.

Technical skill certainly mattered, but what separated Vent-I from Sudiharto’s decades-long shunt journey was intense urgency at the finish line.

Hospitals were actively waiting. Frontline doctors helped specify exact clinical requirements, while government regulators stood alongside engineers to expedite testing. Because everyone shared the same destination, the invention moved swiftly.

Syarif later noted the crucial flip side of that wartime mobilization: private industry differs fundamentally from a charity, as manufacturers must calculate profit margins and only invest when commercial demand is clear.

The takeaway is stark: the fate of a medical invention hinges less on its creator’s brilliance than on whether an eager buyer is waiting at the end of the road.

This dynamic holds true even within the world’s most established innovation ecosystems.

Robert Langer, the Massachusetts Institute of Technology chemical engineer who later co-founded Moderna, saw his first nine research grants rejected and was once advised by a senior colleague to find another career.

Langer persevered in his laboratory until major pharmaceutical companies eventually recognized the commercial value of his drug-delivery breakthroughs and licensed them.

Higher Education, Science, and Technology Minister Brian Yuliarto cited Langer’s persistence before scientists at the Indonesian Science, Technology, and Industry Convention in Surabaya this week as a blueprint for turning academic research into industry.

At the same convention, Health Ministry Director of Pharmaceutical and Medical Device Resilience Wenny Indriasari urged academics to align closer with market realities, reminding them that the government remains Indonesia’s largest healthcare spender.

That reality carries a clear policy imperative. If the state is the biggest buyer, the government is uniquely positioned to stand at the end of the road and signal exactly what hospitals need.

Several institutional tools already exist to bridge this divide. Jakarta has established a regulatory sandbox to test novel health innovations before formal rules are written.

A national clinical research center now coordinates multi-hospital trials, while a government procurement catalog can delist imported medical gear whenever a comparable domestic product meets clinical standards.

In early October, the Health Ministry brought researchers and medical-device manufacturers together in Semarang. Its measure of success was practical: locally developed equipment should reach community health centers and integrated health posts, not merely generate memorandums.

The next task is to make those needs visible before research begins. Clinics should tell scientists what equipment they lack, while manufacturers should help design early for safety, scale, cost and usability.

That would make commercialization a shared process, linking researchers, regulators, industry and buyers from the outset. Sudiharto took almost four decades to move his tube into production; future researchers should not face the same wait.