Picture this: A 28-year-old woman in the highlands of Rolpa is diagnosed with cervical cancer. Her genetic makeup, medical history, daily routine, diet, metabolic profile, gut microbiome, as well as the viral strain afflicting her are all data, valuable and unique to her geography. Today, we lose most, if not all, of it. What if all of that could be at her fingertips, just an app away? What if her data could be used to develop unique theranostics that could help patients like her? And what if sharing that data helped with their treatment bills?

With a clean political slate and a government more than eager to deliver, Nepal now sits amid significant buy-ins in healthcare from both governments, north and south of the border. The urgency to invest in biodigital solutions is even more palpable as Nepal lies on the precipice of graduating from Least Developed Countries (LDCs).

In digital health, Nepal isn’t exactly a laggard in its league when it comes to strategy papers, policies and guidelines. We also see some traction with pilots for community healthcare, telemedicine, federal health information management systems or even the national health insurance scheme. Almost all our larger hospitals, government or non-governmental, are in various stages of digitalisation. We have discreetly implemented indigenous as well as global open-source solutions for it, but we now must think of integrating all these, as well as with global value chains. The larger problem is not in the initiative, but in the implementation.

Our biotechnology sector, meanwhile, is non-existent, despite having had the same access as any other LDC to the World Trade Organisation’s Trade-Related Aspects of Intellectual Property Rights (TRIPS) facilitations. We do meet about half of the domestic demand for generic pharmaceuticals, but it’s almost totally via active pharmaceutical ingredients imported in bulk, and their quality is often questioned. Bangladesh, however, now meets almost all of its own needs and exports to more than 150 countries. It is climbing the biotech stairs from pharma, making anti-cancer drugs, monoclonal antibodies, hepatitis-C vaccines, hormones and more.

Often funded by donor agencies with disparate interests and with stakeholders shifting priorities, our piecemeal solutions in digital health have created their own challenges. There is notable ‘pilot fatigue’, and the data is often distributed in redundant siloes, unable to deliver compounding gains for policymakers in Singha Durbar or a patient in Surkhet.

On the other hand, the lagging pharmaceutical and non-existent biotech sectors require a strategic long-term gambit from the state itself. While donors have helped with soft assets to orient us to digital health as followers, no donor would, or even could, create the harder assets needed for leadership, more so in biotech. This is something Malaysia achieved quite organically in Penang, as did the perpetually sanctioned Cuba via will and brute force.

Right across the border in India, we find a world-class pharmaceutical and a growing biotechnology sector, along with decades of leadership in software and data-driven solutions. The Ayushman Bharat Digital Mission, implemented by the National Health Authority as a digital health backbone, has delivered huge public benefits. More than half of their huge population now have unique health IDs, and almost a quarter have their health records on it.

Estonia, a country almost 20 times smaller in population than Nepal, has a universal Electronic Health Record system, as well as a genomic biobank. These infrastructures position it near the top of the digital health ladder, as well as an exporter of technologies and experience. Rwanda, an LDC nonetheless, is now exporting its health informatics experience to the rest of Africa. This shows that smaller countries can and do often punch above their weight, especially when it comes to niche solutions.

Nepal should jump onto this bandwagon, first converting the National Health Insurance ID of enrollees into a nationwide unique Digital Health ID. One that can be used to register, upload, access and share securely protected health information, via a federal health information exchange; an information highway poised to be the foundation of the biodigital unicorn we’re sitting on. With a robust national digital health infrastructure in place, with secure yet comprehensive access to anonymised data, Nepal can begin to aggregate resources required for world-class research in biotech. We can develop our knowledge economy, along with sowing seeds for local manufacturing, even.

The country should also begin to see itself as a future Research and Development node for India, China and other partners’ biodigital moats, attracting some of their growing healthcare expenses. Armed with our expert diaspora in science and technology as well as investment, and a growing, globally oriented in-house talent, we can be where cutting-edge work is done. It could be related to healthcare AI validation, working out genomics and other multi-omics solutions, or new drug discovery for the globally increasing burden of cancers and other non-communicable diseases.

Furthermore, Nepal can harness the full advantages of its mid-sized population spread across one of the world’s most biodiverse corridors, sandwiched between two of the largest demographies and economies. Additionally, our neutrality lets partners hedge their risks, with investments in an ecosystem that includes us as an indispensable frontier.

We are about to miss the train of the biodigital revolution sweeping across the Global South. We cannot afford to sit back anymore. The new government’s call to build a national patient portal is a first step in the direction that sets Nepal up for success in digital health. But this is not enough, and we must integrate biotech and digital health solutions to offer our niche biodigital solutions.

For far too long, Nepal has been a recipient of biodigital solutions it did not realise it could build itself. It is about time we changed this narrative. The treasure trove of information here, just waiting to be harnessed from each of us, and utilised for all of us, almost naturally sings to us in a democratic fashion—of the people, by the people and for the people.

This piece is part of an op-ed series in collaboration with The Nepal Discourse, a convening at Harvard University and MIT (April 25-26) focused on shaping Nepal’s strategic vision for the next decade.