Professor Gagandeep Kang, executive director, Translational Health Science and Technology Institute, Faridabad, is the first Indian woman scientist to be elected as a Fellow of the Royal Society (FRS). Kang’s research on transmission, development and prevention of enteric, or intestinal, infections in children and in developing Rotavac, India’s first indigenous vaccine against the rotavirus, has been well recognized by the scientific world. In an interview, Kang spoke about her journey and the status of medical research in India. Edited excerpts:
How can enteric infections and nutrition deficiency in Indian children be tackled?
Malnutrition, particularly chronic malnutrition, continues to be a major problem for Indian children—generally much less in the south, and some parts of the north and west, than in the rest of the country. Things have improved since the 1980s. We no longer see acute malnutrition and easily recognizable vitamin deficiencies have reduced, but chronic malnutrition, resulting in stunting, is still common with at least 10% of children in every district suffering stunted growth. In over 200 districts (out of the total 712 districts) it is greater than 30-40%. Enteric infections contribute to malnutrition, but are not the only cause. Food inadequacy, low birth weight, among others, are important contributors. Deaths have reduced, but in children diarrhoea continues to be the second leading cause of child deaths, after the first month of life. Tackling enteric infections and nutrition requires improvement in the living environment of children, better hygiene, safe water and food. Other preventive strategies include rotavirus vaccination—currently we only have rotavirus and cholera— besides vaccines, for other enteric infections that cause gut damage.
Does lack of funds impact the quality of medical research?
I think among all fields of scientific endeavour in India, medical research receives proportionately much less funding. It is important to understand that no nation advances without significant investment in science and technology. In fact, many countries try to attract scientific talent. Take the examples of China, Germany, and even tiny Singapore. But in India, we have few ways of retaining truly outstanding talent, and few systems of reward, particularly within government ecosystems. In medical research, our academic structures are set up almost to dis-incentivize research, with much stronger focus on clinical service and teaching than on research, even in our premier institutes. I do not think we realise how quickly the fields of medicine are changing with new technologies and how rapidly we are being left behind. The current system of requiring a minimum number of publications and time as the only objectives measures of academic promotion in medical colleges, is leading to high numbers but low quality work. I am concerned that this poor quality of research will become the benchmark.
Is funding for vaccines in India adequate to handle the disease burden?
In terms of existing vaccines, we have come a long way in the last 10 years. We have introduced multiple new vaccines—the pentavalent and rotavirus vaccines nationally, and pneumococcal vaccine in parts of the country. We have introduced the injectable poliovirus vaccine, expanded the Japanese Encephalitis vaccine use, changed to tetanus and diphtheria vaccine, conducted a campaign for measles and rubella vaccine. In at least some parts of the country we have used the human papillomavirus vaccine. But a lot remains to be done. We have no policies for adults and the elderly who could benefit from influenza and other vaccines. Good cholera and typhoid vaccines are available, but we are not using them. Multinational companies estimate that it costs half a billion dollars to develop a vaccine. In India, we can do it for less than $100 million, but no funding agency provides money at that level. The view generally is that companies will make a profit from products, so let them pay R&D costs. But then, R&D costs have to be recovered from the consumer, which means products will be priced higher, which makes it difficult when you have to vaccinate a population as large as India. This is a Catch-22 situation that requires strategic policy from the government.
What are you working on at present? How will it be helpful for India?
I am working on typhoid, along the lines of rotavirus, but without needing to develop a new vaccine since one exists. My colleague, Jacob John, is coordinating a three-tiered surveillance system to develop an estimate of how many cases of typhoid are there in the country, and where it is found so that we can propose a vaccination strategy for India. At THSTI, we are working on HIV to identify neutralizing antibodies, on dengue to study disease and support vaccine development and on tuberculosis treatment and prevention. We are also working on predicting diabetes and developing drugs for non-alcoholic fatty liver disease—both huge public health problems in India. In diagnostic, THSTI scientists are focusing on point of care, or almost dipstick tests for fevers, for blood-borne viruses, for antimicrobial resistance, typhoid and snakebite. Our maternal and child health focus is on infections and preterm birth.