Gagandeep Kang is a clinician-scientist, professor in the Department of Gastrointestinal sciences at CMC, Vellore and the executive director of Translational Health Science and Technology Institute, Faridabad. Last year, she became the first Indian women to be elected as the Fellow of Royal Society (London). Professor Kang is known for her research on the transmission, development and prevention of enteric infections in children in India. She is credited for building the national rotavirus and typhoid surveillance networks and has conducted phased trials of the vaccines. For her contribution towards understanding the natural history of rotavirus and other infectious diseases, Professor Kang was honoured with the prestigious Infosys Prize in Life Sciences in 2016.
SheThePeople.TV had an interesting conversation with Professor Kang about her research on rotavirus, public health policies of India, pollution and new health challenges and women in science. Some snippets from the interview.
Rotavirus was entirely new when you worked on developing and using it. India has often been reluctant in funding research. Besides, there is a lot of distrust among the people for vaccines in India. How difficult was it to convince the authorities for the vaccines and the people to participate in the trials?
To eradicate any disease and to develop a vaccine, is not an individual but a team contribution. It was very challenging to get rotavirus vaccines in India because we have so many children. There are 26 million children born every year in India. So, in order to give them free doses, we need to be able to buy at least 100 million vaccines which is very expensive. This means that to immunize India completely, vaccines need to be cheap. Besides, the rotavirus vaccine was a foreign vaccine and to make it cheap and available in India, it had to be developed within the country. My contribution was uniquely in putting forth the burden of the disease - how many children are getting affected and dying - to convince the government that it is worth using the vaccine. We developed the vaccine, built laboratories that tested it, did clinical trials and cost-effective analyses about the price of the vaccines required and how much disease we can potentially prevent. Building this comprehensive picture is what my group did uniquely.
I started with doing not trials but observational studies during which I learnt a lot about the communities. I asked people to participate in the study, give blood and stool sample and also promised to give free health care. But then I found that most of them were daily-wage earners who were reluctant to take time off their work and bring their children for healthcare losing their wage for the day. Then I started a clinic within the area which has now been running for 18 years and provides free health care to children in that area. Whenever we do observation or trial we keep the community informed about the results. When I do research, I hope that they feel like we do it together. We always ask them before we do the studies and they are informed about all the good findings or failed results. So I never had a problem in recruiting people for clinical trials. I think the problem in India with recruiting people is that they do not spend time in building that trust. If they did, I don’t think people will be reluctant to participate because all of us understand that if we need a new treatment, it has to be tried on humans and not animals. If you take the time to explain what clinical trials are about, I think people will trust.
Whenever we do observation or trial we keep the community informed about the results. When I do research, I hope that they feel like we do it together. We always ask them before we do the studies and they are informed about all the good findings or failed results.
Research funding has always been a challenge in India. The Rotavirus vaccine was discovered in 1985 and licenced in 2014 in India. In India, we don’t fund long enough and deep enough. If we need actual products this is what we need to do and funding agencies should understand.
Since you have been focusing on the public health of India, what do you think about the public health policies of India? Has it been able to provide universal healthcare?
Around 70 per cent of healthcare in India is out of pocket expenditure which means 30 per cent of the care is being provided by the government and that is not universal health coverage. We need to invest more on the primary health care first, but we don’t. Why are we not making sure that there is sufficient staffing at every primary health centre? In terms of prioritization for virus outbreaks issues, it is a failure of primary care. People on the ground cannot be blamed. It is the system that needs to provide them with resources and the structures that enable them to take care of the affected children.
With the increased contamination in the environment, there is a rise in both the infectious diseases and the AntiMicrobial Resistance (AMR) that hinder the potentiality of the vaccines. This is being predicted as a major challenge for India in the coming decades. How can this be dealt with?
In the gallop towards development, we did not realise how much harm we are doing to ourselves and the environment. We still have problems like people can't breathe, soil and water are contaminated and the changing climate. These are something that we have caused to ourselves. However, the young generation is aware of the importance of the environment and is taking steps to protect it. This gives me hope what my generation broke will be fixed by today’s generation. We need to talk about the problem with AMR because children still die of infectious diseases. We need to have access to antibiotics and treat them appropriately. The problem with AMR comes when there is excessive use of antibiotics. So this access and excess use of antibiotics needs to be balanced. It can be done through education, regulation but there is a need for the whole society to work together. It is not an individual responsibility. I hope that with increasing awareness, we will.
Women in India are not encouraged to take up a career in STEM. Did your gender come in way of all the achievements in science?
I think I was really lucky that I did not have a brother, I had a father who thought daughters were equal to any sons. I was taught to change bulbs, do the wiring in the house, fix car tyres. In fact, my father stopped me from learning how to cook. That was probably a good thing. Only recently I realized the discrimination that is present among men and women based on career. It is however acceptable for women to pursue a career in medicine as it is viewed as a caring profession. But, when you move towards the science of medicine, women disappear. As you go higher and higher in science, the proportion of women decreases. It is viewed as a demanding job for a woman which is completely inaccurate. Women are capable of doing pretty much anything. We multitask; we look after the home and everything. In India, the problem is not so much about women in science as working women. Families don’t let their women work, whether they are in science or in humanities, doesn’t matter. Today, we have 25 per cent women working force which has decreased from 36 per cent about 10 years ago. If we could get society to agree that women should be in paid employment, I think the women in science problem would fix itself.
In India, the problem is not so much about women in science as working women. Families don’t let their women work, whether they are in science or in humanities, doesn’t matter.
Prevention is always better than cure. Vaccines cannot provide total immunization. If children are being increasingly affected by gut damage, what are the major preventive measures?
Good nutrition, safe water, safe food are the things that will protect children and help them grow for a healthy future.
Rudrani Kumari is an intern with SheThePeople.TV.