Bengaluru: Dr. Gagandeep Kang, the first Indian woman scientist to be picked a Fellow of the London’s Royal Society, is a well-known figure in the fields of health and medicine in India.
Kang is currently the executive director of the Translational Health Service and Technology Institute (THSTI), Faridabad, which is an autonomous institution under the department of biotechnology of the science and technology ministry. She is also a professor in the department of Gastrointestinal Sciences at Christian Medical College (CMC), Vellore, which is her alma mater.
Kang has played an instrumental role in understanding neglected tropical diseases and developing indigenous vaccines for children in India.
ThePrint profiles Kang, her academic career and work in the field of science and medicine.
Childhood and career influences
Kang was born in Shimla on 3 November 1962. Her mother was a teacher of English and history, and father a mechanical engineer in the Indian Railways. Kang has a younger sister, who is a journalist.
“There was no question of us not working. That construct didn’t even enter our heads,” Kang told ThePrint in an interview.
Kang had been interested in physics, medicine and also history. She ultimately decided to appear for the entrance exam for CMC-Vellore. While growing up, Kang was fascinated by stories told by her doctor uncle, who had trained at CMC-Vellore. Thus, a trust in the institution was established in her at a very young age.
After her MBBS at CMC-Vellore in 1987, Kang was a junior house surgeon at AIIMS in ophthalmology, a subject she enjoyed a lot. However, owing to the fact that her family has a hereditary essential tremor that becomes worse with age, she decided that a profession of a surgeon would not be right for her.
Kang did her post-graduation from CMC-Vellore in microbiology, graduating with an MD in 1991. However, she was bored of it. Choosing not to spend a major part of her time in a laboratory, she instead joined a group within CMC called the Wellcome Trust Research Laboratory, which did community research.
“I enjoyed the idea of public health and working with community rather than working with a single patient,” she said. “So I decided to try it out and I ended up in gastrointestinal research.”
She did her PhD with a focus on a class of bacteria that caused persistent diarrhoea and realised through her research that there was incredible heterogeneity among these bacteria that should all have been similar. She instead shifted focus to rotavirus, which has only 11 proteins as opposed to the thousands in the bacteria.
Rotavirus is a virus that causes gut and intestinal disorders among children such as inflammation, diarrhoea, dehydration, gastroenteritis, among others.
When looked at under a microscope, the virus is circular in shape and thus named ‘rota’, meaning ‘round’ in Latin. It is a highly contagious virus and spreads rapidly, especially in temperate climates. According to WHO, rotavirus killed over 450,000 children in 2008.
Kang wanted to study the virus more and understand how it affected Indian children and public health. So, after her PhD in 1998, she went to the UK after obtaining membership from the Royal College of Pathologists to study the characterisation of rotaviruses.
After a year in the UK, Kang moved to Houston, Texas, in the US to the famed Baylor College of Medicine. There, she did her postdoc and worked with one of the world’s leading experts on rotaviruses, Dr. Mary Estes.
“She came with a strong clinical background in medicine with experience in gastroenterology, microbiology, and pathology, and wanted to gain more experience in basic research in virology,” said Estes.
In the late 1990s and early 2000s, rotavirus infections were leading to over 130,000 deaths annually in India.
“During her time in my lab, she mastered working with rotaviruses, the cause of severe life-threatening diarrhoea globally,” Estes added.
Kang said: “No matter what I did, Mary really challenged me… And 20 years later, I’m still working with her and learning from her.”
Kang and Estes wrote a project together on rotavirus, which received funding, and since then, the two have been working together.
On returning India
Upon her return to India a year following her post-doc, Kang set up field studies on a scale that has never been done before to properly understand rotavirus infections in children.
She found out these infections in Indian children occurred when they were much younger than their counterparts in other parts of the world. Consequently, Indian children experienced an increased number of infections before they developed protective immunity in their bodies.
This kind of information was important for the development of vaccines that would be more effective for Indian children, as compared to their international counterparts. Furthermore, Indian children needed more dosages of vaccines for the same level of effectiveness as regular vaccines for children from other countries.
Kang and her multi-disciplinary team’s work also involved complementary studies on water safety, vaccine trials, and evaluation of vaccine efficacy and its reasons to prevent the spread of diarrhoeal disease.
One of the results of this work was the indigenous oral ROTAVAC® vaccine, a collaborative effort by multiple organisations, where Kang played a developmental role. The vaccine can now be used by middle and lower-income countries to combat the spread of diarrhoeal disease and save the lives of half a million children every year. A 2014 study said the vaccine can prevent over 26,000 deaths in India.
“Her passion for helping to improve the health and lives of children and the Indian population guides her work, keeps her focused, and makes her effective,” said Estes.
“She is also a wonderful teacher and mentor who enjoys training others to allow them to achieve their potential and contribute to global health. The research teams she has put together are top notch and as capable as any I know. As a mentor and colleague, I always look forward to hearing her new ideas and learning about her continual new projects and achievements,” she added.
Barriers to research in India
Kang joins a chorus of voices highlighting the very basic problems faced in India that prevents effective research.
“If you want to get a good quality reagent in India, it would cost you twice as much and take twice as long as buying the same reagent in the US,” Kang said. Reagents are mixtures for use in chemical analysis.
“The process of doing research is painful and expensive, especially if we want good quality materials and infrastructure,” she said.
Kang further elaborates there simply isn’t enough investment in Indian research to be compared to international research quality standards.
She said clinical trials require very tight quality controls with detailed monitoring. However, funding agencies in India are hesitant to fund that much level of expense. “The most common question asked by funding agencies tends to be, ‘Do you really need this?’ rather than ‘How do I facilitate this research?’”, she said.
“From basic science to applied science, there are significant barriers to research because funding never comes from the point of view of making it easier for people to do high quality research. It is always filtered down to individual projects,” she said.
Because agencies need to make a profit, it is the academics who end up paying the difference in cost to ensure good quality research. This problem is further compounded by low salaries in academia and research.
On urgent problems in Indian public health, Kang zeroed in on the treatment for tuberculosis and said, “We still haven’t done enough about it. The disease is being researched and worked on by both government and private agencies, leading to the need to have the two working together.
“In all these years, we haven’t done a good job of marrying the two sectors,” she said. “If I am providing treatment and I am also responsible for measuring the outcome of the treatment, how open will I be if I fail drastically?” she asked.
“To me, it is a question of how well a job can be carried out when you are both the implementer and measurer. We need policy commitment to be independently evaluated to understand why we aren’t making quicker progress with tuberculosis,” she said.
Rise of the Indian anti-vaxxer
Working to deliver vaccines at multiple levels among communities has enabled Kang to trace the growth of mistrust in vaccines among local communities across states.
Just like in America, infamously, even in India, it is the well-educated that seem to be against certain vaccines. However, unlike America, the reasons here have almost nothing to do with autism.
A common argument here is why foreign antigens need to be inserted into the bodies of children when they can be protected from diseases “in other ways”.
The upsurge in such voices adds to the locally prominent vocal voices who have been advocating for a long time that vaccines are a conspiracy by the government and big pharma companies to sell their products.
“Individually and without context, each argument might seem rational. But stitched together, they create this construct that there is no need for vaccines and (thus) disparage really crucial measures needed to ensure public safety,” she explained.
This played out in the recent Measles-Rubella (MR) campaign in 2017 in which India had committed to vaccinating 405 million children by 2019 and avoid preventable deaths. During this campaign, anti-vaccine distrust spread due to social media.
“There was an organised WhatsApp campaign — mainly in the form of videos of vernaculars speakers on stage — against the vaccine, saying that over time, the campaign will result in population shrinking and vaccinated children will have decreased facilities,” Kang said.
“It is hard to fight such ideas because populations indeed are shrinking but not because of vaccinations,” she said.
The spread of distrust for vaccination is a growing cause for concern, and thus Kang’s work now involves a lot of educational outreach, including meeting local leaders and explaining details about the vaccine and vaccination programs.
However, attempting to directly combat this distrust for vaccination is impractical, she said. “It is like religion. People have deep-seated beliefs that they try to communicate to others, and have made up their minds.”
The best way to quell this distrust is by spreading awareness not about individual benefits but about how vaccines help entire communities.
Additionally, it is important to make people understand that vaccinations don’t need to continue forever. When infrastructure improves, such as provision of clean water, which reduces the spread of typhoid, vaccines can be phased out, Kang said.
“That is complicated messaging,” she explained. “People need to understand what works. So, what we need to create is a situation where there is a pull for vaccines, (and) not the public health system pushing for it.”
Recognition and awards
Accolades have come pouring in for Kang in her 20-year career.
She was awarded the 2006 Young National Woman Bioscientist of the Year award given by the DBT. She was the recipient of the Abbott Oration Award from Indian Society for Gastroenterology (2009), the Dr. Y. S. Narayana Rao Oration Award from Indian Council of Medical Research (2011), and the Dr. S.C. Parija Oration Award from Indian Academy of Tropical Parasitology (2015).
She was also elected a Fellow of all three Indian science academies as well as the American Academy of Microbiology. She has also won the Infosys Prize in Life Sciences (2016).
Reacting to Kang being inducted as a Royal Society Fellow, Estes said, “This is a great honour for her and I am very proud of her achievements. I think what sets her achievement apart from many others is that most of what she has achieved has been through studies that were spearheaded and carried out in India.”
Kang is also the first Indian and the first woman to edit the 120-year-old text boook Manson’s Tropical Diseases. She is also a member of the WHO’s Global Advisory Committee on Vaccine Safety and the WHO’s Immunization and Vaccine Implementation Research Advisory Committee as well as the chair of the WHO SEAR’s Immunization Technical Advisory Group.
Women in STEM
Women in the fields of science, technology, engineering, and mathematics (STEM) often fall behind or lose out as they move through the system to reach senior positions.
To retain more women, Kang said, the environment needs to be more conducive to develop a mentality where women are required in the system.
“I have found that when I hire more women, my team is very different,” she said. “There is increased productivity and the team is capable of solving many more problems when it had so many women.”
About women who’ve been hammered early in their career, Kang said, “Take on big problems, explore every aspect thoroughly by yourself or in collaboration and do not give up. If you are not failing, the problem might not have been hard enough. Our society needs to enable women to fulfil their potential, not hold them back. Women in leadership need to support and enable women.”
This article has been updated with new information about Kang’s background.