There’s no end in sight with COVID-19, we have to learn to live with it, says leading virologist Dr Gagandeep Kang

As the country’s most eminent virologist, Dr Gagandeep Kang has also been one of the sane voices disseminating the right information as the virus passed through the first, second and the Omicron waves of the COVID-19 pandemic.

The first Indian woman scientist to be elected as Fellow of Royal Society, Gagandeep is a key contributor to rotavirus epidemiology and vaccinology in India. A leading researcher, she is currently professor in the Department of Gastrointestinal Sciences at Christian Medical College (CMC), Vellore, also her alma mater, where she pursued her MBBS, MD and a PhD.

The recipient of many accolades and awards including the Infosys Prize in 2016, Gagandeep’s journey has been one characterised by cutting-edge research in a field dominated by men. In a conversation with HerStory, she talks of the importance of scientific communication, her work on the rotavirus vaccines, living with COVID-19, and being a woman in science.

Edited excerpts from the interview:

HerStory (HS): Can you tell us about your early days and how you developed an interest in science and scientific research?

Dr Gagandeep Kang (GK): Before enrolling at CMC Vellore, I was a typical railway child, moving a lot around the country because of my father’s job. That meant changing schools, adapting to new states, environments, languages and catching up on school curriculum. My interest in science came from reading very widely. Our house was full of books, I had relatives in medicine or psychology, all of whom I admired very much and had opportunities to spend time with.

I knew my interest in science would be channelled towards something related to medicine, in what is a very competitive environment. I'm glad it worked out. I'm not sure that if I was applying today for medical college, I would actually get in; the competition has become very much about your subject knowledge out of textbooks, whereas at the time that I applied all schools that I was interested in, were also very interested in general ability, general knowledge as well as your subject knowledge, those components don't figure as much anymore.

HS: You have been part of cutting-edge research over a long time. Can you elaborate on your path-breaking work?

GK: I think research stems from questions, and then figuring out how to solve problems that you place before yourself.

Much of what I learned about problem solving evolved in college through participation in not so much science as extracurricular activities.

For example, we used to run a student health clinic every Wednesday, be part of camps for screening children and as part of immunisation programmes. In fact, I was part of the first measles vaccine campaign in the country. That led me to an interest in infectious diseases and I was very fortunate to be at the Christian Medical Colleg, which had an environment of research.

One of the leading researchers in vaccines virology and infectious diseases was T Jacob John, who had been working on polio and the measles campaign. Some of the work that was done on polio in Vellore in the 1980s was his brainchild.

The other thing Vellore had was a strong exposure to the community, where students lived in the community during their first year, and then followed up with identifying problems and figuring out ways to address them during subsequent years of training and community health.

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HS: You are known as the vaccine godmother – instrumental in contributing to WHO-approved vaccines that can treat rotavirus – the Rotovac of Bharat Biotech and the Rotasill, developed by the Serum Institute. Can you tell us more on the development of these vaccines?

GK: The rotavirus vaccine development actually started in the 1980s, long before I had any interest in rotavirus, or knew that I was going to do public health science. It was started by Dr MK Bhan, who had identified that children who were infected during the neonatal period, in the All India Institute of Medical Sciences (AIIMS), were infected with a unique strain of rotavirus.

The children who had that infection, if they were followed up subsequently, had less rotavirus diarrhoea than children who had not had that infection in their early life, a fact which made this strain a good vaccine candidate plan. The development of this vaccine started in the late 80s and early 1990, in partnerships that Dr Bhan set up with Dr Roger Glass and the Indo US Vaccine Action Programme.

The reason I got interested in rotaviruses and in the use of neonatal rotavirus, as a vaccine strain, was that when I started to look at rotavirus in our community in Vellore, I found that our community also had a neonatal rotavirus strain that was different from the one that had been identified by Dr Bhan. I tried to replicate his studies and found that I could not, and the strain that we were looking at was G10P[11] strain as opposed to Dr Bhan’s G9P[11] strain, which did not protect children from subsequent rotavirus diarrhoea.

I tried to draw a lot of people's attention to the fact that while both these strains were being developed as vaccines, one was likely to work and the other was one was unlikely. So that got me started on talking to people about what could be done.

Ultimately, Dr Bhan invited me to work with him on the development of the Rotovac vaccine in two ways. One was to participate in the phase three clinical trial of the vaccine. And the other was to establish a reference laboratory that could analyse all samples that came out of the vaccine trial. It was a partnership across the clinical development teams and the laboratory evaluation teams. We wound up with a vaccine network that was pretty phenomenal.

But, for the Rotasiil vaccine, because we had established a laboratory that was able to analyse all kinds of samples from the vaccine studies, we have been involved with the vaccine development from a much earlier stage. This was a vaccine that had been developed at the National Institutes of Health in the US, and was licensed by Serum Institute of India, but developed wholly in India.

We participated in the studies that started from the animal models, or through phase one, phase two, phase three studies. And for both Rotovac and Rotasiil, they got licenced and there have been studies that were needed to be done even after licensure. We have participated in those studies as well, in terms of the clinical evaluation of effectiveness of the vaccines, as well as for the additional voluntary analyses that have needed to be done.

HS: As one of the country's leading virologists disseminating information during the pandemic, yours is a sane voice. What were the biggest challenges you faced in this regard?

GK: I think one of the things that society really needs to understand and often does not, is how do you figure out who is a credible voice and who is not. For example, we've had people who are in multiple different specialties of medicine, from gastroenterologists to cardiologists commenting on SARS COV-2 to form various perspectives that you think would be more in the domain of public health or virology.

That brought home to me the importance of being able to communicate to society, what science really means and how you identify credible voices inside. The good thing about the pandemic and about learning to communicate during this time, was really the fact that society in general has recognised that science is really important, is bringing us solutions, both for the measurement of how much SARS-COV2 is out there and for developing solutions like drugs and vaccines. For me, it's been quite a learning experience on how to think about conveying information that is appropriate without making it something that is esoteric or difficult for people to understand. So, I think doing science communication, building the credibility of science, has been a challenge, but a worthwhile one.

HS: With a number of states removing the mask mandate, is there an end in sight for the virus, or should we simply learn to live with it?

GK: There is no end in sight. It may sound depressing, but it's not really. We live with a lot of infectious diseases and we are capable of handling most of them quite well. This was a new infection that came into the population and spread very rapidly and went everywhere. Now we are in a situation where everybody has had exposure, including children. All adults, by and large, have received at least two doses of the vaccine. That puts us in a good position to be able to handle what comes next. There is of course a danger that we might have variants that will both be highly transmissible and capable of causing severe disease.

There will be more variants, we are not going to get rid of this virus. The reasons include – it causes asymptomatic infections, it infects animals and it knows how to evolve. All three put together means we have to learn how to live with it.

The analogy I use for masks that I think is most appropriate is think about the weather. When it's really hot, what do you do? You obviously don't wear woollens. And if it rains, you know, you need a raincoat or an umbrella. In places where there is very low transmission of disease, you can go back to life as normal, you don't necessarily need to wear masks. But if you see a rise in cases or if a new variant emerges, then we will have to go back to what we know works and masks in a way, is a variant proof protection that we can easily use and we shouldn't discard them forever.

HS: Do you think it's advisable to send young children back to school?

GK: Quite frankly, I think kids should have been in school a long time ago. Vaccines for children are still something we need to think about very carefully. You know, if a child is healthy, I actually believe that as a public health policy, we should not necessarily be giving every child the vaccine in India. Studies show that 80 percent of children are seropositive. Now 80 percent of children have not received the vaccine, and 80 percent of children have not been sick. We know that when the virus infects children, it tends to be asymptomatic.

I'd be more comfortable vaccinating children if we had detailed data on immune responses to and the safety data for each vaccine.

HS: Is it difficult being a woman in science and research?

GK: I can say I come from a position of relative privilege. CMC Vellore was started by a woman. When I entered medicine, 40 percent of the class had to be women. Now, it's more like 60 percent women. So being in an institution that has recognised the role of women, the importance of women and contributing to health care was very empowering.

But there were no women leaders in research, even at CMC. So as I got engaged in research, I found I was often the only person in the room. And sometimes it's difficult to make yourself heard, when the group is largely male. This was less of a problem at CMC, where I was an alumna and therefore, you know, had no problem putting myself across.

But when you go to meetings in Delhi or internationally, you find that you're pretty much one of a kind.

I used to have some of the imposter syndrome and I think that is conditioning that we have as women to not think we are capable or worthy. What I try to do is to make sure that women in my group are recognised and learn early, how to speak up, speak out and get out to meetings, because quite frankly, if you're not given a platform, then women tend to hide in the background.

The FRS actually helped a lot since I was the first woman from India to receive it, it gave me credibility. In terms of my own research, nothing much has changed. But I think I am heard more than I was previously because of the recognition.

HS: What is the significance of prizes like the Infosys prize, you know, to encourage a culture of scientific thinking, especially in light of the challenges we have faced during the pandemic.

GK: The Infosys prize is recognition given to relatively younger individuals who have achieved a lot but still have more to contribute. And to have a prize that's not a lifetime achievement award is a challenge in a way to make sure that you continue to contribute beyond the recognition that you received.