THE IMPACT OF rotavirus—the leading cause of diarrhoeal disease among children and infants globally—is particularly terrible in India. Every year, an estimated 78,000 children under five years die here. And several million are hospitalised. Vaccines have been around since the mid-1990s, but their high cost, between Rs 2,000 to 2,500 for a course, has put it out of the reach of most Indians. And strangely, even when children here are vaccinated, it is found to be far less effective than this measure has proven in the West. Not only is the burden of the bug tremendous here, for a long time it has also been little understood.
Among the six individuals awarded this year’s Infosys Prize is one of India’s top rotavirus researchers, Dr Gagandeep Kang, a physician scientist who has been studying the bug and its impact in India for several years. Dr Kang has also been part of a team that developed the country’s indigenous rotavirus vaccine. The vaccine, Rotavac, only Rs 54 per dose, was launched in March last year. It is currently being made available free of cost in four states—Odisha, Himachal Pradesh, Andhra Pradesh and Haryana. The launch of this vaccine is considered a significant moment in public healthcare in the country because the vaccine strain was isolated in India (from a patient in AIIMS), studied and worked upon here and developed by an Indian vaccine manufacturer. Dr Kang has spent several years as a Microbiology professor and the head of the gastrointestinal sciences’ division at Christian Medical College’s Wellcome Trust Research Laboratory. More recently, she was appointed executive director of the Faridabad-based Translational Health Science and Technology Institute, where she is developing a new programme on vaccines, among other public healthcare initiatives.
Dr Kang first became interested in studying the virus, she says, when she was an intern at CMC, Vellore. A child had been wheeled into the hospital, but was so dehydrated by diarrhoea that no one could even find a vein to start a drip. ‘It was not for many years that I connected the rapid dehydration of the child with rotavirus, because when we were taught about diarrhoea, it was more about bacteria than viruses. It was only when I began to work on childhood diarrhoea myself that I realised that the real burden of rotavirus was something that the medical and paediatric communities in India had not measured well,’ she says in an email. Dr Kang then began to study the virus and its impact. ‘I went out to collect stool from as many locations as I could— even had my mother, who was in Punjab, [collect] samples from local paediatricians and [store it] in her fridge. When I tested them and found one after the other [turn] up positive, I knew this was a problem we really needed to highlight and work on.’
Dr Kang has over the years, through her research, established that immunity to rotavirus infections in the Indian population is much lower in comparison to others. ‘We do not completely understand why this happens,’ she says. ‘But we think it has a lot to do with multiple exposure to intestinal infections and the effect of the environment on intestinal function.’ Dr Kang is part of an eight-country research project studying the link between malnutrition and enteric infections.
An article in the news portal The Ken mentions that Dr Kang and her team are trying to combat vaccine inefficiency, from using antibiotics to treat enteropathy, zinc and vitamin D tablets for nutritional deficiencies and interrupting breastfeeding during vaccination, to a later proposed trial where they change the timing of additional vaccine doses and add a neonatal dose or a booster.