Gagandeep Kang is one of India’s most prominent virologists and a member of the COVID-19 Working Group under the National Technical Advisory Group on Immunisation. Kang holds the distinction of being the first Indian woman to become a Fellow of the Royal Society and currently works as a professor in the department of gastrointestinal sciences at the Christian Medical College, Vellore. In a conversation on how India fared during the last two years of the pandemic, she said that the marked expansion of infrastructure and platform used for adult vaccination should also be leveraged to target other diseases. Edited excerpts:
In the last two years, what do you think has changed most in the Indian healthcare ecosystem?
The two things that have changed most markedly are our ability to test, particularly using molecular testing approaches, and our ability to deliver vaccines to adults. We have never previously had molecular testing as the first line of testing for an infectious disease. Even for tuberculosis, we used microscopy and followed that up with molecular testing. For the other two diseases that have nationwide programmes, we use microscopy or rapid tests for malaria and serology for HIV. For SARS-CoV2, we have thousands of laboratories which can carry out real-time PCR (polymerase chain reaction test). This infrastructure could be utilised for other diseases as well.
Similarly, the platform that has been established for adult immunisation could be leveraged for other vaccines, or we could consider the integration of immunisation as a life course approach.
What do you think have been the high and low points of the pandemic in India?
The standout high point for me has been the delivery of COVID-19 immunisation to adults. This has never been done on this scale in India before. The low point of the pandemic was the lockdown without support systems that left people struggling for survival in many places, and damaged the lives and livelihoods of the most vulnerable.
What have we learnt from the pandemic thus far as we prepare to move, possibly, to face another COVID wave or a new pandemic in the near future?
That preparedness is critical and that we live in a connected world. All of the challenges that we have faced—whether it is the lack of personal protective equipment in the early days of the pandemic or chemicals, drugs or vaccines—were overcome, but what difference would it have made had we been able to respond faster?
If the pandemic has shown us anything, it is that we were made to work together to develop and implement solutions. Whether this is policies, travel guidance, drugs or vaccines, we need aligned approaches to prevent confusion, wasted efforts and lack of equity.
A key issue is the need for clear, fit for purpose, publicly available, real-time data which can inform both citizens and policymakers on what needs to be done and where. Transparency builds trust and is critical when public behaviour determines how a pandemic will progress.
During the pandemic we also saw many drugs and therapies that were not evidence-based or not backed by science and data thrust on people by pharma companies and even AYUSH drug makers, and many of these were also politically endorsed. What mistakes, in your view, were made that ought to have been avoided?
Whether pharma or AYUSH, all medications need to be evaluated carefully and in sufficient numbers of patients to ensure that we are providing drugs to the general population that have been shown to work. Politics should have nothing to do with the delivery of evidence-based medicine.
Finally, what are the markers that should be used to determine whether COVID-19 has reached an endemic stage in India? Are we there yet?
Everyone has a different definition of what constitutes an endemic disease. To me, it is one that is caused by a pathogen that is expected to continue to circulate in the human population in our region for the foreseeable future. This does not mean that there will not be ups and downs in the numbers of cases or changes in the circulating strains. By that definition, COVID-19 has been endemic in India since the second wave, and we need to stop managing it the way we did in 2020. Our approach to surveillance needs to change, even as we continue to use all opportunities to improve treatment and ensure that protection from vaccination is maintained.
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