Dr. Gagandeep Kang, a leading expert and principal investigator for the Rotovac vaccine against rotavirus-related gastroenteritis, expresses immense enthusiasm following the publication of a nationwide study confirming the vaccine’s effectiveness.
Currently serving as the director of the global health team at the Bill and Melinda Gates Foundation, Dr. Kang oversees a portfolio encompassing enterics, diagnostics, epidemiology, and genomics. In her previous role at the Christian Medical College, Vellore, she established comprehensive surveillance networks to investigate enteric infections, including rotavirus. Her extensive research provided vital insights into the disease’s spread and was instrumental in the clinical development and testing of Rotovac. This vaccine was a collaborative effort involving the Department of Biotechnology, Bharat Biotech, the U.S. National Institutes of Health, the Centers for Disease Control and Prevention, Stanford University, and PATH, with significant backing from the Bill & Melinda Gates Foundation.
(An image featuring Gagandeep Kang, director of the global health team at the Bill and Melinda Gates Foundation, is associated with this article.)
From Clinical Trials to Real-World Impact
Speaking from Seattle, Dr. Kang pragmatically questions the real-world impact of vaccine trials. She explains that trials typically involve healthy participants following a strict dosage schedule, ensuring optimal outcomes. However, the crucial question remains: ‘Will it be equally effective in diverse community settings, especially where children may be malnourished, might not receive all doses, and conditions vastly differ from a controlled trial environment? Does successful widespread coverage require complete vaccination?’
This particular study employs a ‘test-negative’ design, conducted after years of government vaccine distribution to children. Researchers monitor hospital admissions, observing how many children receiving diarrhea treatment have been vaccinated. A higher incidence of unvaccinated children among those with diarrhea effectively demonstrates the vaccine’s protective power.
The study revealed an effectiveness of approximately 54%, consistent with the findings of earlier efficacy trials. Notably, while the initial trial involved 200 participants, this recent investigation examined over 4,000 children, providing robust data.
Dr. Kang emphasizes that while successful trials are excellent, real-world performance outside controlled environments is paramount. She raises lingering questions: ‘Are there specific regions where the vaccine performs better? What about overall coverage?’ She acknowledges that ‘every vaccine aims for 100% effectiveness, but realistically, no vaccine achieves this. Our focus must be on finding innovative ways to enhance protection.’
Previous concerns arose regarding Rotovac potentially causing intussusception in children—a condition where one part of the intestine telescopes into another, leading to a blockage. However, Dr. Kang confirms that a thorough safety study found no evidence whatsoever of this link, and subsequent data further disproved intussusception as a side effect of Rotovac.
(An image depicting the introduction of Rotovac into the Universal Immunisation Programme, highlighted by Dr. Kang as a game changer, is included with this article.)
India’s Rotovac: On Par with Global Standards
In light of ongoing scrutiny regarding pharmaceutical standards in India, what does this mean for the nation? Dr. Kang confidently states, ‘This confirms that Rotovac stands shoulder-to-shoulder with any international vaccine; our domestic companies are producing exceptionally high-quality vaccines.’ India has made significant strides in rotavirus vaccination since its introduction in some states in 2016, becoming freely available nationwide by late 2019. ‘Despite initial challenges, the government’s efforts have been remarkable,’ she notes. ‘Approximately 90% of the target population is now vaccinated, which is an incredible achievement given our vast birth cohort. However, it also means we still need to reach the remaining 10%.’
Universal Immunisation: A Powerful Tool for Equity
Dr. Kang asserts that integrating Rotovac into the Universal Immunisation Programme (UIP) was a pivotal moment. She explains, ‘While the private sector offers access to global vaccines, true equity demands that every child has the right to protection—a goal only the UIP can accomplish.’ She recalls that after measles was added in 1986, the UIP saw no new vaccines for over two decades until the Pentavalent vaccine. Since then, Rotavirus, pneumococcal, and injectable polio vaccines have been included. The National Technical Advisory Group on Immunisation has also approved HPV and typhoid vaccines, and Dr. Kang hopes to see them soon become part of the UIP, further cementing its role as a vital instrument for health equity.
In an era marked by widespread vaccine skepticism, Dr. Kang urges all proponents of evidence and rationality to unite. She observes, ‘Uninformed individuals are often quick to embrace conspiracy theories.’ She stresses the need to ‘cultivate trust in science, which inherently acknowledges limitations. It’s crucial to be transparent about what we know and what remains uncertain. This transparency isn’t a weakness; it’s a fundamental aspect of scientific progress, enabling us to remain open to future discoveries.’
Fostering Critical Thinking Amidst Disinformation
However, Dr. Kang acknowledges that those who spread skepticism are often stubbornly confident in their lack of knowledge and indifferent to facts. She believes the antidote is to foster a scientific mindset, encourage critical thinking, and educate ourselves to seek out trustworthy information rather than sensational headlines. ‘It’s a challenging task,’ she admits, ‘especially with the constant deluge of disinformation bombarding us today.’