Gagandeep Kang on Vaccines, Surveillance and Child Health in India ^{CEFR B2}

Gagandeep Kang, a leading expert on enteric diseases, argues that India must prepare the tools needed to prevent viral outbreaks. She supported development and introduction of indigenous rotavirus vaccines and helped build national surveillance networks. In 2019 she became the first Indian woman elected a Fellow of the Royal Society, and in 2024 she received the John Dirks Canada Gairdner Global Health Award. She now serves at the Gates Foundation as director for enterics, diagnostics, genomics and epidemiology.

When Kang started medical college the infant mortality rate was 125 per thousand live births, so more than one in ten children died in their first year. That rate has fallen to about a quarter of that number. In Tamil Nadu the rate is well under 20 per thousand and officials aim for ten per thousand. Kang says policy should move beyond death as the only measure and also consider hospital admissions and the time children spend ill.

Kang notes that rates of viral infection among children have not fallen as much as deaths. Bacterial infections can be reduced with clean water and sanitation, but viruses are more resistant and spread across social classes; she calls rotaviruses “democratic” because they eventually infect most children. Developing a rotavirus vaccine in India involved scientific and regulatory challenges: no one had previously developed and shown a vaccine from scratch in the country at that scale, and Phase 3 trials of this size had not been done there. To deploy the vaccine developers needed to convince the National Technical Advisory Group of Immunisation about disease burden, vaccine efficacy and align with World Health Organization recommendations. They also had to show the vaccine promoted equity and was affordable; cost-effectiveness analysis showed preventing hospitalisation would save money.

Kang says rebuilding public trust in science requires continuous communication, not only during emergencies, and that trusted messengers and evidence-based explanations matter. During the pandemic India improved surveillance, expanded One Health work to include animals and birds and set up the National Institute for One Health in Nagpur; some states, such as Kerala, can detect single cases of Nipah virus. India developed vaccines indigenously nearly in parallel with the West, and domestic companies are now more confident. Kang warns that influenza remains a clear pandemic risk because it is a respiratory virus and would take a long time to make a vaccine. She adds that India’s role as a major vaccine and generic manufacturer could be used to improve public health.