Wednesday, December 7, 2016

Measles and Vaccination Failure

Widespread immunization against measles began in the 1980s and the vaccination programme had critical success in preventing spread of this contagious disease. The World Health Organization recommends that all children should be given two doses of the MMR vaccine as part of national immunization campaigns. The Centers of Disease Control and Prevention (CDC) recommends that the doses be separated by at least 1 month and administered on or after the first birthday for all children. Death due to measles has reduced from 5,62,400 deaths in the year 2000 to 1,22,000 in the year 2012. The WHO goal is to eliminate measles globally by the year 2020.

The measles vaccine provides long term and normally lifelong immunity. However, secondary vaccine failure - where the body does develop immunity after two doses of vaccine but still falls prey to measles  has also be reported. A study published in the Indian Journal of Medical Research (2011) examined antibody concentrations in children from Delhi for over a year. The study concluded that four out of five children, who had been given two doses of the vaccine as per the country’s immunization programme, still remained susceptible to contracting the disease, as they had not developed the necessary seroprotection levels. The United States is among other countries that have reported cases of outbreak of measles among vaccinated populations.

The waning immunity of the vaccine has been attributed to several factors. In countries like India with a huge vulnerable population, the first dose of MMR is given when the child is nine months old. At this age, the mother’s antibodies interfere with seroconversion after the vaccination thus affecting immunity. Delaying the first dose to 12 months may prevent the waning of immunity. Secondly, the potency of the vaccine and the conditions under which it is preserved could also pay a role in vaccine failure. The solution to the problem of vaccination failure may thus lie in delaying the first dose, regular surveillance or immunity checks of the vaccinated population and better storage/preservation of vaccines.

Monday, November 7, 2016

Resurgence of Malaria

The world’s see-saw battle against malaria began in 1955 with the launch of the Global Malaria Eradication Programme (GMEP). GMEP, which was halted in 1969, did have a measure of success. Europe, North America, the Caribbean and parts of Asia and South-Central America became malaria free. But with periodic episodes of malaria resurgence, the war against the vector disease remains a deadly one.

The term malaria resurgence is applied when the disease reappears in areas where it had been eliminated or was previously well in control. A study conducted by the Clinton Health Access Initiative, in conjunction with the UCSF Global Health Group and the Johns Hopkins Malaria Research Institute analyzed the causes of 75 documented episodes of malaria resurgence throughout the world over the past 80 years. The study was published in the April 24, 2012 issue of Malaria Journal. It concluded that 68 out of the 75 episodes of resurgence (91%) were due to reduced focus on malaria control programmes. In 39 of these 68 cases, the programmes failed to take off due to a lack of funds.

The cessation of the GMEP brought to an end the global fight for eradication of malaria and shifted the focus to regional elimination via the use of tools like vector control and insecticide treated nets. However, the newly independent countries of Africa in the 1990s did not have the funds to fight malaria on a war footing, causing a resurgence of the disease. The Roll Back Malaria initiative was launched by the World Health Organization in 1998 in view of this resurgence. Increased resources were allocated to fight malaria through the Global Fund to Fight AIDS, Tuberculosis and Malaria, the World Bank’s Booster Program, the US President’s Malaria Initiative. With more funds available for anti-malaria intervention, malaria eradication in specific geographic areas has gained momentum since the year 2000.

But there is a caveat to the success of the malaria control programme. The success is fragile. It can be maintained and sustained only if accompanied by financial and political support. Otherwise, malaria resurgence is likely to rapidly erase any gains made towards elimination or eradication.

Tuesday, October 4, 2016

Better Regulation of Quality Control in Higher Education

The classroom scenario in institutes of higher education in India, with a few notable exceptions, is uninspiring. Curriculums are taught ad nauseam with little innovation or change.  Our students learn concepts and theories that do not move from the pages of their textbooks and the confines of the classroom to laboratories and real life situations. The end result of this festering higher education system is that every year thousands of unemployable youngsters pass out with degrees from our colleges and universities.

How do we stem this rot? The quest for quality control in higher education will be successful once we focus on the most valuable stakeholder in the education system – the student. The bureaucracy that runs our higher education system is remote and removed from the student.  Higher education courses are guided by rules set by the University, rules set by the college and rules set by the professional council (example the Medical Council of India) that awards the degree. This results in a tremendous amount of inbuilt inflexibility and red tape. A simple example is, as mentioned above, the curriculum. The teacher who teaches the course has little freedom to tailor or interpret it. This quells innovating thinking and teaching. Breaking down the bureaucratic structure would improve the quality of education imparted.

The outcome of higher education should be students who are competent, skilled individuals with reasoning and analytical capabilities. But our higher education system seems to have lost track of this lofty goal. The talk is always about norms and regulations for setting up an institute, the facilities to be provided, the faculty appointment rules, enrollment numbers and more.  It’s necessary to reset the focus on the outcome rather than the input. This can be done by putting monitoring and evaluation processes in place, but giving institutes of higher education the autonomy to decide how restore the joy of learning to the thousands of students who languish in the confines of our outdated higher education system.

Tuesday, September 27, 2016

Role of Civil Society in Control of Mosquito Borne Diseases

Effective engagement of civil society is crucial if the world is to win the battle against mosquito borne diseases. Upsurges in vector borne diseases in the 1940s and 1960s were controlled mainly by chemical controls like fogging and spraying. However, this single focus approach may not succeed today. Rather, successful vector control strategy must focus on an integrated approach. Targeted environment management and the introduction of biological controls must be a part of the overall vector control strategy. Civil society can play a key role in both awareness creation and implementation.

Aedes aegypti, which causes dengue and chikungunya, flourish in urban settings. The larvae are found in large concentrations in artificial water containers near human habitats. The Government’s well publicised awareness campaigns have already spelt out the steps needed to control vector breeding. The solutions for targeting mosquito ecosystems are simple and inexpensive. Civil society must consider it their social responsibility to start implementing the dos-and-don’ts rigorously. Covering domestic water storage containers with tight lids or mesh and planting more trees to prevent water from collecting on the ground are doable goals for every family unit. Waste management is an important aspect of environment management. Correct disposal methods must be inculcated as damp organic matter, discarded containers, coconut shells are all potential larvae habitats. Better waste management is possible only with an enlightened civil society that cares for the common good.

In countries like Vietnam and Tanzania, civil society and the scientific community have come together to promote the use of biological controls to bring about long term reduction in disease transmission. Community participation helped scientists in Vietnam to successfully introduce a crustacean Mesocyclops (Copepoda) into domestic water tanks and storage containers. Copepoda feed on newly hatched Aedes aegypti larvae. The campaign involved local health workers, school children and community leaders. The combination of enthusiastic civil society participation and an effective biological control helped eliminate the dengue fever in a 380,000 strong community in northern and central Vietnam.

Community participation and civil society engagement is critical if incidence and transmission of vector borne diseases are to be reduced in an eco-friendly, environmentally sustainable manner. Prevention of breeding and targeting the larvae are important fronts in the fight against vector borne diseases and it is here that we, the people, can play an important role. 

Tuesday, September 13, 2016

Onam: Changed yet Unchanged

The haunting melody of evergreen folk songs juxtaposed against blaring, flashy ‘Onam sale’ advertisements; the natural grace of the traditional pookalam contrasting with the bindingly colourful festival lights; the fierce dancers of the pulikali  vying for attention with new movie releases – God’s own country celebrates Onam with a panache that is both modern and traditional.

With the 10-day annual shopping and sadya frenzy well underway and the Onam festivities building up to a crescendo, it is time for us to take stock. What is the significance that Onam holds in today’s world? Are the new and the old in conflict? Do the raucous sales and flashing lights of modern day Onam festivities overshadow the gentle rhythm of the old style celebrations? Are our youngsters alienated from the cultural ethos of this harvest festival?

Philosophically Onam represents renewal of life and relationships. The bountiful harvest brings with it the hope for the future. The grand welcome accorded to Mahabali in every home represents the untiring effort to keep relationships eternally alive. Kerala’s Onam celebrations may have evolved over the years with a newer glitzier style in keeping with a more aspirational and ambitious world. But behind the glitz, the spirit of the festival remains unchanged.

As it has been down the ages, Onam remains a time for families to come together and weave a tapestry of unforgettable experiences that include singing, dancing, feasting, giving, taking and merry making. The beats of the music may have changed from folk to pop, but the lyrics still tell the story of love and relationships. The rhythm of the dances may be more modern, but the performers still express a tale of finding happiness and joy in togetherness. The colours of the pookalam compete with the blaze of the fairy lights, but both teach us the wisdom of looking ahead with optimism.  

Yes, Onam has changed; but most importantly, its message, spirit and significance remain unchanged. It will forever remain a time when families bond together to renew relationships and optimism pervades our soul.  

I take this opportunity to wish our Governing Council members, our Scientific Advisory Council members, all our colleagues at the Department of Biotechnology as well all my colleagues and students at RGCB a most wonderful and prosperous onam.

Wednesday, September 7, 2016

Biotechnology and the Start-up Era

India’s fastest growing knowledge based industry, the biotechnology sector, has been in the spotlight over the past several years. With a vast talent pool of trained scientists and engineers, world class R&D institutes with access to cutting edge technologies and India’s inherent manufacturing cost advantage, the country’s biotechnology industry is expected to hit an average growth rate of around 30 percent a year and touch $100 billion by 2025.

The optimism and expectation surrounding the industry owes much to the strong focus by Central and State governments on creating biotech hubs to tap the entrepreneurial and innovative talent of industry professionals. The Startup India initiative launched on January 16, 2016 has given a further impetus to the momentum created by the Make in India campaign. The key challenges to biotech innovation were lack of funds, high capital intensity needed to launch startups and the resources required to sustain the long gestation period between ideation and end product manufacture. To meet these challenges, the Department of Biotechnology and the Biotechnology Industry Research Assistance Council (BIRAC) have provided funding support and incentives for the development of biotech incubators. Other noteworthy steps taken to create a nurturing ecosystem include creation of University Innovation Clusters, innovative funding by Small Business Innovation Research Initiative (SBIRI) and Biotechnology Industry Partnership Programs (BIPP) where the Government partners with the industry on a cost sharing basis to support the development of high risk but innovative technology. Results indicate that this concerted effort to ensure that the biotech industry achieves its enormous potential has started paying rich dividends. As per figures published by the Department of Biotechnology, there are more than 240 start-ups and innovators and 89 incubatees in the country.

The Rajiv Gandhi Centre for Biotechnology (RCGB) is an active participant in India’s race towards developing an innovative, versatile and cutting edge biotechnology sector. RCGB-managed Bio-Nest technology and business development incubator at KINFRA Biotechnology Park in Kochi is a 50,000 square foot business incubator where a dynamic environment exists for biotech start-ups. The objective is to accelerate the commercialization of new technologies, nurture emerging ventures and to assist entrepreneurs to forge appropriate link with other biotech companies, academia and government.

Bio-Nest also provides the overheads that start-ups often lack. This includes management, administrative and back office support. Freedom from the nitty-gritty of running an establishment and access to funding, research and technology provided by Bio-Nest gives entrepreneurs and innovators the opportunity to concentrate on product development, marketing and sales. This comprehensive support will help India’s young tech generation to breach new frontiers of innovation in the biotechnology sector.

Thursday, March 3, 2016

Zika Epidemic: Separating Hype from Fact

What is Zika?

It is a virus spread by Aedes mosquitoes - these are the ones that are active during the day. It usually causes no symptoms. In some cases, mild flu symptoms may be produced. But this is often cured with rest. All these are obviously no cause for concern. The reason why the world has taken note is because pregnant women affected by the Zika virus gave birth to babies with small heads. The WHO (World Health Organization) has declared it to be an international public health emergency. After it affected a million people in May 2015, the virus has spread to 24 nations in the Americas and Caribbean, and there is no known vaccine, cure or treatment.
These are the facts surrounding the epidemic.

Does the Zika virus cause microcephaly?

The evidence linking the virus to microcephaly or shrunken heads in newborn babies is at best circumstantial. In Brazil, the transmission of the virus picked up in 2014-15. Up until 2014, the four-year average for microcephaly was 163 cases a year. Brazilian health authorities have now recorded 3,530 cases of microcephaly between October 2015 and January 2016, and this figure includes 46 deaths. But for some reason, most of these have occurred in the northeastern part of the country, leading many to wonder if it is really the Zika virus that is the cause.
The Physicians in the Crop-Sprayed Towns (PCST), a group of doctors, blame it on Pyriproxyfen, a larvicide that was added to Pernambuco’s drinking water supply by the Brazilian Ministry of Health way back in 2014. This was done to check the growth of the Aedes aegypti mosquitoes in the region, after it was determined that these mosquitoes were carriers of the Zika virus. The chemical Pyriproxyfen is known to cause birth defects, and in this immediate instance, a commercial version of it, called SumiLarv, was used. Sumitomo Chemical, believed to be a Japanese subsidiary of Monsanto, produces SumiLarv.
Others are skeptical of this claim. Pyriproxyfen is used in 40 countries worldwide, including developed nations like France, Spain, Denmark and the Netherlands. Recife is the epicenter of the outbreak, but Pyriproxyfen has not been added to the drinking water here. Pyriproxyfen does cause birth anomalies, but because of this, it is added carefully, and only in minutely small quantities, just enough to prevent Aedes aegypti larvae from becoming fully-grown adults. To be at risk from Pyriproxyfen, one would have to drink 1,000 liters of water treated with the chemical. Monsanto also has clarified on its association with Sumitomo – the Japanese company actually supplies it with technology, not the other way around. And this is restricted to herbicides. Monsanto does not own any stake in Sumitomo Chemical. The doctors' group PCST is also an Argentinian organization and not a Brazilian one.

Popular myths surrounding the Zika virus

The most widely circulated of them include how Zika is a killer, like the Ebola virus. The Zika virus is not fatal, and despite over a million being affected, no one has actually died. Those affected need not be hospitalized, and the mild flu-like symptoms pass off in a few days.