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Having worked in enteric disease research for the past three decades, Gagandeep Kang has a broad perspective on many of the health challenges confronting her native India. Kang, who is Professor of Microbiology in the Department of Gastrointestinal Sciences at the Christian Medical College (CMC) in Vellore, southern India, also directs CMC's Wellcome Trust Research Laboratory. There, rotavirus vaccine work—which has been a central part of her career—remains a priority. “We are currently collaborating with a network of 25 hospitals across India to enable us to better understand how much disease is alleviated and why the key prevention tool of rotavirus vaccines does not generally work as well as they do in high-income countries”, she says.

entral part of her career—remains a priority. “We are currently collaborating with a network of 25 hospitals across India to enable us to better understand how much disease is alleviated and why the key prevention tool of rotavirus vaccines does not generally work as well as they do in high-income countries”, she says. Typhoid disease research is another important area. With CMC colleague Jacob John, she led a comprehensive 4-year disease surveillance programme that recently concluded. “Our work here shows the high prevalence of typhoid and the urgent need for new vaccines. Although there are two licensed vaccines in India, their use is based on immunogenicity rather than efficacy data. We might consider a different approach of evaluating efficacy, potentially with a human challenge design, although we would need trained researchers and an appropriate research facility, such as the one used at the University of Oxford, UK”, Kang explains. Past controversy around clinical research in India—the Indian Supreme Court banned clinical trials in 2013, although the decision was later reversed after the introduction of new processes—suggests that she may have an uphill struggle. “Our discussions on human challenge studies have lasted 4 years so far, with clinical scientists and ethicists in favour of such an approach, but with there being no clear path ahead as yet”, she says.

the decision was later reversed after the introduction of new processes—suggests that she may have an uphill struggle. “Our discussions on human challenge studies have lasted 4 years so far, with clinical scientists and ethicists in favour of such an approach, but with there being no clear path ahead as yet”, she says. Kang's early career after qualifying in medicine from CMC in 1986 was in ophthalmology at the All India Institute of Medical Sciences in New Delhi. “I loved the specialty, but a familial tremor in my arm put an end to any ideas I had of being an ophthalmic surgeon”, Kang recalls. Instead, she chose microbiology at CMC for 3 years of laboratory training, “which bored me stiff”. In 1991, she was offered a junior faculty position in enteric disease research at CMC's Wellcome laboratory, the start of her research career. Kang's immersion into rotavirus research began later, in 1998, when she spent a year at the UK Public Health Laboratory Service in London. She persuaded Mary Estes at the Baylor College of Medicine, Houston, TX, USA, to let her join their rotavirus research team, which has led to an enduring collaboration between CMC and Baylor. “Our work at Baylor and back in India has been to try and identify a correlate of protection for rotavirus disease. We have failed in all our efforts so far, but it remains a clear priority for our ongoing international research collaborations”, Kang says.

ch has led to an enduring collaboration between CMC and Baylor. “Our work at Baylor and back in India has been to try and identify a correlate of protection for rotavirus disease. We have failed in all our efforts so far, but it remains a clear priority for our ongoing international research collaborations”, Kang says. In 2016, she took a position as Director of the Indian Government's Translational Health Science and Technology Institute. When COVID-19 emerged in India in March, 2020, Kang's priorities were to assess the institute's role for epidemiological research and to create platforms to provide the basis for vaccine scale-up by the pharmaceutical industry. She returned to CMC in 2020, and is active in COVID-19 policy work, notably through her role on WHO's SAGE Working Group on COVID-19 Vaccines and WHO's South-East Asia Regional Immunization Technical Advisory Group, and through various national and state advisory roles in India. And it is the impact of COVID-19 on widening health inequities in India that underpins Kang's determination to help shape future health system reform. “The lack of delivery of health care in the public sector has led to an overdependence on private health provision, with around 65–70% of expenditure for health services being out of pocket, often at catastrophic personal cost”, Kang explains. She is a co-architect of the Lancet Citizens’ Commission on reimagining India's health system that is now underway. “This will call for an achievable 10-year road map towards universal health coverage, with tangible targets of reducing out-of-pocket expenses over the coming decade. It is all about creating transitional pathways, not trying to do everything tomorrow”, she says.

reimagining India's health system that is now underway. “This will call for an achievable 10-year road map towards universal health coverage, with tangible targets of reducing out-of-pocket expenses over the coming decade. It is all about creating transitional pathways, not trying to do everything tomorrow”, she says. Kang also believes that change needs to extend to India's medical education. “Our academic medicine system disincentivises research, with limited training and opportunities for electives in undergraduate and postgraduate studies, something that needs urgent reform”, she says. Sasirekha Ramani, Kang's first PhD student at CMC and currently Assistant Professor of Molecular Virology and Microbiology at Baylor College of Medicine, says Kang “has that unique combination of ‘big picture’ vision and doing what it takes to achieve that vision. One of her striking traits is that she does not say a lot, particularly at large meetings; she is not the loudest voice. But when she speaks, people listen. Her impact on my career has been profound; I learnt the values of hard work, persistence, collaboration, and of building a supportive environment for people to succeed from her incredible mentorship.”

e does not say a lot, particularly at large meetings; she is not the loudest voice. But when she speaks, people listen. Her impact on my career has been profound; I learnt the values of hard work, persistence, collaboration, and of building a supportive environment for people to succeed from her incredible mentorship.” Kang is already future proofing her area of expertise. “I plan to ensure there are at least 20 public health research focused faculty members, who will nucleate their own groups, not just at CMC. If I can pass on my experience and hopes for improved infectious disease prevention and treatment, while also having a lasting impact on India's future health system direction, then I will look back and say I made a difference, and have left a strong legacy to carry my work forward”, she says.