INTRODUCTION
President of the Indian National Science Academy (INSA), R. Gadagkar, opened the joint Indo-U.S. Workshop on Challenges of Emerging Infections and Global Health Safety by stating that the topic of the meeting could hardly be more important or more timely. Infectious diseases respect no national borders; hence, the focus on global health safety. The joint effort between INSA and the National Academy of Sciences (NAS) provides an opportunity to lead our nations to establish state-of-the-art life sciences research infrastructure and to meet the multiple and complex human and animal challenges ahead.
Krishnan Lal, immediate past president of INSA, added that the unexpected emergence of infectious diseases like Ebola and the recurrence of influenza attract the attention not only of the scientific community, but also of the academies and the governments of India and the United States. Another persistent issue, which remains unsolved and deserves attention according to Lal, is that of drug resistance such as drug-resistant tuberculosis. V. M. Katoch, director general of the Indian Council of Medical Research and secretary of the Indian Department of Health Research, noted that scientific cooperation among experts in India and the United States has deep roots extending back decades, and has resulted in formal agreements with the Centers for Disease Control (CDC), the National Institutes of Health, and other agencies. Immense contributions to addressing emergent and persistent health challenges have been made by experts from both countries. Together they are mapping outbreaks of many infections and identifying which are emerging and reemerging, and are trying to solve real problems of disease.
Animal and human influenza in particular motivated a great deal of cooperation. The H1N1 outbreak of 2009 led to the development in India of a plan to create a network of research and diagnostic laboratories.
Thus far, 15 laboratories have been established that have enhanced the speed and capability of diagnostics. Some laboratories are investigating approximately 800 viruses simultaneously representing a wide coverage of the potential disease burden, and have mapped all viral diseases in a specific geographic area. This has resulted in some initial metrics of emerging diseases in some parts of the country.
Through cooperation with the CDC, novel technologies have been incorporated into a network of 10 regional laboratories, which will be part of the Indian federal laboratory network slated to be completed by 2016. In addition, there are 30 state-level laboratories in medical colleges. These colleges have a strong record of publishing both on viral diseases and on bacterial illnesses, such as outbreaks of anthrax, plague, tuberculosis, and other infections. In addition, there are 120 government medical schools, called college-level laboratories.
Katoch highlighted the support provided by U.S. colleagues on the development of the laboratory network, and the need to continue cooperation on growing challenges such as that of drug resistance. In addition, persistent problems remain, such as the potential for outbreaks of anthrax and plague. Due to the potential threats posed by these and other diseases, high-containment laboratories are being used by researchers seeking to address these human and animal health concerns. Regulatory bodies in India are empowered by law to oversee the research and diagnostics in these labs.
The Indo-U.S. partnership has greatly accelerated, and it is truly a unique opportunity to combine the various strengths and the long-term relationships between Indian and U.S. scientists and governments and to harness them for the particularly urgent issues confronting the world. Katoch expressed his hope that the United States would continue to both empower and fund its agencies that work on the ground in India, including CDC, the National Institutes of Health, the Food and Drug Administration, the U.S. Agency for International Development, and the State Department. The cooperation has enjoyed high-level support: When President Obama and Prime Minister Modi met in the United States in September 2014, both specifically highlighted cooperation on health and the desire to strengthen assistance for these efforts.2 Katoch said that the voices of scientists are necessary to speak truth to power and
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2 U.S.-India Joint Statement. September 30, 2014. Available at: https://www.whitehouse.gov/the-press-office/2014/09/30/us-india-joint-statement; accessed April 10, 2016.
he asked participants to continue to hold their government leaders to their commitments; these efforts on public health security are incredibly important and that importance will not diminish. Katoch then noted recent positive trends. Many countries are starting to reevaluate the implementation of the International Health Regulations (IHR) based on the results of new research and such reevaluations often point to the need of further research. Further implementation of the regulations can only happen if scientists are both producing good work and maintaining strong collaborations with their public health and policy colleagues so that science is translated into strong public health programming.
Amy DuBois, Health Attaché to the U.S. Embassy in India, stated that the joint workshop could not be more timely: The issues of global health safety and emerging infections are in everyone’s consciousness. The World Health Organization declared the 2014 Ebola outbreak in West Africa a public health emergency of international concern. The participants who came together for the workshop, and all of the work the event represents, reflect the global community’s commitment to start addressing these issues. We must, she said, mitigate the resulting humanitarian crisis and dedicate ourselves to the science necessary to increase the likelihood of preventing future outbreaks. When outbreaks cannot be prevented, we must be able to respond with better management and better tools.
DuBois hoped that the results of the workshop would include innovative ideas and new areas for collaboration, new proposals, and new opportunities and that participants would communicate those to the world and translate them into reality.
DuBois emphasized that participants should take the discussions from the workshop beyond the conference hall to people who are not as aware of what needs to be done and are likely to forget the urgency of these issues as soon as the immediate crisis has been addressed. These discussions should be shared with the people upon whom we depend to ensure that there is funding, sustained engagement and political commitment, and that there will be an effort to put the science that is created—the science that is analyzed, packaged, and published—into strong public health policy.
B.M. Gandhi, who is responsible for biosafety-related issues at the Department of Biotechnology (DBT), then noted that ensuring universal research safety is challenging in India because there are so many universities and so many institutions and private industries. As a result, it is not clear whether the necessary biosafety precautions are being taken
by everyone engaged in these activities, and if not then biosecurity issues could arise. At a meeting in Hyderabad, an expert discussion was held on these issues, and the participants felt it necessary to have a dedicated body in India to address biosecurity and biosafety, because experience indicates that until recently there was little attention given to biosecurity. A further challenge is that many hospitals use potentially hazardous materials, and they are often discarded in open containers. Some precautions have been taken, but participants therefore suggested that these issues should be examined very seriously and ways to mitigate these problems should be developed. Due to the magnitude of the challenges, India would definitely gain from the experience of the United States, Gandhi said. He suggested that it would be useful for workshop participants to outline collaborative programs that can be initiated by the government agencies of the United States and India.
Indira Nath added that she also believes that there are not enough people working on biosafety and biosecurity in India. Experts at the biosafety lab in Bhopal have been doing a great deal, but they concentrate on animal health, and a similar human equivalent is needed, perhaps through an association or society. This does not seem to exist currently in India.
Diane Griffin, NAS vice president, stated that the academies of sciences across the world, but certainly those in the United States and India, are extraordinarily important in providing independent advice to governments on many issues, including those related to infectious diseases. The ability to bring that kind of independent advice to speak truth to power is informed by having strong interactions with other countries.
She continued by saying that we live in a global world, and that is very obvious when we talk about infectious diseases, which do not respect national borders. But being able to learn from each other and having strong interactions with other academies also makes the advice that the individual academies can provide to their governments much stronger and much better informed. This kind of workshop is important to reflect the long-term, long-standing interactions between the Indian and U.S. governments, and also among Indian and U.S. scientists.
Griffin noted that there are many Indian experts who have been elected as foreign associates of NAS, including some of the workshop participants, as well as of the U.S. National Academy of Engineering, and the Institute of Medicine. This provides another mechanism by
which scientists can interact and inform each other and eventually their respective governments.
Dinakar Salunke, vice president of INSA, underscored the fact that in addition to epidemics faced over the last decade, new diseases continue to emerge. The two democracies and their independent science academies are in a unique position to discuss emerging challenges and global health safety. He believes there is no other combination of academies that could do this better. The workshop discussions raised important policy-related issues, and considering that the Indian health research secretary and the biotechnology secretary have addressed workshop participants, it is obvious that the government of India is listening. Given the interest and commitment of the two governments, as Lal said, scientists at the workshop and beyond should develop ideas that will be useful to our governments.
