Fixing the Leaky Pipeline for Leelavati’s Daughters

Women (and men) with a passion for science management. The authors Bela Desai (front row 2nd from left) and Shahid Jameel (back row extreme left) can be seen.

Note: This is the unedited version of our article, which appeared in the Indian Express on 9th October, 2017 under the title "Women of Science"

A news item on the front page of Indian Express newspaper (02.10.2017) lamented how only 16 women scientists have won the Shanti Swarup Bhatnagar Award since its inception in 1958. The Bhatnagar award is the highest research award given to a scientist, under 45 years of age, for research carried out in India. This year’s awardees are all male. The Council of Scientific and Industrial Research (CSIR), which administers this award states that only “science is discussed when the advisory committee meets to discuss nominations”. One of us, a former Bhatnagar awardee, has sat on this committee and supports CSIR’s claim. However, the problem lies elsewhere.

We write from our experience of researching at India’s premier institutions and working at the Wellcome Trust/DBT India Alliance - a partnership between the Wellcome Trust, a British charity and the Department of Biotechnology, Government of India – dedicated to supporting biomedical research in India.

Women make up 37% of PhD’s in science overall but the percentage of women holding faculty positions in science research institutions is less than 15%. T(I. . here could be several reasons for this. For women, the childbearing age coincides with the age that requires the greatest dedication to the lab to establish oneself. Women also have to deal with the “two body problem”, whereby institutions do not give faculty jobs to both partners. This is slowly changing.

It is against cultural conditioning, against great odds and while running against the biological clock that women have to establish themselves. These daunting circumstances lead many women in their 30’s to dropping out of the STEM workforce. The base of the pyramid never becomes wide enough to support a peak – a phenomenon called “the leaky pipeline”.

During 2010-16, the Indian National Science Academy (INSA) elected about 230 Fellows, of which only 30 were women. This is not restricted only to India but it is a global phenomenon. A 2013-14 survey of 69 science academies worldwide showed only 12% of their members to be women. There is also a dearth of women in leadership positions as heads of research institutes or in higher decision-making committees where they can influence policy. We believe that the low numbers of women researchers getting the Bhatnagar Award or fellowship of science academies is a yet another consequence of the “leaky pipeline”.

Statistics at India Alliance also show evidence of this. So far, we have awarded 280 fellowships to researchers of the highest caliber and 31% of our Fellows are women. However, a close examination of numbers reveals a different picture. For our early career fellowships, awarded to scientists who have recently finished their PhD, 51% of the awardees are women. But for the intermediate and senior fellowships, awarded to scientists to establish a new research program or expand an already established research program, there is drastic drop – only 22% of the awardees are women.

How can the “leaky pipeline” be plugged? The change has to be at two levels  - attitude and policy.

Real change requires a smaller effort across a larger population – a change in the mindset of the people, a gentle breaking down of stereotypes. The male child who believes that girls are not good at Maths (or Science) will grow up to become the stalwart questioning the professional commitment of child bearing women. Girls should not be told that being an engineer or a scientist will make them less appealing. They should be given more opportunities to interact with successful women scientists and have role models. At India Alliance, we have commissioned short videos of 20 of our women Fellows to inspire others.

Young women researchers should know that they always have a choice. The tough times don’t last and like others who have traveled the same road earlier, they too will make it through. “Leelavati’s Daughters”, a book published by the Indian Academy of Sciences, Bangalore (2007), chronicles the experiences of women scientists in India. It features many inspiring women who broke the glass ceiling to reach the top of Indian science. The ready availability of enlightened mentors, a terribly inadequate commodity in Indian science, would help young women just as much as they would young men. At India Alliance, all Fellows at the early career and intermediate levels must formally declare a mentor. On average, women scientists make up about a third of the membership of committees at India Alliance.

Real change also requires policy to push it forward. Two things critical for a researcher today is a position with stability and funds for research, the latter coming as fixed tenure grants. Though India has now increased maternity leave from 16 to 26 weeks, the effects of having a child on a woman’s career last much longer. This calls for increasing the time given to women researchers who have a child early in their career to apply for tenure. Typically, 5-7 years from appointment is given to researchers to seek tenure; adding a year or two to this timeline for women with young children will empower them to succeed. Similarly, a full cost one-year extension should be given on research grants to women scientists who take maternity leave during the term of the grant. Currently, India Alliance is the only funding agency in the country to do this. Other small steps such as the availability of a crèche within the institution will go a long way in making young women more productive.

More women are entering the STEM fields but the challenge now is to make them stay.  This is not a time to lament but to act. Change begins small and change begins at home. Let’s tell at least one girl today that she is good at Maths and Science, and that she can grow up to be whatever she wants.

 Authors:

Bela Desai is a PhD in molecular biology from TIFR Mumbai. She is now a Grants Advisor at the Wellcome Trust/DBT India Alliance.

Shahid Jameel set up and led the Virology Group at ICGEB, New Delhi for 25 years. He is now the CEO at the Wellcome Trust/DBT India Alliance.

"Suberbug" bugs India

Coming back to the blog after a long time.

The issue today is the “Superbug”. Indian print and visual media is full of reports about NDM-1, translated as New Delhi metallo-beta-lactamase-1. No, NDM-1 is not the “superbug”. It is the name given to a gene that causes multiple drug (antibiotic) resistance to bacteria that carry this gene.

The Lancet Infectious Diseases, a British journal, published an article titled “Emergence of a new antibiotic resistance mechanism in India, Pakistan, and the UK: a molecular, biological, and epidemiological study” on August 11, 2010. This article reports results from a study in which the authors “investigated the prevalence of NDM-1 in mutidrug-resistant Enterobacteriaceae in India, Pakistan, and the UK”. They found widespread prevalence of NDM-1 in India and Pakistan. Some, but not all, of the UK cases were linked to travel and hospitalization in India.

Here is a link to the paper.

If you want to read it, you have to register at the Lancet site. This is surprising since the work was partially funded by the Wellcome Trust, which has a stated Open Access policy.

“The potential of NDM-1 to be a worldwide public health problem is great, and co-ordinated international surveillance is needed”. This is the final interpretation of this scientific study. There is nothing wrong about that.

So what is the brouhaha all about?

It is the last paragraph of the paper, which reads as follows.

“Several of the UK source patients had undergone elective, including cosmetic, surgery while visiting India or Pakistan. India also provides cosmetic surgery for other Europeans and Americans, and blaNDM-1 will likely spread worldwide. It is disturbing, in context, to read calls in the popular press for UK patients to opt for corrective surgery in India with the aim of saving the NHS money. As our data show, such a proposal might ultimately cost the NHS substantially more than the short-term saving and we would strongly advise against such proposals. The potential for wider international spread of producers and for NDM-1-encoding plasmids to become endemic worldwide, are clear and frightening”.

This is an unusually tough conclusion, not fully supported by results shown in the Lancet Infectious Disease paper. The authors say, and I quote “We could not prove statistically significant strain relatedness between the Indian and UK isolates”.

Naturally, the growing medical tourism industry in India has felt threatened. And the response from the Indian media and its political class has been along expected lines. It is a classic case of paying no attention to the message, but trying to shoot the messenger.

India’s Minister for Health and Family Welfare and his deputy have gone on record to debunk the findings as being overblown and underwritten by multi-national drug companies (see Report).

If we buy that, should we not consider the possibility that the Indian press and politicians are reacting so at the behest of our medical tourism industry?

Objections have also been raised on equating the drug-resistance gene with India’s capital, New Delhi. So how did this name – NDM-1, come about?

This gene was discovered by one of the authors of the Lancet study, Timothy Walsh from Cardiff University, UK. His group obtained this gene from a Swedish national of Indian origin who underwent surgery in New Delhi and acquired a urinary tract infection due to an antibiotic-resistant form of the bacterium Klebsiela pneumoniae. The discovery was described in a paper titled “Characterization of a New Metallo-b-Lactamase Gene, blaNDM-1, and a Novel Erythromycin Esterase Gene Carried on a Unique Genetic Structure in Klebsiella pneumoniae Sequence Type 14 from India”, published in the December 2009 issue of the journal Antimicrobial Agents and Chemotherapy. This article is open access, so I can post it. Click here for the paper.

The Lancet Infectious Diseases research was a natural follow up to investigate how widely prevalent this gene might be in enteric bacteria in the Indian sub-continent. And, as expected, they found it to be widely prevalent in India and Pakistan.

Some might consider associating the city (New Delhi) with the bug/gene (NDM-1) to be offensive. But it is not unusual in scientific research to name a pathogenic organism after the place of its possible occurrence or discovery. Names like Chandipura (named after a village in Maharashtra), Kyasanur Forest (in Karnataka), Rift Valley Fever (an area in Kenya) are commonly found names in the virus world.  

While every Western tourist to this city is familiar with “Delhi Belly”, the Lancet report is too much to digest for the Indian establishment. Instead of crying foul, it would do everyone a lot of good if we focused on the huge problem of antibiotic resistance facing the country. Rampant and unchecked over-the-counter sale of antibiotics is causing high levels of drug resistance. And since bacteria (and other pathogens) can travel fast (without visas of course) in this jet age, it does not take very long for pathogens with newly acquired properties (genes) to go around the globe. The 2009 swine-origin influenza (first called Mexican flu, despite protests by Mexico) is an excellent recent example of this.

The priorities of our Health Ministry seem to be all wrong. Instead of shooting down the Lancet Infectious Disease report, they should be addressing the overuse of antibiotics in India.

For a different point of view, see the blog of a respected Indian microbiologist.

April Fools' Day 2010

April 1, 2010 is a historic day for India. It has wisdom and vision written all over it.

Today the Right to Education (RTE) becomes a Fundamental Right. The Constitution of India contains a Charter of Rights, which guarantee civil liberties to every citizen. Rights mean those freedoms that are essential for personal good  as well as the good of the community. Thus far, the Indian Constitution guaranteed the following Fundamental Rights to each Indian.

1. The right to equality
2. The right to freedom of speech and expression
3. The right to freedom from exploitation
4. The right to freedom of religion
5. Cultural and educational rights
6. The right to constitutional remedies
And now:
7. The right to education

It now becomes the duty of the State to ensure that every child in the age group of 6 to 14 years goes to a school. This is poised to benefit over 10 million children in India - children like Azharuddin and the anonymous girl from my photo archives. Azharuddin was pictured loitering around the tomb of Bahlol Lodi in the Chirag Dilli area of New Delhi. He did not go to school, but loved playing cricket and getting his picture taken. The girl, a polio victim (notice the stick in her hand; she uses it to walk) was pictured in the Charminar area of Hyderabad.

Azharuddin - Chirag Dilli, New Delhi

Girl child - Charminar, Hyderabad

There will be problems, issues of logistics, not enough schools, not enough teachers, not enough trained teachers, etc. etc. etc. We now have the will and therefore we will solve these problems.

Thank you and well done Prime Minister Dr. Manmohan Singh and Education Minister Mr. Kapil Sibal.

Stand up and be counted

This All Fools' Day the 15th Census of India was also kicked off. This is the largest counting exercise ever done. Over 1.2 billion people will be enumerated and everyone over 15 years of age will be photographed and fingerprinted, issued a unique identification number (UID) and issued a biometric card.  Over 2 million volunteers will span the length and breadth of this land to do this over the next year. For more information on this unique exercise see:

Official site: http://www.censusindia.net/; http://censusindia.gov.in/
News Reports: http://news.bbc.co.uk/2/hi/south_asia/8598159.stm
http://timesofindia.indiatimes.com/india/Counting-a-billion-India-begins-new-census-/articleshow/5749740.cms
UID Authority: http://uidai.gov.in/

Way to go India. This April Fools' Day is truly historic for us.

Hyderabad - A Photo Essay

Hyderabad, the city of Nizams, pearls and biryani, is also the most rapidly expanding of Indian cities, a hub of high technology companies, but still full of charm and tradition.  As always, the pictures are all mine, from a trip in July 2009.

In its most recent history, the region was ruled by the Kakatiyas and then the Bahmani sultans, the latter possibly of Tajik-Persian descent, and possibly the first Islamic and Shi'ite kingdom in South India. The Bahmani Sultanate, which broke away from the Delhi sultanate during the rule of Muhammad bin Tughluq in 1347, itself broke up into 5 states - the Deccan Sultanate in 1518. Golconda was one of these, rules by the Qutub Shahi dynasty. The grand Golconda fort was the power centre and a few miles away stand the beautiful Persian style Qutb Shahi Tombs.

The Golconda Fort walls and ruins

 City from the Golconda Fort

 

 Makkah Gate, Golconda Fort - The old Sultan used this gate  to leave the Fort for the Hajj pilgrimage after abdicating the throne to his successor.

 

Hyderabad, according to popular lore, was established by Sultan Muhammad Quli Qutb Shah after he fell in love with Bhagyamati, a Hindu Banjara girl. After her acceptance into the royal fold, she was named Hyder Mahal, and thus the name Hyderabad. Another theory is that Hyderabad is the 'City of Hyder', named after Ali, the fourth Khalifah (Caliph) of Islam. The city was established on the banks of the Musi river in 1591. Today, the river is no more than a drain, but thankfully its cleaning and preservation work has started.

The Qutb Shahi Tombs are fine examples of carved stonework set in a large garden, and are a rare example of almost the entire dynasty buried in one area. An elaborate hamam, with great natural lighting, and reminiscent of the baths of Central Asia, is also within the precincts and was used to wash the dead before burial.

Tomb of Hayath Bakhshi Begum

The Mortuary Bath - built by Sultan Quli Qutb ul Mulk (1st king) along with his own tomb

Tomb of Sultan Muhammad Qutb Shah (6th king)

Tomb of Kulsoom Begum (daughter of Muhammad Qutb Shah)

 

Graves on the platform of Sultan Quli Qutb ul Mulk Tomb. In background are the Tomb of Kulsoom Begum and Muhammad Quli Qutb Shah

 

Tomb of Sultan Muhammad Qutb Shah (6th king)

 

 Tomb of Sultan Muhammad Qutb Shah (4th king)

 

Aurangzeb's Masjid at the Qutb Shahi Tombs; Aurangzeb is said to have prayed here during the siege of Golconda in 1687

 

Golconda was finally captured by the Mughal king Aurangzeb in 1687 and was governed from Delhi through Governors, who in time gained autonomy. In 1724 Asaf Jah I, Nizamul Mulk (Governor of the country) established control over Hyderabad and the Asaf Jahi Dynasty. His descendents, the Nizams governed Hyderabad till 1948, when the State of Hyderabad joined the Union of India.

The Chowmahalla Palace of the Nizams is a neo-classical palace modeled on the Shah of Iran's Palace in Tehran. Its construction was started by Salabat Jung (4th in succession) in 1750 and was finally completed by the 5th Nizam, Asaf Jah V, in the period 1857-68. With elegant gardens and fountains, the palace has two courtyards - the northern courtyard housing the administration and the southern courtyard housing four palaces - Afzal Mahal, Aftab Mahal, Mehtab Mahal and Tahniyat Mahal. Its construction over a long period ensures a number of architectural styles. The jewel of the Palace is Khilwat Mubarak, the Durbar Hall of the Nizams.

Northern Courtyard, Chowmahalla Palace

Northern Courtyard

 

 Khilwat Mubarak

 

 Khilwat Clock; entrance to Chowmahalla Palace

 

 Durbar Hall

 

The Throne

 

 Entrance to the Southern Courtyard

 

Southern Courtyard

 

Palace details, Southern Courtyard

 

The old city of Hyderabad is crowded but a shopper's delight, with its pearl and saree shops and the Laad Bazaar with glittering shops selling shiny bangles, a Hyderabad trademark.

Laad Bazaar

 

 Beautiful Hyderabadi Bangles

 

Two special buildings dominate the old city - the Charminar and the Makkah Masjid. Sultan Muhammad Quli Qutb Shah (5th Qutb Shahi king) built the Charminar after he shifted his capital from Golconda across the Musi River to Hyderabad. This is a monument of gratitude to Allah for sparing the city of the plague outbreak in 1591. It is actually a masjid (mosque), which is hidden on the upper floor, but the structure is dominated by four beautifully ornate, strong yet aesthetic minarets with exquisite carvings.

The Charminar

The Makkah Masjid, so called because Sultan Muhammad Qutb Shah (6th king) commissioned it using bricks made from earth brought from the Islamic city of Makkah (Mecca). The work began in 1617 and was finished 77 years later by Aurangzeb in 1694. Next to the masjid stands a simple but elegant structure that houses the graves of the Nizams.

Makkah Masjid (right) and the Mausoleum of the Nizams (left)

The lovely minarets of the Nizam mausoleum

Here rests the Asaf Jahi dynasty (the Nizams)

 

Pigeons are in plenty at the Makkah Masjid, with Charminar in background

 

Sultan Muhammad Quli Qutb Shah, a poet of great versatility and distinction in Persian and its forms later developed as the Urdu language, and in Dakhni (Southern Indian), dialect prayed at the inauguration of his new city.

Mera shehar logan soon mamoor kar
Rakhya joon tun darya mein min Ya Sami
(O God, fill my city with people, as you have the river with fish)

His wish seems to be granted. Hyderabad is teeming with people and more wanting to move there for the opportunities it offers today.

Swine Flu in India – Are we prepared?

This is festival time in India. The festivities for Ganesh chaturthi and Eid barely over, this weekend is the culmination of Vijaydashami, celebrated across India in various forms. Whether it is Dussehra, Dasara, Dashahara, Navaratri or Durgotdsav, the common theme is victory of good over evil. Large crowds gather every day in temples and puja pandals across India.

In times of a flu outbreak, this is a public health nightmare. This year’s Ravana is the microscopic influenza A H1N1 (2009) virus. Will the arrows of public health preparedness be able to slay this new age Ravana? This unlikely in India, if you listen to what experts have to say.

I wrote earlier about the 3.1% mortality among swine flu cases in India. The latest Ministry of Health and Family Welfare (MoHFW) release is for September 24, 2009; it reports 8979 cases and 277 deaths – 3.08% mortality.

Prof. T. Jacob John, unarguably India’s most prominent public health scientist, thinks this high mortality could be due to a selection bias – those with more severe illness are being tested. So, what has been India’s testing policy? A larger question is how has India dealt with this outbreak from a public health perspective.

An editorial in the August issue of the Indian Journal of Medical Research (IJMR) written by Prof. Jacob John and Prof. Jayaprakash Muliyil, provides a very frank and analytical assessment. It also provides sagacious advice to the Government on what it should and should not be doing.

The editorial can be read at http://www.icmr.nic.in/ijmr/2009/august/editorial1.pdf (I am grateful to the authors and the Editor, IJMR for their permission to post this link).

They say, and I quote – “At the request of the World Health Organization (WHO), many countries including India had made a detailed Pandemic Preparedness and Response Plan (PPRP). Many experts believed that India would, for the first time in our history, be well prepared to face an epidemic.-------- The events that took place in June, July and up to mid-August (as we write this) are still fresh in our memory. The expectation that India would face the pandemic with confidence and competence gradually gave way to disappointment and dismay. While the virus is reaching many places and spreading among the population, as anticipated, India does not have a public health infrastructure that could put into practice the PPRP”.

Prof. Jacob John agreed with my call in an earlier post and adds – “Science must guide policy. Policy must drive public health. So public health interventions must be evidence-based”.

Those who matter at the MoHFW and Indian Council of Medical Research will do well to read this editorial (which is in their own journal), and to ensure that policy is driven by science and not the other way around.

Swine Flu in India

The last situation update from WHO puts the number of positive cases worldwide at over 296,471 with at least 3486 deaths (http://www.who.int/csr/don/2009_09_18/en/index.html).

India's Ministry of Health and Family Welfare (MoHFW) puts out daily updates on the swine flu situation in the country (http://mohfw.nic.in/press_releases_on_swine_flu.htm). The updates started on August 1, 2009, by which time there were already 534 positive cases but no deaths. The first death, a 14-year old schoolgirl from Pune, was reported on August 3, 2009. Since that time, the number of positive cases have gone up steadily. As I write this, the last MoHFW update from September 21, 2009 reports that samples from 35,148 persons have been tested across the country, 8153 (23 .1%) have been found positive and 257 persons have died as a result of this infection.

The mortality rate in India stands at 3.1%, compared to a global average of 1.1%. What is the reason for this higher mortality in India? We don't know as there is no epidemiological analysis available. The reasons could be
(a) virological - increased virulence of the virus circulating here,
(b) host genetics - maybe Indians are genetically predisposed to get more severe disease
(c) environment -  poor healthcare infrastructure, late reporting of cases, selection bias with only severe cases being tested, etc.
It could also be an interesting mixture of all of the above.

The point is - unless we look at these issues systematically, we will not know.

I have made a graph on the situation in India based on MoHFW updates. The plot shows positive cases and deaths every 5 days from the start of updates (Aug 1, 2009) for the first 50 days of reporting.

 

It is quite clear from the graph that the outbreak in India is growing at a steady rate. Since early in the outbreak, the number of cases have gone up  at the same rate. The pink line in the graph has a constant slope. Curiously, the death curve shows a hint of biphasic nature to it. The death rate seems to be picking up lately. After running almost parallel with the positive cases curve for some time, the death curve has now intersected it.  Will it continue its upward spiral? In the absence of any analysis or models, only time will tell.

India has done well in gearing up resources to put testing in place. Scientists and technicians involved in testing for swine flu have done an admirable job. They have used all the resources at their command to test quickly and have adhered to quality.

But this is only half the job done. We should be analyzing this outbreak. The Indian Council of Medical Research (ICMR; http://www.icmr.nic.in/), whose mandate is medical research, should be driving this. We have a National Institute of Epidemiology, an ICMR institute in Chennai (http://www.icmr.nic.in/pinstitute/nie.htm). What are those guys doing? What are the public health experts at the  Public Health Foundation of India (http://www.phfi.org/) doing? The PHFI website has H1N1 flu advice (http://www.phfi.org/h1n1flu/index.html), but no analysis.

It is the same case with virological analysis. No genomic data is available on the virus circulating in India. The Influenza Virus Resource uploads genomic data in the public domain on a daily basis. See http://www.ncbi.nlm.nih.gov/genomes/FLU/SwineFlu.html. There is no data in the public domain from India. And it is truly shameful.

Is the virus in India showing genomic signatures of increased virulence? How many mutations will it take to make it highly virulent? Are we beginning to see the H274Y mutation in the NA protein, which is reported to be associated with Oseltamivir (Tamiflu) resistance? WE DON'T KNOW.

Should we not have science drive policy? Where is the science? It is time for ICMR, PHFI, Ministry of Health, Ministry of Science and the scientific and biomedical research community at large to ask these questions.

In India, our flu season is just beginning. Wake up.