Collaborations in Health Care

Dr. Preetha Rajaraman speaks at a panel discussion held at the launch of the Global Innovation Index 2019, in New Delhi. The report analyzes how medical innovation will transform the delivery of health care worldwide. Courtesy Dr. Preetha Rajaraman

As the U.S. Health Attaché to India and Regional Representative to South Asia for the U.S. Department of Health and Human Services (HHS), Dr. Preetha Rajaraman coordinates, monitors and represents the work of all HHS agencies in India, including the National Institutes of Health (NIH), the Centers for Disease Control and Prevention (CDC), and the U.S. Food and Drug Administration (FDA).

Dr. Rajaraman was trained as a cancer and molecular epidemiologist and worked for many years as a researcher in this field. Her current job involves a much wider perspective and represents the entire regional U.S. portfolio in health and biomedical research, spanning health policy, communicable and non-communicable diseases, health safety and security, and research and innovation. “This required transitioning from knowing an awful lot about a few topics to having to know at least a little bit about a huge array of topics,” says Dr. Rajaraman. “It has been an exciting change, and an incredible opportunity to be working on building the health and science relationship with India at a time when there is so much potential for growth.”

Excerpts from an interview with Dr. Rajaraman.

You joined Reed College, Oregon, to major in literature–theater. What made you switch to biology and then environmental health at the University of Washington?

I have always loved biology, but before I came to college, I didn’t think of myself as particularly talented at the hard sciences underpinning many of the advanced biomedical fields. A handful of dynamic college professors changed that perception. With the right mentors, I found that science was both easy and fun—a realization that played a big role in my change of study and career.

I’m a big fan of the liberal arts education that allows such dramatic switches and encourages interdisciplinary thought. And, in fact, I find my early training in literature and drama quite helpful in my current role!

In your opinion, what are some of the biggest health concerns for India right now?

Like many countries in the region, India currently faces a double burden of diseases—a high burden of infectious diseases as well as a growing amount of non-communicable diseases like cardiovascular disease, cancer and mental health problems.

Some priority areas for HHS in the region are global health security, which includes improving the prevention, detection and response to infectious diseases; biomedical research and innovation; digital health; and identifying practical ways to increase access to safe, effective, affordable and life-saving medicines around the world.

In what ways do you think U.S. experts, especially those at the U.S. Department of Health and Human Services, can help India overcome these challenges?

U.S. scientists and policy makers, including those within the HHS agencies, have unique expertise and skills to share with our Indian counterparts and we, in turn, can learn from these collaborations. Through grant funding, technical assistance, capacity building, and policy engagement, we have been working to find joint solutions to pressing health problems for India, the United States and other countries around the world.

Could you please tell us about the cooperation between the United States and India to help prevent the further spread of coronavirus?

Our long history of collaboration in health, including research and development, such as for vaccines, global health security, and strengthening of regulation for drugs and devices, has provided a strong platform for Mission India’s current response to COVID-19. Since January of this year, our U.S. government agencies have been working closely with Indian partners to help strengthen laboratories in India; improve the skills and knowledge of health workers on the frontlines of the epidemic, including at airports, in health facilities and within communities; and develop and share guidelines on infection prevention and control, and risk communication with various partners.

The team remains fully committed to providing both technical and financial support for immediate COVID-19 response, including in the areas of strengthening surveillance and contact tracing, laboratory strengthening, development of guidelines and training for infection prevention and control, risk communication, and developing surge capacity for emergency operations. We are also collaborating on the development of candidate therapeutics, vaccines and related counter measures against the virus causing COVID-19.

Could you please share some more examples of U.S.-India collaborations on health innovations?

Biomedical innovation is one of the most vibrant areas of U.S.-India health cooperation. For example, the Indo-U.S. Vaccine Action Program, led by the U.S. NIH and India’s Department of Biotechnology (DBT), is considered a model bilateral initiative. Its success is reflected in the indigenous development of ROTAVAC, a vaccine that can prevent infection with Rotavirus, a common childhood diarrheal disease. Rollout of this vaccine is expected to save millions of lives in India, and globally. The Vaccine Action Program continues to support vaccine research for diseases like malaria, dengue and tuberculosis.

Another urgent global health problem is antimicrobial resistance (AMR), or the ability of germs to develop resistance to the drugs designed to kill them. The number of resistant infections is growing worldwide. These infections are harder to treat, leading to longer hospital stays, higher medical costs to individuals and societies, and often death. Many U.S. agencies, including HHS (Office of the Assistant Secretary for Preparedness and Response, CDC, NIH and FDA) and the U.S. Agency for International Development (USAID) are working closely with Indian partners to tackle the problem from various perspectives, including strengthening hospital infection control, building surveillance systems for antimicrobial-resistant infections, supporting scientists and innovators working toward AMR solutions, and funding the development of critically needed new antimicrobials.

Scientists from the United States and India also conduct joint research on vision, HIV/AIDS, tuberculosis, malaria, emerging infectious diseases, and chronic diseases like diabetes, cardiovascular disease and cancer, vision, mental health and environmental health, including on air pollution and its health impacts. To strengthen research capacity, U.S. agencies, including NIH and CDC, host hundreds of scientists from India and organize several training workshops and exchanges each year.

What role can technology play in boosting global health diplomacy?

Technology plays a vital role in global health diplomacy, which ultimately hinges on defining and finding joint solutions to key unresolved challenges in health. India recently introduced the Ayushman Bharat health care program, which aims to provide expanded primary care through 150,000 Health and Wellness Centres (HWCs) across the country and, simultaneously, provide health insurance coverage to over 500 million Indians. In the United States, the government has identified health insurance reform, drug pricing and value-based care as key priorities for health care.

Although these programs are being rolled out in vastly different settings, we share the same goals of providing our citizens affordable, high-quality solutions. Many of these are derived from biomedical research and innovation, including drugs, vaccines, diagnostics and devices.

Which medical technology or area of research seems to be most promising to you?

Dr. Francis S. Collins, director of the NIH, recently identified 10 particularly promising opportunities for biomedical innovation over the next 10 years. These include fields like single-cell analysis, which could provide key insights into autoimmune diseases and cancer; regenerative medicine; cancer immunotherapy; the development of new vaccines; gene editing to cure diseases; precision medicine; and mapping of the brain.

What are some of the key concerns for facilitating relationships between the U.S. and Indian governments?

While the opportunities for biomedical innovation are immense, it is critical to simultaneously create an enabling ecosystem to ensure the maximum diffusion of these innovations. This can be done by ensuring sufficient and sustainable funding for research; deploying big data and digital health along with infrastructure and policies that support data sharing; ensuring efficient regulatory approvals; and investing in building a skilled scientific and health workforce.

Do you have any message for our readers studying or working in the field of health and medical technology?

As we move into a new era of global biomedical innovation in science and technology, the United States remains committed to bringing knowledge and resources to our shared agenda of protecting lives and enhancing the health and well-being of people around the world. We hope that you will join us on this exciting journey of discovery.

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