On 9 September 2019, the Department of Science and Technology (DST), India, released the draft of the Scientific Social Responsibility (SSR) policy. The policy, drawn on similar lines as Corporate Social Responsibility, aims to harness the potential of the country's scientific community to strengthen science and bridge the gap between science and society.

The policy: framework and funding

According to the policy, the central and state government ministries should plan and execute SSR in collaboration with knowledge workers (defined in the draft as "anyone who participates in the knowledge economy in the areas of the human, social, natural, physical, biological, medical, mathematical and computer/data sciences and their associated technologies"), and institutions. At the institutional level, this requires knowledge workers of academic institutions to dedicate at least ten person-days each year for SSR activities. Such activities include lectures, training, awareness, mass media programmes, resource-sharing, and providing solutions to local problems.

The policy encourages scientists to move beyond ‘publications’ and directly cater to societal needs using their skills, thereby benefitting both society and scientists. On one hand, it aims to foster scientific temper in society, while on the other, it will provide scientists with fresh perspectives, new challenges, and research problems.

Further, the draft proposes to establish a national digital portal to implement the SSR policy effectively. The portal will provide a space to identify societal needs that require scientific interventions and track the pertinent SSR activities. The activities will also be evaluated by a special body of stakeholders from the scientific establishment and society.

The policy also proposes funding for SSR activities through funding agencies on the basis of activities or as a fixed percentage of the project budget.

Scientists’ reactions to the policy draft

Many academicians have underscored the need for this policy and have welcomed it. “In India, far from understanding the actual societal needs, ‘research’ has been reduced to publications and abstractification”, says Pranjal Chandra, Assistant Professor at the Indian Institute of Technology-Banaras Hindu University (IIT-BHU), Varanasi. “I believe this policy will help generate some fantastic ideas for the field of research and also clarify the concept of ‘research’ to the general public.”

Rohini Godbole, Adjunct Faculty at the Indian Institute of Science (IISc), Bengaluru says, “Scientists have a duty to explain to all why ‘blue skies research’ needs to be done. Tools for societal developments and solutions to societal problems arise out of these, sometimes directly and most of the times indirectly. Hence, scientists owe it to explain what the intellectual compulsions of such research are.”

“Each research lab should undertake SSR activities related to their research and/or areas of special interest such as women in STEM, mentoring young scientists, awareness of science with citizen scientists, or the area of research the lab works on such as advocacy for autism and awareness on rare diseases, which can be called ‘non-profit arm’ of the lab”, says Karishma Kaushik, Assistant Professor at Savitribai Phule Pune University (SPPU), Pune.

A few researchers have, however, raised the issue of diversion of funds. N. Raghuram, Professor at Guru Gobind Singh Indraprastha University (GGSIPU) says, “Unless our Science & Technology budgets are significantly enhanced, this may lead to diversion of funds from our already pathetically low budget.”

Tapasya Srivatsava, Assistant Professor at the University of Delhi (DU), added that funding should be given to ideas, perhaps involving teachers and researchers from multiple institutions rather than to individual institutions. Such a model of funding could foster new collaborations, thus building the science–science connect — one of the objectives of the policy.

Debate over mandate and incentivization

The policy also proposes to incentivize SSR activities. For example, in the interest of knowledge workers, the policy proposes to consider activities with due weightage during their performance evaluation.

Although the policy provides the means for scientists to engage in SSR activities, many researchers feel that demanding a specific duration of time for SSR — ten person-days — trivializes the idea.

R. Geeta, former Professor at DU says, “the idea of requiring a minimum number of hours of engagement is not likely to go well with many, especially teachers, who already are fulfilling an important societal role in educating young minds.”

Srivatsava agrees: “University teachers already do extensive teaching as well as research, and doing anything additional takes planning and preparation, which should also be well-acknowledged in time duration.” She adds that the draft lacks clarity on whether SSR is a voluntary or mandatory exercise – whether one can evade SSR activities without hampering their professional growth.

Raghuram reiterates the importance of not punishing people who may not contribute to SSR, even if those who do are rewarded with due weightage in recruitments and promotions.

Radha Gopalan, Visiting Faculty at Azim Premji University, Bengaluru echoes this concern. “When voluntary service gets mandated, it impacts the quality of the engagement,” says Gopalan. She adds that “The engagement should be driven by interest and commitment to mutual learning if it is to be meaningful for both researchers and the schools. In implementing this policy, it is important to design arrangements that enable such learning.”

Further, since the policy is aimed at a two-way engagement, the incentivization also has to be on both ends so that places such as schools are keen on providing space for SSR activities, says Srivastava. Geeta adds: “Adequate mechanisms such as inputs from beneficiaries and implementers for making this engagement two-way are missing in the overall plan. Also, it is not clear where such information about ‘need’ for intervention will come from and therefore absence of some thought on this aspect may end up with more of the same – I, scientist, will tell you what you need, which will essentially be what I know. Therefore, serious thought needs to be given on how to set up a mechanism to enable dialogue between beneficiaries and implementers.”

Clarifications required

Although the policy allows researchers to engage in a range of SSR activities — one being media engagement — Raghuram believes that unless the government exempts knowledge workers (faculty, scientists) from Central Civil Services (CCS) conduct rules that prohibit media engagement, it makes no sense to include media engagement in SSR activities.

Gopalan wonders how the policy aims to bridge the science–society gap in rural areas where research institutes are not in the vicinity. She also asks how the policy aims to build the capacity of scientists and technologists in research institutes to engage with school teachers and students.

Further, she points to the need to integrate this policy with the newly-approved National Education Policy 2020 and emphasizes the necessity to implement it through a decentralized programme that is contextually developed, shaped and sustained.

Creating careers

The policy could provide a major thrust and create opportunities for science communication, public engagement and management. Although science communication and public engagement are evolving fields, they are now mostly restricted to central departments and a few other organizations, limiting growth opportunities. The policy implementation at the institutional level will require strategizing and managing SSR activities. This may provide an opportunity for the scientific cadre who are more interested in communicating and managing science rather than doing science.

Overall, scientists look forward to the policy. The policy intends to build scientific temper in society in the long term, which will reflect back as increased support for science in terms of funding and respect for the workers engaged in bringing the hidden laws of nature into light and using them for the good of mankind.

“Oh, so you work with crazy people, do you? I hope you don’t end up going mad along with the rest of them!” chortles a distant relative, upon hearing that I work at the National Institute of Mental Health and Neurosciences (NIMHANS). I sigh and choose not to take his words to heart. Statements like this one are commonplace in India, where insensitivity, myths and misrepresentations around mental illnesses are a dime a dozen. Talking about mental health continues to be heavily stigmatized in India, where people worry more about what their neighbours will say rather than their doctors. A sharp rebuttal is usually enough to silence self-styled jokers who choose to make fun of people struggling with mental health disorders. But what happens if patients themselves choose not to see a doctor, because of this stigma?

Dhruva Ithal, a clinician-researcher in the Department of Psychiatry at NIMHANS, says that patients are usually extremely hesitant in seeking medical advice for mental illnesses. “Most people are generally unable to muster up the courage to visit a doctor until their situation becomes quite dire. Patients suffering from psychosis (a condition which causes people to lose touch with reality; e.g., schizophrenia ) usually approach doctors only when they see their loved ones being affected by their behaviour. Patients with neurosis (a class of mental disorders that is characterized by feelings of distress; e.g., depression or anxiety) are hesitant to see a doctor because they don’t believe their problem is serious enough to warrant a visit to the clinic,” says Ithal.

Another reason for delays in seeking medical attention may be when symptoms in a patient coincide with gender stereotypes prevalent in our society. For instance, a woman's excessive cleaning (a symptom of someone with obsessive-compulsive disorder (OCD)) or a man’s addiction to alcohol may be perceived as ‘normal behaviour’. In reality, however, a person battling with addiction cannot stop at will, similar to someone with OCD preferring neatness. Both conditions can be extremely distressing for patients and their families, and require medical intervention. But patients themselves, and people around them, may not deem medical intervention as necessary in such situations (as stereotypes dictate that women should actively keep their households clean, and drinking in men is common).

As a psychiatric social worker at NIMHANS, Anand Jose Kannampuzha has encountered many types of myths pertaining to mental disorders. “People try to ‘explain away’ their symptoms in different manners. Patients suffering from addiction issues will make excuses for their behaviour, like saying it is ‘a way to deal with stress’. Patients with psychosis often believe in spiritual or religious reasons for their behaviour. Some think they are possessed by a supernatural force. Others believe that their families are cursed, and generation after generation will suffer the same consequences when this ‘curse’ could simply be a heritable condition being passed down from parents to their children,” he says.

The idiosyncrasies of select individuals lead to staggering collective consequences. The National Mental Health Survey of 2015–16 revealed that “nearly 15% of adults in India are in need of active interventions for one or more mental health issues''.

A foundation for public healthcare systems pertaining to mental health has existed in India, but it needs to be further developed. The Government of India introduced the National Mental Health Program in 1982 to develop manpower, modernize departments for mental health specialities in medical colleges, provide aid to upgrade mental hospitals, and set up district mental health programmes.

A comprehensive report from 2011–12 on the state-wise status of schemes shows that many states succeeded in providing citizens with access to psychiatrists, suicide prevention clinics, and counselling. However, several district mental health programmes were shut down after running for a few years. It may have been difficult to recruit trained professionals due to a severe shortage of mental health professionals in the country. In a 2019 letter to the editor of the Indian Journal of Psychiatry, psychiatrists from NIMHANS estimated that there are only 0.75 psychiatrists per 100,000 persons in India, when ideally, it should be between 3–5. Findings such as these, and from the National Mental Health Survey, led to a revamping of the National Mental Health Program, with the introduction of the Mental Health Care Act of 2017. This act aims to recognise and protect the rights of people with mental illnesses. It allows people to make decisions regarding their health, given that they have the appropriate knowledge to do so. It also decriminalized suicide attempts, in order to provide people with opportunities for rehabilitation. Such steps are a welcome option for patients to have a voice in their psychiatric treatment and general mental well-being.

To go forward from here, an important facet is the provision of comprehensive and easily accessible information. Both Ithal and Jose agree that spreading awareness about mental illnesses is the best way to prevent myths from spreading. “There should be primary centres in towns and villages, where people can approach doctors easily,” says Ithal. Jose adds, “The reach of social media is incredible. A lot of information is spread even in small places through mediums like films, WhatsApp and Facebook. I think it’s important that the correct information about mental illnesses be provided through these agencies.” Many people might be unaware of the provision of such programmes and schemes, either due to a lack of information or misrepresentation of mental illnesses in our society. This could be one of the reasons that many of the programs were unable to run long-term.

Addressing the importance of easily accessible and understandable information about current research being done in this field, V. Sowmya, a doctoral researcher in the Molecular Genetics Lab at NIMHANS, says, “I have seen patients being much more open to the idea of treatment once we explain the intricacies of the illness to them and tell them about the research we do. The hope that we may someday be able to treat these disorders using data we collected from them makes them understand the importance of their contributions.” She also stressed the need for more qualified healthcare professionals and primary mental healthcare centres in small cities and towns. “It often becomes difficult for patients and their families to travel to institutions like NIMHANS for follow-up appointments, which often leads to discontinuation of the treatment,” she says.

It is extremely important that awareness and information about mental illnesses penetrates not just our cities and towns, but also the most remote villages. Pertinent information, access to treatment, and starting conversations about mental health cannot be limited to just metropolitan cities. India is on the brink of a mental health crisis and it is important for government programs, non-government organizations, professionals, and local volunteers to come together and make sure our citizens are informed about what they are experiencing and that help is right around the corner.

“Humans are not 70 kg rats,” remarked Thomas Hartung, Director, Centre for Alternatives to Animal Testing, John Hopkins University, USA, while describing the differences in the biology of widely used laboratory animal models and humans.

Humans share a high degree of genetic similarity with various animals. Hence, the usual paradigm to understand the effect of a chemical or a drug on humans involves testing them on specific animal species (such as rats and mice) and subsequently extrapolating the potential effects to humans.

However, scientists have increasingly observed that subtle genetic differences between animals and humans may contribute to pronounced differences in severity and features of human diseases. For example, in humans, similar groups of genes are employed in inflammation and stress response. In contrast, in mice, distinct sets of genes are involved in fighting different types of stress. Also, mice can be more resilient to inflammation compared to humans. For example, 30 nanograms/kg of endotoxin (a toxic compound usually found in the cell wall of gut bacteria) turns lethal in humans. In contrast, mice can tolerate almost a 1000 times higher concentration of the chemical.

Also, animals metabolise drugs differently from humans, leading to species-specific differences in how drugs are absorbed, distributed, metabolised, and transported.

Challenges associated with a data-rich era

The past decade has seen a rise in the development of miniature 3D tissues and organs-on-chips. These are miniature model systems that capture elements of human biology and are built using human cells that aim to mimic human organs. Also, new-age medical imaging and tracking tools are helping to visualise biochemical, molecular, and cellular changes occurring in the human body. These tools generate a vast amount of organism-level biological information. However, there is a need to connect such data and create a complete picture of how disease manifests and affects the human body.

A global resource that collects and organises such biological information is the Adverse Outcome Pathway (AOP). This platform is an open and crowdsourced framework promoted by the Organisation for Economic Co-operation and Development (OECD). Akin to a jigsaw puzzle, the AOP framework helps to piece together toxic effects of biological/chemical agents observed at various levels (e.g., molecular, cellular, or organ-level) to understand such effects at an organismal level. The information can be curated and organised further to build robust models for predicting human biological events.

Call for a national strategy

The Centre for Predictive Human Model Systems (CPHMS), Atal Incubation Centre-Centre for Cellular and Molecular Biology (AIC-CCMB), Hyderabad, along with the Humane Society International India, recently conducted a virtual event to discuss the advancement of human-relevant model systems and related frameworks to integrate such data in India.

The discussion initiated a dialogue between various stakeholders from academia, industry, and private funding bodies to address the challenges and promote emerging technologies that would make biomedical research more relevant to human biology in India.

The discussion’s focus was on advancements in three areas: new model systems based on human biology, crowdsourced databases that can integrate existing information, and computational systems that can use this organised information to develop predictive models of human diseases. While several research labs and start-ups in India have started working in these areas in the last five years, much research still occurs in silos. There is a lack of multidisciplinary cross-talk, which is essential for developing this area and bringing research closer to understanding human biology.

Rakesh Mishra, Director, CSIR-CCMB, Hyderabad, said “Innovative technologies based on human biology are no longer aspirational goals for a distant future but ready for implementation in India today.” He adds that advanced cell-culture methods and improved genomic understanding can lead to more precise drug discovery programs and better outcomes.

Promoting open access knowledge-integrative structures

With the advancement in ‘omics technology’ (a collective term for comprehensive analysis of cellular components such as molecules, metabolites, or genes), big data, and high-content imaging there is an explosion of collected data. There is a need for parallel development of frameworks and databases that can organise and collate this enormous amount of information.

The MANAV Human Atlas Project, a crowdsourced citizen science project launched by the Department of Biotechnology (DBT), is based on a similar idea to collate all available macro to micro-level information from life science literature and public databases to map how changes at the molecular level affect organs and the human body.

C. Ramachandran, Senior Principal Scientist at CSIR- Institute of Genomics and Integrative Biology (IGIB), suggested that data collation and integration should also be acceptable formats for publication in journals, which can serve as positive incentives for upcoming researchers. Indira Ghosh, Retired Professor, Jawaharlal Nehru University (JNU), New Delhi, and Shandar Ahmad, Professor, JNU, highlighted the need for context-based searching algorithms, guidelines on collecting and curating biological data for integration, and inter-institutional data managers who could collect, standardise, and classify the data.

Developing tools and technologies in India

Karishma Kaushik, Assistant Professor, Institute of Bioinformatics and Biotechnology, Savitribai Phule Pune University, and Indumathi Mariappan, Research Scientist, L V Prasad Eye Institute, Hyderabad, commented that establishing central facilities for manufacturing tools and instruments for creating organs-on-chip can reduce the dependence on international vendors and reduce the time and cost for Indian scientists. According to Jugnu Jain, Co-Founder and CEO, Sapien Biosciences, Hyderabad, “Leveraging India’s computational science and bioinformatics strength can help create a theoretical backbone for experimental results.”

Several panellists at the virtual discussion agreed that developing proof-of-concept and validating these emerging technologies are essential for acceptance by the regulatory bodies and the industry. V Radha, Emeritus Scientist, CSIR-CCMB and Ponnari Gottipati, Consultant - Grant Manager, LV Prasad Eye Institute, Hyderabad, suggested that dedicated centres of excellence, as established by the USA, the European Union, Canada, Japan, Korea, and Brazil, could provide the necessary infrastructure along with aiding collaborative science.

While there is a rise in the regulatory and funding initiatives worldwide to develop and validate these technologies, it is still a nascent field in India. Besides, new technologies are often viewed as risky investments, bringing down the private funding in these areas. Shirshendu Mukherjee, Mission Director, Program Management Unit (DBT- BIRAC-BMGF-Wellcome Trust), suggested an alternative to help reduce investor risks: a co-funding model that involves joint investments by the government, pharma companies, philanthropic bodies, and venture funds.

In his note, N Madhusudhana Rao, CEO, AIC-CCMB, remarked, “Sufficient traction for such emerging and human-relevant methodologies exists in India; however, the current activities remain highly fragmented and on a small-scale.”

As a way forward, in 2019, the Indian Council for Medical Research (ICMR) published a perspective paper and a roadmap on the need to promote alternatives to animal research in India.

On an ending note, the speakers collectively hoped that proposals that emerged from the initiatives by ICMR and this roundtable discussion could lead to actionable outcomes to bring biomedical research in India closer to human biology. These proposals include establishing centres of excellence and centralised facilities for tool development, including end-users and regulatory bodies in the technology development process, encouraging collaborative funding mechanisms, and promoting training and awareness amongst the student community.

Have you ever felt the elation of a goal reached? Of a dream fulfilled—perhaps graduating with flying colours or landing a dream job? We all certainly have such memories. But for how many of us are these moments marred by feelings of inadequacy, with that nagging voice in the head, “I do not belong here; I do not deserve all this?” A lot of us would nod our heads in agreement, including yours truly. That constant and persistent fear of being exposed as a fraud has a name – “Impostor syndrome”.

Impostor syndrome is characterized by perpetual self-doubt and an inability to objectively take credit for one’s accomplishments. Most people plagued by impostor feelings attribute their successes to external factors like luck, serendipity, or support from others. It was first described by psychologists Pauline Clance and Suzanne Imes in 1978, who observed that it was seen mostly in high-achieving women. However, research over the years shows that impostor syndrome is prevalent across genders, social structure, and professional hierarchies.

I got in touch with students as well as established researchers to find out what triggers impostor-like feelings in academics. Pooja (name changed upon request), a female researcher who graduated from the Indian Institute of Science (IISc), Bangalore says, “I felt impostor-like feelings when I joined the Bachelor’s program at IISc, which is highly competitive. The skewed sex ratio – there were five times more boys than girls in the program – did not make it any better. I often felt excluded and inadequate, even though I was doing better than my peers.”

Siddharth Kankaria, science communication and outreach manager at the National Centre for Biological Sciences (NCBS), Bangalore, also an alumnus of the Bachelor’s program at IISc, tried working in a new field of biology every summer, in the hope of finding his “true calling”. He says, “Perhaps the only outcome of this ‘exercise in sampling’ was a realization that I wasn’t really cut out for pursuing a career in life science research – primarily a reflection of my state of burnout coupled with my impostor syndrome, rather than a true reflection of my academic skills and capabilities.”

Both Kankaria and Pooja went on to pursue careers in science communication and are successful in their chosen paths today. To do this, they had to learn new skills and seek out opportunities – proof of their talent and capabilities. However, silencing that inner voice is never easy. “I was still working in an academic setting, and was often perceived by others to have taken the “easy way out”, which just triggered my impostor syndrome even further,” says Kankaria.

Does this mean that this feeling of perceived imposture only affects the novices and not the experts in a particular field? Perhaps not. Sreelaja Nair, Associate Professor at the Indian Institute of Technology (IIT), Mumbai, draws on her experience. “I am heavily plagued by impostor feelings when I compare myself to my peers or when reviews for a submitted research paper land in my inbox,” she says. Nair has found an effective way to counter these feelings. “I pull myself up by reminding myself that I got into research because of the incomparable creative freedom possible in academia. Academic research can be considered an art form and all artists are perhaps insecure on some level of their capabilities and skills,” she says.

Leslee Lazar, Assistant teaching professor at the Centre for Cognitive and Brain Science, IIT Gandhinagar, feels that there might not be a simple solution to this problem. However, he believes that trained counsellors on campus, as well as periodic conversations about this topic, might be helpful. Kankaria suggests a few more approaches. “Mentorship programs ensuring greater awareness about impostor syndrome, ensuring the availability of accessible and affordable mental health services, and creating safe spaces for people to engage in dialogue about such issues,” are some actions he believes may be useful.

While social media is a constant reminder of the “ideal” lives of others and can be a powerful trigger of impostor-like feelings, Kankaria feels it can be a boon as well. “It offers increased visibility of people across hierarchies struggling with similar feelings, and more opportunities to network with them. It also leads to greater awareness of impostor syndrome and the systemic issues in academia contributing to it.”

Implicit social biases may form one such systemic issue. It is often believed that impostor syndrome is more common among women. Nair provides one explanation for what the problem could be: “It is the society’s fault that it does a double-take when a young girl does well in any kind of competitive field, especially involving numbers, logic, or physical strength. The extra effort from there on to ‘indulge’ the girl (framed as support, encouragement, progressive viewpoint etc.), sow the first seeds of ‘perhaps I do not actually belong here’ in her young mind. These blossom into full-blown ‘I do not belong here, but I have to try to blend in so people better than me don’t realise that I do not belong here’ as she enters any professional sphere.”

Pooja explains how deep-rooted our social biases are, “I remember teachers in my school mentioning how girls are good in biology while boys are better in mathematics. Whenever a boy topped, it was often attributed to his logical reasoning and intelligence. On the other hand, if a girl topped, it was hard work and good memory. Such descriptions still go around in academia – women are rarely applauded for their smartness and intelligence; they are often described as hard-working and patient.”

While Indian universities are often a cultural melting pot, with students from different parts of the country studying together, they also serve as sites of segregation based on caste, gender, region, political ideologies, etc. A vulnerable student, particularly someone hailing from a disadvantaged background or a minority community, could end up feeling isolated, which might trigger feelings of imposture.

How can universities and team leaders help such students? Nair describes some methods she employs to make her students feel comfortable, “In my group, we have weekly “addas” or non-scientific discussions for members to get to know one another through personal stories and narratives of their experiences. For a research team, it is important to achieve that safe space for all members, where one can be their real ignorant self, without judgment, especially with their advisors.”

While the feelings of imposture can be emotionally debilitating, it is important to find ways to move past them. As Lazar says, “There is no single way to deal with these feelings. Talking to friends and reassuring oneself that there are multiple metrics and what we see on the outside doesn’t tell the whole picture, helps.”

It also helps to learn how to live with these feelings when they strike. Kankaria says, “The number of times I have to deal with such feelings has not reduced, but I’ve definitely gotten better at acknowledging and addressing them. I have become more accepting of myself, have greater confidence in my capabilities, and try to consciously focus on acquiring skills that I don’t yet possess.”

Although there have been many discussions on impostor syndrome, it remains to gain clinical relevance. An apathetic approach to this serious issue can dramatically alter the lives of the affected —some even downshift their career goals resulting in severe long-term consequences.

India is on the brink of a mental health crisis and a large part of the solution could be placing qualified support groups in place at educational institutions and workplaces. Seeking help for worsening mental health should be treated akin to seeking help for any other health problems: typhoid, anaemia, diabetes, COVID-19, etc. And while that takes time, perhaps each of us could look around and take active steps to help someone who needs a patient ear or a shoulder to cry on.

Returning to India is often a long-cherished dream for Indian scientists working and living abroad, but responding to the call of home is never easy. This is particularly challenging when you have lived abroad for several years, completed advanced degrees and professional milestones, received exciting and lucrative job offers, and adapted culturally and socially to a new country.

Nevertheless, every year, a bunch of Indian-origin researchers undertake a huge professional transition, deciding to return to India. Having undertaken the professional and personal transition ourselves, and after discussions with fellow colleagues in the Indian ecosystem who had made similar return journeys, we recognised the need to discuss and highlight the opportunities and challenges associated with the return.

We conducted a webinar, ‘Return to India’, catering to early-career researchers planning to come back to India in the near future. The panel comprised seven scientists at different career stages from a range of institutes and with varied sources of funding to support their initial research. The panellists represented diverse geographic locations (both in their previous overseas experiences and current affiliations in India), genders, and scientific areas.

The panellists included Anand Krishnan (DST Inspire Faculty Fellow, Indian Institute of Science Education and Research (IISER) Pune), Chandana Basu Mallick (Assistant Professor/Ramalingaswami Re-entry Fellow, Banaras Hindu University (BHU), Varanasi), Deepa Agashe (Assistant Professor, Reader F, National Centre for Biological Sciences (NCBS), Bengaluru), Divya Kumar (Assistant Professor/Ramalingaswami Re-entry Fellow, JSS Medical College, Mysore), Karishma S Kaushik (Assistant Professor/Ramalingaswami Re-entry Fellow, Savitribai Phule Pune University (SPPU)), Nagraj Balasubramanian (Associate Professor, IISER Pune), Poonam Thakur (Assistant Professor, IISER Thiruvananthapuram). The discussion was moderated by Snehal Kadam, a research fellow at SPPU.

The webinar hosted over 500 participants from across the world. Here, we share some takeaways from the webinar, with the aim of serving as a repository of information for colleagues looking towards this transition. The discussion slides and recording can be accessed online.

Taking the ‘call’ to return

There are various reasons that may prompt one to make the decision to return to India, and the motivations and considerations are almost always very personal. For example, Thakur mentioned that her calling ‘struck’ when she received an award, and her affiliation announced was ‘Sweden’. “It should have been India,” she remembers thinking. For Agashe, it was her long-standing goal to contribute to the small field of evolutionary biology in India. Similarly, for Kaushik, it was the idea to contribute to the niche pool of physician-scientists in the country.

Some other common reasons included wanting to be close to family, the opening up of a good career opportunity, and a desire to contribute towards shaping the country’s next generation of people in science.

While the decision-making process and subsequent timing of the move may be unique to you, once the decision has been made, it is a good idea to initiate ‘active engagement’ with the science community in India. This could involve looking for host institutes looking to recruit, giving guest talks at your preferred institutes, building relationships with scientists in India (via email and Twitter), as well as seeking networking opportunities such as the Young Investigators’ Meeting by IndiaBioscience and the Sci-ROI forum.

So, once you have the decision and timeline in place and have initiated the process, what are the next steps?

The right host institutes

Working in the Indian ecosystem after spending a substantial time outside of India has a unique set of challenges. Choosing the right host institute is a crucial and important step to facilitate this transition. For this, it is important to give seminars and talks to meet potential colleagues, assess the facilities and infrastructure in the institutes you are considering and get an overall picture of the working of the organisations. If possible, a prior visit to the institute in person is helpful before planning your application.

“Every place has a vibe, and this has to speak to you. The people define the vibe, and that is what you are looking for. This will be instrumental for your research later. So, go and see for yourself,” says Balasubramanian.

Agashe shares similar thoughts, “It is important to know that you will be happy and you will be able to function in the place you will join. At the end of the day, you want your science to move ahead, and it is important to ensure that the host institute and colleagues respect your work and vice versa”.

How do you approach a potential host institute? In general, it is advisable to approach the director or head of the department via email and ask for a one-on-one meeting either when you visit India or via a virtual interface. Alternatively, you could write to a faculty member in your subject area and request a meeting. You can also suggest the possibility of giving a talk at the institute.

Getting the application ready

As with fellowship applications, it is important to start early. Start your fellowship or job hunt at least a year in advance of the move. Explore the eligibilities and deadlines of different schemes for which you wish to apply (e.g. Ramalingaswami Fellowship, DST-INSPIRE, DBT-BioCARE for women, DBT/Wellcome Trust India Alliance). Some institutes have faculty applications open all year round, while others fill positions based on advertisements.

“Your proposal and your host institute should go hand in hand”, says Kumar. In other words, do not base your proposed work on a piece of equipment or facility that is completely absent from your potential host institute. Basu Mallick adds, “If you have any preliminary data, do include it in your application. Also, ensure that the proposed work is feasible and in line with the timeline of funding.” Regarding the level of technical depth in the proposal, Krishnan says, “The proposal should be such that it can be well understood even by non-experts of the field.”

While starting the application process, a common and serious consideration is the “two-body problem”, which refers to married partners finding professional opportunities in a common geographic location. For this, Thakur suggests that If one of the partners has secured a long-term faculty position, then the other partner can apply for various fellowship schemes and activate them at the same or nearby institutes.

Ways to approach some common challenges

Securing the ‘right’ host institute may take a few trials: It is important to point out that several grants and fellowships do offer a provision to change the host institute if, for some reason, the initial choice does not work out. This is not unheard of and is sometimes the path towards finding the right institute.

Substantial paperwork: Basu Mallick says, “One of the challenges I faced outright was a large amount of paperwork, coupled with physical signatures and stamps, to initiate the process of starting my grant. It is important to have supportive colleagues and non-teaching staff to help you through this.” In most institutes in India, applications, procedural processes, recruitment, and expenditures require many institutional and signatory approvals and still operate with physical copies of documents. This means these processes take time and will have to be initiated and planned well in advance of deadlines, keeping in mind pay cycles and the financial year-end.

Delays in the procurement of consumables: In general, procurement in India does take longer than that experienced in the US or Europe. For Thakur, who started her lab in the pandemic, procurement of consumables was a particular challenge. “You need to be a little brave, very patient and hugely resourceful,” she says. “There might be several delays in the initiation of the fellowship, in the procurement of chemicals, and in hiring PhD students and postdocs”.

Teaching responsibilities: Research in India is often coupled with teaching, though it does vary from institute to institute. It is a good idea to discuss the expected teaching load at the time of application. As Kaushik says, “At a large state university, undergraduate teaching is a semester-long and ongoing commitment. One also has to be open to teaching courses beyond your area of core expertise.”

Other common concerns brought up by participants during the session

What about nepotism in grants, positions and awards in science in India?

As Kaushik explains, “Nepotism or favouritism in science has been discussed across several science systems worldwide. I describe myself as an outsider to Indian science, and I have to say that science in India has been hugely welcoming. Nepotism exists in every field, including science in India, but it does not mean that you cannot do well.”

Is it true that only established host institutes receive funding?

Kumar says she is a classic example of receiving the Ramalingaswami fellowship with a private medical college as a host. Further, Basu Mallick adds that the India Alliance initiative funded her on her return, even though she had almost no professional roots in India, with a PhD and postdoc in Europe.

What about age limits for faculty positions?

Several participants discussed the issue of ‘ageism’ in science in India. The fact that there is an ‘invisible’ and ‘unwritten’ age cut-off for faculty recruitment was discussed, and many were concerned about age limits. While this is true, the consensus across panellists was that there is variability in policies across Indian institutes, so formally or informally checking with the institute is the best place to start.

Are faculty fellows considered on par with faculty?

As per fellowship norms, Ramalingaswami Re-entry fellows are expected to be at par with Assistant Professor/Scientist D grades. Kaushik, Basu Mallick and Kumar state that in their current positions, they are considered Assistant Professors, albeit funded via the Ramalingaswami Program. However, this may vary across institutes, and once again, this is a must-have conversation with host institutes.

Advantages and opportunities of doing science in India

Unique aspects of the ecosystem: When you are setting up a research group, there are numerous challenges. A culture where people talk more and interact more does make it easier to deal with these. Kaushik says it has definitely been easier to build scientific as well as clinical collaborations in India compared to what she has seen in the US. “In general, medical professionals in India are very open to collaborating on projects,” she says. Basu Mallick adds, “You often do not have to depend on collaborators, you can have direct access to samples”. Krishnan mentions that he missed the “community feel” of Indian labs when he was abroad.

Build capacity in your field in India: In general, India has a relatively small and well-connected biology community. In certain scientific areas, there are very few people working in the field. So, working in India gives you the opportunity to lead the building of capacity in the field and thereby grow as an independent researcher.

Contributions to science teaching and mentoring: Specialized areas of research are often not part of standard undergraduate curricula, so having a lab in India provides opportunities for student research in these fields. Furthermore, in your own country, there are fewer language barriers in teaching. This point was driven home by Basu Mallick, who did her PhD in Estonia, where she could not teach undergraduate classes as they were conducted in the local language. Krishnan, whose passion is teaching, says he enjoys interactions with undergraduate students and feels blessed to have this opportunity to interact with them and contribute to their growth.

Areas that are difficult to ‘break into’ in a foreign country: Kaushik says one big win from her return to India has been the opportunity to engage with the scientific ecosystem beyond traditional academic research. These include collaborative grants with industry, science communication, outreach activities, as well as science policy. She says, “As an expatriate or immigrant, I felt I had little or no say in the science-policy of a foreign country. I also did not possess the relevant insights to comment on them. But as a member of the committee drafting the recent Science, Technology & Innovation Policy (STIP) 2020, I felt I had the had ground to participate and contribute to shaping the next science policy of my country”.

These opportunities also go hand-in-hand with personal factors such as proximity to family, more affordable day-care and education for children, as well as relief from the pressures of immigration and visa renewals.

In conclusion, while there are challenges to doing science in India, there are also unique opportunities and gains. As Nagaraj says, “India is a vibrant country, and this really added to the quality of my life when I came back. Science in India is challenging, certainly, in many ways. The language of getting things done here is different, and this is something that you will learn or re-learn with time”. Deepa adds, “You also need to distinguish the challenges of science in India from the universal challenges of being an early-career independent investigator; this will give the right perspective”.

India is home to 1.4 billion people - nearly one-sixth of the world's population. 600 million Indians - almost half the country's population - are less than 25 years old. This rich human resource , if effectively trained, can be leveraged to realise an immense potential for national growth. However, our education system is heavily skewed towards rote-learning and cracking competitive examinations.

Nobel laureates Abhijit Banerjee and Esther Duflo's pioneering works on the Indian education system revealed that the system is biased towards top achievers while ignoring the needs and outcomes of average and low performers. Their work also revealed that the focus of most teachers is on completing the assigned syllabus, not on assessing whether the students could achieve the desired learning outcomes or not.

The concept of mentors and mentoring mostly remain unexplored in the present Indian education system, except in a few prestigious higher education institutions. Oftentimes top-achieving students approach their teachers for general academic and career guidance, that can be considered as a ‘proto- mentoring’ . There are indeed academic internship programs in the country, Science Academies’ Summer Research Fellowship Program coordinated by Indian Academy of Sciences-Bangalore being the most famous example (I am an alumnus of this program ).

However, such programs usually have strict eligibility criteria, are research-focused and are only open for students enrolled in recognized educational institutions , not for the general public. In addition, there has been no nationwide initiative for virtual open idea-matchmaking . Frequently, all that the youth need is personalized guidance and compassionate motivation from mentors to find the right career path. The need for this gentle push is what motivated me to kick-start India's first virtual mentoring platform MentX: Mentor-Mentee Exploration and Exchange.

MentX came into existence in July 2020, during the COVID-19 lockdown. It was created as a free and open platform to match mentees with mentors to foster interdisciplinary dialogues. Celebrated Scottish morphologist D'Arcy Thompson wrote in "On Growth and Form" in the 1910s:

“Let me tell you that the fertile field of discovery lies for the most part on those borderlands where one science meets another… Try also to understand that though the sciences are defined from one another in books, there runs through them all what philosophers used to call the commune vinculum, a golden interweaving link, to their mutual support and interpretation.”

Nurturing trans-disciplinary knowledge exchange remains the main motive behind MentX. Coincidentally, the New Education Policy (NEP) 2020, which was drafted around the same time, focused on the need to support transdisciplinary research in the country.

Today, the MentX database lists approximately 20,000 mentees and mentors from across India, covering almost all areas of rational knowledge, including sciences, humanities, business, and even arts and entertainment. MentX could very well be one of the world’s largest mentoring platforms. In comparison, Growthmentor enlists 100+ mentors, SCORE has 10,000 members, iMentor has 10,000+ members, and DesignLab has 3000+ students.

The MentX program is entirely free and open; we did not insist on any minimum academic qualifications for mentees or any minimum experience and/or professional recognition for mentors. Mentees who were benefitted include hundreds of school students and unemployed youths, while our mentors included professional artists and dancers with no formal education.

An example of the transdisciplinary research that a MentX intern has undertaken is a project titled 'Physics and genetics behind masterly execution of Indian classical dance' in which a student from Delhi who is passionate about Indian classical dance got a rare opportunity to work with two mentors: Anjana Munshi, a renowned geneticist at Central University of Punjab, and V. Madhurima, a physicist at Central University of Tamil Nadu.

The impact of MentX has been profound; thousands of young people across India, especially those from rural communities, got a rare chance to experience the thrill of knowledge discovery by undertaking brief research projects. Most of the projects were transdisciplinary in nature. The mentees received much-needed career guidance from the mentors. Mentors were specifically instructed to encourage mentees' holistic personal development, enabling them to achieve their career goals. MentX paved the way to foster professional connections that are expected to last a lifetime for both mentees and mentors.

Apart from boosting their self-confidence, mentorship helps the mentees identify specific weaknesses and strategies to compensate for the same, as well as personalized life-coaching. The research undertakings as part of MentX have resulted in several peer-reviewed publications (e.g. Mal, N., Srivastava, K., Sharma, Y. et al.Facets of diatom biology and their potential applications. Biomass Conv. Bioref. (2021)). One of our interns, Sonit Sisolekar, a plus-two student from Pune, won this year's Prime Minister's Bal Puraskar award.

The MentX initiative is one amongst many activities of a new young academy born during the COVID-19 lockdown period: Young Academy of India (YAI). YAI is the first and the only young academy in India that is open to all fields of rational knowledge. Membership of YAI is open to everyone; there is no insistence on minimum qualifications or experience. All interns who complete their two-month MentX internship program become inducted in YAI as associates, providing them with a lifelong platform to contribute to science education in the country.

YAI is actively involved in science communication and outreach activities through YouTube videos in multiple Indian languages focused on scientific thinking, sustainability, health and the environment. YAI is a youth think-tank organization in the country - a collective voice of young scholars from all disciplines, both sciences and humanities. The academy brainstorms both international and national issues regularly and issues thematic white papers on various policy-related contexts.

Putting on the shoes of an “ideological matchmaker” in a country flooded with matrimonial matchmaking websites is a unique and very satisfying experience of my life. YAI-MentX continues to transform India's youth, helping them mould their career and enabling them to be responsible citizens who can contribute to building our national wealth and well-being in all spheres.

Right before entering her PhD supervisor’s cabin, Garima (name changed) mentally rehearsed her meticulously worded script. She was going to break the news of her impending wedding and foresaw a not-so-pleasant reaction. But what she didn’t imagine was that she would be dismissed from a project she had spent a year’s hard work on. For the next month, she cried before getting out of her bed every morning. Her mental health worsened post-marriage, as she tried to juggle professional and societal expectations. While Garima has now progressed in her career, it took panic attacks, anti-depressants, and counselling to get so far.

This may sound like a one-off story. But if you are a female Indian researcher, chances are you know someone who has at least partly been in a similar position.

The research environment is often stressful and hostile. Adding societal conditioning and intrusion to the mix can exacerbate the situation, especially for women. The global perspective of the mental health of female researchers doesn’t factor in the effect of an inherently intrusive traditional society on mental fitness.

To survey the impact of societal norms on the career choices and mental health of Indian women in science, I posted a questionnaire on select social media platforms, to reach out to female Indian researchers and a few women on other science career paths and stages. I received almost 300-odd responses within a matter of a few days - far beyond my expectations.

Many-a-story and emotion were shared in response to the questions. Like a PhD scholar who aptly describes our society as one that “obsesses more about a woman’s marital status than their career aspirations, with everyone having an opinion on it—right from your doctor, shopkeepers, maids, to perfect strangers”*.

Even with the rise in the number of women enrolling in higher education in India, most respondents mention how it remains a means of improving marriage prospects. A paradox that we live by is to encourage young girls to be rank-chasers in school but, as a PhD researcher remarks, “discourage them from having career aspirations as home-making and childbearing abilities determine a woman’s value in the society”.

Resoundingly, most respondents find their families preferring medical or teaching professions suitable for their daughters. While the former brings in “prestige”, the latter “allows women to fulfil her household duties”. A few others remarked how their parents preferred the IT sector for them, supposedly a way for quicker professional settlement, and subsequently better marriage prospects. A general practitioner also believes that girls are conditioned into choosing specific careers such that they “don’t think outside the box and follow the choices ingrained into them”. Another PhD scholar observes, “Matrimonial profiles state nothing about the bride-to-be’s educational qualifications, but mainly focus on her home-making and physical qualities”.

But when a PhD instils critical thinking and leadership qualities in women, it goes against the accepted norms of our society. Some responders wrote how many believe their qualification has made them “too-educated”, “arrogant”, “egoistic”, “demanding”, “temperamental”, “intimidating”, “non-adjusting”, “high-standard” and “argumentative”.

A researcher mentions balancing home with career, which she has been taught is her sole responsibility, “leaves her tired out”. Her husband supports her decision to pursue PhD but doesn’t contribute to domestic work. Known as the double-burden syndrome, this leads to many women quitting their jobs. Even then, sharing of the mental load remains a distant dream. Some responders voluntarily quit work post-marriage or post-baby. While privilege may provide such an option, socio-economic constraints and pressure to conform to traditional gender roles also influences this preference.

The male breadwinner notion also leads to power imbalances within homes, creating breeding grounds for mental distress in both men and women. Many women noted the limitations that come with being the trailing spouse. A PhD aspirant, engaged to be married soon, says, “I got excellent offers to study abroad, but obediently decided to marry at the acceptable age. Here I am now in India, looking for a PhD”. The lack of job opportunities post-PhD in many places in India compounds the problem.

Institutional bias continues even after a century after CV Raman, the second Indian Nobel Laureate, infamously denied admission to a woman at IISc in the 1930s. “Despite securing the 63rd rank at the National Eligibility Test (NET), I was always asked not to get married by the Professors I approached,” a Research Associate recalls. “My PhD mentor gave me a tough time after my baby, and the society thinks I am career-oriented and selfish with no time for family”, she adds. Ironically, a study showed that delaying or foregoing normative family roles doesn’t fetch better opportunities for women in STEM. Another postdoctoral researcher points out the inadequacy of the resources provided by the government schemes for women.

Of the lesser discussed issues, reproductive and gynaecological health problems such as endometriosis, infertility, pregnancy complications, postpartum depression and menopause can negatively affect mental health. According to an Assistant Professor who responded to the questionnaire, “family pressure to conceive a child combined with infertility issues and treatment failures during my postdoc in a very demanding lab impacted my mental health”.

But all was not grim. Many respondents from across the board mentioned being “lucky to have families (and cats!)” who supported them and helped navigate around the stressors. This tweet from Vatsala Thirumalai, Shanti Swarup Bhatnagar Prize awardee, crediting her success solely to her parent’s unwavering support in an orthodox society, is a testimony to the same.

Societal conditioning leads to women doubting their self-worth and downplaying their talents. While mental health issues of women in science are actively discussed online and among youngsters, they are not reaching those who need to be sensitised more - the corner wali aunty who judges professionally successful woman or the building uncle who disses the character of a 30+ single woman. Indian pop culture revolves around domesticated women taking care of four generations of family members. Indian films on female scientists are also more of a disservice - whether it is the pill-popping, “mad-scientist” portrayal of the female protagonist in Hasee Toh Phasee or the male-saviour plotline of Mission Mangal.

Navigating around the problem

Many practical institutional reforms have been discussed and are being implemented to support women. Societal restructure will bolster these reforms for which change needs to start young. A subject on gender equity at school level can create a more lasting effect. Public awareness on how gender diversity leads to better scientific outcomes and structured mentorship programs can create more inclusive spaces.

Schemes and policies for women empowerment must go beyond mere tokenism. Providing provisions to transfer PhDs and work part-time will allow many females to stay within research. Childcare supportfellowships can help female researchers circumvent the burden of additional expenses. Schemes focusing on the two-body problem can help easy relocations for partners.

Further, rather than pinning biological issues against women, we should accept them as the norm and work around them to create an equitable environment. Cultivating an environment of open conversations is a requirement that goes beyond just academic discussions. Many institutions have a sexual harassment cell in place. Similar setups that deal with gender bias also need to be added to the support system of researchers.

As Caroline Criado Perez writes in her book, The Invisible Woman, “The result of this deeply male-dominated culture is that the male experience, the male perspective, has come to be seen as universal, while the female experience—that of half the global population, after all, is seen as, well, niche.” Calling issues that women encounter as female-specific problems derails the conversation. It is a societal problem for which only a woman is penalised.

*Statements within quotes are from responses from the survey. Some of them have been edited for clarity and length.

Independent studies from across the world have revealed worsening mental health among researchers, particularly graduate students. A global survey of 6320 graduate students conducted by Nature in 2019 found that about 36% of the respondents had sought help for anxiety or depression. In October 2020, CACTUS Foundation reported the findings of their survey of 13,000 researchers from 160 countries, which corroborated these conclusions. Both studies found that while a majority of the researchers were satisfied with their career choice, many reported feeling overwhelmed, anxious and depressed on a regular basis.

Although these studies focus on the mental health scenario of graduate students globally, the Indian scenario is quite similar, if not worse. While there are many factors influencing the deteriorating mental health condition among young academics in India, financial struggles and job insecurity are two major concerns.

“It’s important mentors think how well the research scholar is supported in financial terms as this plays a critical role in the mental health of the person. Just passion and interest can’t sustain a person for long – Reality Check!” Divya P. Kumar, Assistant Professor, Department of Biochemistry, JSS Medical College (JSSMC), Mysuru, tweeted in October, 2020. Many other academics expressed their agreement with this view. “Financial stability is very important for mental stability and general wellbeing,” Shilpy Sharma, Assistant Professor, Department of Biotechnology, Savitribai Phule Pune University, Pune, replied.

The financial difficulties that young researchers face in Indian academia branch from two factors: (i) variation in stipends, and (ii) irregularities in the timely disbursal of stipends. “Low fellowship amount has always been a major issue in Indian academia. It can be frustrating when researchers don’t get enough money after reaching a certain age, and that may hold us back from reaching our full potential,” said a research fellow who responded to an anonymous survey circulated regarding this issue. Akshatha N. S., Research Scholar, JSSMC, Mysuru, echoed this thought in her tweet, “Constant worry about financial insecurities drains out all the energy which otherwise could be put into pursuing the passion.”

PhD students in India receive different stipends depending on their funding source. With the exception of the Prime Minister’s Research Fellowship (PMRF), most fellowship amounts range from reasonable to low considering the expertise required. Although the total stipend amount (with the HRA included) is reasonable, central government agencies/institutions do not provide HRA for students who stay in hostels, and hostel charges are additionally levied on students' stipend. Further, most public funding agencies require the candidate to qualify via a national level exam like DBT-BET, CSIR-NET, ICMR-JRF or GATE. Those who fail to crack one of these or do not have a professional master's degree, and are recruited through extramural grants, get stipends that are reduced by almost half for the same kind and level of work.

The system also lacks an established mechanism for increments. Stipend increments occur only once in 4 or 5 years and many a time after several protests by students. The Government of India increased the JRF stipend to INR 16,000 in 2010, to INR 25,000 in 2014, and to INR 31,000 in 2019, each time after sustained protests.

As for PhD students funded by private universities, the stipends are typically much lesser than their public funding counterparts (with a few notable exceptions) and with no provision for house rent allowance in most cases.

A larger issue is the irregular disbursal of funds. Many PhD students often go without stipends for several months. The problem with timely disbursal varies a lot with the source of funding. The issue has been the worst for CSIR scholars, who despite several requests, protests and media reports, see little progress on the ground. Institute-provided funds, on the other hand, have the reputation of being prompt with their disbursal of stipends.

While PhD fellowships from public funding are for five years, almost all private universities fund students only for a period of three years with an extension for six months. So, when a student’s research extends beyond this period, they are left searching for other sources of funding – e.g. a project-based grant received by the student’s advisor. If the advisor does not have a grant to support the student, the student is often left without an income. So, long PhD durations add to the financial woes of the student, especially given that many scholars would have families to support by this time.

While researching this issue, I polled 80 young academics – PhD students, project fellows and postdoctoral researchers - to get a deeper understanding of the situation on the ground and to gather suggestions for improvement. Out of these, 54 respondents said that they experienced mental distress and 10 respondents were formally diagnosed with mental health conditions during their stay in the research institution. The top reasons noted for mental distress were financial struggles (33), job insecurity (33) and toxic lab environment (30).

While 31 researchers mentioned that the stipend was inadequate, 18 complained about the irregular disbursal of stipend. Also, 11 respondents said that the direct deduction of additional or mandatory expenses (like mess bills or rent) by the institute from the bank accounts of students added to their mental stress.

Most participants thought that a fellowship amount of INR 45,000 per month for PhD students and INR 70,000 per month for post-doctoral researchers would be adequate. One respondent also said that while the current stipend may be adequate, providing additional benefits for research scholars who are married and have children can ease their financial burden. These benefits include health insurance for the student and family, employee provident fund, and daycare centres for kids.

To tackle the issue of job insecurity alongside financial struggles, some respondents also suggested the extension of the fellowship period in private universities from three years to five years. One further suggested that the PhD training be made independent of the compulsory paper publications so that it becomes possible to complete within the fellowship period of five years, given how difficult it is to obtain stipends when one is pursuing a PhD beyond five years.

Financial insecurity and its bearing on mental health are leading many young researchers to consider studying and working abroad. In fact, some researchers who participated in the poll suggested studying abroad as the appropriate solution to the worsening mental health among graduate students in India.

As Aristotle said, “Education is the creation of a sound mind in a sound body.” But when published reports and anecdotal evidence indicate an opposite effect, brought about by many factors including financial struggles and job insecurity, it is time to rethink and adopt appropriate changes.

The Indian STEM academic community is finally talking about mental health issues that affect people in STEM. Recent efforts from IndiaBioscience, TheLifeofScience.com and other science media platforms stand testimony to this fact. However, not all people in STEM are equal, and therefore, not all of their mental healths are affected in a similar fashion. For queer-trans people (or, more commonly, LGBTQIA+ [lesbian, gay, bisexual, transgender, queer, intersex, asexual, and other diverse gender and sexual identities] people), oppression due to their gender and/or sexual identities are additional factors that affect their mental health.

As a BSc student from a research institute mentions, “The stress of being closeted and trying to figure out who you are at the same time [as] concentrating on studies is very mentally challenging and emotionally draining.” Another person who wishes to remain anonymous puts it aptly, “Simultaneously navigating being queer in the personal sphere along with dealing with academia in the professional sphere can be particularly taxing on one’s mental health and significantly affects both these roles.”

So, what affects the mental health of queer-trans people in STEM disciplines? To find answers to this question, I reached out to people from these communities using a survey-based questionnaire. The questionnaire asked a few simple questions: respondents’ gender and sexual identities, stage of the STEM career they were in, what kind of institution they came from (state/central/private universities, research institutes, etc.), whether they felt that their mental health had been affected due to being queer-trans in STEM, whether they had access to affordable and queer-trans-sensitive mental health practitioners and the elephant in the room - what could be done to make the situation better.

The survey was open only to people who identified as queer-trans/LGBTQIA+ and were in STEM disciplines. 47 respondents with various gender and sexual identities, coming from different institutions, filled the survey. This report summarizes the findings from this survey. It highlights various issues that affect the mental health of queer-trans people in STEM and ends with action points for the STEM community to ponder over and work upon to make STEM more inclusive for queer-trans people.

What affects the mental health of queer-trans people in STEM?

When asked if being LGBTQIA+ in STEM has affected their mental health, 38% of respondents responded with a yes, while a further 38% mentioned that being LGBTQIA+ in STEM may have impacted their mental health, although they weren’t sure.

The respondents identified a few key concerns: bullying and harassment, fear of ostracization, the silence about gender and sexuality in STEM spaces, and STEM syllabus that is discriminatory against queer-trans people.

Bullying and harassment

“I feel like the crowd in STEM fields tends to be less accepting of various communities, than in other fields...they have lesser awareness of issues such as queerphobia and really do not understand the scale and effect of these problems. So they will often make rude remarks, and support discriminatory views in the name of "brutal honesty", and it becomes very stressful to either bear with or try to explain to them why this is bad. I feel exasperated with my friends sometimes and come away feeling small,” says a respondent who is a BSc student from a Private University.

Many respondents mention facing both overt and covert harassment for being queer-trans in STEM. This can take many forms, from disrespecting one’s gender and sexual identities to blatant discriminatory remarks. A BSc student from a private university mentions, “Some people sometimes treat LGBTQIA+ people as a joke or raise eyebrows at it, which is disturbing.”

Another respondent, pursuing a PhD from a research institute, says, “Unfortunately, I've heard inappropriate comments and unsolicited advice, even from close peers, which has been hard to deal with. I've also not felt comfortable enough to discuss this with my superiors including my principal investigator (PI). All the lying by omission has taken a toll on me.”

Respondents also mentioned a form of harassment on campuses that involves propagating rumours around a queer-trans person. This is quite common in a lot of campuses and can take a heavy toll on the mental health of the person concerned. Moreover, it also puts the person at risk of being outed without their consent to people who they do not yet feel comfortable being out to. For a lot of queer-trans people who live double lives, it is important to not be the centre of attraction, and spreading rumours about such people not only makes them a topic of discussion against their will but also risks their safety.

Fear of ostracization and exclusion

“A large part of my anxiety is the way I may be discriminated [against] by superiors who already would view me as incompetent if I was out to them. I had to learn to compartmentalise the two aspects of my life and move on. The constant fear of being unwantedly outed still lingers over my head,” says an MSc student from a private university. Many other respondents agree.

Ostracization, leading to exclusion, is a common fear among a lot of queer-trans people. Since any STEM endeavour is a collective effort, being ostracized due to one’s gender and/or sexual identities leads to a severe impact on one’s career, confidence, and consequently, mental health.

Silence about gender and sexuality in STEM spaces

Quite a few respondents also mention how people in STEM disciplines do not engage with questions of gender and sexuality. This non-engagement feeds into an environment where sensitization towards queer-trans issues is not considered important. This makes queer-trans people in STEM feel unwanted and takes a heavy toll on their mental health. Also, they often do not have the option to go by their preferred pronouns, and even when they do, they are under constant fear of being sacked or discriminated against.

“In STEM for me, gender identities/sexual identities were also a hidden sort of thing. It’s more of a “don’t ask, don’t tell” situation as far as I have seen,” says a respondent working as a software engineer from a state university.

Another respondent, an MSc student from a central university, also points out how this non-engagement leads to STEM becoming an exclusionary and unsafe space for queer-trans people. He says that the “lack of LGBTQIA+ representation in STEM leads us to believe that it’s difficult for people who are gender and sexual minorities to survive and thrive in this area.”

A discriminatory and disrespectful STEM syllabus

Some respondents point out that the root of the discrimination might be in the STEM classroom itself. They mention how the representation of queer-trans people in STEM syllabi is often pathologized. Moreover, such topics are often taught by people who are not sensitive to queer-trans issues, making the classes a cause of mental health issues for many queer-trans people.

For example, Akasha, a research assistant at a private university mentions, “Biology classes with backdated syllabi rife with prejudiced/un-nuanced research have to be reviewed and critically analysed before incorporating them into the course. The teaching of such materials jeopardizes the mental health of queer people like me. A diverse faculty composition would have eased my mental health as opposed to all cis-heterosexual male faculty.”

Anasuith P. Pridhvish, a student from a private university, also mentions how such materials in the classroom can be used against queer-trans people by their cis-heterosexual colleagues. She says: “Studying [a] syllabus which excludes me or claims my identity to be a disorder and realising that others who are studying along with me in the same class could use it against me if situations favour them triggers anxiety in me.”

Accessing queer-trans–friendly support for mental health issues

About 53% of the respondents mention that they are not able to access affordable mental healthcare for their mental health issues. Interestingly, although about 75% of respondents mention having a mental health practitioner on campus, 78% of respondents also mention that the mental health practitioners are either not sensitized to queer-trans issues or are available too infrequently. They mention that often there are only one or two allocated mental health practitioners for the entire campus, and these practitioners are also available only on select days of the week. This leads to the practitioner not having enough time to deal with all the people.

Since most mental health practitioners are not trained to handle queer-trans issues, going to them sometimes runs the risk of feeding into the trauma that led to mental health issues in the first place. Respondents also mention how accessing mental healthcare on campus may lead to a breach of confidentiality or involvement of faculty/parents who they are not out to.

So what can be done to improve the accessibility of mental health services for queer-trans people in STEM spaces? The survey respondents point out the following:

1. Having mental health practitioners who are sensitized to queer-trans issues and have undergone special training to accommodate the needs of queer-trans people. These practitioners also need to be available to students and staff either free of cost or at a nominal fee. Mental healthcare also needs to be included in the insurance policies of institutions to reduce the financial burden on people unwilling to access mental healthcare on campus.
2. More mental health practitioners, who are also available more frequently, so that the mental health services on campus are not overbooked and waiting times are reduced.
3. Strict confidentiality clauses to ensure the safety of the queer-trans people accessing the mental health service.
4. For queer-trans people who are considering sex reassignment surgeries (SRS), it is important that the mental health practitioners and the institution supports the people throughout the process.

Ways forward

Having discussed what affects the mental health of queer-trans people in STEM, it is important to spend some time on what can be done to improve the situation. The action points mentioned below are a starting point for people in STEM to start engaging in a more sensitive way with queer-trans people and collectively improving their mental health.

1. Dedicated bodies to tackle cases of harassment against queer-trans people in STEM.
2. Increased sensitization on campus about issues concerning queer-trans people.
3. Better access to mental health services.
4. Acknowledging the intersectionality of mental health and other forms of social marginalizations like caste, class, gender, sexuality, disability, etc., and tailoring mental health services accordingly.
5. More queer-trans role models and mentors to support and motivate young queer-trans people in STEM.

A lot of these are also mandated by the NALSA and ors. vs. Union of India judgement (2013) and the Navtej Singh Johar and ors. Vs. Union of India judgement (2018) from the hon’ble supreme court of India and the Transgender persons (protection of rights) act (2019) from the government of India. However, the implementation of these legal frameworks remains poor. The onus is on the current generation of people in STEM to start working on the action points and make STEM a more inclusive and welcoming space for queer-trans people.

Recently, Indian Scientists’ Response to COVID-19 (ISRC) collated publicly available information related to the vaccines globally in use in an easy-to-access format. We present an abridged version of some frequently asked questions answered in this document, reproduced here with permission.

What is a vaccine and how does it prevent/reduce disease for an individual and for a population?

When a person is infected by a pathogen for the first time, their immune system gradually learns to recognise it, and then potently and specifically neutralise it. But this process takes one to two weeks, in which time, the person suffers from the disease and produces many copies of the pathogen, potentially infecting other people. A vaccine is a non-infectious, inactivated version of a pathogen, or part of a pathogen that can be injected into a person’s body to train their immune system to recognise the wild, harmful pathogen and rapidly neutralise it. This ability to quickly recognise and neutralise future infections or immune memory prevents severe disease in the individual and also reduces the chances of spreading the disease to others.

As more and more people in a population have an immune memory to quickly fight off a particular infection, the chances of it spreading get lower and lower. A population reaches herd immunity for a disease when each infected person spreads the disease to less than one other person, on average. The chances of disease spread depend on biological factors such as the pathogen’s virulence but also societal factors, such as physical distancing measures. Vaccinating as many people in a population as possible is one important way to reduce infection spread. But it is just as important to maintain physical distancing and other measures to reduce spread, especially to end the COVID-19 pandemic.

What are the different phases of vaccine approval under normal (non-pandemic) situations? What are the parameters to gauge success at each stage?

A vaccine is a preparation that contains one or more pathogens in inactivated (also known as avirulent) form. Alternatively, the preparation may contain only some part of the disease-causing organism or it may comprise an artificial substance that mimics a pathogen. The main purpose of any given vaccine is to generate immune response in the recipient that is sufficient enough to provide protection against a particular disease. This leads to priming of the recipient's immune system against the foreign pathogen. If this particular pathogen is encountered by the recipient in the future, the recipient's immune system will be able to act more swiftly and effectively against the pathogen and hence protection is ensured in the recipient.

In general, accessibility to a new vaccine spans a period of 10-15 years, beginning from the discovery of a new vaccine candidate to the licensure of the vaccine formulation. The overall process of vaccine development is rigorous, involving careful study design and continuous monitoring throughout to efficiently determine the final vaccine formulation and analyse whether the vaccine is safe, tolerable and does not outweigh the benefits of protection. The various phases involved in the research and development of a vaccine are mentioned below:

1. Exploratory phase and pre-clinical studies

Aims:

• To identify a novel vaccine candidate
• To evaluate safety and potential to prevent the ‘disease in question’

Tested in: Animals like mouse, hamster, rabbit, rat, monkeys, etc. that mimic the targeted human disease. The testing involves ‘challenge experiments’ to analyse the level of protection by the vaccine candidate against a virus (or another pathogen).

Outcome: A suitable vaccine candidate is identified which is then taken forward to Phase I clinical trials in humans. The pre-clinical phase allows decision-making for further development of vaccines. If the immune response elicited is insufficient, the vaccine candidate is abandoned.

Approval methodology: The vaccine candidate must not be toxic, should generate binding and neutralizing antibodies against the target pathogen. The tests include toxicity analysis, immunoassays like ELISA, virus neutralization assays etc.

2. Phase I clinical trials

Aims:

• To evaluate whether the vaccine is safe for use in humans
• To confirm if it generates an immune response in the recipients
• To estimate the appropriate dosage and route of administration of the vaccine

Tested in: Small numbers of healthy adult volunteers, who are preferably enrolled and observed at a tertiary care hospital. The reason for such preference is to ensure immediate health care service, just in case any adverse reaction post-vaccination occurs.

Outcome: Vaccine safety, tolerability and dosage is identified.

Approval methodology: Antibodies and other parameters of immunity generated as a result of the vaccine are assessed. The vaccine must not be toxic. It must be able to generate antibodies that bind and neutralize the pathogen, thereby exhibiting effective protection against the pathogen. Apart from this, T-cell immune responses are also assessed by highly sensitive and robust immunological techniques.

3. Phase II clinical trials

Aims:

• To further assess the immune responses generated by the vaccine. This includes evaluation of types and magnitude of immune responses
• To determine the exact dose and immunization schedule

Tested in: Larger numbers (compared to Phase I) of volunteers having characteristics (like age, health conditions, etc.) similar to the target population (people more likely to be affected by the disease in question; for instance, COVID-19 at present). In this phase, vaccines are administered in some of the volunteers. The non-recipients form the control (or placebo) group, who receive a shot of saline instead of the vaccine formulation.

Outcome: Comparative analysis of vaccine effects on recipients and non-recipients. Efficacy end-points and immunogenicity are determined.

Approval: Generation of sufficient levels of neutralizing antibodies against the target pathogen. Achievement of expected seroconversion rates (time period for antibody development).

4. Phase III clinical trials

Aims: To assess the efficacy and safety of the vaccine so as to progress towards registration and marketing of the vaccine.

Tested in: Thousands of individuals representing the targeted population are enrolled. Similar to phase II, vaccine is administered to some, while others form the control group.

Outcome: This phase generates more conclusive data regarding the effects of the vaccine in the targeted population. In other words, the vaccine efficacy and final formulation is determined based on the results of phase III trial.

Approval: The success of phase III trial is dependent on the vaccine efficacy. Vaccine efficacy is defined as the percent reduction in incidence (of an infection) among vaccinated individuals. It is calculated by the following formula:

(IU-IV/IU)*100 = (1-IV/IU)*100 % =(1-RR)*100%

Where, IU = Incidence in placebo population (number who get disease amongst placebo / total number of placebo or control)

IV = Incidence in vaccinated population (number who get disease amongst vaccinated / total number given vaccine )

RR = Relative Risk

The results of all the clinical trials are carefully reviewed to evaluate the efficacy and safety of the vaccine. This follows application for regulatory and public health policy approvals and subsequent production and roll-out for public use.

5. Phase IV post-marketing surveillance

Aims:

• To monitor adverse events
• To study long-term effects of the vaccine

Outcome: This enables determination of effectiveness of the vaccine in routine use setting. Since this phase involves vaccine administration in larger numbers of individuals with varied clinical/health features than in the previous phases, the actual assessment of the vaccine-enabled protection is possible.

How is the vaccine development and approval process different in pandemic times?

Traditional vaccine development consists of a discovery phase, which includes an exploratory phase and pre-clinical stages. In the exploratory phase, vaccines are designed (time taken is usually in years), followed by preclinical experiments which include exploratory as well as formal preclinical experiments and toxicology studies as mentioned here. Please see the previous question for a description of phase trials in normal (non-pandemic) times.

In the case of SARS-CoV-2 vaccine development during the COVID-19 pandemic, the discovery phase has taken months (instead of years) because of knowledge gained from vaccine development for SARS-CoV and MERS-CoV. During the clinical development phase, there has been overlap of phase 1, 2 and 3 clinical trials, and the overall clinical trials time has been in months, followed by large scale vaccine production. This is followed by vaccine license application and approval (1-2 months). The vaccine is approved in a pandemic only if it is safe, efficacious and the benefits outweigh the risks, as mentioned here. Thus the traditional time of vaccine development during the pandemic is reduced from 15 years to 10-18 months.

What does emergency use authorization (EUA) mean and how is EUA different from “approval” for vaccine candidates?

In the USA, during an emergency, like a pandemic, it may not be possible to have all the evidence that the Food and Drug Administration (FDA) would usually have before approving a vaccine. When there is a declared emergency, such as during a pandemic, the FDA can make a judgment that it is worth releasing a vaccine for broader use even without all the evidence that would fully establish its effectiveness and safety. If there is evidence that strongly suggests that patients have benefitted from a treatment or test, the agency can issue an EUA to make it available. EUA is different from "approval" in that it authorizes FDA to facilitate the availability of an unapproved product, or unapproved use of an approved product, during a declared state of emergency.

What does “restricted use” mean, since approval for COVID vaccines in India has been granted as “restricted use in emergency situation”?

This concern has also been raised in a recent Lancet report. There is no definition provided by the Government, but in a press conference, Drugs Controller General of India (DCGI) explained that “India’s first indigenous vaccine against COVID-19 has been approved for restricted use. This means it should not be given to everyone. Only those in extreme need of it based on his/her medical condition will be given the vaccine.” Later on, it was noted that children, pregnant women, the elderly, or persons with co-morbidities should not be given the vaccine.

In the Indian regulatory system, is there a provision for EUA?

According to news reports published in Hindustan times, Times of India, and DGCI Press release on EUA for the Serum institute and Bharat Biotech vaccines, along with approval for Cadila Healthcare Vaccine Phase 3 trials, there is no mention of the phrase ‘Emergency Use Approval’ or EUA in the Indian regulatory system. However, in the New Drugs and Clinical Trials Rules 2019, in the Second Schedule under 2) A) a), there is a provision for granting accelerated approval in special situations (“Accelerated approval process may be allowed to a new drug for a disease or condition, taking into account its severity, rarity, or prevalence and the availability or lack of alternative treatments, provided that there is a prima facie case of the product being of meaningful therapeutic benefit over the existing treatment”).

What is “efficacy” for a vaccine, and why do we need phase 3 trials to estimate it?

The efficacy of a vaccine is the percentage reduction in disease incidence in a vaccinated group, as compared to a control group under optimal conditions such as a randomized controlled clinical trial. As outlined in answer to the second question above, the objective of trials at phase 1 and 2 is to determine side effects, safety, dosage, and immunogenicity. It is only during the phase 3 trial that it can be calculated how effective a vaccine candidate is, as there is a placebo/control arm that consists of volunteers to whom the test vaccine is not given, and a test arm consisting of volunteers to whom the vaccine is given. The disease incidence can be calculated in both groups and compared to calculate the efficacy of the vaccine.

Such a trial is also needed to determine efficacy in different target populations. If the efficacy of a vaccine is even 50%, it means 50% fewer or half as many vaccinated individuals got severe disease as compared to people given placebo or in the control arm. So even if the efficacy of a vaccine is lower than 90%, as reported for some of the most efficacious COVID-19 vaccines (Moderna and Pfizer), there is still significant benefit to the population from individuals getting vaccinated.

Before being authorised for general use, or even for emergency authorisation, a vaccine candidate must first pass phase 3 clinical trials (see note on approval process above). The vaccine candidate needs to be administered to tens of thousands of volunteers, to make absolutely sure it is safe. Also, these volunteers then need to be tracked for some months, to make sure they are protected from getting infected in real-world conditions. Around the world, and also in India, vaccine candidates have been authorised for emergency use after clearing phase 3 clinical trials. Such clearance is typically accompanied by the publication and release of phase 3 trial data. Concerns have even been raised over emergency use approval for COVID vaccines. Bharat Biotech’s Covaxin candidate has been authorised for emergency use while simultaneously being in Phase 3 clinical trials. This is inconsistent with the established policy on vaccine candidate approval (Hindu article, see note on approval above).

How is vaccine safety estimated and how safe are the COVID-19 vaccines?

Covishield and Covaxin both have no safety concerns as they have done well in phase 1 trials. Immunogenicity is also clear from phase 2 trials. ChAdOx1 nCov-19 (the vaccine from Oxford University - AstraZeneca which is manufactured as Covishield by Serum Institute India) was subjected to randomised phase1 clinical trials in the UK. 1077 participants took part of which 537 were given the Covid vaccine. Here a small set of 56 participants who got the vaccine also received paracetamol as part of the study. Fatigue and headache were the most commonly reported symptoms. Other adverse reaction included muscle ache, malaise, chills and feeling feverish. The severity and intensity of local and systemic reactions were highest on day 1 after vaccination. ChAdOx1 nCoV-19 was safe, tolerated, and immunogenic, while reactogenicity was reduced with paracetamol.

Covaxin underwent randomised phase 1 clinical trials involving 375 participants of whom 300 were given the vaccine and 75 the placebo. It was found that the most common adverse event was pain at the injection site, followed by headache, fatigue, and fever. The overall incidence of solicited local and systemic adverse events in the study was 14–21% in the vaccine treated cases.

What are some reported side effects of the vaccines?

Common side effects include redness, tenderness, pain at the site of injection, the feeling of being sick/unwell, fatigue, headache, chills or feeling feverish, nausea, muscle pain/ body pain/joint pain, other flu-like symptoms, including runny nose. Uncommon side effects are dizziness, decreased appetite, abdominal pain, excessive sweating, itchy skin. Any untoward medical event after vaccination is considered an Adverse Event (AE) and must be reported to the concerned officials. If the AE is related to the vaccine it is called an Adverse Drug Reaction (ADR).

A cross-sectional online survey was done involving 5396 people that included questions pertaining to the immediate post-vaccination experience in India. As was reported “Tiredness, myalgia and fever were most commonly reported. These symptoms were consistent with an immune response commonly associated with vaccines and correlated with the findings from previously published phase 2/3 trials. In 90% of cases, the symptoms were either milder than expected or meeting the expectation of the vaccine recipient. No serious events were reported. Symptoms were more common among younger individuals. There was no difference in symptoms among those who had a past history of COVID-19.”

How effective are the current vaccines against new COVID-19 virus variants?

Over time, viruses naturally accumulate changes in their genetic sequence. The more they multiply in number, the higher the chances of mutations. While most changes (mutations) are of little to no consequence, sometimes the virus acquires a mutation that gives it an advantage over its original form (variant), making it more transmissible or more infectious. The chances of new virus variants emerging are higher if more people are infected, as it is multiplying more.

The SARS-CoV-2 virus uses its Spike protein to enter the host body by binding to a specific protein on human cells called the ACE2 receptor. Thus, mutations in the gene for the Spike protein can potentially facilitate better affinity or binding and enable easier entry into the host cell, as was the case with the D614G mutation (which has been the globally prevalent SARS-CoV-2 variant in circulation for the majority of the year 2020). Mutations that enhance viral fitness need to be identified and monitored to check if the available Covid-19 vaccines are effective in raising an immune response in the human host.

The currently approved vaccines raise a host immune response against multiple parts of the virus. So, even if one of the parts of the virus changes due to a new mutation, the vaccine will identify the other parts. This decreases the chances of newer variants escaping the vaccine. Even as the vaccination process has now been initiated globally, the current vaccines need to be evaluated for their potential against the new viral mutations as they arise.

Variants that are of the greatest concern currently include those that have changes (mutations) in the Spike protein that causes immune escape or the Spike mutations N501Y (located in the viral receptor binding site for cell entry and increases binding to the human receptor) and/or E484K (reduced susceptibility to neutralization by antibodies), shared by variants that were first identified in the United Kingdom, South Africa and Brazil (called 501Y.V1, 501Y.V2 and 501Y.V3 respectively).

A key factor with the new mRNA based vaccines (Pfizer’s and Moderna’s) is that they appear to produce a heightened immune response, such that a drop in the level of neutralization antibody detected with these variants may not be highly worrisome, and they may still provide effective immunity. Pfizer’s vaccine shows a reduction in neutralization against engineered mutations found in variants of concern; however, the degree of reduction is variable in serum from different individuals and is not very huge. Moderna has also demonstrated reduced but still significant neutralization against the variants following mRNA-1273 vaccination. They are however looking to develop booster shots and/or altered vaccines for emerging variants; the mRNA vaccines may probably be the fastest to tweak and redesign (possibly within a few weeks).

The vaccines by Johnson & Johnson and Novavax may also be less effective against some of the new variants, especially the variant identified in South Africa, although new data are being released at a rapid pace. Novavax released data from clinical trials showing that its experimental vaccine, designed to combat the original virus, was about 89% effective against the current COVID-19 virus strain, 85% effective against the variant identified in the United Kingdom, but less than 50% effective against the one identified in South Africa. Bharat Biotech has also released information showing that their vaccine works against the variant seen in the UK - still in a clinical trial mode, though approved in India, the vaccine was found to be fully effective against the N501Y mutation.

The Serum Institute of India, currently offering the Oxford-AstraZeneca vaccine that may have lower efficacy with emerging variants, is planning to conduct trials to bring a second vaccine called Covovax (which is based on Novavax) that may be more effective against them. Adenovirus vector-based vaccines are also relatively easy to update, though they may take longer than the mRNA based ones.

Evidence shows that most of the vaccines will confer some degree of protection from the currently evolved variants, though the combination of mutations carried in a particular variant, its prevalence in a region, and the host immune response will ultimately decide the final efficacy of any vaccine.

The original explainer by ISRC lists some of the tests conducted by the various companies for vaccine efficacy against the new variants (Section 2, Q4)

Is it worth taking the vaccines now if new variants are emerging?

The best way to prevent further mutations from arising and accumulating is to avoid giving the virus a chance to replicate, i.e. reducing the number of infected people. This can be safely achieved by vaccinations and hence, the rise of worrying mutations should not be a deterrent for vaccination programs. A possible lowered efficacy to new variants will still provide some degree of protection against the disease and also help stop viral transmission in the population. A recent pre-print has shown that the N501Y mutation in the variant seen in the UK can be neutralised by both convalescent sera (serum from an individual who has overcome a recent COVID-19infection) as well as post-vaccination serum (serum from a vaccinated individual who has mounted an immune response to the COVID-19 vaccine).

Of greater concern is the so-called South African variant that escapes convalescent serum antibodies. It also reduces neutralizing abilities (~6 fold) of mRNA vaccine evoked serum antibodies, but significant neutralization activity still remains. South Africa has paused the roll-out of the AstraZeneca vaccine, following concerns regarding poor efficacy against the variant identified there. Recent work, however, highlights the importance of mRNA vaccines even against such emerging variants.

The WHO has released a statement on 8 February 2021 regarding vaccine efficacy concerns in the light of immune escape variants, affirming that “we need to adjust to the SARS-CoV-2 viral evolution, including potentially providing future booster shots and adapted vaccines, if found to be scientifically necessary”. However, the statement also highlights the need to prioritize the vaccination of high-risk groups everywhere in order to ensure maximum global protection against new strains and minimize the risk of transmission.

Does being vaccinated prevent people from infecting others?

The COVID-19 virus infects the wet, soft, mucosal tissues first, as it enters the body through the nose, mouth or eyes. At first, the virus replicates in the upper passages of the nose and throat, not causing severe disease for a few days. The infected person releases these replicated viruses into the air around them, by coughing, speaking or even just breathing, potentially infecting others around them. Only over a period of days, in a second phase, does the virus then spread into the lungs, where severe disease might be caused. So viral replication and spread happens early on and in a different part of the body from severe disease.

Many of the vaccines that have been authorised around the world have released phase 3 clinical trial data, but these have only been tested for efficacy at preventing severe disease (see also study results for Moderna , Pfizer, AstraZeneca vaccines) ie. we know they prevent the second phase of the infection, in the lungs. But they could still cause the first phase of infection, in the upper respiratory mucosa. In fact, we know that vaccines injected into the arm make the body produce a type of antibodies (IgGs) that circulate in the blood, and are effective at protecting the lungs. But they do not reach mucous tissue. For protection there, we would need another class of antibodies (IgA), which are elicited by different, nasal vaccines.

We know that when a person gets infected with COVID-19, their body’s first defensive response is IgA production in mucosal tissues, followed later on by IgG in the blood. In fact, among people vaccinated with the Oxford - AstraZeneca vaccine (Covishield in India), a study found 67% fewer people had virus in their nasal swabs as opposed to unvaccinated people. But even among the vaccinated, people still produced the virus and could potentially spread the infection.

The good news is that the new COVID-19 vaccine injections we will get in our arms will give us protection from severe disease in our lungs, potentially for years. But we might still get mild or symptom-free infections in the mucous tissue in our noses and throats and spread the virus to others. So even after getting vaccinated, we need to continue to wear masks and physically distance until population infection numbers come down.