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Indo‑U.S. Workshop on biosafety, infections and disease: a report

Sandhya Sekar

Participants of the Indo-U.S. Workshop
Participants of the Indo-U.S. Workshop  (Photo: INSA)

It’s an interconnected world. An outbreak in one place is a threat everywhere”. With new infections emerging every few years, among which many jump across species, our interconnected world is a hub for diseases to take hold and spread at an alarming rate. The recent Ebola outbreak is an illustration of what an infectious disease can do even before we realise we have a global epidemic to deal with.

Participants of the Indo-US Biosafety Workshop

The above statement was made by James LeDuc, who was co-chairing a two and a half day workshop on Challenges of Emerging Infections and Global Health Safety” at the Indian National Science Academy (INSA) premises, New Delhi, between 18th and 20th November, 2014. Indira Nath, Emeritus Professor, National Institute of Pathology, was the other co-chair of the workshop, a joint effort between INSA and the U.S. National Academy of Sciences (NAS). The main aim of the workshop was to address challenges posed by infectious diseases within India and the United States and across national borders”.

India is planning a massive explosion of its laboratory facilities over the next few years, said VM Katoch Secretary, Department of Health Research (GOI) and Director General, India Council of Medical Research (ICMR), in his short talk. The aim is to have 160 new labs by March 2015. 48 have already been established. We also plan ten federal labs for infectious disease. At ICMR, we want to move from an institution-centric approach to a public health-centric approach”, he said.

What makes it all the more important to strengthen laboratory and associated infrastructure in India is that India is the only country with BSL‑4 (Bio Safety Level 4, the highest level of bio-containment) laboratories in South Asia. BSL laboratories are meant to house and isolate potentially dangerous biological agents like disease causing microorganisms. This makes it imperative for India to ensure the highest standards of biosafety in its labs, not just for the country itself, but for the region as a whole. As Aparna Singh Shah from the World Health Organisation Southeast Asia Region office said, Laboratory facilities vary a lot between countries and the awareness about biosafety is very limited. The region however houses 25% of the world’s population and a staggering 30% of the diseases.” She drew attention to two important resources: the WHO guidelines on laboratory safety, called Enhancement of Laboratory Biosafety”, put forth during the 58th World Health Assembly in 2005, and a document on Emerging Infectious diseases and laboratory safety in the Asia Pacific region.

Plans for biosafety regulations in India

When the two participating countries exchanged notes about the various biosafety protocols in each country, it emerged was that while there are various safety guidelines available in India, there is no strict rule enforcing these guidelines. Even though we have plenty of exhaustive guidelines, how many people are aware of them, how many are following them — that is the main concern”, said Vasantha Muthuswamy, who was with the Indian Council of Medical Research (ICMR) and is a worldwide authority on ethics in research.

However, this may soon be rectified. Muthuswamy said that there is a Bill prepared for the Indian government, based on the biosafety guidelines available for ICMR. The bill, titled The Biomedical Research on Human Participants (Ethical, Legal, Social Issues) Bill”, is being proposed by ICMR to the Government of India. The Bill will have provisions for a body, which would be in charge of biosafety regulation, and would also train personnel in the field. She also said that capacity building for everyone – researchers, ethics committee members, sponsors, policy makers and medical professionals, is the need of the hour. Bioethics education and biosafety training and dissemination, along with legislation, would ensure that regulations are better followed in India.

Six breakaway brainstorm sessions tackled a variety of topics. Of special interest, especially given India’s plans of expanding its network of BSL labs, is the need for strategies that make this expensive endeavour more economically feasible. It takes a lot of money to run BSL labs: an estimated 4 million USD are currently spent just on overheads. Various suggestions to reduce cost came in: collaborations between facilities so that fewer high level BSL labs are needed, maybe at the regional level. At the building level, the suggestion was to focus on proper training rather than over designing”, and the usage of indigenous technology from Indian small and medium entrepreneurs rather than importing expensive equipment. 

The workshop also had a session on how cutting edge technologies can be employed in the diagnosis and rapid screening of diseases. Mohan Rao, Director of CCMB Hyderabad spoke of novel, inexpensive tools for diagnosis and treatment of diseases. An efficient, antifungal nanoparticle operates on an elegant principle: the biocompatible particle acts as a substrate for proteolytic enzymes produced by fungi. Once the fungi degrade the proteins, the anti-fungal is released. This makes for an extremely site specific drug delivery mechanism. As part of a multi-institution team, Rao has developed a platform for identifying pathogens causing eye infections from their DNA. This sensitive, highly specific technique uses a small chip as a platform, and can identify 15 pathogens in a span of five hours, using just one reaction. The product won Product of the Year” award from the magazine Biospectrum.

Moving forward, INSA and NAS have agreed to partner together to conduct a regional workshop in 2015 focusing on building the capacity of laboratories and affiliated researchers to tackle the region’s most difficult public health challenges safely and securely”, says the final statement released at the end of the meeting. The next workshop will provide an opportunity to convene life science, biological safety and disease surveillance experts from academia, industry, and government to come up with a set of guidelines, development of manpower like laboratory training, leadership development, transport of samples and responsible research practices.

A special note on Ebola

Thomas Ksiazek from the United States Centers for Disease Control and Prevention (CDC) spoke of his personal experiences from Sierra Leone, where he was monitoring the Ebola outbreak. He felt strongly that as much as the virus, hospitals are responsible for early transmission and eventual outbreaks of Ebola. Traditional healers, an important part of the first line of care in Africa, can also play a role in disease transmission, he said. He spoke of his Ebola Playbook”: find all cases, isolate them, find who all the patient comes into contact with, protect the staff, make burials safe. Poor logistics like insufficient transport, ambulance vehicles, burial vehicles, infection control agents like chemicals and payment to workers all worsened the situation”, he said. In the disease epicentres of Sierra Leone, there is now a downward dip in the number of cases simply because people have wised up” and realised the measures they have to adopt to combat spread of infection.

Ksiazek’s hands-on account formed the perfect backdrop for Ram Manohar Lohia Hospital’s Ratnakar Sahoo to talk on India’s plans in dealing with a potential Ebola outbreak. The high number of Indians in Africa, and the chances of them travelling back home carrying the disease, is also high. There are about 45,000 Indian nationals in Africa, many of whom travel home frequently. In rural India, hygiene standards are quite low — both factors lead to an increased danger of Ebola in India”, he said. After many inter departmental meetings, India has hit upon an action plan to deal with Ebola. International airports have been given thermal scanners. Anyone with high body temperature is screened, and those travelling from Ebola areas are classified as High Risk. Personnel from all over the country have been trained at Delhi for Ebola management; they will in turn hold training programmes in different areas of the country. Isolation wards have been identified in government hospitals. The National Institute of Virology, Pune, has been certified for running Ebola tests; ten other labs from across the country have the necessary training to process samples.