Implementation of Public Health & Vaccination programs in a country as vast and diverse as India requires a participatory approach to overcome the humungous challenges in scale and scope. This is something we have seen through the “covid” lens.
Shikha Dhawan, our next pathbreaker, Director Programs at SHARE INDIA, conducts public health research on diseases such as TB, Dengue, Chikungunya and COVID-19 in order to develop prototypes and innovative, technology-based communication strategies to control spread of diseases.
Shikha talks to Shyam Krishnamurthy from The Interview Portal about her work on development of malaria vaccines, travelling to the remotest districts and villages in the country, interacting with healthcare workers, and amassing learnings from the field by understanding the perils and difficulties faced by people in accessing the healthcare cascade.
For students, if you want to work for the betterment of communities and vulnerable (socially, economically, clinically) populations, be a foot soldier and first understand the ground realities of public health in the country.
Shikha, can you talk a little bit about your background?
I belong to a family of academicians and scholars. My parents were teachers in University of Delhi. My father is a physicist and my mother was a Hindi teacher. From my father, I inherited my love of sciences; appreciation for prose and poetry was a gift from my mother. Since early childhood, I have been an avid reader. I loved reading both science and fiction books. I had the habit of reading the newspaper daily- I still do!
I’m a dreamer. I have high aspirations and strive to be the best in whatever I do.
During school days, I was a “Jack of many trades”. I participated in science quizzes, debates, poetry, painting, classical dance; basketball, kabaddi, kho-kho, did cycling for recreation and played chess with my mother and brother.
I was a sponge for knowledge and kept myself busy in productive activities throughout the day. I collected stamps and coins and read Tinkle, Amar Chitra Katha, Champak, Famous Five and Nancy Drew in my growing years. In school, I was the “Best Science Student” in the Science Section with 100% attendance over multiple years. I loved my school and looked forward to going to school every day and learning new things.
What did you do for graduation/post-graduation?
For graduation (1997) and post-graduation (1999), I studied Microbiology from University of Delhi. I was a Gold Medalist in post-graduation for securing the highest marks.
I completed my PhD from Department of Microbiology, University of Delhi (1999-2002)
What were some of the drivers that led you to such an offbeat, unconventional and uncommon career?
I was deeply fascinated by the invisible microbes. They are ubiquitous, omnipresent and a part of our daily lives. Microbes are our friends and foes. I was in awe of these living forms as part of curd formation, cheese production, wine making, pickled foods, sewage treatment and also for their notoriety as disease causing agents.
In Microbiology, we studied Industrial Microbiology, Medical Microbiology, Food Microbiology, Molecular Biology and Genetics. I fancied cloning and mass producing of vaccines, drugs and enzymes through recombinant DNA technology. I lived, breathed and romanced Microbiology in many ways. I could tell stories about how fermented beverages like whisky were made exotic by additives. I could see fungus stealthily crawling with hyphae and sporulating on leftover bread. When I was sick with jaundice, I could fathom the Hepatitis A Virus inside me cruising, spreading, multiplying and bursting to release progeny that invaded new cells. At home, we were either discarding or refrigerating leftover food based on my sense of doubling time of food spoilage microbes. The invisible microbes had thus become an integral part of my existence. Each day, I used to read more and more about the microbial world; even beyond the conventional school and college teaching. I had even memorized Prescott’s Microbiology – a book that I still proudly own!
During post-graduation (1999), I did my summer training at White Cross Blood Bank and AIIMS-New Delhi. My zone of interest thereby shifted to the fields of Immunology, blood biochemistry and tests to identify pathogens in blood. I mastered the art of growing “Kombucha” (culture of bacteria and yeast growing on water steeped with tea leaves) from a starter culture gifted by a friend and also researched about the benefits of Kombucha. With help from my Genetics teacher, a mentor and friend for life, we wrote about Kombucha. My first article “Kombucha Tea-Health in a Cup” was published in the journal “The Botanica” (1999). The elation of having published my first publication made me delve deeper into academic research in Biotechnology and Microbiology with a touch of Applied Molecular Biology.
Till date, I have 21 scientific publications in national and international journals of repute (1999-2021) to my credit. I was also part of teams that published six public health guidelines to implement different aspects of Tuberculosis and HIV/AIDS national programs (2012-2017). In addition, I was consulting editor for three magazines- Life Science India, a Confederation of Indian Industry (CII) initiative; Good Governance; and Government Technologies wherein I invited budding scientists and innovators to publish their work (2012-2014). I myself wrote eight articles and published six interviews from a plethora of experts for these magazines.
During my PhD at Department of Microbiology, University of Delhi (1999-2002), I rapidly found ways to tame microorganisms to produce enzymes through recombinant DNA technology. I became the first Molecular Biologist at the Department of Microbiology. I owe my success to my beloved teachers for their stupendous leadership in mentoring me. I completed my PhD in a record time and set off to do Post-Doctorate in Biomedical Research at Caritas St. Elizabeth’s Medical Center, Boston, USA (affiliated to Tufts University) where I worked in the field of malaria (2002-2003) and also met my future husband. I handled blood-based cultures of malaria parasites and published interesting papers in international journals of high impact, on recombinant protein expression and fluorescent images of malaria parasites invading blood cells.
How did you plan the steps to get into the career you wanted? Or how did you make a transition to a new career? Tell us about your career path
When I returned from the USA, I joined the International Centre for Genetic Engineering and Biotechnology (ICGEB), New Delhi as a Research Scientist (2004). I worked on novel vaccine candidates for malaria. In parallel, I completed a Postgraduate Diploma in Biotechnology Business Management (2006, part-time). The ICGEB lab was gearing to conduct translational development activities for Plasmodium falciparum malaria vaccine. Equipped with a management diploma, I took the plunge to become Project Manager for Malaria Vaccines in the same laboratory (2008). The Principal Investigator gave me six months to decide if I wanted to return to lab work or to become a manager/administrator full time. This was the time when I needed to choose one path and there was no turning back.
In three months, I had made my choice. Though I continued to mentor new PhD students in the laboratory, I was an enthusiastic Project Manager juggling project management with CROs (Contract Research Organizations), CMOs (Contract Manufacturing Organizations), pre-clinical (animal studies) and clinical (human studies) trial sites for clinical development of malaria vaccines. In less than two years, I was promoted to Manager-Malaria Vaccines (2010). I was responsible for financial management of multiple national and international grants for novel malaria vaccine development, contracts assignment, resource allocation and selection of sites for pre-clinical and clinical studies.
With regards to development and translation of vaccines from lab to humans, I was part of the team that successfully advanced a malaria vaccine from bench to first-in-man clinical trial after seeking approvals from Indian regulatory authorities. I learned the principles of International Committee on Harmonization of Good Clinical Practice (ICH-GCP) and international quality standard required to conduct clinical trials on human subjects. I was instrumental in establishing a Good Clinical Laboratory Practices (GCLP) compliant immunoassay laboratory for analysis of pre-clinical and clinical samples at ICGEB.
After being witness to the clinical development process at ICGEB, I decided to delve into the public health space in India. I was selected to work as a Microbiologist to scale up the Tuberculosis (TB) diagnostic laboratory network under the National TB Elimination Program (NTEP), Government of India (earlier called Revised National TB Control Program-RNTCP) (2012). With NTEP, we conducted evaluation, demonstration and scale up of molecular diagnostics for TB (Line Probe Assay, GeneXpert-MTB/Rif, TrueNAT MTB) in public and private sector laboratories across India and IPAQT (Initiative for Promoting Affordable and Quality TB Tests) that made World Health Organization (WHO) endorse TB tests available at affordable prices in the private sector. I continued as a National Consultant-Monitoring and Evaluation to monitor and supervise all programmatic aspects at national and sub-national level, active interventions and innovations for TB and translation of these findings to national applications.
My work required extensive travel to remotest districts and villages in the country. I interacted with healthcare workers across India. I was a foot soldier. I amassed learnings from the field, understood the perils and difficulties faced by people to access the healthcare cascade. I contributed my two cents worth to enhance the national public health program and make the lives of TB affected patients better by advocacy and sensitization on quality assured universal TB care services (diagnosis, treatment and care) provided by Government of India. This successful innings ended abruptly and I was propelled to become Executive Director at Partasia Biopharm-a consultancy company.
At Partasia Biopharm (2016), my health research and public health expertise was harnessed to collaborate with different stakeholders and to develop proposals for development sector, research partners, clinicians, contract vendors and multiple stakeholders in public and private sector for funding by Government of India and International donors aligned with policies and innovation landscape for drugs, vaccines and therapeutics. We supported the Malaria Vaccine Development Program, New Delhi, a not-for-profit research society to transition to a Multi-Vaccine Development Program by preparing a roadmap for vaccines on infectious diseases and business development plan for collaborations and funding.
While at Partasia Biopharm, I joined a non-government organization-SHARE INDIA as an Associate Project Director (2017). We handled Cooperative Agreement with Centers for Disease Control (CDC), USA funded through President’s Emergency Plan for AIDS Relief (PEPFAR) to Implement Quality Management Systems (QMS) in National AIDS Control Organization (NACO), Government of India, laboratories and strengthening laboratory testing network and service delivery for PLHIV (People Living with HIV). We spearheaded teams engaged in strategic roll out of Public Private Partnership with Metropolis Healthcare Ltd., a Private Health Laboratory that provided 13.15 lakh Viral Load testing for PLHIV across India on turnkey basis. The innovative partnership is the first of its kind and largest so far in India’s public health arena.
How did you get your first break?
My “Just start moment” was when I was promoted as Director Programs at SHARE INDIA (2020). The work required the whole nine yards from grant writing to grant management. Two years into the game and I have done good for myself and the teams that I nourish and nurture; living my dream and helping others also to grow personally and professionally.
What were some of the challenges you faced? How did you address them?
I was never shy about traveling. I have tremendous support from my family which allows me to be away from home for work. I missed many of my son’s parent teacher meetings but my husband was always there to cover up for my absence at personal front.
At work, I understood that language of the heart is the core to interacting with people rather than knowing the local dialect. My work is an adventure that takes me to new places, meet new people, work with people from different cultural and ethnic backgrounds, experiment with new cuisines. The biggest challenge has always been to understand local needs, issues and finding local solutions with local resources.
I have learnt everything by doing. I have an eye for details. Beauty is in every small detail. In a systems-based approach, I have trained my mind to catch the minutest details and then work on finding and implementing holistic solutions. I have learned that no single answer is correct; complex problems need to be viewed in all dimensions to create win-win situations for all stakeholders.
Can you tell us about your current role?
Currently, I’m engaged as Director Programs at SHARE INDIA. My health research portfolio includes projects on TB, Dengue, Chikungunya and COVID-19. Public health portfolio encompasses developing prototypes and innovative, technology-based communication strategies (multimedia, digital) for National AIDS Control Organization (NACO), Government of India; capacity building for implementation of HIV/AIDS Prevention and Control Act and project management for Indo-American Artificial Heart Program (IAAHP). IAAHP is a stupendous amalgamation of engineering institutes in India, premier research institutes in USA, cardiologists from India & USA and medical devices manufacturers from India & Germany, with the objective to jumpstart “made in India” cost effective 3-D printed blood pump in preclinical studies (sheep/cattle). The moonshot is to develop artificial assistive devices for people with defects that affect functioning of human heart.
What skills are needed for your role? How did you acquire the skills?
At SHARE INDIA, my work includes people management, community engagement, strengthening operations, capacity building, partnerships, collaborations, networking, strategic planning to focus energy & resources on health research and development sector projects. I’m enthusiastically pursuing new funding streams that align with organizational and country strategies on antimicrobial resistance, antibiotic stewardship, one health, non-communicable diseases, infectious diseases and advocacy for rapid quality assured point-of-care molecular diagnostics for infectious diseases.
In my health research and public health career, I have worked with Indian government agencies, managed multiple national projects funded by Indian Council of Medical Research (ICMR), Department of Biotechnology (DBT) and national/international projects funded by World Health Organization (WHO, India); Malaria Vaccine Initiative-Program for Appropriate Technology in Health (MVI-PATH, USA); European Vaccine Initiative (EVI, Germany); Centers for Disease Control (CDC, USA); United States Agency for International Development (USAID, USA) & GFATM (Global Fund for AIDS Tuberculosis and Malaria, Switzerland).
With skills acquired over the years, I have added a lot of accolades to my professional career. I’m a working group member of The International Union Against TB and Lung Diseases (The UNION), TB and Migration Group with International Organization for Migration (IOM) and authored The UNION’s global policy statement on “TB and COVID-19 for migrants” (2021). I’m a mentor for Product Development projects and guide startups and young entrepreneurs to make perfect pitches to fund their ideas and innovations. I’m a Master Trainer for “Faculty Development Courses”. I have given lectures in “Inculcating Research Culture in Teaching and Learning Process” (2021), and conducted multiple “Grant Writing Workshops” (2020-2021). I have travelled to the USA, Africa, Asia and Europe to present research policy and public health work at international forums.
How does your work benefit society?
We work for the betterment of communities and vulnerable (socially, economically, clinically) populations in India. In public health, we believe that health literacy and service delivery should always be through a participatory approach. SHARE INDIA calls it the HAPPEN (Health Advancement Peer Partner Engagement Network) model, wherein the one seeking healthcare and the one giving healthcare engage in meaningful dialogues. Also, we empower the communities to improve their health seeking behavior and be vocal about their health needs. The HAPPEN model ensures that voices of the people we serve are heard. In the spirit of equity and leaving no one behind from accessing health services, we go to communities, conduct health camps, discuss their health needs, and provide health literacy. We provide solutions to their basic health needs and further link to government health facilities for management of health issues.
We have fostered, developed and nurtured relationships with government, development partners, private sector, industry, donors, NGOs and corporates. With technical, business, people and operations leadership, I have demonstrated abilities to organize projects, out of box thinking, mentor staff and make prioritization decisions on project milestones and deliverables. My acumen to develop solutions, pro-activeness and people management skills have led to timely delivery of projects that have made lives of the people we serve better.
Tell us an example of a specific memorable work you did that is very close to you!
We helped establish point-of-care rapid molecular diagnostics for Tuberculosis at Tso Jey Clinic, Rumtek Dharma Chakra Centre, Sikkim. The Monks’ Community at Rumtek Monastery consists of young children studying at Karma Jamyang Khang Primary School, a preparatory school to educate young members of the monks’ community in Tibetan grammar, poetry, English, ritual arts and instruction in Buddhist texts. The Karma Shri Nalanda Institute for higher Buddhist studies at Rumtek hosts Tibetan refugees and students from India, Nepal, and Bhutan.
At Rumtek, we did extensive screening and testing for TB with support from the National TB Elimination Program. The TrueNAT MTB testing workstation used in TB testing was a gift from MolBio Diagnostics Pvt. Ltd (Goa, India). It was a proud moment to provide healthcare solutions in a geographically difficult terrain.
Your advice to students based on your experience?
I’m an ardent student of human spirit and ethos. Challenges have driven me to break away from the routine and undertake diverse tasks both on a professional and personal front. I’m a pioneer and a trend setter and many “firsts” are credited to me. The key is “Never Give Up”. Be a believer first and work towards your goals. Failures should not stop us. Not repeating the same mistakes is also learning.
I’m valued for my leadership and management skills. I’m defined by the choices I have made. I wear multiple hats but at the same time each one is an integral part of me. My advice to all students is to compete with self only and strive to be a better version of yourselves each day.
Keep the child in me curious and alive. My future plans include learning a new skill, enhancing competency in new subjects, exploring new territories, reading new books, learning a new sport, being a happy loving human being and regularly updating my bucket list.