Eulogising the efforts of Soumya Swaminathan in making the world a healthy place to live-in

A name that stands out in the COVID-19 pandemic world, and one that every Indian should be proud of, is Soumya Swaminathan. Based out of Geneva, Soumya joined World Health Organization (WHO) as Deputy Director General in 2017 and then became its first Chief Scientist in March 2019. Reminiscing on her life before joining WHO, Soumya fondly recalls her career as the Director General at Indian Council of Medical Research (ICMR), and at National Institute for Research in Tuberculosis (NIRT), Chennai, in various capacities. At that time, she had neither any ambition nor any interest in joining WHO. However, as fate had it, she was the chosen one. Under her leadership, WHO embarked upon the ambitious modernisation goal of building a science division that would be forward looking, crosscutting, and an enabling function across the organisation, and position WHO ahead of the curve in the twenty-first century. Little did she know then that her life and that of the rest of the world were about to change in exactly a year, on 11th March 2020, when WHO declared COVID-19 a global pandemic.

Interestingly, Soumya’s tryst with destiny began in her childhood and has continued to shape her life and career. On 2nd May 1959, she was born in Chennai, when India was in turmoil. In her teenage years after independence, India was a land of food scarcity, prohibitions on entertainment, and control on freedom, many of which are privileges we take for granted today. Soumya’s father, the renowned scientist MS Swaminathan, was busy shaping India’s agricultural landscape by organically developing high-yielding varieties of wheat and rice. In the 1960s, a growing Indian population relied extensively on the import of staple crops. Called the father of the Green Revolution in India, MS Swaminathan carried out basic research in cytogenetics, ionising radiation, and radiosensitivity in food crop production. As a young girl, Soumya was exposed at a very early age to laboratory instruments, lab animals, scientific methods, and field work through her father’s seminal work. Many of her childhood memories revolve around taking a trip with her father to the “gamma garden,” where gamma rays were used to change the genetic composition of plants to breed specific favourable properties and thrive. Soumya’s mother, Meena Swaminathan, was an educationist who focused on preschool education and started her centre at Indian Agricultural Research Institute (IARI) called Nehru experimental centre. Using the power of language, music, and theatre, she developed a new paradigm in early childhood education which was unheard of before the 1960s. Her foundational work eventually shaped the Integrated Child Development Services programme beyond just preschool education, taking a holistic approach to developing and nurturing children with nutrition, immunisation, and healthcare.

If Soumya’s father imbibed in her learning and enquiring spirit towards science and research, her mother planted the seeds of teaching. She opened her eyes to how socioeconomic disparity affects the development and education of young children. She knew research would be her career by the time she was a teenager. Soumya had applied for the All-India Science Talent Competition and spent one of her summer holidays in Calcutta working on a project under Dr Archana Sharma, Professor of Genetics in the Centre of Advanced Studies in Cell Chromosome Research at University of Calcutta. At Professor Sharma’s clinic, she met a young girl of sixteen, a teenager just like herself, admitted to the hospital with her parents complaining lack of puberty. Professor Sharma asked for a bloodwork. When the samples arrived at the laboratory, Soumya was tasked with karyotyping the girl’s blood cells for chromosomal abnormalities. She placed the blood cells in a laboratory dish, stained them, and peered through the microscope. With trepidation, she laid out the 23 pairs of chromosomes. She found that the girl was missing one X chromosome (a chromosomal disorder known as the Turner syndrome that leads to specific phenotypical changes resulting in lack of puberty). The fact that a single missing chromosome can have such a profound impact on a person’s life riveted her. It was a defining moment in her life that put her on the path of research.

After finishing school, Soumya wanted to study human genetics and joined the Hindu college in the BSc Zoology programme. She aspired to pursue the traditional BSc, MSc, PhD, and research path. To her surprise, she found out that every one of her classmates was taking the BSc course to prepare for their medical entrance exam. It seemed that young India of the 70s wanted to be a doctor and preferred a career in medicine over research. The thought was not too remote to Soumya either – after all, she was fond of young children and animals and didn’t rule out being a veterinarian altogether. Whether it was peer pressure, going with the flow, or her second choice of being a vet, the cause is lost in time. The effect was that Soumya decided to test which way fate would guide her and took only one exam: the Armed Forces Medical College (AFMC) entrance exam. Her parents were both forward looking and supportive of her decision and encouraged her with the idea that she could always get back to research after finishing medical school.

Her interest in paediatrics grew while in the AFMC, although the yearning for research was burning inside her. She chose to specialise in paediatrics and applied to the All India Institute of Medical Sciences (AIIMS) for her Doctor of Medicine (MD) degree. She would gain valuable experience at AIIMS with extensive clinical exposure but little to no research. While waiting for the academic year to start at AIIMS, she did her internship at the military hospital in Safdarjung, New Delhi. Part of the internship required her to make home visits to many patients and undertake rural service in an underdeveloped Palam village. She was stunned to witness firsthand the unscientific biases, superstitions, and unhealthy childcare practices prevalent in rural areas. In her wildest dreams, it didn’t occur that parents could feed tea and honey to newborn babies, caring less about the child’s health. The villagers were bound by tradition, didn’t understand the importance of colostrum to newborn babies, and considered it impure and harmful. This was a pivotal moment in her career, opening her eyes to the absence of health and safety knowledge in many parts of rural India, something that would resurface again many years later during her fight against HIV and Tuberculosis in Chennai.

After her MD from AIIMS, and still, without an opportunity to carry out any research, Soumya finally decided in 1987 to venture outside India for a two-year post-doctoral medical fellowship in neonatology and pediatric pulmonology under the supervision of Thomas G Keens, Professor of Pediatrics at the Children’s Hospital Los Angeles at the Keck School of Medicine of University of Southern California, USA. The mentorship of Prof Keens inculcated in her how a researcher should frame a question, design a study and implement it, write a scientific paper, publish in a reputed journal, and present at international conferences. He empowered her with the right research skills and mindset and then gave her the freedom to pursue her interests independently. Soumya took this opportunity and published six papers in reputed journals based on her research on paediatric pulmonology between 1987 and 1989. After her stint at the Children’s Hospital, she spent another year as a Research Fellow at the Department of Pediatric Respiratory Diseases at the University of Leicester in the United Kingdom before returning to India in 1991.

Having gained a lot of research, teaching, and clinical experience abroad, Soumya’s return to India was driven by dreams of building a similar career back home. She held an honorary appointment in the USA, a dual role of teaching and research at the Tufts University School of Medicine in New Jersey, where she was both an Adjunct Associate Clinical Professor and a Senior Research Officer. In her naivety, she was confident that she would get similar opportunities in India as in the US. Nothing could be farther from the truth. It was a quandary for her because she wanted a position where she wanted to combine her interest in research with her clinical skills and teaching but quickly found out that this was impossible. Forget pursuing three disciplines; she can’t even have two. Incumbents and seniors in her field told her to give up one or the other. She quickly found out that medical research was not considered an aspiring career in India. The prevailing attitude was manifold. Why on earth would a Gold Medalist like her want to pursue medical research at the cost of a lucrative career as a doctor? And why did a bright clinician wish to return from the USA to India anyway? This was perhaps the biggest disappointment and setback in her life. There were very few medical schools in India that provided the kind of platform that Soumya was seeking, and sadly, the situation in India has not changed much in the three decades that have gone by since her time. This is a situation that Soumya feels modern India needs to improve upon. Medical schools should encourage practitioners to pursue serious research, provide opportunities to apply for research grants, and get time off from practising medicine to do research. Young people coming into science and medicine need to be allowed to try out new ideas.

Soumya didn’t give up. She returned to Chennai with her husband. She had heard about Indian Council of Medical Research (ICMR) and its National Institute for Research in Tuberculosis in Chennai and their research in the field. Armed with renewed hope and nothing to lose, she visited the NIRT. It is said that luck favours the brave. The day she visited NIRT, the Director General of the institute, Dr SP Tripathi, was speaking at an event. On Dr Tripathi’s request, she applied as a Pooled Officer, a scheme that catered to returning scientists from abroad. She applied and joined as a Research Fellow at the NIRT in 1992. She had a lot of ideas for carrying out research in India. She tried to develop collaborative programmes with her contacts in the US.

India was entering the 21st century, and HIV was becoming prevalent and becoming a scourge of society. There was widespread fear, confusion, and stigma around the disease. The nation lacked the infrastructure and the know-how to manage it. To worsen the situation, HIV and Tuberculosis were already recognised as coinfections, an exponentially growing problem in Asia and Africa. ICMR and NIRT decided to face the problem head-on. The NIRT Director asked Soumya to lead the research on HIV and take on the leadership of managing the epidemic. To her pleasant surprise, the Director General of ICMR also supported her in this venture, giving her the confidence and backing to forge ahead in unknown territory. She got the grants she wanted, support to set up the lab, set up the clinical trials, build the infrastructure, form the team, train and mentored people, and go from clinical to behavioural to laboratory sciences. Soumya essentially designed and created the entire programme of HIV and Tuberculosis research.

This was a turning point in her career. Looking back today, she acknowledges all it took was a change in leadership mindset, supportive seniors who believed in her potential, and mentors and guides who gave her the space and the opportunity to promote her. A leader can make a difference in nurturing the next generation. Having a woman in the Chief Scientist position has inspired younger women that anything is possible. She firmly believes if men can have a family and a career, so can women. Her advice to young aspiring women in science and technology is to “be clear about what you want to do in life and your goals. For that, you need a little bit of exposure, mentorship, and guidance. Try to find a mentor you can trust, talk to, and get advice when things are not going well. Look for opportunities. Women tend to underestimate themselves compared to men. This is where men get the advantage. It becomes difficult to compete if you are from a developing country and don’t get international exposure. This is why exposure is significant.”

Back at the NIRT, the recognition of her work was not the only thing that kept her going. Her research and field work reminded her of the socioeconomic disparity she had witnessed through her mother’s work many decades ago. Her research at the NIRT meant she had to follow the patients for many years. She used to do home visits to all her patients. She had been to all the slums in Chennai. These were impoverished people, often tribal communities. Often, she had to travel to tribal areas, walking many kilometres to treat them. In many rural and remote areas, she was the first government official to visit the community. She was surprised to know from the tribal people that Tuberculosis was not the problem; villagers told her that it was not a common disease. Instead, their children died more often because they didn’t get access to diarrhoea treatment or suffered from typhoid or fracture. When she started working on HIV, it was evident how all this played out in a patient’s life. The social stigma around HIV made the patient and their family untouchable. Without proper healthcare support, the patients were left to either recover on their own or die. Socioeconomic determinants of health and the reality of life in tribal or rural areas were very different from those in the cities.

If the reality on the ground was a problem, the systematic approach to healthcare was not a practical solution either. Soumya realised that the researchers and field practitioners like her always approached the problem top down. It wasn’t out of intention but by design. Each social programme only focused on its agenda. She was there for Tuberculosis and nutrition, not to address diarrhoea or typhoid. She was there to follow up on HIV patients, not change the disease’s social perception. This had to change. Being in the research institute allowed her to go in depth and recognise that behavioural and social science was equally crucial for public health. Social workers in the institute were not considered to be social scientists. When she got the opportunity, she changed it. In her view, behavioural and social scientists were equally important as doctors. This was again an uphill challenge to overcome because the paternalistic system in India considers doctors at the top of the hierarchy compared to the other medical staff. This was about to be shaken up with her leadership in the field. Many years later, when she became the Director General of ICMR (2015-2017) and the Secretary of the Department of Health Research (Ministry of Health & Family Welfare) for the Government of India, her mandate was on merging science and evidence into health policymaking.

The lessons she learned from her time at NIRT and ICMR didn’t go to waste. As Chief Scientist at WHO, Soumya now works on public health guideline development, focusing on research, promoting research priorities, and use of digital technologies to enable all the technical departments to remain ahead of the curve and focus on things that are coming down the pipeline, looking both at the regulatory and ethical aspects of new technologies. The COVID-19 pandemic put her vision to the test, allowing her to be at the forefront of Research & Development and use policy based on evidence that drove the science and communication to the public. The pandemic has brought science to the top of everyone’s agenda, with an appreciation of how investing in science and using tech tools can make lives easier for us. Sadly, the pandemic also brought out the downside, the misinformation campaigns, the anti-science and anti-vaccine movements that got their platforms, and all the politics surrounding it. Soumya was not prepared for this at all. She didn’t expect ideology to play a part. Like her apolitical self, returning to India after the fellowship three decades ago, she hoped it would all be driven by science and data alone. Her job is far from being done.

Soumya Maitra

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