Seroprevalence Study in Mumbai: In Conversation with TIFR Scientists -- Part 4

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Part 4: Personal Perspectives, Risks and Challenges During the Study, and About Public Private Partnership

 

Uma Ramakrishnan: So you talked about some of the key insights and also basically about false positives and false negatives. Can you may be discuss a little bit more about whether this was challenging as a study in itself. From a personal perspective, what were the challenges which were not scientific, not just logistic, but also with the whole execution.
 
Sandeep Juneja: I think Ullas has a lot to say about this.
 
Ullas Kolthur: Yes, I would like to start of by saying that it was a unique experience. Doing public health research is a totally different ballgame, unpredictable, challenging, and involves a lot of other aspects that we normally do not encounter  when we are normally working within the labs. Uma, you would be able to relate to it better, but animals are slightly easier to predict than humans (on a lighter note). I think it is not just logistic challenges, this experience brings in view of exactly what would matter for a public health policy perspective, includes all the way from thinking about designing the study itself. So how do you even approach these individuals and what kind of information do you want to give? Whether that information is going to make them scared, participate or not participate, how to think about consent? These are very interesting questions. Although in public health, the survey itself is going to be challenging, but if you are dealing with a survey of infectious diseases it brings in even more difficult problems, because of these things. So one could ask if there are several cases where people would not consent, because they were fearing that if they turned out to be positive they would have to be quarantined.
 
Now information itself is a very important component. And then of course you have to think about all the regulatory aspects which are also not trivial and are very important. As you are dealing all the way from privacy related issues, identities of individuals, and who does and does not get to see the data. How do you safeguard the information is another challenge. So this was particularly challenging. It was an important learning exercise for me certainly and I think it will also be true for Sandeep, (I do not know how much it will be relevant for his probabilistic simulations), as we get to learn more about what matters, what kind of information and science matters to public health. That is an important learning, I would say.
 
Sandeep Juneja: I will add to this. It was a very successful example of Government, private sector and academia partnership. The funding came from the private sector. People were actually reacting to the crisis and were very forthcoming. The NITI Aayog oversaw this activity, the BMC (Brihanmumbai Municipal Corporation) helped on the ground, and us as academics. So usually, having such a partnership, just by its nature, by its structure, could have friction etc. built in to it. But somehow because this was an important cause for all of us, and people came together, things moved on quite well actually. That was a good part of it that people rose up to the challenge.  Now for academics, you want to reveal any information as soon as can. So in that sense one has to manage different parties, people have their own perspective. So that was more of learning for all of us. The other thing, I guess from mathematical point of view,  you wear a very different hat when you do mathematics, for example in our own research. You make assumptions, and you draw what theorem follows from it. But now in this world, we really do not know how much bias came in from this or that. So you have this pragmatism, which lets you not use anything funky or fantastically sophisticated when the underlying foundations are not well understood. So in that sense our mathematics and statistics draws the broader conclusions and lets the data talk without doing anything very intricate.
 
Uma Ramakrishnan: That is a great point.
 
Ullas Kolthur: Similarly also for biological perspective. I think, the information that we gather actually has potential to raise new hypothesis. But you have no idea what information you are going to get. So you have to make certain assumptions, but some of those assumptions need not be true at all.  So your ability to actually think broadly about a disease, its spread and susceptibility has to be constantly kept in mind to design such a study. So that is also a very interesting thing.
 
Uma Ramakrishnan: That is a great point. For me something, I really relate to because when we do field studies, we have some predictions and hypothesis but we do not really know what we will find. But when you are working in the field, I think a lot of it is exploration, and then refining those hypotheses. For example, with models which you can then possibly test in a larger data sets. So would you say that is accurate, Sandeep? May be you could bring some of these patterns to better hypothesis which could then be used in some statistical framework to test other data?
 
Sandeep Juneja: This is well understood, that surveys have been going on for quite a long time. So statisticians have a very good idea about how to interpret data. But yes, your point is well taken that as a scientist you want to have more control over the situation, so you can then isolate exactly what you are testing and check if it is happening or not. Here we only have so much of control. I do not really know what is going on in the field when sampling is done, what are new things that are happening. So one lives with that. In that sense, one accepts things that are out of  control.
 
Uma Ramakrishnan: Did you feel any personal risk. This was during the lockdown, and this was also a very sensitive information and as you said, at any point did you feel nervous about it. The people who are working in the field are taking risks. So you are taking risks, so was that feeling ever there during the study.
 
Sandeep Juneja: Well, Ullas and I spoke about this. Our worry was that on the field, what if  some dispute happens, media event that happens, some infection may pass on accidentally. So we were enormously concerned about these things. Fortunately, nothing major happened. Now from our point of view, or at least my point of view,  I was sitting at home so there was no personal risk as such involved. We went to BMC a few times. We went there for only a few days, while BMC officials come every day. So our risk was so much lower than theirs.
 
Ullas Kolthur: Yes, I think Sandeep really said it well. There was no personal risk but  there is a risk of being responsible for activities on the field, where you feel responsible for the teams  that are working for the study and also for the participants themselves. You have to be absolutely on top of every check list that you want to make sure it is ticked. Because you do not want things to go out of hand, either due to the community behavior against or towards the field people or because of your study. Or if there is an outbreak, independent of whether it was caused due to your study or not, you have to be extremely careful and mindful of these concerns. So that was pretty nerve wracking.  At the end of the day, this is associated with institutions, people and we are talking about real lives. It is a disease that can be fatal in some cases.
 
Uma Ramakrishnan: So overall in terms of your experience, you said very eloquently that it is a very unique partnership between private and public and academia. That is really, I feel personally, the future for a country like in India. There are so few people in each of those spheres with good intent and willing to do things, to engage in things. So what do you think in terms of this, especially coming from an institution like TIFR and participating in the study, engaging in such a creative and novel partnership? What do you feel about the future of such partnerships and academic institutions? How should they engage, and should they engage? It is a very open ended question, but it will be really great to hear from you on that.
 
Ullas Kolthur: So, okay may be I will start up and Sandeep can also add again. It is true.  The public private engagement with researchers, interfacing with NGOs and people in the social sector who work with the community, all this is unique that happens rarely. This actually points out a couple of things. One, if I can make a slightly provocative statement: as basic or fundamental scientists, whether in an ivory tower or a small lab in some small university, we do not necessarily think about how our expertise or abilities to organize things, can have an impact at a society level. In principle, this could have been done by many people, and I am sure many people would be able to do this. This is not just an example of me and Sandeep. This happened across the country. Many people who were doing fundamental basic work have actually stepped up for the crisis and then contributed to the nation's call. This shows that we are capable and we can actually engage with activities and research which has some direct impact. In terms of the engagement with public and private partnership, this also throws open the possibility that when needed, when the narrative is right, there is ample opportunity and possibility for public and private organizations to come together to work.
 
Now of course, the million dollar question is who should take the first step. Do we expect the companies to come and put in money in institutions, or it should happen the other way round. Again this is a very provocative statement. Perhaps scientists could still take a lead on this and try to reach out to institutions and organizations. Because in reality, if you define a problem well and if you define the strategy well, there is the possibility that other such organizations will show an interest. It is likely that, we, if not done enough, could be doing more. I strongly think that this shows that we could do more and this is an opportunity for sure. I do not know what Sandeep says.
 
Sandeep Juneja:  Yes, I completely agree, you know, because this problem was obviously  important, it had a life of its own. It did not take much to get money for it,  it did not take much to get people to volunteer for it, it did involve the government to come together.  So in that sense, identifying the right problem is obviously important, and to get others to understand that this is important. That is a good thing. I think from our point of view, the key thing was when Government called for it, we took the initiative. We agreed to spend our time on this. This is something that should be encouraged in a place like TIFR. What is strong about TIFR is that we have certain reputation, prestige and credibility. So that makes people say that as these guys are involved, job will get done in a feasible  manner. So that should be exploited. And what is also good about TIFR is you actually have time to devote yourself to a project like this. In IIT and also in many other places, they have lot of other responsibilities which absorb them. We are uniquely placed and that is why it really is an opportunity.
 
Uma Ramakrishnan:  That is a great point you have brought up Sandeep, because this is something which the Director of TIFR, Sandeep Trivedi said in the 75 years of TIFR celebration that, and I actually do believe it is true, that we do have our unique position to really jump into these very important problems. Congratulations to both of you again for a really well executed wonderful study. Any last thoughts that you would like to share with readers of CovidGyan?
 
Sandeep Juneja:  We have said enough!
 
Ullas Kolthur: I guess we have said enough. I think what is important, continuing with the last point, what is relevant from a scientist's perspective is what is the real motivation and what is the reward, and how do you value your contributions and these becomes an important aspect. Now it is not easy to tackle these questions either at a personal level or at an institutional level. But I think we need to have more debates and ways and means by which we do encourage such activities. That should be put forth. I think it is not just that this is the thing that will happen, there are so many other issues that we need to tackle. And nobody is asking you to change. Given that in another two months or less than that, I will go back to doing what I am doing and Sandeep will go back and do what he is doing. We are already doing what we are doing. It is not that we have left what we are doing, you know we have not completely gotten derailed.
 
There is an opportunity to contribute and we should seek out. It is up to us to seek out and it is up to the institutions to make it more attractive to encourage such activities, because otherwise, I think, we will be missing out in a larger context.
 
Uma Ramakrishnan: Meena, any last questions?
 
Meena Kharatmal: No. Thanks all. Bye.
 
About the People:

Dr. Ullas Kolthur is a Professor at the Department of Biological Sciences of the Tata Institute of Fundamental Research, Mumbai. His research interest is in the area of cellular metabolism and energetics.
 
Dr. Sandeep Juneja is a Professor and Dean at the School of Technology and Computer Science, Tata Institute of Fundamental Research, Mumbai. His research interests lie in applied probability including in sequential learning, mathematical finance, Monte Carlo methods, and game theoretic analysis of queues.
 
Dr. Uma Ramakrishnan is a Professor at the National Centre for Biological Sciences (TIFR), Bangalore. Her research investigates population genetics and evolutionary history of mammals in the Indian subcontinent, including work to save India’s tigers.
 
Ms. Meena Kharatmal is a Scientific Officer at the Homi Bhabha Center for Science Education (TIFR), Mumbai. Currently she is contributing articles, resources for the CovidGyan. She is also trying to complete her PhD in the area of Biology Education.
 
This interview was recorded on 19th August 2020. Since then, the preprint on the findings of the Mumbai seroprevalance study is available as a report published on TIFR website.