A Global Exchange of Yusuf Hamied Researchers Aims to Elevate Public Health in India

Even the most rigorous scientists occasionally need a touch of alchemy to take their research to the next level. For 24 scholars, the Yusuf Hamied Fellowship Program has been that alchemy. The program has enabled an ambitious group of public health experts from India and the U.S. to exchange ideas, form crucial collaborations, and orient their projects from small pilot studies to large-scale research trials. The ultimate goal: improve public health on the ground in India in tangible ways that could lead to vital shifts in public policy there, in areas as varied as climate change and air pollution; heavy metal exposure and cancer; and access to health care across the life course.

Since the program launched in 2018, competitively selected Yusuf Hamied Fellows from India have come to Columbia Mailman to collaborate with faculty, meet students, and present their research on topics from environmental and mental health to access to medicines. Similarly, Columbia Mailman faculty Fellows have traveled to India to pursue their own research projects, in collaboration with Indian colleagues and thanks to the partnership of the Columbia Global Center in Mumbai.

The heart, soul, and funder of the program is scientist, industrialist, and philanthropist Dr. Yusuf Hamied, who is himself a game-changer in the field of global public health. The founder of generic drug giant Cipla, he is widely known for making anti-retroviral drugs to treat HIV and other vital medications more affordable in the developing world. Twenty-five years later, his ideas and ambitions are just as momentous. Currently, his passions—and there are many—include tackling major public health issues such as antibiotic resistance and the scourge of tuberculosis in India, where the incidence of the disease is among the highest in the world.

Yusuf Hamied was already funding interdisciplinary exchange programs at his alma mater, Cambridge University in England, when he came to Columbia University to visit his grandniece who happened to be a student there. “On one bright day, I met [Columbia Mailman Dean] Linda Fried and we became friends. I was impressed with Mailman and decided to fund a similar research exchange there.”

To his mind, the goal of the Yusuf Hamied Fellowship Program was to engage interdisciplinary researchers to solve big problems, conducting work on urgent public health issues throughout India. “Academics like to talk about theory, but I’m a scientist and what I’m interested in is implementation,” says Yusuf Hamied. “We in India need the kind of help you can offer in America, not just with knowledge but with how to implement changes that will make a difference to the survival of all of us.” Adds Dean Fried: “Yusuf Hamied is to be commended for his vision to connect and support the public health communities of the world’s two largest democracies.”

Often, however, researchers have to start in small increments, with ideas and projects that need some resources so they can go on to make an exponential impact. That’s why the program tends to select fellows on the cusp of achieving their goals, explains Kavita Sivaramakrishnan, founding faculty director of the Yusuf Hamied Program and associate professor of sociomedical sciences. “Often all they need is a specific type of collaboration or training to tip the balance in a way that would make their work ten times more effective,” she says. One reason that extra push is so necessary is that in India, certain areas of public health are still evolving. “Many of our Indian scholars tell us that they are often the only person interested in a particular research question in their institutions,” Sivaramakrishnan says. By connecting these scholars with academics in similar fields at Columbia Mailman, “they have the opportunity to meet people who share their passions, and who can often help them get where they need to go to make more progress back in India.” The ultimate goal: “To allow each of these scholars to be a catalyzing force on the ground,” she says, “building India’s capacity to advance public health for what is essentially 18 percent of the world’s population.”

Building a research portfolio for a complex understudied public health topic in India: cancer and the links to the oral microbiome and environmental toxins

One conundrum of doing public health research is that it is tough to get funding if you don’t have preliminary data—but it’s impossible to get preliminary data if you don’t have any funding. To complicate matters, funding can be doubly difficult to secure if the research you are doing is in a particularly complex or a less-explored area of public health. That was the frustrating situation for Krithiga Shridhar, MDS, MSc, an epidemiologist at the Centre for Chronic Disease Control in New Delhi. “I’m studying the relationship between environmental toxins, the oral microbiome and oral and digestive tract cancer risk and survival, including certain rare cancer sites. The oral microbiome, particularly, is a very complex topic because you have to consider the influences of patients’ lifestyles, genetics and the environment, and that interplay can be difficult to measure,” she says. For one thing, the work requires precise sample collection, sophisticated lab technology and expertise in bioinformatics and data analysis. “It wasn’t easy to find the resources I needed on my own.”

That’s why the network Shridhar built through the Yusuf Hamied program was so crucial to her project. Thanks to the Yusuf Hamied program, she met professor of epidemiology Pam Factor-Litvak (see below), who has herself researched environmental exposures and the microbiome, and whose connections in India helped Shridhar find labs for her own work. Shridhar also used Factor-Litvak’s lab experience as a model for her own work. “And [Epidemiology Professor and a U.S. Yusuf Hamied Fellow] Rupak Shivakoti at Columbia Mailman helped me with training modules, analytic reference books, and advice on how to develop analytical pipelines.” That’s part of the magic of the Yusuf Hamied program—scholars with overlapping interests meet, talk, help one another, and make introductions sharing resources and knowledge in the U.S. and in India.

Just as important, Shridhar was able to collect the preliminary data that is so crucial for securing future grants. “The funding from the fellowship allowed me to do a pilot study on tongue cancer patients where I began to explore oral bacteria linked to early-onset cancer risk,” she explains. Now that she has the preliminary data in hand, she says the next step is to undertake full-scale studies in India on the oral- and gut- microbiome and cancer. “We’re poised to obtain large-scale joint grant applications for studies related to cancer risk and survival in India—and the Yusuf Hamied grant was the catalyst.”

Because of her efforts, public health experts in India interested in similar areas will have an easier path ahead of them: “With the research consortium we developed, we now have a network of facilities in both the public and private sectors, in New Delhi in the north, Chennai in the south, and Ahmedabad in west India, with epidemiologists, clinicians, lab scientists, bioinformaticians, and biostatisticians,” Shridhar says.

Reversing the effects of air pollution and environmental toxins in young children—and lifting them out of poverty

Pam Factor-Litvak, PhD, a professor of epidemiology at Columbia Mailman is passionate about measuring the effects of air pollution on school readiness. In recent years, she has focused on young children living in some of the most impoverished areas of India, the so-called “slums,” as locals refer to them, specifically in Jaipur and Bengaluru. “For children, this is a time of life where the brain is developing rapidly, which means it is especially vulnerable to environmental insults,” says Factor-Litvak. To understand school readiness, she includes data on cognition, attention, executive function, and the ability to process information. “These are all necessary for success in the classroom, which is essential for lifting these kids out of poverty. But until now, the measure hasn’t been used in this kind of research,” she says.

Like Shridhar, Factor-Litvak used the opportunity of being a Yusuf Hamied Fellow as a springboard to conduct pilot studies, which will now help her secure much larger grants. “We went into the urban impoverished areas and used local researchers and women from the village who distributed personal air pollution monitors to families, which the children wore around their neck,” she says. “We pilot-tested these monitors to see whether children would indeed wear them for 48 hours except for bathing and sleeping. They did wonderfully. We also piloted measures of the gut microbiome, which entailed asking mothers to provide a stool sample. Again, this was highly successful. Finally, we confirmed that the tests of school readiness and attention and executive function would work. Now we have submitted applications for further funding. In these applications, we also measure aspects of the environment that may interact with air pollution on these child outcomes. Those variables may be much easier to intervene on than air pollution in the short term.”

While the sample sizes were small—20 or 30 kids were in the pilot study—the collaborations were vast: “We did work with researchers from the Center for Chronic Disease Control in New Delhi, the Public Health Foundation of India, and local NGOs on the ground in Bengaluru,” says Factor-Litvak. She is also working with Yusuf Hamied fellow Aditi Roy, PhD, a research scientist at the Centers for Chronic Disease Control of India. “Aditi is a co-investigator on the air pollution, child cognition, and school readiness study, serving as the overall coordinator. She’ll be the one supervising the field teams in Jaipur and Bengaluru.”

Factor-Litvak says she generally tries to stay “invisible” while in India, letting the Indian researchers and locals do the work and earn the trust of study participants. Trust was necessary for this kind of intimate study, she explains. “We collaborated with the Birla Institute of Technology in Jaipur to collect pilot data on the microbiome—and we learned so much,” she says. “That the mothers would allow their kids to wear these air pollution monitors; that the kids would wear them; that the mothers were willing to collect stool samples from their children but not urine or hair samples—there is no way to learn any of this from my office in New York City.”

Roy will also be taking the lead in another study in Jaipur, on the effects of the pollution generated from trash burning on local children’s school readiness. Factor-Litvak’s collaborators in India are enthusiastic about the possibilities for this work. “Indian officials view exposure to pollution and its effects on children’s cognition as a high-priority public health problem, with implications for the development of human capital down the road,” Factor-Litvak says. “And while air pollution won’t be solved tomorrow—it’s a decades-long endeavor—if we can find factors that modify the association between air pollution and a child’s readiness to go to school, it’s going to be quite important.”

Indeed, Factor-Litvak, who came to Columbia Mailman in 1987 for her PhD and never left, says that this work in India “has a lot of potential to do good by finding modifiable factors to improve children’s health.”

Currently, she is submitting a large NIH/NIEHS grant for a full study of 650 children to study relationships between air pollution and school readiness outcomes. “We’ll be looking at all kinds of variables that can potentially serve as beneficial modifiers, including the homes children are raised in, maternal mental health, and the childrearing environment. I think we can really move the needle, and we wouldn’t have had the ability to do the pilot work or flesh out these projects without the Yusuf Hamied program.”

Laying the ground for new policies for health and social care across the life spectrum in India

On the other end of the age span, Rama Baru, PhD, a professor of social science at the Centre of Social Medicine and Community Health at Jawaharlal Nehru University in New Delhi, is delving into access to health care and social support in India as people age. “When I applied for the Yusuf Hamied fellowship, I’d observed that the research in India on aging was largely dominated by demographers and had a lot to do with number crunching,” she says. “Policymakers here also tend to focus on health care in the public sector but not on the larger ecosystem of health and social care, which includes the private sector and emerging markets.” With funding from the Yusuf Hamied fellowship Baru started looking at those emerging markets for older person’s care in India in the southern and western states of India. “There are quite a few for-profit investments but very little oversight,” she says. “This area of study is just opening up in India and I want to build on it.”

Baru’s passion for studying how people age, how they fare, and the choices they make is shared by Kavita Sivaramakrishnan, a renowned expert on global aging, author of As the World Ages, and a collaborator with Baru on her project. “Rama has access to top policymakers in India—so she can really make a difference there, now and in the future, Sivaramakrishnan says.” On the horizon for the next study: “She is keen to expand her work to the effects of climate change on older people—filling in some of the gaps that India has continued to have in public health.”

The devastating effects of climate change happen to be a major concern for Yusuf Hamied, as well, who is now funding research on biodiversity and water management, including the possibility of desalination plants to prevent water shortages in an increasingly hot and dry planet. “Public health isn’t just about medicine,” says Yusuf Hamied. “It also involves problems with our planet that are going to arise five or ten years down the line.”

Solving problems of that scale in health requires bold thinking about problems and anticipating emerging health crises, says Sivaramakrishnan. It requires cross-pollination and knowledge partnerships, across India, the U.S., and the globe. “With the Yusuf Hamied fellowship, it’s happening,” she says. “And while Indian scholars may have learned a great deal from us—we at Mailman are learning just as much from them.”