CORE Net Conversations — Dr. Vivekanand Jha from the George Institute for Global Health (India)
In the interest of facilitating deeper connections with CORE Net members, we developed “CORE Net Conversations”. This series features conversations between members of the CORE Net secretariat and an individual or group of individuals from one of the member organizations. As the name suggests, these are intended to be conversational, in an effort to not only explore the work that is being done, but also to get to know the individuals doing the work.
In this post, we share some takeaways from our conversation with Professor Vivekanand Jha of the George Institute for Global Health (India), and Chair of Global Kidney Health at Imperial College, London, UK. Their manifold projects throughout India are investigating the impact of COVID-19 on multiple aspects of daily life and interventions to improve the outcomes of those impacted by COVID-19. The intention of this diverse project portfolio is to dispel incorrect information while strengthening health systems through rapid evidence generation and synthesis through randomised clinical trials.
What motivated your organization and you to take on this research effort?
The George Institute’s approach is to generate evidence that is implementable, especially in disadvantaged/ or vulnerable communities. We work with a range of stakeholders so that the evidence can be converted into practice. The focus of George Institute has been around non-communicable diseases, so we haven’t had much experience with research during large scale infectious disease outbreaks like what we’re experiencing with COVID. However, our expertise in working with healthcare systems, in identifying opportunities to improve healthcare systems, makes us well positioned to positively contribute to the research around the pandemic. COVID-19 is all about healthcare systems after all! And the intersection of COVID-19 with non-communicable diseases is critical: the risks related to COVID are higher for those people suffering from underlying chronic conditions or comorbidities. Finally, it is important to emphasize that doing randomized clinical trial is the most ethical and responsible way to seek out the truth about any proposed intervention. This makes our work important. Since regular checkups and in-person interactions have been a struggle owing to constraints in movement, we are trying to use novel ways of collecting data to evaluate the entire health system response to COVID and to provide and put rapid response evidence into the public domain in order to dispel incorrect information.
What were some of the challenges you faced and how did your team respond to these??
Some of the most significant challenges we have faced are related to time. Under normal circumstances, we allocate a fair amount of time in planning the trial, setting up collaborations getting ethics approvals and navigating other administrative approvals. All stakeholders want to make sure that all the ‘i’s are dotted and ‘t’s crossed, which is understandable as we need to ensure scientific rigour, participant protection and ethical conduct of studies. The timelines have been severely compressed during the pandemic, there is a need to not only initiate the studies faster, but also to synthesise and share research findings quickly as well. In order to help accelerate the process, you really need a good clinical trial infrastructure (which we have thanks to our considerable experience with RCTs), a responsive trial design, simplified process of data collection, while ensuring data integrity, a good set of collaborators who believe in the value of clinical trials and a responsive regulatory environment to roll out the trials and disseminate findings amongst researchers quickly.
What are the short, medium, and long term aspirations you have for your project, especially in terms of the impact you would like for the project to achieve?
In the short-term, we need to ensure that our organization and processes remain strong, that the research staff is taken care of, and that the research is tended to appropriately and safely. In order to accomplish this, we will continue to support our staff in any way necessary and possible. Mental health issues, work-life balance — these are not trivial and need to be monitored and considered. Like many of the other research organisations studying COVID, our employees are stressed about the long-term future and things like job security. We need to help assuage their concerns and stresses so that they are healthy in today and remain so tomorrow. Practically speaking, we also need to ensure that our COVID-19 related projects are successfully completed. Given the protean manifestations and deep impact of COVID-19 on all aspects of healthcare delivery, it has become important that we embed COVID research into all of our ongoing projects, and that we continue working to understand all aspects of life that have been impacted by COVID-19.
In the medium- to long-term, we want to really answer the question, “What is the best way to conduct research during COVID19, especially for RCTs?” In normal circumstances, doing RCTs needs lots of physical visits for assessment and monitoring. We are having to create new processes and collect data safely using methodology and tools that can be used from a remote location. How we have had to react to the realities of COVID-19 will hopefully provide the necessary lessons today on how to do research more efficiently in the future. We also want to be able to develop tools necessary to rapidly disseminate research findings at appropriate time periods so that the entire global community benefits, but making sure we maintain data and study integrity. We do not want to keep the data just with us, we want to share! I also hope that the collective response from the healthcare community is to reinforce our desire to focus on generating more evidence to find answers to important questions that directly impact the care of people whose lives have been affected by the pandemic. There is a growing imbalance with what needs to be done and what is being studied and where this is being done. A large proportion of research is focused on studying a small proportion of the challenges we are facing, with only a small proportion focused on studying the challenges that need to be prioritised. For example, we found on a survey of global clinical trials database that only about 5% are focussed on NCD control as a consequence of COVID-19 despite the obvious impact. I hope that we can work together to change that.
“This kind of a crisis calls for a multi-model and multidisciplinary collaboration, and an organisation like CORE Net, brings everyone together and provides a platform to share and learn and collaborate.”
What has been the greatest value for you/what would you like as a value addition, as a CORE Net member?
We are a collaborative organization by design and practice, and the COVID-19 pandemic has really reinforced the importance of learning from one another and collaboration. This is a great time to learn and work together, not only with regards to responding to the disease itself but also with how our own health systems respond to such pandemics, as we also know this will not be the last pandemic. This kind of a crisis calls for a multi-model and multidisciplinary collaboration, and a network like CORE Net, brings everyone together and provides a platform to share and learn and collaborate. Even if you attend just a few CORE Net sessions, you find collaborators; you are sparked with an idea.
What is one thing you would like everyone to know about the coronavirus pandemic’s impact in the communities you’re working in?
I wish more people could see and understand the resilience that these communities have shown in the face of such extreme adversity. It really brings into focus the sharp inequities of our societies. There are people who have lost everything, are trying to get back to their feet and are doing their best. I wish our general response was less divisive: the differences in the experiences of the “haves” and “have nots” are very apparent and disturbing. I am not sure what will it take to reduce this, but my wish is that society comes out with this lesson: that we need to reduce this gap, this divide. That would be a silver lining to this extremely dark cloud.
“[COVID-19] really brings into focus the sharp inequities of our societies. There are people who have lost everything and are still trying to do their best.”
