Vaccines in India: Science, State Power and Big Pharma

Even for a medical practitioner, this book is an eye-opener. The landscape you cover—from history to science to politics and economics of vaccine production—is fascinating. How did you tackle this difficult topic?

I faced criticism from some reviewers that I fell between serving a common reader and an expert reader. While writing, I tried to balance these two segments carefully. Medical professionals require scientific depth, while lay people need elementary explanations. I provided extensive footnotes for basic concepts—even explaining what a vaccine is at the start—so average readers could follow from the beginning.

During COVID, I was working with a healthcare consultancy helping both the government and industry. Mid-2020, when various companies began developing vaccines, I became curious about India’s vaccine research history. I looked for a comprehensive book but found nothing that narrated the history of vaccine research or immunisation in our country. That’s when I decided someone should write it—and if nobody else had, I would.

You begin with the Serum Institute story rather than following chronology. Why?

Chronologically, this chapter about the Serum Institute should have come later, since vaccine history properly begins around 1800-02 with variolation in Europe and how vaccines first arrived in India through arm-to-arm transmission. However, I thought the Serum Institute story was a compelling start because it’s the most recognised vaccine company today—most readers associate vaccines with Serum Institute. I also wanted to connect this to the Haffkine story and show how their relationship developed and eventually ended.

The chapter on Haffkine is fascinating. We’ve all heard his name but didn’t truly understand his contributions. Can you elaborate?

Haffkine’s story is remarkable. He was from Ukraine, from the province of Odessa, where he worked with Nobel laureates like Metchnikoff. He moved to Switzerland, then Paris, where he joined the Pasteur Institute as a librarian. He gradually moved into the labs, and Pasteur and his colleagues noticed his work, eventually inducting him into cholera research. He landed in India in 1893, and started field trials in Calcutta before shifting to Bombay for plague trials.

I was surprised to learn that India was involved in vaccine production as early as the 1890s, on a par with the Pasteur Institute of Paris.

Let’s look at two aspects. First, the institutes developed during that period were phenomenal. Multiple Pasteur institutes existed across the country—from Coonoor to Shillong, even in Burma (then part of India), and Kasauli. These institutes did remarkable work on various vaccines—typhoid, anti-rabies, and others. Haffkine’s institute in Mumbai also contributed significantly. Indian vaccine research findings were discussed at the International Anti-Rabies Conference in Paris year after year, so India was definitely on the radar of international vaccine research.

Second, regarding field trials: the British Indian army had Indian citizens in lower ranks—sepoys and havildars who lived in barracks. This made it convenient to conduct clinical trials. Initially, these happened in army barracks, then for cholera—which required large samples—they moved to villages. Plague trials took place in Byculla prison in Mumbai.

The Malkowal tragedy shows there was scientific audit even in the 1900s. Haffkine had to argue hard to vindicate himself.

The Malkowal tragedy in current-day Punjab, about 150 kilometres from Chandigarh, was probably one of the earliest adverse vaccine reaction stories. Upon examination, it wasn’t actually an adverse impact of the vaccine itself but contamination from mishandling. Nineteen people died. The British government followed proper procedures—commissions, inquiries, reports, questions in Parliament.

Haffkine was placed on notice and removed from his position. He sat unemployed in the UK for two years. This wasn’t just about scientific imprudence—racial discrimination played a role. Being Russian and Jewish, the British never fully trusted him, suspecting he might be a Russian agent. After exoneration, he was told not to conduct clinical trials, restricting him to lab research only. For a scientist of his stature, this curtailed his entire work. He eventually died destitute and lonely in Switzerland, without research for almost ten years.

But India recognised him well. Grant Medical College closed its doors in his honour.

Indians applauded his work, though the British did not. He received much better recognition after Independence when Indian scientists realised his foundational contribution to India’s vaccine research.

Tell us about Sahib Singh Sokhey.

We can credit Sokhey for the foundations of India’s pharmaceutical and healthcare legacy. He came exactly at Independence, taking the reins of the Haffkine Research Institute. He had a British Army background, maintaining good relations with the British administration, which he leveraged for work benefiting Indians. At his core, he was Indian—a great transitional figure from British colonial research to independent Indian research.

He was a Rajya Sabha member and laid the foundation for India’s pharmaceutical and vaccine research, contributing significantly to the Patent Act. He was completely against the British Patent Act and wanted to repeal it. They couldn’t completely abolish it but reached a compromise in 1972 by modifying it. His name is also associated with CSIR, IDPL, and the National Biological Laboratory.

You explain the difference between variolation and vaccination. Can you elaborate?

Most people don’t know the difference. The term “vaccine” itself came from the smallpox vaccine—from “vaccinia”. Variolation was practised before formal vaccination existed. As Jenner demonstrated in 1796, you take pustules from a cowpox-infected animal and apply them to a wound. This creates a mild infection, leaving the virus in your body in a subdued form sufficient to prevent future infection. This is the fundamental thesis behind vaccines, even today.

Surprisingly, such practices existed in India and China even before Jenner. Records suggest the practice was prevalent in India as early as the 15th or 16th century. The British government passed the Vaccination Act, outlawing variolation and enforcing vaccination—that’s the formal cut point where variolation became politically defunct.

Traditionalists cite variolation in India to ridicule modern scientific development.

Modern medical science is only 100-200 years old. Before that, people relied on observations—and observation is science. People observed that those dealing with cowpox-infected cows didn’t die; they survived. This pure observation led them to try transmitting that material to humans.

When you have a better solution, use it—it’s that simple. We won’t forget that outdated solutions helped people 100 years ago. Even in physics, we can’t forget Newton, though many laws have advanced far beyond him. Without Newton, Galileo, and others, science wouldn’t have advanced—they laid the foundation. But it’s foolish to suggest we should only use old solutions.

Tell us about Typhoid Mary.

I thought Mary Mallon’s story was a good start for the typhoid chapter, especially since COVID revived concepts of spreaders and super-spreaders. She unknowingly spread typhoid because she showed no clinical symptoms. She worked as a cook in New York households in the early 1900s, when no antibiotics existed.

This was fascinating for two aspects. First, the robust public health system in the 1900s that could zero in on one individual in New York with limited investigative facilities. Second, the individual autonomy—she was advised cholecystectomy (gallbladder removal) and refused. The state couldn’t do anything except prevent her from cooking.

Salk refused to patent the polio vaccine, saying one cannot patent sunlight.

In the book, I make a conscious argument that vaccines and pharmaceuticals are life-saving solutions. One question haunts me: who owns and controls life? If pharmaceutical companies control life, they are gods. Who has authority over that?

Both polio vaccine inventors—Salk and Sabin—said they wouldn’t claim patents. Polio was crippling the world—children dying and becoming disabled in the 1950s and 60s. Both could have made billions. Salk’s statement was golden: “Can you patent the sun?” He created a vaccine to save people, not to make money.

Unfortunately, that spirit disappeared by the end of the 20th century. Research shifted from publicly funded institutes to multinational pharmaceutical corporations. When driven by public institutions, patent debates weren’t prominent. But as research moved to multinational pharma companies, lobbies emerged, dictating global rules. We became hostages to pharmaceutical lobbies.

Tell us about the Bhore Committee and nation-building efforts around Independence.

It’s interesting that tall figures like Sokhey and the British scientist A.V. Hill contributed immensely to post-Independence foundations for both medical and pure scientific research. The Bhore Committee report came in 1946. Hill, a British Nobel laureate, came in 1944 when the British understood they would soon leave. There was serious nation-building effort—not just slogans but actual work, forming committees and strategising.

Hill said in a 1944 radio speech: “India requires a supreme science commander to plan and apply scientific research to India’s development.” The person chosen was Bhatnagar—the tallest figure in Indian science research until his death in the early 1970s. Nehru trusted him with responsibilities for science, universities, and the University Grants Commission. He established institutions across pharmaceutical, vaccine, chemical, physical, biological, metallurgical, and industrial research.

The Chingleput BCG trial had equivocal results. Yet we continue giving BCG (Bacillus Calmette–Guérin; against tuberculosis) vaccine.

The first trial started in Madanapalle in Andhra Pradesh, then moved to the larger Chingleput area. The Chingleput trials became a cornerstone for BCG vaccine testing—double-blind field trials. The Indian Journal of Medical Research followed the study closely. Contrary to expectations, the study concluded it wasn’t as effective as thought—probably not 60-70 per cent effective.

We continue because we don’t have a great alternative. BCG may not prevent pulmonary tuberculosis but affects miliary tuberculosis and TB meningitis in children. It also incidentally confers some immunity against cancers like urinary bladder cancer—I mention in the book that BCG is used as therapy for early-stage bladder cancer.

The pulse polio programme originated in Vellore through Dr Jacob John.

The polio vaccine story is the story of Vellore. I would credit the entire success of polio vaccines to Vellore, CMC (Christian Medical College), and Dr Jacob John. As a paediatrician, he initially observed aberrations which led him into this work. In both measles and polio, he did phenomenal work.

Without ministry support, he started his own initiative, collaborating with the local Rotary Club. Rotary International supported him at his own risk. CMC Vellore and the Tamil Nadu government supported him despite the Ministry of Health’s reservations. This started with Vellore Municipal Corporation, then expanded. The pulse immunisation idea itself came from Dr John. Later, his words became the wisdom of the Government of India—a story from a small Tamil Nadu town becoming the global benchmark for polio vaccination.

Part Four deals with the transition from government to private sector, where science is stumped by commerce. You describe how political interference stopped vaccine production.

The transition from publicly funded to privately funded vaccine research happened worldwide—in India, it started later than in Western countries. Two clear examples: the polio vaccine stoppage at Coonoor Pasteur Institute, and the Anbumani Ramadoss saga stopping vaccine production in multiple public sector undertakings. Both bear the hallmark of political interference.

If you look at post-Independence vaccine history, Tamil Nadu has the lion’s share—the Chingleput BCG studies, Coonoor Research Institute at the preeminence of vaccine research, controversial figures who manipulated the system. The entire country’s BCG production came from Guindy, much of polio vaccine from Coonoor. Many vaccine scientists came from Tamil Nadu. There was also King Institute in Chennai. But Pasteur Institute and the BCG lab have become ghosts of what they were.

Tell us about Professor Talwar and Dr Varaprasad Reddy.

Talwar is almost 100 years old, another tall figure in India’s vaccine research and immunology. Migrating from Pakistan during Partition, he joined AIIMS and convinced Indira Gandhi to set up the National Institute of Immunology while working on vaccines for leprosy and preventing pregnancy. Unlike Sokhey and Bhatnagar who weren’t deep in labs, Talwar worked day and night, picking talents, a hands-on man in vaccine research.

If we were to pick one icon of India’s vaccine research in the last hundred years, it’s Varaprasad Reddy. This non-medical person from completely outside the field picked the right topic, understood vaccine industry dynamics, and priced his hepatitis B vaccine at $1 per dose—a phenomenal achievement. He didn’t become a billionaire, though he could have. He also gave company shares to employees—very altruistic for a businessman.

The Khammam story reveals how vaccines were tried on children without proper consent, breaking all ethical protocols.

This was a pointer to policymakers about what to take seriously. Two companies were doing Phase 4 clinical trials for cervical cancer vaccines—one in Andhra Pradesh, one in Gujarat. The tested children were below 18, in tribal hostels. They got consent from wardens rather than parents. Some girls died in suspicious circumstances without post-mortems.

The whole process was questioned. Parliamentary committees examined it, the Ministry of Health Special Secretary investigated. This was an eye-opener for policymakers to frame rules for future clinical studies.

Tamil Nadu’s contribution to AIDS research—tell us about Madras Medical College.

In mid-1985, I was working in Chennai as a healthcare journalist—my first job with Press Trust of India. AIDS was in the headlines. I reached out to Suniti Solomon from the Madras AIDS Research organisation. That’s when I learned the story of her involvement and how this started at Madras Medical College.

Surprisingly, contrary to expectations that Bombay—the prostitution capital—would be first, AIDS was first identified in Chennai. This was unusual because Madras was considered very conservative. Dr Suniti Solomon and Dr Nirmala broke all myths around Chennai’s conservative nature.

Finally, cancer vaccines—once thought impossible.

Cancer vaccine remains a grey area—like unresolved world mysteries, we’re inching toward a universal cancer vaccine. If we achieve a vaccine preventing all cancers, that will be miraculous.

In the book, I’ve discussed various cancer vaccines and the difference between vaccines and immunotherapy. Cancer vaccines require engineering the patient’s immunity. Many immunotherapies can be described as customised vaccines. With mRNA and new technologies like circular RNA, phenomenal research is happening worldwide. If these lead to good preventive mechanisms, that will be an immense contribution from world vaccinologists.