Title: NIHR Global Health Research Group on Gastrointestinal Infections: Facilitating the Introduction and Evaluation of Vaccines for Enteric Diseases in Children in Eastern and Southern sub-Saharan Africa
Funder: Department of Health and Social Care

Abstract: Gastrointestinal infections are responsible for over 500,000 deaths annually in children under age five years; the highest mortality rates occur in sub-Saharan Africa. While diarrhoeal deaths have fallen over the past two decades, morbidity remains high. Moreover, improvements in diarrhoeal mortality have not been uniform between and within countries; populations with high rates of malnutrition, poor sanitary conditions and reduced access to healthcare suffer the greatest burden. Enteric vaccines comprise a critical public health tool to reduce the burden of gastrointestinal infections, but applied health research is required to enable equitable population benefit._x000D_ _x000D_ Work undertaken by the University of Liverpool in partnership with the Malawi College of Medicine and Ministry of Health informed a recommendation by WHO to introduce a vaccine against rotavirus diarrhoea in childhood immunisation programmes across Africa. The roll-out of rotavirus vaccination has reduced diarrhoeal illness and deaths in African children, but in some populations vaccination does not work well, and vaccination is received late or not at all. Vaccines against other enteric infections, including Shigella and Enterotoxigenic E Coli, are urgently needed and multiple candidates are in clinical development._x000D_ _x000D_ The Global Health Research Group in Gastrointestinal Infections will apply world-leading, multidisciplinary gastrointestinal infection and vaccine research to build capacity and improve health outcomes from childhood diarrhoea in Eastern and Southern Africa. In response to clinical and health needs identified by Ministries of Health and local communities, we will extend our work on rotavirus to include other key, vaccine-preventable enteric infections. We will extend the geographic scope of our work by forging new partnerships in Kenya and Ethiopia, where the burden of diarrhoea is high and research capacity is limited. We will address inequalities in diarrhoea burden by bringing together expertise in social science, mathematical modelling, statistics, epidemiology, health economics and policy with excellent laboratory science to maximise the benefit of enteric vaccines for all children._x000D_ _x000D_ in Malawi, Kenya and Ethiopia, we will (i) develop sustained engagement with communities and key stakeholders to provide greater national and regional visibility of gastrointestinal infection research; (ii) estimate the clinical and cost burden of vaccine-preventable gastrointestinal infections (rotavirus, Shigella, ETEC) presenting to health facilities, and examine the impact of COVID-19 on disease presentation; (iii) model the clinical impact and cost-effectiveness of vaccination; (iv) create sustainable systems to measure the burden of gastrointestinal infections and the outcomes of vaccine interventions to inform policy decisions; and (v) develop research capacity by training postgraduate (Masters) students and Postdoctoral Fellows in gastrointestinal infection research, leveraging additional support through existing PhD programmes run by the partner organisations._x000D_ _x000D_ Through close links with Ministries of Health and ongoing community engagement, we will ensure our research is translated into policy for population benefit. Development of a cohort of gastrointestinal infection researchers will sustain this work in the years ahead, helping to reduce the burden of vaccine-preventable diarrhoeal diseases among children in sub-Saharan Africa.

Lay abstract: The Global Health Research Group in Gastrointestinal Infections will apply world leading research to improve health outcomes from childhood diarrhoea in Eastern and Southern Africa. We will also build capacity in diarrhoeal infection and vaccine research. _x000D_ _x000D_ Diarrhoea kills about half a million children under 5 years of age each year, and most of these deaths occur in Africa and Asia. The highest rates of diarrhoea deaths occur in sub-Saharan Africa. In children who survive a diarrhoeal illness, malnutrition, poor growth and impaired brain development commonly follow. So vaccines to prevent diarrhoea are critical. _x000D_ _x000D_ Rotavirus is the main cause of severe diarrhoea in children. Work by the University of Liverpool together with the Malawi College of Medicine and the Malawi Ministry of Health, informed a recommendation by the World Health Organization to introduce a vaccine against rotavirus across Africa. Rotavirus vaccination has helped to reduce diarrhoeal illness and deaths in African children. But the benefit has not been equal across countries. In some populations, vaccination does not work well, and vaccination is received late or not at all. _x000D_ _x000D_ Vaccines being developed against other bugs causing diarrhoea offer hope that suffering and death can be further reduced. For example, a range of vaccines against Shigella, a major cause of diarrhoea in children, are undergoing clinical trials. _x000D_ _x000D_ However, more research is required to enable current and future vaccines to bring improved and equitable benefit to all children. We will address inequalities in diarrhoea burden by combining expertise in epidemiology, social science, mathematical modelling, statistics, health economics and policy with excellent laboratory science. This approach will help to maximise the benefit of vaccines against diarrhoea for all children. _x000D_ _x000D_ The Global Health Research Group in Gastrointestinal Infections will enable us to extend our work beyond Malawi. We will develop new partnerships in Kenya and Ethiopia, where the burden of diarrhoea is high and research capacity is limited. We have responded to clinical and research needs identified by key stakeholders including Ministries of Health, and by our community engagement programme involving village leaders. We will undertake multidisciplinary research in three linked themes in Malawi, Kenya and Ethiopia to: _x000D_ _x000D_ • develop sustained engagement with communities and key stakeholders to provide greater national and regional visibility of gastrointestinal infection research;_x000D_ • estimate the burden of vaccine preventable diarrhoeal diseases; _x000D_ • predict the clinical impact and cost-effectiveness of vaccination; _x000D_ • work with policy makers to inform vaccine introduction and evaluation._x000D_ _x000D_ We will build capacity in gastrointestinal infection and vaccine research through existing postgraduate training programmes (primarily at masters level) run by the partner organisations. Development of a cohort of researchers and public health practitioners with expertise in gastrointestinal infections will sustain this work in the years ahead. Through our close links with each Ministry of Health and ongoing community engagement, we will ensure our research findings are translated into policy for public benefit. The Group’s impact will include enhanced and more equitable use of current and future vaccines to prevent diarrhoea and its consequences, particularly among disadvantaged children in sub-Saharan Africa.

Research activity codes: 2.1 BIOLOGICAL AND ENDOGENOUS FACTORS;2.4 SURVEILLANCE AND DISTRIBUTION;3.4 VACCINES;8.5 RESOURCES AND INFRASTRUCTURE (HEALTH SERVICES)
Health categories: ORAL AND GASTROINTESTINAL