Title: NIHR Global Health Research Group on Controlling Vector Borne Diseases in Emerging Agricultural Systems in Malawi
Funder: Department of Health and Social Care

Abstract: Infectious diseases are emerging at an unprecedented rate while food production struggles to keep pace with population growth. Large-scale irrigation schemes have the potential to permanently transform the landscape with health, nutritional and socio-economic benefits yet, this also leads to a shift in land-use patterns that can promote endemic and invasive insect vectors and pathogens. Vector-borne diseases (VBDs) account for 700,000 deaths annually, disproportionately affecting those communities which are subject to the greatest shortfalls in dietary intake and uncertain year-on-year harvests. The balance between ensuring food security and preventing emerging infectious disease is a necessity, yet, the impact of irrigation on VBDs at the epidemiological, entomological and economic level is uncertain and depends on the geographical and climatological context._x000D_ We aim to reduce the transmission and burden from VBDs while maintaining the socio-economic benefits of expanding agricultural development in southern Malawi. The overall goal of this proposal is to develop cross-sectoral and locally tailored solutions that minimise vector-host contact in an agriculturalized transformed environmental landscape. The Group’s programme of work will focus on a ~$500M irrigation scheme, the Shire Valley Transformation Project (SVTP), in southern Malawi. Our research will target those VBDs which are endemic and cause the largest burden of disease (malaria and schistosomiasis) as well as emerging VBDs (e.g. arboviruses) associated with irrigation and water redistribution. Our vision is to develop and promote sustainable practices at the interface of agriculture, public health and socio-economic development that mitigate against the threat of future VBDs._x000D_ Our aims and objectives are:_x000D_ 1. Strengthen VBD surveillance, management and research capacity between the agricultural and health sector._x000D_ 2. Detect, define and quantify the risk of acquiring currently endemic and future emerging VBDs during the transformation of the Shire Valley landscape._x000D_ 3. Pilot locally tailored interventions which tackle either single or multiple vectors, determine their acceptability to the community and establish their value for money._x000D_ 4. Integrate VBD control into agricultural and irrigation policy, using the evidence generated through this GHRG to provide recommendations for mitigating VBDs in future planned extensions of the SVTP and other national agricultural development schemes._x000D_ To ensure the success of this GHRG we will deliver four integrated work packages via an equitable partnership of Malawian and UK scientists. We will use the recently formed Technical Vector Control Advisory Group (TVCAG) in Malawi to bring together stakeholders in agriculture and public health to determine research priorities, advocate for vector control and disseminate findings (WP1). A network for ‘Vector Research in Irrigated Agriculture’ will strengthen individual and institutional capacity. Empirical evidence for VBD transmission will be assessed via vector and epidemiological surveillance supported by ethnographic research (WP2) and this will guide three pilot interventions to minimise vector-host contact and evaluate the community acceptability (WP3). Finally using a combination of mathematical modelling and policy engagement (led by AFIDEP) we will determine the future impact of agricultural expansion on VBDs in the Shire Valley and throughout Malawi beyond 2025.

Lay abstract: Food production will need to keep pace with rapid population growth in Africa during the 21st century. Large scale irrigation schemes address this issue by providing food security and significant health benefits, but at the same time can increase the risk of vector-borne diseases (VBD) such as malaria and schistosomiasis. Furthermore, drastically altered landscapes disturb the relationship between insect vectors, hosts and wildlife and can lead to emerging infectious zoonotic diseases. Maintaining the benefits of agricultural intensification (SDG#2 ‘Zero Hunger’) while offsetting the negative impacts from infectious disease (SDG#3 ‘Good Health and Well Being’) will be one of the biggest challenges for LMICs over the next few decades. _x000D_ The vision of this GHRG is to bring together experts from across multiple disciplines of vector research (epidemiology, anthropology, public health, agricultural economics) to reduce the transmission risk and burden of VBDs while maintaining or improving equitable economic benefits from newly expanded irrigated land in Malawi. We will focus our research on a new 40,000-hectare irrigation scheme in southern Malawi; the Shire Valley Transformation programme (SVTP). Construction on the SVTP began in 2020 and will continue throughout the decade. This provides a real-time natural longitudinal experiment to determine (i) the impact of land-use transformation on VBDs, (ii) how local smallholder farming practices will change on the ground and how this influences risk of vector-borne infection and (iii) practical solutions which can integrated across both public health and agriculture. Our primary diseases of interest will be malaria and schistosomiasis due to the unequivocal link between irrigation and their host-vector life cycle, but we include provisions to look at the impact on emerging VBDs such as arboviruses._x000D_ The GHRG is a collaboration between LSTM and leading African academic scientists at the College of Medicine, the Malawi-Liverpool-Wellcome Trust Centre, the Lilongwe University of Agriculture and Natural Resource and African Institute for Development Policy (AFIDEP). We will pursue four integrated work packages themed on the following: 1. Stakeholder analysis, capacity strengthening and community engagement. 2. Determining the risk of VBDs through vector and epidemiological surveillance and ethnographic research. 3. Piloting interventions. 4. Planning for future agricultural expansion. Bringing together stakeholders from across public health and agriculture will be key to the success of this GHRG and this will be achieved through the Technical Vector Control Advisory Group of the Ministry of Health in Malawi. We will achieve real impact by engaging with the local farming communities of the lower Shire Valley from the outset via a dedicated Community Engagement and Involvement team and the establishment of a Community Advisory Group. While the GHRG must focus its primary research and outcomes on the population within the SVTP catchment area, our aim is to broaden the impact of our work towards agricultural expansion schemes across Malawi and southern Africa beyond 2025 via policy engagement and communication activities led by AFIDEP. Our position to achieve this aim will be strengthened and sustained by the cohort of pre- and post-doctoral trainee posts and the establishment of a Network for 'Vector Research in Irrigated Agriculture’.

Research activity codes: 2.2 FACTORS RELATING TO PHYSICAL ENVIRONMENT;8.3 POLICY, ETHICS AND RESEARCH GOVERNANCE
Health categories: INFECTION