NIHR Global Health Research Group on Vaccines for vulnerable people in Africa (VAnguard) Vaccination is a central public health intervention: key to smallpox eradication, polio elimination, and control of Ebola outbreaks and the COVID-19 pandemic. But not everyone benefits equally. Some vaccines give weaker protection in people from rural, tropical settings than in those from high income settings: for example, BCG for tuberculosis and oral polio vaccine for polio. Some new vaccines also elicit weaker responses in people living in low-income, rural settings. The biological reasons for this are not fully understood. Also, some people benefit less from vaccines for socioeconomic reasons, such as the social context of the communities they live in, including limited access to accurate information to aid vaccine choices. Social and biological factors can interact to make communities “vulnerable” in terms of vaccine impact. For example, poor people in rural communities with limited vaccine access may also be undernourished or exposed to infections that alter immune responses to vaccination. This needs to be addressed to promote health equity, but also to secure maximum global benefit from vaccines: non-immune communities are foci for recurrent disease outbreaks.
VAnguard brings together African and UK experts in vaccine research, implementation and stakeholder and community engagement, to work in Uganda and Kenya to
1. Investigate how biological factors (such as infections, nutrition) influence vaccine responses
2. Explore how communities perceive and access vaccines, what influences them to take up vaccines for themselves and their families, and how this relates to social vulnerability, biological health status and vaccine information
3. Bring together biological and social data, and engage communities, to work out how vaccination can best be optimised for vulnerable communities, thereby also benefitting entire populations.
First, we shall work with national stakeholders (such as Ministries of Health, and vaccine-related non-governmental organisations), review literature, and work on samples from previous studies, to identify Ugandan and Kenyan communities likely to have most difficulty in getting the best out of vaccination programmes (“vulnerable communities”). Then, with stakeholders and communities, we shall co-design the VAnguard Community Study, and implement it to investigate in detail which biological and social factors most influence vaccine impact in vulnerable communities.
Data and economic modellers will study the results to identify which factors could usefully be modified, and we shall work with the communities to explore ways in which this could be done. Hence we shall co-develop strategies which national stakeholders may be able to implement straight away, or which can be tested in future studies.
The work will be led by young African scientists, supported by local and international experts, to build capacity for African vaccine research. Biological, social, and implementation scientists and experts will work closely together to understand each other’s disciplines, establishing a culture of collaboration that will foster sustainable pathways to the desired impact: healthy communities. VAnguard’s goal is to identify modifiable structural, social and biological determinants of impaired vaccine impact in vulnerable African communities, and hence to develop integrated strategies to address them and to drive health equity. VAnguard brings together East African leaders in vaccine research, implementation and community engagement, with UK experts in vaccine biology and the social anthropology of vaccine hesitancy. Our specific objectives are, in Uganda and Kenya, to

1. Investigate biological drivers and mechanisms of population differences in vaccine response
2. Understand how social and biological determinants of vaccine response interrelate to determine vaccine impact
3. Identify and model integrated strategies to inform development of future interventions to optimise vaccine impact among vulnerable populations

First, we shall work with national stakeholders (such as Ministries of Health, and vaccine-related non-governmental organisations), review literature, and work on samples from previous studies, to identify Ugandan and Kenyan communities likely to have most difficulty in getting the best out of vaccination programmes (“vulnerable communities”). Then, with stakeholders and communities co-design the VAnguard Community Study, and implement it to investigate in detail which biological and social factors most influence vaccine impact in vulnerable communities.

Based at the UVRI, VAnguard will initiate a new multidisciplinary Group comprising the London School of Hygiene &amp; Tropical Medicine (LSHTM), East African partners at the forefront of building vaccine research capacity in the region: UVRI and Kenya Medical Research Institute (KEMRI) Wellcome Trust Research Programme. Additional contributions will be made by the Medical Research Council (MRC)/UVRI and LSHTM Uganda Research Unit (MUL), Makerere University, Uganda Christian University (UCU), the Ugandan and Kenyan Ministries of Health (MoH) and expert collaborators.