NIHR Global Health Research Group on Vaccines for vulnerable people in Africa (VAnguard) Vaccination is a hugely important 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, under development, 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 difficulties in 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’s goal is to understand how biological and social factors interact to impair vaccine impact in
vulnerable African communities, in order to develop integrated strategies to optimise vaccine benefits
and drive health equity.

VAnguard will bring 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 nongovernmental 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.