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UK Public Health Rapid Support Team - Research
UK - Department of Health and Social Care (DHSC)
"Created in 2016, the UK-PHRST is the primary arm of Her Majesty’s Government to provide and coordinate the UK’s public health response to outbreaks in LMICs. The UK-PHRST is a unique collaboration between Public Health England and the London School of Hygiene and Tropical Medicine with input from a number of academic partners. The UK-PHRST’s remit covers outbreak response, research, and capacity building, as components of its integrated triple mandate: • Rapidly investigate and respond to disease outbreaks at their source in LMICs eligible for UK Official Development Assistance (ODA), with the aim of stopping a public health threat from becoming a broader health emergency • Conduct research to generate an evidence base for best practice in epidemic preparedness and response • Build capacity for improved and rapid national response to disease outbreaks in LMICs and contribute to supporting implementation of IHR at the request of national governments or international stakeholders such as WHO. The UK-PHRST rapidly deploys a standing team of multidisciplinary public health professionals and researchers as required in countries that are a priority for the UK’s ODA programme. The UK-PHRST full-time Core Deployable Team consists of specialists in epidemiology, laboratory microbiology, infection prevention and control, clinical case management and clinical research, social science, data management and logistical support who are available to deploy within 48 of an approved request. Reservists and Field Epidemiology Training Programme (FETP) Fellows complement this team, providing surge capacity and specialist expertise when needed. The UK-PHRST is financed through UK Official Development Assistance (ODA) funding through the Department of Health and Social Care. The UK-PHRST Director is the accountable person to the UK Government, through PHE, for delivery of the UK-PHRST objectives." The UK Public Health Rapid Support Team (UK-PHRST) has the following main objectives: 1) Within ODA eligible countries to support the rapid investigation and response to disease outbreaks at source, with the aim of stopping a public health threat becoming a health emergency. 2) Conduct rigorous research to aid epidemic preparedness and response and improve future response. 3) Generate an evidence base for best practice in disease outbreak interventions within ODA eligible countries. 4) Train a cadre of public health reservists for the UK-PHRST who can be rapidly deployed to respond to disease outbreaks. 5) Build capacity in-country for an improved and rapid national response to disease outbreaks and contribute to supporting implementation of the International Health Regulations (IHR).
GCRF Network Plus: Disability under Siege
DEPARTMENT FOR SCIENCE, INNOVATION AND TECHNOLOGY
Building resources required by practitioners to transform education provision for children with disabilities in conflict affected states. Benefits education system, practitioners, NGOs in Jordan, Lebanon and West Bank. SDG:4,10,16
GCRF Network Plus: Disability under Siege
DEPARTMENT FOR SCIENCE, INNOVATION AND TECHNOLOGY
Building resources required by practitioners to transform education provision for children with disabilities in conflict affected states. Benefits education system, practitioners, NGOs in Jordan, Lebanon and West Bank. SDG:4,10,16
Imagining Futures through Un/Archived Pasts
DEPARTMENT FOR SCIENCE, INNOVATION AND TECHNOLOGY
Using archiving to reduce inter- and intra-community conflict among diverse social, political, religious, economic and regional groups. Benefits local communities, NGOs, policymakers in Lebanon, Ghana, South Africa and Tanzania. SDG:10,11,16
Imagining Futures through Un/Archived Pasts
DEPARTMENT FOR SCIENCE, INNOVATION AND TECHNOLOGY
Using archiving to reduce inter- and intra-community conflict among diverse social, political, religious, economic and regional groups. Benefits local communities, NGOs, policymakers in Lebanon, Ghana, South Africa and Tanzania. SDG:10,11,16
GCRF Network Plus: Disability under Siege
DEPARTMENT FOR SCIENCE, INNOVATION AND TECHNOLOGY
Building resources required by practitioners to transform education provision for children with disabilities in conflict affected states. Benefits education system, practitioners, NGOs in Jordan, Lebanon and West Bank. SDG:4,10,16
Imagining Futures through Un/Archived Pasts
DEPARTMENT FOR SCIENCE, INNOVATION AND TECHNOLOGY
Using archiving to reduce inter- and intra-community conflict among diverse social, political, religious, economic and regional groups. Benefits local communities, NGOs, policymakers in Lebanon, Ghana, South Africa and Tanzania. SDG:10,11,16
Generation Malawi: A study of family, maternal and childhood mental health
DEPARTMENT FOR BUSINESS, ENERGY & INDUSTRIAL STRATEGY
A lack of research training, resources, infrastructure and data in Low- and Middle-Income Countries (LMIC) greatly limits their ability to conduct studies of common mental health conditions. Nowhere is this more true than in Africa generally and in Malawi specifically, where sparse mental health care alone limits not only clinical research capacity, but also the ability to attract inward investment. In a partnership between UK and Malawian institutions, we propose to directly address this challenge by building clinical research capacity through the coordinated appointment of new researchers and research assistants, a programme of education and dissemination, and the development of a population mental health dataset focussed on an area of great unmet need - the mental heath of mothers and their children. After a period of piloting our research assessments and obtaining the necessary approvals, we will recruit 5000 mothers prior to delivery of their child from antenatal clinics in Lilongwe and Karonga districts, selected to represent urban and rural populations respectively. We will assess the mental health of mothers before and after birth, and the mental health of their spouses and other family members with a view to identifying the major risk factors for mental health disorders and mitigating variables that promote resilience. We will then examine the impact of maternal and, where possible, paternal mental health on the neurodevelopment of their offspring. In addition to creating new and highly valuable data, we will also create the bioresources needed for future genetics and 'omics based research. We believe this is essential to prevent the current imbalance in genetic research favouring rich countries of predominantly European ancestries leading to greater entrenchment of global health inequalities. As part of the proposed work, we will develop internationally competitive research capacity and datasets in Malawi, augment standard of care treatment, develop research training and the availability of affordable and effective interventions for depression and other common mental disorders, such as the "Friendship Bench" intervention. Our research will be multidisciplinary, involving experts from psychiatry, clinical psychology, nursing, reproductive and child health, and social sciences in both UK and Malawi. Throughout the project, we will carefully monitor our progress and impact on the participants and their communities. The project, if funded, will lead to a step change in mental health research capacity in Malawi, paving the way for new inward investment and the development of evidence based interventions and policies.
Scalable TRansdiagnostic Early Assessment of Mental Health (STREAM)
DEPARTMENT FOR BUSINESS, ENERGY & INDUSTRIAL STRATEGY
Worldwide, over 250 million children are at risk of not obtaining their developmental potential due to exposure to adverse circumstances. India and Malawi house some of the most disadvantaged populations in the world, with over 10% of all children aged 2 to 9 years estimated to have neurodevelopmental disorders. However, social and economic barriers to access qualified health personnel mean that most of these children do not receive any assessment of neurodevelopment or a clinical diagnosis when needed. Moreover, many parents are unaware of developmental milestones, so clinical opinion is sought only when symptoms become more pronounced and begin to impact daily life with a lost opportunity for early interventions. This avoidable delay is an unfolding tragedy in light of evidence showing that frontline worker delivered interventions can lead to better behavioural and social outcomes and improve long term developmental trajectories. Scalable methods to assess child neurodevelopment and mental health would promote early referral to specialist facilities, ultimately connecting families with affordable, community-based interventions. Directly measuring neurodevelopment allows us to identify the most vulnerable children as early as possible, allowing limited resources to be focused on those most likely to benefit from preventive approaches. Taken together, focusing on brain development in early childhood is critical to revolutionising global mental health of young children. We will realise this goal by developing a Scalable Transdiagnostic Assessment of Mental Health (STREAM), a mobile platform usable in the home or in a routine health facility by non-specialist workers. STREAM will be delivered on a tablet PC and will collect different types of data from 4000 children in India and Malawi. First, parents will be asked simple questions about their child's everyday behaviour, based on established questionnaires that have been validated in low income settings. Second, gamified tasks designed to measure motor, social, and cognitive abilities will be administered on the tablet. Additionally, novel low-cost eye-tracking technology on the same tablet PC will be used to monitor the child's eye movements in simple tasks, such as those assessing preference for social versus non-social images, and measuring how quickly attention shifts to new objects appearing on the screen. Finally, a segment of parent and child interaction will be recorded using the inbuilt camera, and used to code for signs of atypical behaviour. This combination of multiple measures will provide independent channels of data collected on a single platform, significantly improving on current assessment methods that often rely on one technique and expensive, highly skilled but scarce human resources. STREAM will be designed such that it will require minimal training to be administered by non-specialist workers in low and middle income countries, thereby promoting task-sharing, a concept endorsed by the World Health Organization to reach wider populations. This task-sharing approach reduces the burden on the small number of highly-skilled mental-health and child development professionals in these low resource settings. STREAM can also help develop community awareness and, in the longer term, address the barrier of low demand for services in these areas. The development and application of the STREAM platform involves collaborations across the breadth of basic and applied sciences. Our network comprising clinicians, neuroscientists, public health specialists and data scientists spread across UK, India and Malawi is optimally suited to leading this challenge because of our combined expertise deploying novel technologies to measure early childhood neurodevelopment in low-resource settings.
Adjunct antibody therapy for severe antibiotic-resistant Acinetobacter baumannii infections
DEPARTMENT FOR BUSINESS, ENERGY & INDUSTRIAL STRATEGY
Unlike in the UK and other Western countries, the bacteria Acinetobacter baumannii is a common cause of pneumonia and other infections in Asian countries. Unfortunately A. baumannii both often causes severe infections and is frequently highly resistant to antibiotics, including penems and extended spectrum penicillins, and A. baumannii infections therefore have a high mortality and require considerable hospital resources. We will investigate whether antibodies that bind to the surface of A. baumannii bacteria could be used as way of providing additional treatment to patients with an A. baumannii infection along with antibiotics. We will look for several protein targets for an antibody therapy that can increase killing of A. baumannii by human white cells or which by inhibiting mechanisms of antibiotic resistance makes a previously ineffective antibiotic able to kill A. baumannii. To do so we will: Aims 1 and 2. Use information that we have recently obtained on the gene content of 300 Thai A. baumannii strains to identify proteins present in most strains, and use these to construct what is called an antigenome array. Antigenome arrays allow all the proteins that cause an antibody response to be identified, and we will use the A. baumannii conserved protein antigenome array to identify which proteins can cause an antibody response after human or mouse A. baumannii infections. Aims 3. Identify which A. baumannii proteins are abundant on the bacteria during infection or in response to antibiotics using a technology called RNAseq to see which genes are highly expressed during infection or when the bacteria has been stressed by antibiotics; these genes should b particularly good candidates for an antibody therapy. Aim 4. Use the data obtained in aims 1 to 3 to identify which A. baumannii proteins should be investigated further as potential targets for an antibody therapy. We will make each protein antigen and obtain rabbit antibodies to the protein to test the ability of the antibody to recognise and kill different A. baumannii strains using laboratory assays of immune function and mouse models of infection. From these data we select a few protein antigens for use in a protective multivalent antibody therapy that targets several important proteins rather than just individual protein antigens as targeting several proteins should make the treatment more effective as a therapy. Aim 5. To identify which patients with A. baumannii infection and when during infection those patients could benefit from an antibody therapy we will collect data on 100 Thai patients with proven A. baumannii infection. In addition we will purify antibodies developing in these patients as a result of the A. baumannii infection for use in our blood infection model to confirm that antibody therapy can inhibit A. baumannni growth in the blood or resistance to antibiotics. Overall the project will identify which A. baumannii proteins would make good targets for an antibody therapy and confirm the potential of this approach for treating antibiotic resistant A. baumannii infections in Thailand and other Asian countries. By allowing experienced research scientists who work on bacterial infections to start investigating A. baumanii as well, the project will also increase the number of researchers investigating how to combat antibiotic resistant bacteria both in the UK and in Thailand.
Preventing cervical cancer in older Vietnamese women
DEPARTMENT FOR BUSINESS, ENERGY & INDUSTRIAL STRATEGY
Cervical cancer is a leading cause of cancer mortality in Vietnam with over 80% of deaths among women aged over 45 years. In Western countries, regular cervical screening allows cancers to be detected and treated, but cervical screening in Vietnam is rare and less than 5% of the population have ever been screened. This means that cancers are detected later and are often fatal. Human papillomavirus (HPV) causes cervical cancer and is common in younger people in Vietnam. Research into how best introduce a vaccine to prevent future cervical cancers is currently being undertaken. However, little is being done to help women who are too old to be vaccinated and are now at highest risk of developing cancer. We propose to strengthen existing research partnerships between LSHTM and both the Pasteur Institute and Cancer Registry in Ho Chi Minh City (HCMC) in order to pilot an innovative HPV screening method among older Vietnamese women. Our research in the UK has indicated that the majority of invasive cancers could have been detected by sensitive HPV testing compared to very few by cytology (a smear test). This project will pilot HPV testing in two districts of HCMC in 300 women aged 45-64 years. The women testing positive will be invited for repeat testing after 1 year and those still positive will be invited to undergo a therapeutic biopsy with the aim of greatly reducing their future cancer risk. In addition, 100 former sex workers will be identified and also invited to take part. These women are estimated to be at much higher risk of developing cervical cancer than the general population and therefore are an important target group for HPV screening. This pilot project will allow us to assess the response rate and also the attitudes to screening in those that accept their screening invite compared to those who refuse. The cancer registry in HCMC is well organised but poorly resourced. Analysis of the data is required to understand unexpected changes in cancer rates which are likely to be due to migration in and out of the city. At least 50 cervical cancer patients identified by the registry will be interviewed in this pilot study to between understand their characteristics including whether they have moved from a rural area to HCMC.
An inter-disciplinary approach to understanding and intervening on contextual factors that shape HIV-risk for young women and men in South Africa
DEPARTMENT FOR BUSINESS, ENERGY & INDUSTRIAL STRATEGY
Globally, and in South Africa in particular, HIV remains a major public health challenge. In KwaZulu-Natal Province, the functional epicentre of the global HIV-epidemic, young women and girls (18-24) are particularly at risk of acquiring HIV, and young men, are the only group in the country with an rising HIV-incidence. These high rates of HIV-acquisition are driven by harsh social contexts of poverty, inequitable gender norms, and widespread levels of violence, driven by the long legacy of apartheid. This project seems to achieve three aims: 1) to understand how social contexts shape young people's HIV-acquisition risk; 2) to develop an intervention to support young women and men to take control of their lives and HIV-acquisition risk; and 3) assess the feasibility, acceptability and potential impact of this intervention. To achieve aim 1 we will use unique existing quantitative data sets to understand how social contexts shape HIV-acquisition risk in young people and then undertake long-term participatory research with 16 youth peer research associates (YPRAs) hired from two sites in KwaZulu-Natal - urban informal settlements and rural KwaZulu-Natal. Through this we will understand in multiple ways how risk manifests itself. To achieve aim 2 we will work with the YPRAs and the team of researchers to develop an intervention with resonates with young women's and men's live. To achieve aim 3 we will undertake a pilot evaluation of the intervention, assessing quantitative and qualitatively whether the intervention was felt to be feasible and acceptable by young people, and whether it shows any evidence of effect. We will share results with the community through producing plain language summaries of the research we produce, and also a short video at endline, all in collaboration with the YPRAs.
Exploring treatment burden and capacity for self care among patients with HIV/NCD multimorbidity in South Africa to inform interventions (EXTRA)
DEPARTMENT FOR BUSINESS, ENERGY & INDUSTRIAL STRATEGY
South Africa (SA) and other sub-Saharan African countries are experiencing a double burden of chronic disease epidemics: one of infectious disease, most notably HIV, and the other, a rapidly evolving epidemic of non- communicable diseases (NCDs) such as diabetes and cardiovascular disease. This is resulting in different patterns of multi-morbidities (two or more simultaneously occurring long term diseases or conditions) to those commonly seen in high income countries. Concerningly, these chronic diseases are being increasingly seen in younger people, which has implications for their families, economic productivity and healthcare costs. Currently, chronic healthcare for patients with multimorbidity in SA is fragmented and uncoordinated and does not take into account the increased challenges the patient faces in trying to manage their conditions. The primary aim of this Seed Funding Application is to identify and understand the illness 'workload' experienced by patients with HIV/NCD multimorbidity, as well as their caregivers. This information will be used to ensure that the patient perspective is fully considered in the healthcare reform initiatives that are currently underway in SA, which aim to improve chronic care services. A further aim is to explore the relevance and applicability of existing models that explain the workload involved in NCD treatment and patients' capacity to deal with it. Existing models have been developed in high income countries and we are interested to adapt them to our setting so that they can inform future research and interventions in South Africa and potentially in other low-and middle- income countries. We will use interviews and discussion groups for this study. We will interview a range of patients and their care givers to explore how they experience self-management workload and their capacity to deal with it. This will be in both an urban and rural setting in the Western Cape province as for example, peoples' access to services may differ. We will then recruit healthcare managers, doctors, nurses and community health workers from the same settings into 'task groups' to discuss these findings and consider what they mean for the redesign of local services and interventions that might reduce patient burden and increase their capacity. We will also hold further meetings to present our findings to policy and health managers at a provincial and national level to influence reforms in the health system. This project will help us develop a culturally and contextually appropriate model of HIV/NCD workload and capacity for a low -to- middle income setting such as SA. This work will contribute to development of interventions that can then be tested across different settings.
The impact of microbial and inflammatory exposures on birth outcomes in rural Zimbabwe
DEPARTMENT FOR BUSINESS, ENERGY & INDUSTRIAL STRATEGY
One in seven babies in Africa are born with low birthweight, either because they are born too small (small-for-gestational age; SGA) or born too soon (preterm). Babies born SGA or preterm have a higher risk of dying, and do not grow as well in early life, leading to a higher risk of malnutrition. The most common form of malnutrition (stunting) affects health into adulthood, reduces learning at school, and lowers earning potential. To reduce child deaths and improve health, growth and prosperity throughout life, it is essential to improve birthweight. To do this, we need to understand the processes during pregnancy that lead to SGA and preterm. The fetus depends on a delicate balance of processes to grow properly and be delivered on time. Infections during pregnancy, and activation of the body's defence system to tackle infections (called inflammation) may disturb these processes, leading to SGA and preterm birth. Mothers with sexually transmitted infections, urinary tract infections, gum disease or diarrhoea during pregnancy have a higher risk of SGA and preterm birth. Inflammation can also occur even when a pregnant woman is not sick with an infection. There are trillions of bacteria in the body, called the microbiome, which generally do not cause disease. However, a change in composition of the microbiome can cause inflammation. Unbalanced vaginal, oral and gut microbiomes in pregnant mothers have all been associated with SGA and preterm birth, although most of these studies have been done in high-income countries. It is unclear whether and how disturbed microbiomes cause inflammation, SGA and preterm birth in Africa. We believe that taking antibiotics in pregnancy could improve birth outcomes by reducing harmful infections and inflammation. In order to test this, we will take advantage of an existing trial examining whether a daily antibiotic (called cotrimoxazole) during pregnancy can increase birthweight. We previously found that this antibiotic reduces inflammation as well as preventing infections. During the new study, 1000 women in rural Zimbabwe will receive either cotrimoxazole or placebo from the time they first book their pregnancy at the local clinic up until birth. The treatment will be decided randomly, like the flip of a coin. During pregnancy, oral samples (tongue swabs, dental plaque, saliva), vaginal swabs, stool, urine and blood will be collected from all mothers when they book and at 26, 34 and 36 weeks into pregnancy. Our first aim is to see whether infections and inflammation during pregnancy are associated with SGA and preterm birth. Women will be examined by a dentist to check their oral health and be tested for sexually transmitted infections, urine infections and diarrhoea, with treatment provided if needed. Using the oral, vaginal and stool samples collected from booking and the end of pregnancy, we will study the microbiome and inflammation to see if they are linked to SGA and preterm birth. Our second aim is to compare the microbiome and inflammation in 100 women receiving the antibiotic and 100 women receiving placebo. We will see whether cotrimoxazole reduces inflammation, infections, or changes the microbiome during pregnancy. We will also test whether bacteria become resistant to the antibiotic. Our third aim is to see what effect maternal antibiotics have on the baby. We will collect samples of the placenta, blood and stool at birth, and collect stool and blood again when they are 4 weeks old, to compare infections, microbiome and inflammation in babies whose mothers received antibiotics or placebo in pregnancy. Through this project, we hope to understand whether infections, microbiome disturbances and inflammation during pregnancy cause SGA and preterm birth, and exactly how the antibiotic works (if at all). This is important, because we may be able to design new treatments that can be given during pregnancy to help babies grow better and be born on time.
VAccine deveLopment for complex Intracellular neglecteD pAThogEns (VALIDATE)
DEPARTMENT FOR BUSINESS, ENERGY & INDUSTRIAL STRATEGY
For several complex pathogens, we have an incomplete understanding of the kind of immune response we need an effective vaccine to induce. In part this is because these pathogens live inside cells and can hide from the host immune response. This makes it very difficult to develop vaccines against these pathogens. The diseases caused by these pathogens, including tuberculosis (TB), leprosy, leishmaniasis and melioidosis, disproportionately affect people in low and middle-income countries (LMICs) and are often neglected due to the poor predicted commercial return and marginalisation of affected populations. The current approach to vaccine development is to identify a part of the immune response that might be important, develop vaccines that induce that kind of immune response and then test that vaccine to see if it works, first in animal models and then in human clinical trials. This approach does not work for these complex pathogens and is slow and inefficient. In this Network we will adopt an iterative approach and develop more accurate working models of the immune response by cycles of repeated integration of data from human clinical studies and animal models across the different pathogens. The inclusion of vets working in large animal models will mean the results obtained are relevant for the development of animal vaccines as well. The inclusion of partners from LMIC where these diseases are endemic, together with partners from industry will help ensure real world relevance. Furthermore, the smaller animal models will allow us to easily look at single components of the immune system. The insight gained into immune mechanisms will allow us to design and develop vaccines more efficiently and more effectively. This Network will provide a unique opportunity to bring together individuals working on four exemplar complex intracellular pathogens (M.tb, M.leprae, Leishmania spp. and B.pseudomallei), which share a common lifestyle as pathogens that live in a particular host cell called macrophages, induce similar end-stage pathologies in humans and are known to affect host immune and metabolic responses. The horizontal collaborations established throughout this network, together with the provision of a protected environment for early data sharing, will exploit the biological synergies between these pathogens. Positive and negative results can be disseminated rapidly, and partners working on each of the complex diseases can learn from the successes and failures of those working on the other diseases. By understanding mechanisms that lead from infection to disease, we plan to uncover common approaches to inform vaccine development strategies for these and other complex intracellular pathogens. Key Network activities and deliverables include annual meetings for knowledge sharing; creation of a virtual network for real-time data sharing; pump-priming funding to fill knowledge gaps, and provide data to enhance the competitiveness of larger grant applications; a website and other communications to enhance collaborations and research dissemination; and career development by funding, training and mentoring of early post-doctoral and new PI researchers. All activities work towards more effective vaccine development for these important diseases, and the improvement of research capabilities in our partner LMICs.
International Veterinary Vaccinology Network
DEPARTMENT FOR BUSINESS, ENERGY & INDUSTRIAL STRATEGY
In many 'low-middle-income-countries' (LMICs) the livestock sector (including poultry and aquaculture) accounts for up to 80% of agricultural GDP, with a majority of the rural poor raising livestock as a means of securing or diversifying income. Improving livestock productivity through the development and deployment of effective veterinary vaccines is thus critical not only to secure food supply and contain the many zoonotic (i.e. transmissible from animal to human) diseases that are prevalent in LMICs, but also to secure income and thus offer a pathway for alleviating poverty. Despite several successful multi-national collaborations addressing livestock health in LMICs there is still not a 'universal' Network that can be readily accessed by all researchers working on veterinary vaccine development for LMIC-application. There is also a continuing unmet demand for increased knowledge and technology transfer between researchers in the UK and LMICs and also between researchers in the human and veterinary vaccinology communities. Here we propose the formation of an International Veterinary Vaccinology Network (IVVN) that provides a forum for the integration of inputs from biological scientists, other specialists (e.g. economists), industry, policymakers and regulatory bodies to focus specifically on development of vaccines for priority livestock diseases of LMICs. By establishing an integrated community and facilitating the formation of strategically devised collaborations between scientists with complementary expertise, the IVVN will enable new approaches to tackling the many scientific 'bottle-necks' that frustrate vaccine development to be adopted. As many of the scientific obstacles that impede development of vaccines are common to both human and veterinary vaccinology, the research conducted by IVVN members will frequently have implications for human vaccine development and so fulfil a 'one-health' remit. The IVVN will actively seek to engage scientists and industrial partners (including those who may not usually consider applying their skills to LMIC or veterinary problems) from the breadth of disciplines that can be applied to vaccine development. The IVVN will provide opportunities for new inter-disciplinary partnerships that tackle specific scientific challenges to be formed (member-led annual scientific meetings and workshops) and then support these partnerships by funding preliminary experiments to generate novel scientific findings (pump-priming funding and laboratory exchanges) that will contribute to the development of new vaccines. The IVVN will identify opportunities across the whole spectrum of veterinary vaccinology where application of new scientific approaches can effectively address long-standing obstacles to vaccine design; to keep abreast of these opportunities the IVVN has assembled a management board that has a wide profile of veterinary and human vaccinology expertise that will enable rapid integration of new scientific developments and challenges and recruitment of new IVVN members that can bring access to these. This new Network will work alongside the UK Veterinary Vaccinology Network (UK-VVN); overlap of the management groups and membership of the two networks will ensure they function collaboratively and bring mutual benefits. To achieve its aim, it is essential that the IVVN considers vaccinology within the context of the agricultural sectors of LMICs; this knowledge will be provided by LMIC vaccinologists and industrial partners whose representation and leadership will be fundamental to the success of the IVVN.
GCRF Action against Stunting Hub
DEPARTMENT FOR BUSINESS, ENERGY & INDUSTRIAL STRATEGY
The global community aims to decrease the number of stunted children under five by 40% by 2025. While targeted and specific, we know that this is presently unachievable. Part of the problem is that over the last three decades, the search for the 'silver bullet' or the specific driver, which if addressed could solve this intractable problem, has narrowed praxis. This is not to say that gains have not been made, but rather our efforts have not been entirely impactful. While substantial disciplinary advances have occurred, often they have not been joined-up. And while systematic reviews abound, pan-disciplinary understandings, do not. Hence, child stunting is an intractable problem, waiting for a unified solution. If we perceive child under-nutrition as a mosaic, we have knowledge of many of the individual elements. For example, biological advances demonstrate there is an identifiable 'epigenetic signature' of stunting. Children who are stunted also have immature gut micro-biomes and we also know a large proportion of the global malnutrition burden is caused (either directly or indirectly), by infectious agents ranging from viruses and bacteria to protozoa and helminths. Food-borne toxins also impact stunting. Equally, we know a range of elements can help to prevent stunting from animal source Foods (ASF) to behavioural elements from dietary choices to feeding practices to water, sanitation and hygiene (WASH). Yet overall, it may be argued that we are missing the shape and structure of the mosaic and the synergies between the component parts. In many quarters, the literature on child under-nutrition is viewed as 'siloed' and non-relational (Perkins et al., 2017). But equally importantly, 'integrated' nutritional programmes have often not had the expected impacts. Herein lies the problem and the related solution: we urgently need to understand the 'cascade' of factors driving child stunting and the synergies and inter-relationship between drivers. And equally importantly, we need to better understand the 'tipping points' or the critical points along this cascade where healthy linear growth diverges to slow or no growth. To do this, we propose to transform our exploration of child under-nutrition from the component parts to the 'whole child'. Where the biological, social, environmental and behavioural context in which stunting occurs is understood in its entirety and where the strength and directionality of these drivers, inform related interventions. Based on this joined-up approach, we will explore the ability of a range of child-centred interventions to disrupt the cascade of factors that inhibit the ability of a child to grow. These actions and outcomes will then form the basis of a decision-making platform to enable users to identify the ex-ante and ex-post impacts of potential interventions. Embedded in this process, however, is a values-based approach that ensures that from the outset, our research directly connects to and betters the lives of the children, families and communities involved. We will work across three countries: India, Indonesia and Senegal in over 50 communities. We aim to decrease child stunting by up to 10% our communities. Finally, to enhance our impact and legacy our Hub, we will engage a range of end-users in both our outputs and in the wider 'whole child' approach. We will support new regional platforms on maternal and child nutrition proposed by UNICEF linking the work of FAO/The World Bank/WHO at the country-level. We will also engage our network of over 100 civil society organizations in our findings. Over the course of the project, we expect to positively impact the lives of up to 1 million children.
Unlocking resilient benefits from African water resources
DEPARTMENT FOR BUSINESS, ENERGY & INDUSTRIAL STRATEGY
Sustainable water resource development remains elusive because development has largely externalized costs to the environment and vulnerable people. There is a need for novel research theory, methodologies & practice in order to meet the UN SDGs and realise the Africa Water Vision 2025. We propose to launch an innovative research approach: the Adaptive Systemic Approach (ASA). Our aim is to apply transformative, transdisciplinary, community-engaged research, to shift water development outcomes towards achieving the SDGs. We focus on continental water development priorities: water supply and pollution. This collaboration brings together the ARUA Water Centre of Excellence (CoE) and UK partner, the University of Sheffield (UoS). The 8 CoE nodes are: i) Addis Ababa U, Ethiopia; U Rwanda, Rwanda; U Cheikh Anta Diop, Senegal; Dar es Salaam U, Tanzania, Makerere U, Uganda (DAC least developed); ii) U Lagos, Nigeria (DAC lower-middle income); and iii) U Cape Town, Rhodes U (CoE Hub), South Africa (DAC upper-middle income). We propose a country-based Case Study structure to support local research development and pathways to local impact (Figure 1 in Case for Support). We use an SDG6 (water and sanitation) centred model, that links SDGs related to landscape water resources with SDGs related to water services. (This model underpins the successful UKRI:GCRF Capability Grant:"Water for African SDGs"). We raise three research questions (RQ) related to water development priorities. Three catchment-based Case Studies address RQ1: HOW IS WATER USED, TO WHOSE BENEFIT? (Rufigi R Tanzania, Senegal R Senegal, and Blue Nile R Ethiopia). Two Case Studies focus on urban water pollution (Kampala City Uganda and Lagos City Nigeria), addressing RQ2: WHAT ARE THE SOURCES, PATHWAYS AND IMPACT OF POLLUTION IN URBAN WATER SYSTEMS? A cross-cutting Case Study addresses water resource protection and biodiversity in all CSs, and a biodiversity site in Rwanda. By the completion of the project we commit to leaving local people effectively linked with institutions making decisions about water that affect them. Therefore all Case Studies address the question RQ3: HOW CAN LOCAL CAPACITY TO ENGAGE IN PARTICIPATORY GOVERNANCE BE DEVELOPED FOR: I) EQUITABLE WATER SHARING, II) COMMUNITY POLLUTION RESILIENCE, AND III) ECOSYSTEM PROTECTION AND RESTORATION? The novel Adaptive Systemic Approach (ASA) provides a coherent methodological framework that will support Case Study comparisons, changed water development practice, and will embed pathways to impact throughout the project. The ASA requires engaged research, and draws on three core theoretical concepts, with associated methods: Complex Social-Ecological Systems, Transdisciplinarity, and Transformative Social Learning (Elaborated in Case for Support). These concepts underpin four ASA steps, followed in each Case Study: 1. BOUND: Researchers engage with a full range of stakeholders to identify a relevant, local, water-development issue, and scope the Case Study. 2. ADAPTIVE PLANNING PROCESS: Stakeholders co-create a contextually informed vision of the future state of their selected local issue, and co-develop an objectives hierarchy to move towards resolving the issue. 3. CONCURRENT ACTIVITIES 3.1 RESEARCH Each Case study team addresses the specific research questions, delivering data for resolving the problem. 3.2 PARTICIPATORY GOVERNANCE DEVELOPMENT Local people, formal, and traditional, water governance institutions together move towards local people being part of land and water decision-making. 3.3 STRATEGIC ADAPTIVE MANAGEMENT (SAM) - stakeholders will be trained in a process for systemic, responsive, contextual, co-management. 4. PARTICIPATORY MONITORING AND EVALUATION OF REFLEXIVE LEARNING Researchers and stakeholders co-develop indicators, co-monitor, co-reflect on progress, co-learn and adapt, using SAM. Following the ASA in the case studies embeds the theory of change, and the pathways to impact.
Out of camp or out of sight? Realigning responses to protracted displacement in an urban world
DEPARTMENT FOR BUSINESS, ENERGY & INDUSTRIAL STRATEGY
For decades, the response by the international community to mass movements of people fleeing war or political persecution has been to provide humanitarian assistance in camps. Yet despite highly-charged debates on the negative impact of maintaining forcibly displaced people in often inhospitable and remote regions and dependent on humanitarian assistance, camps have continued to be a default response to new refugee crises. Camps are not, however, the choice of the majority of the world's displaced people, and estimates suggest that over 60% of refugees and half of internally displaced persons (IDPs) now live in towns and cities. Research, international policy discourse and local action have been slow to catch up. The experiences of urban refugees and IDPs, their understandings of well-being and self-reliance, and their contributions to host communities remain understudied. There is a critical need for evidence to inform innovative solutions to protracted displacement that support both the specific vulnerabilities of displaced people and the needs of the urban poor amongst whom they often live. With the ultimate goal of improving self-reliance, well-being and the productive livelihoods of refugees, returnees and IDPs this research examines the potential of an urban response to protracted displacement to assess how cities can foster displaced people's self-reliance and local integration, while benefitting host governments and communities. The research is the first large-scale study to compare experiences of displacement in cities and camps and provide evidenced analysis of the comparative outcomes for displaced people in these different settings. It focuses on four countries with large displaced populations: Afghanistan, Ethiopia, Jordan and Kenya, The ultimate goal is to improve the well-being and productive livelihoods of displaced people and to enable their full participation in urban life and contribution to host cities. The overall aims of the research are to: 1. Build an evidence base for national and local governments, humanitarian agencies and donors on the opportunities and challenges of hosting displaced people in camps vs. urban areas 2. Promote an assessment of current responses to urban protracted displacement, raising awareness of unmet need and the potential economic and social contributions of refugees and IDP for host cities 3. Build the capacity of municipal authorities, displaced people, organisations of the urban poor and other local actors to use participatory planning to develop innovative, inclusive solutions to forced displacement. The countries studied host some of the largest refugee and IDP populations in the world. All four countries rely on international aid to support the costs of the displaced - particularly those in camps who lack the right to work and whose freedom of movement may be limited. Three of the four countries are piloting the Comprehensive Refugee Response Framework, the UN's 2016 vision for managing forced displacement. Through partnership with displaced and host populations, and collaborations between international experts, operational actors, developing-country academics, local NGOs and affected communities, this research project will produce: an assessment of how an urban response can support a rights-based approach to local integration; guidance for municipal governments facing large influxes of people, and evidence to support international policy and decision-making on innovative solutions to protracted displacement.
Improving healthcare at the intersection of gender and protracted displacement amongst Somali and Congolese refugees and IDPs
DEPARTMENT FOR BUSINESS, ENERGY & INDUSTRIAL STRATEGY
This project aims to help displaced people to access appropriate healthcare for long-term physical and mental health conditions associated with protracted displacement, conflict, and gendered violence. The category of Sexual and Gender-Based Violence (SGBV) receives a great deal of attention. However, there is limited research on how gendered violence, including violence relating to sexuality, is experienced in displacement contexts. There is also limited understanding of how gender, sexuality, and related violence affect access to healthcare, and how that can result in neglected chronic health conditions, particularly mental ill-health. Similarly, much attention is devoted to immediate healthcare needs following SGBV, but longer-term physical and mental health conditions are not adequately addressed. Displaced people face multiple barriers when seeking healthcare in protracted displacement settings, with the result that long-term health conditions are often misdiagnosed and mistreated or undiagnosed and untreated. This project examines access to care and the responsiveness of healthcare providers for displaced Congolese and Somalis in Eastern Democratic Republic of Congo (DRC), Somali, Kenya, and South Africa. Eastern DRC and Somalia have both experienced long-term conflict and displacement since the early 1990s, leading to large populations of Internally Displaced People (IDPs) within these countries and large refugee populations across the region. Conflict and displacement in Eastern DRC and Somalia are characterised by high rates of sexual and gender-based violence, and victims are stigmatised through prevailing gender and sexual norms. Existing health research tends to focus on the immediate aftermath of violence rather than on long-term mental and physical health conditions. The project has eight field sites in four countries. The four IDP field sites are one formal camp and one informal settlement each in Eastern DRC and Somalia, both of which have weak health systems. The four refugee field sites are Congolese and Somali settlements in Kenya and South Africa, which have different health systems and different refugee laws and policies. The project brings together researchers and practitioners from international development, migration studies, gender studies, medical anthropology, public health and health policy, and medical sciences to undertake interdisciplinary empirical research in these protracted displacement contexts. Panzi Foundation (DRC) and War Trauma Foundation (Netherlands) will guide teams of researchers based at the University of Edinburgh (UK), the University of Kinshasa (DRC), the Somali Institute for Development and Research (Somalia), Amref International University (Kenya), and the University of Witwatersrand (South Africa). Project activities are designed to: 1) enhance the capacity of partner organisations; 2) support the inclusion of displaced people in healthcare systems; 3) foster international networks.
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