NIHR Global Health Research Group on Vaccines to Control Respiratory Pathogens & AMR across Africa (VacAMR)

RESEARCH QUESTION: Can control of infections & deaths due to respiratory pathogens & AMR be improved through vaccine & non-vaccine multimodal interventions?

BACKGROUND: AMR-attributable deaths (~1.3 million/yr) are mostly due to lower respiratory infection (LRI). Annually there are >2 million LRI deaths globally, most commonly in sub-Saharan Africa (SSA). Streptococcus pneumoniae (Spn), then RSV & Hib are the leading causes of LRI deaths among under-5 children.

AMR Klebsiella pneumoniae is a leading cause of pneumonia & sepsis in newborns & vulnerable adults. Influenza, RSV & Spn infections are major drivers of antimicrobial use & therefore AMR. Deaths due to AMR respiratory pathogens are vaccine preventable.

We therefore propose to improve AMR control by focusing on preventing disease syndromes (e.g. fever & pneumonia), as part of a multimodal approach that includes vaccine and non-vaccine interventions. Building on previous NIHR-funded success, we will tackle AMR through new strategic South-South partnerships between KEMRI-Wellcome, Kenya, Malawi-Liverpool-Wellcome (Kamuzu University of Health Sciences), Navrongo Health Research Centre, Ghana Nigeria Centre for Disease Control, & Nigerian Institute of Medical Research.

OVERALL AIM: Africa-led transformation of the public health approach to controlling respiratory pathogens & AMR through vaccine & non-vaccine-based multimodal interventions. OBJECTIVES

i) Identify multimodal interventions to reduce AMR, developing the evidence base, co-creating interventions, modelling impact & prioritising methodologies. ii) Accelerate implementation of diagnostic approaches to support AMR intervention evaluation. iii) Evaluate candidate immune markers of protection to support intervention & outcome evaluation.

iv) Strengthen evidence-to-policy translation. v) Engage communities to evaluate AMR risk & identify behaviour change interventions. vi) Empower Africa-based leadership & innovation in AMR. METHODS

WP1: MULTIMODAL INTERVENTIONS - identify target pathogens, co-create multimodal interventions, model impact, prioritise interventions & plan evaluations.

WP2: DIAGNOSTICS & SEQUENCING - with Africa CDC, industry & academic partners, identify target diagnostic platforms & WGS strategies for multimodal interventions. WP3: VACCINE IMMUNITY & PROTECTION – select & test immunological tools for intervention & outcome evaluation.

CROSS-CUTTING THEMES: Community Engagement & Involvement; Behaviour Change & Risk Communication; Evidence-to-Policy; Leadership Development. DELIVERY TIMELINES VACCINE & AMR PLATFORM; EQUITABLE AFRICA-BASED LEADERSHIP [Year 1].

MULTIMODAL INTERVENTIONS (WP1): Intervention prioritisation [Mid-Year 2]; modelled impact [Mid-Year 3]; feasibility assessment [Year 4].

DIAGNOSTICS (WP2): expert group [Year 1]; field tested diagnostics to support interventions [Mid-Year 4]; WGS analysis training [End Year 2]; open-access protocols [Year 4].

PROTECTIVE IMMUNITY (WP3): expert group [Year 1]; protective immunity tools to support interventions [Mid-Year 4]; Open-access protocols [Year 4].

IMPACT: Leadership in the global response to AMR pandemic, involving communities & policymakers; new multimodal approaches to AMR intervention; improved diagnostics & immune biomarkers to support evaluation.

DISSEMINATION: Communication via social media, publications & policy briefs. Policy-relevant evidence disseminated to communities, health professionals, academics, policymakers & industry.