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Vital vaccine research to prevent and control epidemics in low and middle-income countries

Caption: Nigerian physicians training on use of personal protective equipment for treating Ebola patients 2014 Credit: CDC Public Health Image Library

The London School of Hygiene & Tropical Medicine (LSHTM) has been awarded £1.5 million by the National Institute for Health Research (NIHR) for new research into vaccines for disease epidemics. Vaccines are an important way of responding to outbreaks of deadly infectious diseases - such as Ebola, plague, Zika and Chikungunya - and for immunisation to prevent outbreaks.

The work will cover three strands - how diseases spread and develop into epidemics in low and middle-income countries (LMICs), development of software and electronic tools for use in outbreaks; and human and anthropological perspectives on vaccines and outbreaks in different communities.

The projects will be led by Professor John Edmunds (Vaccine Efficacy Evaluation for Priority Emerging Diseases (VEEPED) consortium), Dr Shelley Lees (Anthropological exploration of facilitators and barriers to vaccine deployment and administration during disease outbreaks (AViD); and Dr Chrissy h Roberts (Emergencies and Epidemic Data Kit (EDK)). The results of the research will allow new vaccines to be tested in clinical trials and eventually used effectively in future outbreaks.

The best way to test the efficacy of new vaccines is during a disease outbreak, but outbreaks occur sporadically and unpredictably. In addition, the main public health priority during an epidemic is to prevent spread and protect lives, so undertaking clinical trials alongside outbreaks is often difficult. This important work will support research into how epidemiological models, tools and technologies can assist with clinical trials and deployment of new vaccines in outbreak situations in LMICs.

One strand of the work will involve using dynamic modelling techniques to investigate how different infectious diseases emerge and spread. The researchers will then use these models to investigate which trial designs might have the best chances of successfully testing a new vaccine during an epidemic, as well as how existing vaccines might be optimally deployed in practice. Another strand of work will focus on the political, economic, health systems, community and zoonotic factors that determine whether vaccines can be deployed effectively in an emergency situation. Finally, the work will develop electronic data capture to support rapid epidemiological research and response during epidemics.

The work forms part of a wider £5 million grant, which is also funding the University of Oxford to look at two additional areas - vaccine efficacy during epidemics and how to deploy the most appropriate vaccines during an outbreak.

Professor John Edmunds, lead researcher at LSHTM, said: “The Ebola outbreak in West Africa highlighted the need for new vaccines to help prevent and control outbreaks of rare and highly dangerous infectious diseases. However, testing vaccines against these diseases is very difficult, as the outbreaks are unpredictable and often short-lived. The VEEPED project will use mathematical and statistical models to design vaccine trials against these highly virulent pathogens and suggest how these vaccines might best be used to control these outbreaks.”

Another aspect of the work will look at human and sociopolitical perspectives on vaccines and outbreaks – including political and economic factors, health system perspectives, and community perceptions and experiences of vaccination. All these factors can affect whether vaccines are able to be used effectively in emergency situations. The team will use anthropological approaches to explore these factors and their influence on vaccine deployment in five countries.

Dr Shelley Lees, lead researcher at LSHTM, said: “It's crucial to understand how different communities respond to vaccine programmes - for example, not all communities have positive relationships with national and international organisations that distribute vaccines, and these tensions can be made worse in an emergency situation. Drawing on stakeholder and community views we can study political, economic, and health system perceptions and dynamics to identify barriers and facilitators to the future deployment and administration of vaccines during epidemics. This will ensure that vaccine deployment strategies are acceptable to different communities.”

The final strand of work involves effective data collection in epidemics and outbreak response. Dr Chrissy h Roberts and the EDK team have been using tablets and an app called ‘Open Data Kit’ to collect data for research studies.

This new funding will allow them to explore developing ‘Open Data Kit’ and other electronic tools for use in outbreak emergency situations, allowing the emergency response to collect and use data to make decisions during an epidemic.

Alongside the start of this research the EDK team have also been providing support to the current Ebola outbreak in the Democratic Republic of the Congo. The research team are working with the Ministry of Health and the World Health Organization in undertaking data collection about the vaccination activities around the outbreak. The team have already deployed new tools to collect data on around 30,000 vaccinations that have taken place so far in the response.

Funding for the project is delivered through the NIHR Policy Research Programme through UK aid from the Department of Health and Social Care (DHSC). The research was recommended by the UK Vaccine Network, chaired by Professor Chris Whitty, Chief Scientific Adviser to DHSC, following the 2014-2016 Ebola outbreak.

The UK Vaccine Network supports research to help LMICs prepare to use vaccines to prevent and respond to future infectious disease outbreaks.