Every year, more than 2 million people die from lower respiratory infections, most of them in sub-Saharan Africa, and antibiotic resistance makes these infections harder to treat. This project tackles that dual threat by testing whether a combination of vaccines and non-vaccine measures—such as better diagnostics and behaviour change—can prevent infections before they start, reducing the need for antibiotics and slowing the rise of drug-resistant bacteria. The researchers will work across Kenya, Malawi, Ghana, and Nigeria to identify which respiratory pathogens cause the most harm, co-design interventions with local communities, model their impact, and evaluate immune markers that could signal protection. If successful, the work could shift public health strategy from treating resistant infections to preventing the syndromes—pneumonia, fever, sepsis—that drive antibiotic use. It would also strengthen Africa-led research capacity, improve field diagnostics for surveillance, and produce evidence that policymakers can use to prioritise vaccines and other tools. The project builds directly on previous NIHR-funded partnerships and aims to deliver open-access protocols and training in whole-genome sequencing within four years.
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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.
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