NIHR Global Health Research Group on Gastrointestinal Infections: Facilitating the Introduction and Evaluation of Vaccines for Enteric Diseases in Children in Eastern and Southern sub-Saharan Africa

Gastrointestinal infections are responsible for over 500,000 deaths annually in children under age five years; the highest mortality rates occur in sub-Saharan Africa. While diarrhoeal deaths have fallen over the past two decades, morbidity remains high. Moreover, improvements in diarrhoeal mortality have not been uniform between and within countries; populations with high rates of malnutrition, poor sanitary conditions and reduced access to healthcare suffer the greatest burden. Enteric vaccines comprise a critical public health tool to reduce the burden of gastrointestinal infections, but applied health research is required to enable equitable population benefit. Work undertaken by the University of Liverpool in partnership with the Malawi College of Medicine and Ministry of Health informed a recommendation by WHO to introduce a vaccine against rotavirus diarrhoea in childhood immunisation programmes across Africa. The roll-out of rotavirus vaccination has reduced diarrhoeal illness and deaths in African children, but in some populations vaccination does not work well, and vaccination is received late or not at all. Vaccines against other enteric infections, including Shigella and Enterotoxigenic E Coli, are urgently needed and multiple candidates are in clinical development. The Global Health Research Group in Gastrointestinal Infections will apply world-leading, multidisciplinary gastrointestinal infection and vaccine research to build capacity and improve health outcomes from childhood diarrhoea in Eastern and Southern Africa. In response to clinical and health needs identified by Ministries of Health and local communities, we will extend our work on rotavirus to include other key, vaccine-preventable enteric infections. We will extend the geographic scope of our work by forging new partnerships in Kenya and Ethiopia, where the burden of diarrhoea is high and research capacity is limited. We will address inequalities in diarrhoea burden by bringing together expertise in social science, mathematical modelling, statistics, epidemiology, health economics and policy with excellent laboratory science to maximise the benefit of enteric vaccines for all children. in Malawi, Kenya and Ethiopia, we will (i) develop sustained engagement with communities and key stakeholders to provide greater national and regional visibility of gastrointestinal infection research; (ii) estimate the clinical and cost burden of vaccine-preventable gastrointestinal infections (rotavirus, Shigella, ETEC) presenting to health facilities, and examine the impact of COVID-19 on disease presentation; (iii) model the clinical impact and cost-effectiveness of vaccination; (iv) create sustainable systems to measure the burden of gastrointestinal infections and the outcomes of vaccine interventions to inform policy decisions; and (v) develop research capacity by training postgraduate (Masters) students and Postdoctoral Fellows in gastrointestinal infection research, leveraging additional support through existing PhD programmes run by the partner organisations. Through close links with Ministries of Health and ongoing community engagement, we will ensure our research is translated into policy for population benefit. Development of a cohort of gastrointestinal infection researchers will sustain this work in the years ahead, helping to reduce the burden of vaccine-preventable diarrhoeal diseases among children in sub-Saharan Africa.