Vaccines work well, but they do not work equally well for everyone in Africa. This research group, VAnguard, will investigate why some communities in Uganda and Kenya get less protection from vaccines than others. The problem is that structural factors—such as poverty, malnutrition, parasite infections, and social marginalisation—can weaken vaccine responses or prevent people from getting vaccinated at all. This leaves pockets of unprotected people, which fuels disease outbreaks and widens health inequities. Current vaccine programmes often overlook these interacting biological and social barriers. If successful, VAnguard will produce integrated strategies to boost vaccine impact for vulnerable communities. These could include combining vaccination with deworming or nutritional support, or redesigning community engagement to overcome hesitancy. The project will also train a new generation of African vaccine researchers, strengthening local capacity to tackle future outbreaks. The ultimate goal is to make vaccination programmes more equitable and effective, reducing the risk of recurrent epidemics in East Africa.
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Vaccines are extremely effective public health interventions. COVID-19 and recent Ebola outbreaks have brought this to public and political attention. But not everyone benefits equally. Structural factors (social, biological, geographical, political circumstances that determine the benefits of vaccination) render some communities vulnerable, unable to secure optimal health benefits from vaccination programmes. This both drives health inequity and undermines wider vaccine impact by allowing persistence of non-immune communities as foci for recurrent disease outbreaks. Our goal is to identify modifiable structural, social and biological determinants of impaired vaccine impact in vulnerable African communities, and hence to develop integrated strategies to address them and to drive health equity. VAnguard brings together East African leaders in vaccine research, implementation and community engagement, with UK experts in vaccine biology and the social anthropology of vaccine hesitancy. Our specific objectives are, in Uganda and Kenya, to 1. Investigate biological drivers and mechanisms of population differences in vaccine response 2. Understand how structural, social and biological determinants of vaccine response interrelate to determine vaccine impact 3. Identify and model integrated strategies to inform development of future interventions to optimise vaccine impact among vulnerable populations We shall work with national stakeholders to explore vaccine uptake and effects of the COVID-19 pandemic on unrelated vaccine programmes, and identify and engage with communities with (i) poor vaccine uptake and/or (ii) high prevalence of hypothesised biological determinants of poor vaccine impact, such as parasite infection or malnutrition. We shall review literature; we shall use data and samples from our current trials in Uganda (on effects of infection exposure) and Kenya (on nutritional exposure) to identify biomarkers (microbial, nutritional, immunological) indicative of vulnerability to poor vaccine impact. In consultative meetings, initial findings will inform co-design of a community-based VAnguard study. We shall use mixed methods, community engagement and analysis of biological samples to further address objectives 1 & 2. A comprehensive analysis, modelling of possible interventions, and iterative stakeholder & community engagement, will inform co-creation of strategies to optimise vaccine impact for vulnerable communities (objective 3), for testing in future studies. Multidisciplinary teams with members from each country, comprising experts and trainees in biological and social science and community engagement, and working with communities and implementation stakeholders, will generate a sustainable, collaborative research culture and facilitate sustainable pathways to research impact. Senior co-applicants will support early (2) & mid-career (2) scientists to lead thematic and study management work packages and co-supervise PhD students (3); cross-cutting leadership, research and research-management training, and vaccinology and modelling training modules, will support personal and institutional capacity strengthening for vaccinology in Africa. Outcomes will be (1) new knowledge on interacting structural, social & biological factors that determine vaccine impact, (2) new strategies for optimising vaccine impact for vulnerable communities & (3) strengthened capacity for multidisciplinary, impactful vaccine research in Africa.
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