Annual Report 2015
Research on Vectors, Environment and Society
TDR/VES/16.1
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Table of contents
1. Introduction ...... 4 2. Overall objectives and expected results ...... 5 3. Key achievements ...... 6 4. Progress in 2015 and planned activities for 2016 ...... 7 5. Workstream: social and community dynamics ...... 13 Expected result 1.3.1: Evidence for improved community access to health interventions in Africa ...... 13 Expected Result 1.3.2: Evidence to strengthen vector‐borne disease control in dengue and Chagas disease control through innovative ecosystem management and community‐ directed interventions in Latin America ...... 14 Expected Result 1.3.4: Improved urban vector control methodologies for dengue prevention and control in three countries of Latin America and the Caribbean ...... 15 Expected Result 1.3.5: Evidence on the utility of social entrepreneurship for the prevention and control of infectious diseases of poverty ...... 16 6. Workstream on environmental changes ...... 17 Expected Result 1.3.3: Evidence on the effects of climate and environmental changes on vectors and vector‐borne diseases; decision‐support processes and tools for health impact assessment ...... 17 7. Workstream on emerging challenges ...... 23 Expected Result 1.3.6: Assessment of insecticide resistance mechanisms in malaria vectors and their impact on control failure in Africa, Asia and Latin America...... 23 8. Workstream on gender equity ...... 27 Strategic Development Funds SDFV1. Improving the careers of women research scientists in infectious diseases of poverty (TDR‐wide activity, 2014‐2015)...... 27 Strategic Development Funds SDFV6. Development of a training course for capacity building on gender‐based analysis in vector‐borne disease research using an innovative global classroom approach ...... 30 9. Proposed new activities and expected results for 2016‐2017 and forward ...... 31 Environmental change and vector‐borne diseases ...... 31 Emerging challenges in the prevention and control of vector‐borne diseases ...... 31 Community and social dynamics ...... 31 Gender equity and vector‐borne diseases ...... 32 10. 2014‐15 financial implementation ...... 33 11. 2016‐17 revised planned costs ...... 34 12. TDR funding in 2015 ...... 36 Annex 1 ...... 37 Addressing comments and suggestions from first SWG (February 2015) ...... 37 Comments and discussion from second SWG (October 2015) ...... 38
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1. Introduction
The Vectors, Environment and Society (VES) Unit was created within TDR in 2011 to specifically address cross‐cutting issues across diseases and sectors focusing on vector‐borne diseases and vector control interventions at the interface of the natural and human environment. The unit develops and evaluates innovative and improved vector control strategies in the context of climate and environmental change, and explores optimal ways to engage with different types of communities to scale up tools and strategies for the prevention of major vector‐borne and other poverty‐related diseases (Figure 1). This includes vector ecology and biology, vector control technologies, community‐based interventions, as well as environmental and climate change.
Figure 1. Results chain for research on vectors, environment and society.
VES objectives and activities were re‐organized in 2014, in part to address the new United Nations Sustainable Development Goals (SDGs) that began 1 January, 2016. The VES structure reflects the change from the former Millennium Development Goals of specific diseases to the new SDGs where health is an integral dimension across the goals. The unit takes into account the multi‐faceted dynamics of economic, social and environmental determinants of health. Consequently, research is not restricted to vector control or community participation or preventive chemotherapy, but developed more holistically in the context of diseases transmitted by vectors.
VES expected results are organized into four main workstreams where each stream has strong links with the others and the projects are interdependent (Figure 2). These streams were developed following JCB, STAC and scientific review committees recommendations, after wide consultation with WHO partners such as Global Malaria Programme, Neglected Tropical Diseases Department, Public Health and
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Environment and the Regional offices in the Americas, Africa, Southeast Asia and the Western Pacific. Additional input came from a TDR Forum with stakeholders from public and private, national and international institutions, and discussions with WHO and external partners, experts, stakeholders, funders and country representatives.
Figure 2. Main workstreams of the VES activities
This report covers the VES activities and achievements during 2014‐2015 and the proposals for the next 2016‐2017 biennium. Within each workstream, the expected results, funding and progress are presented in the Progress section, both in the summary Table 2 and by narrative.
The recommendations of the first VES Scientific Working Group (SWG) are also presented in a table and addressed point by point.
2. Overall objectives and expected results
The objectives for the 2014‐2015 biennium: Enhance access to control interventions through community engagement for the prevention of major vector‐borne diseases and other poverty related diseases in Africa. Design and implement community‐based ecosystem management and environmentally friendly vector control interventions for the prevention of dengue and Chagas disease. Undertake interdisciplinary research towards the understanding, prevention and mitigation of the impact of climate and environmental change on vectors and vector‐borne diseases. Assess the implementation and scale‐up of community‐based dengue vector control interventions in urban agglomerations of Latin America and the Caribbean, transitioning to a more global approach of urban health and urban vector‐borne diseases. Demonstrate and substantiate the utility of applying the concept and principles of social innovation to the control infectious diseases of poverty, to enhance access to health products and health interventions. Assess insecticide resistance mechanisms in malaria vectors and their impact on control failure in Africa, and explore the burden and causes of residual malaria in areas where all control measures are well established.
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The outcomes of the 2014‐2015 expected results are listed in Table 1 in the chapter on progress.
The new activities developed with Strategic Development Funds (SDF) during 2014‐2015 are: SDFV.1. Improving the careers of women research scientists in infectious diseases of poverty (TDR‐ wide activity). SDFV.2. Implementation of a regional network on surveillance, diagnostic and vector control of vector‐borne emerging diseases in the Caribbean region. SDFV.3. Laying the groundwork for the establishment of a new research initiative on environmental health services for the prevention and control of vector‐borne diseases in the Southeast Asian and Western Pacific regions. SDFV.4. Development of an online platform to increase the visibility of learning courses on vectors and Vector‐Borne Diseases (VBD) for low‐ and middle‐income countries. SDFV.5. Selection of a consortium of institutions for the organization of a workshop and commissioned reviews to develop an international network on surveillance of insecticide resistance and alternative methods of vector control for vectors of emerging arboviruses.
3. Key achievements
Evidence generation, knowledge management, policy‐making and scale‐up of community‐ based vector control for dengue and Chagas disease advanced in Latin America A special issue (Vol 109, No 2, February 2015) of the Transactions of the Royal Society of Tropical Medicine and Hygiene was dedicated to the research effort “Innovative community‐based vector control interventions for improved dengue and Chagas disease prevention in Latin America”. Results were taken forward in large implementation research projects in Brazil, Colombia, Mexico and Uruguay scaling the interventions at city level, with funding from government and other sector and implemented through multi‐stakeholder support and partnerships.
Publication of Biosafety for human health and the environment in the context of the potential use of genetically modified mosquitoes This manual is based on a series of biosafety courses on genetically modified mosquitoes that were held in Africa, Asia and Latin America. They were developed to create a pool of regional scientists well trained in the assessment and management of biosafety related to the implementation of genetically modified vectors for the control of vector‐borne diseases such as malaria and dengue.
An intersectoral, transdisciplinary and multi‐stakeholder ‘Community of Practice’ established within the Climate Change initiative is actively engaged through the knowledge‐sharing platform on vector‐borne diseases: VBD‐environment.org.
Web‐based training materials and tools developed for accessing and analysing relevant climate and environmental data derived from remotely‐sensed data through the IRI Climate and Health Map and NASA SERVIR platform. These include: a) precipitation; maximum and minimum temperatures (ENACTS); b) precipitation for Africa CHIRPS (FEWS Net) daily data set from 1981 at 5km spatial resolution; c) temperature MODIS LST at 1km spatial resolution for night/day; d) MODIS data set at 250m; d) LANDSAT images at 30m. These data sets are available for access, visualization, analysis and download by the climate change research teams through the IRI Data Library: http://iridl.ldeo.columbia.edu/maproom
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4. Progress in 2015 and planned activities for 2016
The following expected results table provides an overview of the top level structure as revised in 2014 and updates on meeting targets. Projects by workstream are in Table 2. A narrative follows.
Table 1. Expected results – Research on vectors, environment and society
Expected results by outcome Indicators and targets
Outcome 1.3 (Research on Vectors, Environment and By 2017, 75% of the innovative knowledge, Society): Evidence‐based policies and practices on access to new/improved solutions or implementation interventions, community‐based vector control, climate and strategies developed are successfully applied in environmental change impact on vector‐borne diseases developing countries adopted and used by countries
1.3.1. Evidence for improved community access to health By 2015, 8 studies published on the uptake of interventions in Africa community‐directed interventions approach Progress: 23 studies published
1.3.2. Evidence to strengthen vector‐borne disease control in By 2014, 8 studies completed and disseminated dengue and Chagas disease control through innovative Progress: 16 studies published ecosystem management and community‐directed interventions in Latin America
1.3.3. Evidence on the effects of climate and environmental By 2015, situation analyses completed in five changes on vectors and vector‐borne diseases; settings decision‐support processes and tools for health impact Progress: Reports on the situation analysis in 7 assessment countries available. Launch of a web‐platform for knowledge‐sharing with 10 studies published.
1.3.4. Improved urban vector control methodologies for By 2015, research evidence provided for the scaling dengue prevention and control in three countries of up of community‐based interventions Latin America and the Caribbean Progress: Scaling‐up of dengue vector control strategies adopted in 4 countries and supported by national control programmes
1.3.5. Evidence on the utility of social entrepreneurship for By 2015, concept developed, landscape analysis the prevention and control of infectious diseases of conducted and case studies compiled poverty Progress: Landscape analysis performed. 25 case studies selected and on‐going.
1.3.6. Assessment of insecticide resistance mechanisms in By 2015, link established between vector resistance malaria vectors and their impact on control failure in to insecticides and malaria control failure in Africa, Africa, Asia, Latin‐America* Asia*, Latin‐America* Progress: Data for insecticide resistance compiled and analysed and study sites selected. 5 research projects on residual malaria selected.
this output and its corresponding target are part of the US$ 60 million budget scenario
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Table 2. Summary of project results by workstream
Workstream Expected results (2014‐2015) Progress and indicators
SOCIAL AND Expected Result 1.3.1: Evidence for improved community access to health COMMUNITY interventions in Africa DYNAMICS Outputs: Research reports, publications and strategies to strengthen primary health By 2015, 6 studies published care, focusing on fever management of severe childhood illnesses in Community research on implementation of HMM+ strategy for enhanced peripheral settings. Primary Health Care in child care in Burkina Faso, Nigeria and Uganda completed, data analysis advanced and special journal issue on the subject in preparation, for publication in early 2016. Review and assessment of incentives for motivation and retention of By 2014, 6 reviews/studies published Community Health Workers (CHWs), including testing of innovative and Realist review completed and published in online manual on community sustainable options. health workers. Multi‐country research (in DR Congo, Ghana, Senegal and Uganda) completed and presented at Global Symposium for Health Systems Research in 2014. Testing of the public health benefit of a treatment package for integrated By 2015, 3 country studies published Community Case Management (iCCM) of malaria and pneumonia, focusing Two studies (Ghana, Uganda) published in 2012, publication on on mortality. Burkina Faso being prepared. The three TDR studies were featured in 2014 as the only RCTs in a major evidence review symposium on iCCM. Meta‐analysis of data from three RCTs under way Knowledge generation and management on community‐based By 2014, 8 systematic reviews on community‐based interventions (CBI) for interventions the prevention and control of infectious diseases of poverty published. These were published as a highly accessed special issue in Diseases of Poverty in 2014. Publication on CBI in Int Quarterly of Community Health Education (2015, Vol 35 (4): 295‐316 Expected Result 1.3.2: Evidence to strengthen vector‐borne disease control in dengue and Chagas disease control through innovative ecosystem management and community‐directed interventions in Latin America
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Workstream Expected results (2014‐2015) Progress and indicators
Outputs: Cross‐disciplinary research framework for eco‐bio‐social (EBS) studies and By 2014, EBS framework developed in Latin America toolkit for EBS research Research framework developed and applied in research initiative in Latin America and the Caribbean. Published in BMC Infectious Diseases (2014). Evidence for EBS approach to strengthen vector‐borne disease control By 2014, 15 studies completed and published Fifteen studies completed and published through special issues of scientific journals: Six dengue studies in Asia (India, Indonesia, Myanmar, Philippines, Sri Lanka and Thailand) completed in 2012 and published between 2010 and 2013; eight studies in Latin America and the Caribbean (Brazil, Colombia, Ecuador, Mexico and Uruguay for dengue studies and Bolivia, Guatemala and Mexico for Chagas disease studies) completed in January 2014 and published in a special issue of Transactions of the Royal Society for Tropical Medicine and Hygiene (Vol 109, No. 2, February 2015). Expected Result 1.3.4: Improved urban vector control methodologies for By 2014, scaling‐up of dengue vector control developed in 4 Latin America dengue prevention and control in three countries of Latin America and the countries Caribbean Urban health approach developed Uptake and scale‐up ongoing in Brazil, Colombia, Mexico and Uruguay, with expected completion of research in 2016. Systematic reviews and research gap analysis outlined and prepared for 2016 Outputs: Implementation research on productive dengue vector breeding sites and By 2015, 4 country studies completed targeted interventions Dengue vector densities reduced to lower levels (measured through pupae indices in intervention and control areas). Study portfolio delayed, to be completed during 2016. Expected Result 1.3.5: Evidence on the utility of social entrepreneurship By 2017, the application of social entrepreneurship for the prevention and for the prevention and control of infectious diseases of poverty control of infectious diseases of poverty shown effective and useful Initiative on social innovation in health established in collaboration with academic institutions (Oxford University, Cape Town University). http:healthinnovationproject.org
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Workstream Expected results (2014‐2015) Progress and indicators
Outputs: Landscape analysis of: i) existing social entrepreneurship initiatives for the By 2015, publication of a web‐based report prevention and control of infectious diseases of poverty; ii) their success, Landscape analysis completed challenges, and lessons learnt; and iii) overall social entrepreneurship Landscape analysis of social innovation in the United Nations system stakeholder environment commissioned Major publication on social innovation in health care delivery planned for 2016 Concept paper and public health based framework related to the By 2016, publication of report and peer reviewed journal articles application of social entrepreneurship to the prevention and control of Case study research under way. infectious diseases of poverty Forum for social entrepreneurship on infectious diseases of poverty By 2015, Forum held successfully launched Major forum held December 2‐4, 2015, in Annecy and at WHO, Geneva. ENVIRONMENTAL Expected result 1.3.3: Evidence on the effects of climate and By 2017, 10 countries adopted the methods and tools developed CHANGES environmental changes on vectors and vector‐borne diseases; decision‐ support processes and tools for health impact assessment Outputs: Complex social‐ecological conditions of water systems in African drylands By 2014, research evidence provided identified and characterized for their potential impact for VBDs; VBD risks The 5 research projects are ongoing in 7 African countries (Botswana, Côte assessed under various exposure conditions and vulnerability context; d’Ivoire, Kenya, Mauritania, South Africa, Tanzania and Zimbabwe) about knowledge and scientific evidence generated about the impact of climate malaria, schistosomiasis, HAT and RVF. change on health. Decision‐support processes and tools for health impact assessment By 2015, processes and tools developed Evidence and knowledge to inform the development of decision‐support process and tools for health impact assessment are currently being generated. Capacity and network built for better management of climate and By 2015, a community of practice established environmental related risks A web‐based knowledge‐sharing platform, VBD‐environment.org, was Launched in July 2015.
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Workstream Expected results (2014‐2015) Progress and indicators
SDFV3 (new): Laying the groundwork for the establishment of a new research initiative on environmental health services for the prevention and control of vector‐borne diseases in the Southeast Asian and Western Pacific regions. Outputs: Consultation meeting Held in August 2015. Expert Panel meeting By first quarter of 2016, the expert panel will meet. EMERGING Expected Result 1.3.6: Assessment of insecticide resistance mechanisms in By 2017, recommendations and policies for better implementation of CHALLENGES malaria vectors and their impact on control failure in Africa, Asia, Latin‐ malaria control trough LLINs and IRS taking into account insecticide America* resistance evolution. Outputs: New scientific information on insecticide resistance mechanisms By 2017, publication of the study results in a peer review journal. generated to fill critical knowledge gap Insecticide resistance mechanisms characterized for the insecticides used for indoor residual spraying (IRS) of insecticide and insecticide treated‐nets (ITNs) in the main malaria vectors will be published by 2017. Link between insecticide resistance mechanisms and malaria control By 2017, publication in peer review journal. failure estimated New scientific information on burden and entomological, as well as social By 2017, publication in peer review journal, policies and recommendations causes of residual malaria available adapted. SDFV.2: Implementation of a regional network on surveillance, diagnostic By 2016, establishment of a network for surveillance and diagnostics of and vector control of vector‐borne emerging diseases in the Caribbean emerging diseases in the Caribbean region. region.
This output and its corresponding target are part of the US$ 60 million budget scenario.
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Workstream Expected results (2014‐2015) Progress and indicators
Outputs: Organization of 2 workshops By 2016, 2 workshops organized. 1 workshop organized in 2015. Publication of proceedings By 2016, proceedings of both workshops published. SDFV4: Development of an online platform to increase the visibility of learning courses on vectors and vector‐borne diseases for low‐ and middle‐income countries. Outputs: Mapping of the courses on vectors and vector‐borne diseases By 2016,mapping available and published. Organization of a workshop By 2016, 1 workshop organized, proceedings published and organization of the platform. SDFV5: Selection of a consortium of institutions for the organization of a workshop and commissioned reviews to develop an international network on surveillance of insecticide resistance and alternative methods of vector control for vectors of emerging arborviruses. Outputs: Commissioned reviews By 2017, publication of commissioned reviews in a peer reviewed journal. Organization of a workshop By 2016, workshop organized, proceedings published and network in activity. GENDER EQUITY SDFV1: Improving the careers of women research scientists in infectious By 2016, 9 case studies on how the careers of women scientists can be diseases of poverty (TDR‐wide activity). improved. Outputs: Research reports, publications and strategies to improve the careers of Report with cross‐site analysis on activity portfolio of 9 sites throughout women scientists Africa being published on the TDR website. SDFV6: Development of a training course for capacity building on gender‐ By 2016, training course on gender‐based analysis developed. based analysis in vector‐borne disease research using an innovative global classroom approach Output: Training course on gender‐based analysis By 2016, training course on gender‐based analysis pilot‐tested and evaluated for feasibility of implementation.
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5. Workstream: social and community dynamics
Expected result 1.3.1: Evidence for improved community access to health interventions in Africa
This expected result has 4 activities.
1. Research portfolio to strengthen primary health care through better‐informed community‐based management of uncomplicated and severe fevers. Context and rationale Community‐based diagnosis and treatment is anticipated to reduce the time to diagnosis (malaria or not) and treatment, reduce the length of time a malaria‐positive child is febrile and infective (and hence reduce transmission), and in the case of patients who have progressed to severe malaria, reduce the time to treatment and referral.
Progress in 2015 Four studies in Nigeria, Malawi, Uganda and Burkina Faso completed an assessment of the implementation process (successes and weaknesses) and feasibility of the community‐based intervention (CBI) process for strengthening primary health care in rural areas of Africa. They focused on prevention, diagnosis, treatment and referral of severe childhood illnesses associated with fever, and measured time and private costs of management of malaria before the intervention and the feasibility (training, supervision, time allocation, referral compliance and coverage) of the intervention. The intervention involved community provision of rapid diagnosis and oral treatment for uncomplicated malaria with artemisinin‐combination treatment (ACTs) and assessment and treatment of suspected severe malaria with rectal artesunate.
Data analysis was advanced at a workshop hosted at the Uganda Ministry of Health. Initial results indicate that community‐case management of children under 5 years with malaria, with community health worker training on rapid diagnostic tests (RDTs), with treatment of ACT for uncomplicated cases and rectal artesunate for severe cases, are resulting in a significant decrease in child mortality and number of severe cases.
Plans for 2016 The results will be published as a special issue of The Journal of Infectious Diseases (Oxford University Press). Additional technical and funding support for three countries (Burkina Faso, Nigeria and Uganda) for translational research in programme implementation will be provided by TDR.
2. Evidence on incentives for community health workers Context and rationale A review and assessment of incentives for motivation and retention of community health workers (CHWs), including testing of innovative and sustainable options, was completed in 2014.
Progress in 2015 Publication of Using a human resource management approach to support community health workers: experiences from five African countries on the multi‐country study was published 1 September, 2015 in the journal Human Resources for Health, authors Joanna Raven, Patricia Akweongo, Amuda Baba, Sebastian Olikira Baine, Mohamadou Guelaye Sall, Stephen Buzuzi and Tim Martineau. Like any other
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health worker, community health workers (CHWs) need to be supported to ensure that they are able to contribute effectively to health programmes.
3. Integrated Community Case Management (iCCM) strategy of malaria and pneumonia Context and rationale This TDR research portfolio tested the public health benefit of a treatment package for iCCM of malaria and pneumonia, focusing on the potential effect on the reduction of overall and childhood mortality. Three randomized control trials (RCTs) in Burkina Faso, Ghana and Uganda, were carried out between 2008 and 2012 and have already resulted in several publications reported in previous annual reports, including a major evidence review symposium on iCCM, led by UNICEF, in Accra, Ghana, in March 2014.
Progress in 2015 The study in Burkina Faso benefitted from additional technical support provided by TDR, notably on statistics, and advancing a publishable single‐site report. Meta‐analysis of data from the three RCTs was conducted during a workshop held at TDR in September 2015.
Plans for 2016 Single‐site publication on iCCM for Burkina Faso and meta‐analysis of data.
4. Knowledge generation and management Context and rationale This area, which met its targets in 2015, has provided evidence on community‐based interventions. A themed series of 8 systematic reviews was earlier published (and noted in previous annual reports) in the journal Infectious Diseases of Poverty. They reported findings for the effectiveness of community‐ based interventions for the prevention and control of helminthic NTDs, non‐helminthic NTDs, malaria, HIV/AIDS and tuberculosis and proposed a way forward.
Progress in 2015 A review of insights from an earlier formative research portfolio on Community‐Directed Interventions (CDI) was developed and published (Brieger, W.R., Sommerfeld, J., Amazigo, U.V. 2015. The Potential for Community‐Directed Interventions: Reaching Underserved Populations in Africa. International Quarterly of Community Health Education 2015, 35 (4): 295‐316.
Expected Result 1.3.2: Evidence to strengthen vector‐borne disease control in dengue and Chagas disease control through innovative ecosystem management and community‐directed interventions in Latin America
Context and rationale “Towards improved Chagas and dengue disease control through Innovative Ecosystem Management and Community‐Directed Interventions: An Eco‐bio‐social research programme on Chagas and Dengue Disease Control in Latin America and the Caribbean” is a five‐year research and capacity building programme in partnership with Canada’s International Development Research Centre (IDRC). It involves eight research studies carried out between 2008 and 2013 in seven countries of Latin America (Bolivia, Brazil, Colombia, Ecuador, Guatemala, Mexico, Uruguay).
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The study completed in 2014 showed significantly reduced vector densities compared to the routine programmes, notably in Mexico, Colombia and Brazil, but also in Uruguay and Ecuador. The EcoHealth approach applied across all study areas appeared to be a novel and innovative approach. Policy‐makers and practitioners were actively involved in the research initiative and committed to scaling up the interventions at city levels.
Progress in 2015 The results were published in a special issue of Transactions of the Royal Society for Tropical Medicine and Hygiene (Vol 109, No. 2, February 2015).
Expected Result 1.3.4: Improved urban vector control methodologies for dengue prevention and control in three countries of Latin America and the Caribbean
Context and rationale The overall objective of this research activity is to test novel locally tailored and ecosystem‐specific tools of dengue vector management applied to extensive urban areas for their ability to reduce dengue morbidity and mortality in the community as well as for cost‐effectiveness and feasibility. Cluster randomized controlled trials were conducted in three Latin American cities ‐ Fortaleza (Brazil), Acapulco (Mexico) and Girardot (Colombia) ‐ and in one city of Uruguay (Salto) to test the efficacy of a novel Aedes aegypti intervention package.
Progress in 2015 Intervention packages in each site were rolled out together with the national control programmes and local industry. In summary, the components are:
1. Window and door screens in a (usually) metallic frame to be developed and installed by local commercial enterprises or, alternatively, insecticide treated window curtains locally tailored by women cooperatives. The screens can be insecticide treated or –where levels of insecticide resistance are high‐ untreated. In Colombia additionally the washing water tanks (main vector producers) will be covered with similar devices (tested in phase 2 by Mexico and Colombia) 2. Targeted interventions in the most productive container types, which have been determined by pupal‐productivity surveys. In Brazil covering unprotected elevated water containers and waste disposal through community actions lead by control agents; in Mexico judicious and environmentally friendly use of biorational larvicides of targeted water containers in residential and public spaces i.e. catch basins and waste disposal through community actions lead by an intersectorial programme “Recycle for your commonwealth”; in Colombia covering the large wash basins (tested in Colombia, Mexico, Brazil in phase 2 studies). 3. Involvement of communities and other stakeholders applying the methodologies tested particularly in Brazil in phase 2 studies.
Plans for 2016 Finalization and dissemination of the four studies through a data analysis workshop in August 2016.
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Expected Result 1.3.5: Evidence on the utility of social entrepreneurship for the prevention and control of infectious diseases of poverty
Context and rationale Many new health technologies exist or are being developed through research and development, but a myriad of access issues hampers their delivery in resource‐poor settings. TDR’s current strategic focus on implementation research calls for innovative approaches to health care delivery and ensuring access to essential health products and services. Implementing prevention and control efforts against infectious diseases of poverty in such settings necessitates social innovation addressing the various social, cultural, economic and health systems‐related bottlenecks of health care delivery.
A landscape analysis of existing programmes and actors indicated that a great number of social enterprises and entrepreneurs exist, some of which are working in the area of infectious diseases prevention and control. There is a need for better understanding enabling and limiting factors in order to facilitate application and scale up of what works. Difficulties in measuring impact highlighted the need for more research on the subject.
TDR developed the Social Innovation in Health Initiative (SIHI, http://www.healthinnovationproject.org). Technical and financial support are provided to the collaboration of several partners: The Bertha Centre for Social Innovation and Entrepreneurship, located at the University of Cape Town’s Graduate School of Business, and the Skoll Centre for Social Entrepreneurship, housed within Oxford University’s Said Business School, bring a range of expertise on social innovation and entrepreneurship and lead the implementation of this initiative.
The research partnership has two main objectives: 1) Generate new knowledge on existing social innovations related to health care delivery in infectious diseases of poverty in Africa, Asia and Latin America through the following approach: i) Identification of social innovations in low‐resource settings which have been effective in improving health outcomes for infectious diseases of poverty; ii) case study research on the nature of the innovation, the inventor and the organizational structure delivering the innovation. 2) Build a global community of practice around the issue, to convene health actors and stakeholders to review the added value of social innovation in health and to design and implement specific capacity strengthening needs.
Progress in 2015 179 submissions of social innovation examples originating from 48 different countries were received. Following a review by an independent panel of experts and facilitated by a steering group, 25 nominations were shortlisted at the end of April 2015 as high potential solutions deserving further exploration and exposure. Case study research on the basis of data collection through site visits was conducted between May and September 2015, following an established case study framework.
Background research was carried out on the theoretical underpinnings of social innovation in health, evidence needs in scaling social innovations and capacity building needs and mechanisms. A meeting specifically on the institutional capacity building needs in academia was held early November 2015 at the University of Cape Town, South Africa.
A major stakeholder meeting convening experts (scholars, policy makers as well as innovators) in social innovation was held December 2‐4, 2015 at the Fondation Mérieux in Annecy, France, followed by a panel event at WHO, on December 4, 2016, with high‐level attendance of researchers and practitioners in social innovation, joined by high‐level WHO officials.
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Plans for 2016 The Social Innovation in Health Initiative is expected to expand enrolment of other partners and funding agencies into the partnership, pursue specific research activities such as monitoring and evaluation, offer targeted capacity strengthening services and provide feeder outputs in support of WHO’s Global Strategy on People‐Centred and Integrated Health Services.
6. Workstream on environmental changes
Expected Result 1.3.3: Evidence on the effects of climate and environmental changes on vectors and vector‐borne diseases; decision‐support processes and tools for health impact assessment
Context and rationale Vector‐borne diseases (VBDs) are a significant burden in dry‐land areas of sub‐Saharan Africa associated with water systems, a region which already suffers from poverty, food insecurity, ecological fragility and social vulnerability. Climate change is adding new pressure on these socio‐ecological systems, for which the impact in terms of VBD hazards, vulnerabilities and exposure are anticipated but poorly understood. The gap in knowledge about climate change and VBDs, and an even larger gap in policy options for addressing the situation, have been identified by African ministers of health and environment, as well as international technical experts. To address these gaps, this research initiative was established in 2012 to develop new knowledge, research capacity, collaboration and policy advice products to support African countries to build adaptation capacities to VBD risks under climate change conditions.
This research initiative (2012‐2016) entitled “Population health vulnerabilities to vector‐borne diseases: increasing resilience under climate change conditions in Africa” is implemented by TDR in collaboration with Canada’s International Development Research Centre (IDRC), the WHO Public Health and Environment (PHE) Department and WHO’s African Region Programme for the Protection of Human Environment (PHE). It has a goal of both research and building research capacity. Through a portfolio of five (5) projects, this initiative provides a holistic research perspective to elucidate how environmental and socio‐economic change affects transmission dynamics and disease burden of VBDs through changes in vector ecology, human ecology, social organization, demography and health systems. Vulnerability and resilience of specified socio‐ecological systems (SES) are being assessed based on multi‐ and transdisciplinary models and frameworks. In addition, social and health systems research are expected to illuminate and analyse community structures, dynamics and resilience, health systems performance and response to VBDs in the broader multisectoral stakeholder context.
The projects are led by researchers in Botswana, Cote d’Ivoire, Kenya, Mauritania, South Africa, Tanzania and Zimbabwe, and in collaboration with national disease control services. They are focused on addressing malaria, schistosomiasis, human African trypanosomiasis and Rift Valley fever. All projects are currently on‐track with: engagement with communities and stakeholders, preliminary activities for vulnerability assessment, activities to determine the temporal trends on the burden of VBDs, generation of preliminary climate and meteorological data and systematic characterization of the socio‐ecological system.
Progress in 2015 This progress update is focused on activities in support of two main programmatic objectives, i.e. generating knowledge and evidence and building capacity for interdisciplinary policy‐oriented research. Phase 1 (Assessment and characterization of complex socio‐ecological systems) and Phase 2 (Assessment of risks through investigation of threats from vector‐borne diseases under climate change
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conditions) have been completed by all teams. Scientific publications and 4 commissioned systematic reviews are currently being undertaken (see systematic review section below). Capacity building efforts were focused on the researchers, students and communities through workshops, technical support from experts/facilitators, the web‐based knowledge‐sharing platform, the online forum for data consultation, and site visits. Topics included ethics in research, gender mainstreaming, integrated data analysis, economics of adaptation and research uptake.
Programmatic objective 1. Generation of knowledge and evidence on the impact of vector‐ borne diseases under climate change conditions on vulnerable populations.
Brief technical updates from the projects
Project 1. Social, environmental and climate change impact of vector‐borne diseases in arid areas of Southern Africa (South Africa, Zimbabwe and Botswana). Data collection is on‐going to determine the temporal trends of the burden of malaria and schistosomiasis (including vector mosquitoes and intermediate snail hosts) and to determine the community perceptions of vector‐borne disease (VBDs) climate change. Participatory Rural Appraisal (PRA) workshops have been held in all project sites. Social data for livelihood and disease exposure analysis have been collected. Based on the information collected so far, study tools have been designed to measure vulnerability of communities to malaria and schistosomiasis in a systematic way.
Some progress has been made in determining the temporal trends of the burden of malaria and schistosomiasis and to establish the influence of socio‐economic, environmental, climatic and institutional factors on the transmission dynamics of malaria and schistosomiasis. A cross sectional parasitology survey and monthly snail surveys were conducted at the South African site. Another cross‐ sectional parasitology survey was also conducted at the Zimbabwe site. Field experimental work on snail aestivation had been ongoing for several together with laboratory studies using a colony of snails that had been established. Monthly entomological surveys had been conducted for several months.
A process was initiated to gather information on existing adaptation strategies in the three countries involved in this project as a background for understanding national plans for climate change related adaption. Preliminary results show that there is no definition of a moderate rainy season; only the two extremes are used to describe the rainy season. The relationship between malaria and the occurrence of rain is coming out clearly with communities indicating the possibility of predicting the occurrence of malaria using the observed indicators for rainfall.
Project 2. Early warning systems for improved human health and resilience to climate sensitive vector‐ borne diseases in Kenya. Malaria and Rift Valley Fever (RVF) are mosquito borne diseases with potential to cause morbidity, mortality and loss in productivity in humans and animals. In Baringo County, malaria is endemic while RVF, which is zoonotic, occurred for the first time in 2006‐2007. The study is being conducted within Baringo County in Central Rift Valley.
Preliminary findings on malaria control show that both communities rely heavily on government and relief‐distributed bed nets for vector control. Treatment of suspected malaria cases is done with both traditional and conventional medicines at home and health facilities, respectively. Malaria risk remains high due to limited use of mosquito nets, non‐adherence to malaria medication regimes and outdoor resting behaviour of community members during peak biting time for mosquitoes. On the other hand, for the risk of exposure to RVF, both communities largely depend on livestock for their livelihoods and the communities exhibit vulnerability based on their low level of awareness of the disease; consumption of meat from animals that die of diseases and unknown causes; cultural patterns of disposal of dead animals; close contact with both healthy and sickly livestock; and management of human febrile illnesses. Community practices increase their vulnerability to malaria and RVF. There is a need for
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targeted awareness creation on the occurrence, transmission and prevention of both diseases in order to increase resilience to human and livestock infections.
Project 3. Predicting vulnerability and improving resilience of the Maasai communities to vector‐borne infections: an EcoHealth approach in the Maasai Steppe ecosystem. This project seeks to understand how various environmental factors, including climate and land cover, influence current tsetse and trypanosomiasis distribution, and to use this knowledge together with future predictions of climate and land‐cover to predict where future hotspots of infection are likely to occur. The researchers are also working with local Maasai communities to understand their level of knowledge ad adaptation strategies both to the disease and to climate variability. The researchers have started developing downscaled climate models in collaboration with their partners at the University of Cape Town (UCT) and expect to have preliminary downscaled models, based on decadal data. The field teams have collected tsetse flies over two months. The social survey instruments for the study have been finalized for social data collections and community engagement.
The study found that there is good knowledge about tsetse flies and trypanosomiasis among the Maasai pastoralists of Simanjiro District. The danger of the disease could have been diluted by the availability of treatment drugs in the area such as insecticides and trypanocides. However, little is known about human African trypanosomiasis among the pastoral communities. For that reason, it is wise to integrate pastoralists’ knowledge in designing and implementing the intervention plans in the areas. The presence of animal trypanosomes was confirmed in the study area but there were no human‐infective trypanosomes. Abundance of tsetse flies as well as their infection with trypanosomes have been shown to be associated with anthropological activities. Distance to the Tarangire National park seemed to be a factor that determines abundance of tsetse flies. This study therefore points to the importance of strategic vector control regimes in livestock‐wildlife interface areas so as to reduce risk and transmission of both animal and human trypanosomiasis posed by wildlife.
Project 4. Human African trypanosomiasis: alleviating the effects of climate change through understanding human‐vector‐parasite interactions. The Tanzania sociology study is moving well ahead of schedule with the completion of the Knowledge Attitudes and Practice (KAP) survey. The simulation and theoretical studies have also been proceeding well. Major advances have been made in understanding the relationship between climate and tsetse population dynamics. There have been significant advances in obtaining meteorological data from both Zimbabwe and Tanzania. As part of the assessment of the vulnerability of marginalised populations, a sociological study was carried out in the neighbourhood of the Serengeti National Park (SNP) and, in particular, on the borders of game reserves which themselves border the SNP. These studies aim to estimate, inter alia, the perceived risk of human trypanosomiasis.
Estimates of risk are at an early stage and no meaningful data are yet available. Most of the remaining project activities were concerned with building an understanding of tsetse population dynamics – and, in particular, the way in which the population dynamics is affected, directly and indirectly, by meteorological variables, particularly temperature, saturation deficit and rainfall. Numbers of both tsetse and G.M.morsitans have declined, but the extent to which these changes in abundance are due to climate, as against other factors such as the abundance of hosts, are under investigation.
Significant progress had been made in the assessment of the risk of trypanosomiasis infection in Zimbabwe and Tanzania and ways of alleviating the risk, via the analysis of existing data (see Hargrove & Ackley, 2014 – under Publications), but at the same time, there are difficult challenges to be overcome in interpreting the data pertaining to the relationship between climate and tsetse mortality. These
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difficulties were discussed in a second draft paper (see Ackley, Hargrove & Liu, 2014 – under Publications) and some progress had been made in overcoming these challenges.
Project 5. Vulnerability and resilience to malaria and schistosomiasis in northern and southern fringes of the Sahelian belt. Using the EcoHealth approach, this research project aims to contribute to develop and/or improve, through a community participatory approach, the tools and appropriate coping strategies to alleviate the effects of climate change on the transmission of both diseases in the towns of Korhogo and Kaédi. This contribution requires a better understanding of the complex and interdependent interface that links the socio‐ecological, economic and health environment of the population. The analysis of this complexity is based on a systemic and transdisciplinary approach in each country that engages all project stakeholders, including communities, local leaders and decision makers. Population vulnerability is analysed from the environmental, socio‐economic and anthropological perspective.
Geographical surveys in Korhogo were conducted during the rainy season. Data were also collected on community perceptions of disease, behaviour on health seeking and access to health facilities. The mode of transmission of malaria and the symptoms of the disease are well known by the population in Korhogo. However, popular knowledge that attributes the main causes of malaria to exposure to the sun and rain and general fatigue still persists in the community.
The study has found a lack of knowledge on the etiology and symptomatology of schistosomiasis. Consequently, this has an influence on the control and treatment of the disease in the community. It appears that in the community, malaria is better known than bilharzia.
Studies were also conducted on socio‐economic vulnerability, vector‐borne disease transmission dynamics, VBD burden and vector ecology, investigations on malaria in the community, malacological surveys, climate/weather data linked with VBD data over time, and characterization of the social‐ ecological systems in time and space.
Commissioned systematic reviews One of the knowledge‐generation products that is expected from this research initiative is a series of commissioned systematic reviews/scientific synthesis on various cross‐thematic topics that are relevant to the research initiative and for possible publication (e.g. as WHO monographs). The first systematic review was commissioned for the period 18 March – 31 August 2014 (with a no cost extension until 30 September 2014). The topic of the evidence review was Climate change and vector‐borne diseases with a focus on interventions for adaptation and risk management. This review was undertaken by the Department of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine through Dr Jonathan Cox, Senior Lecturer & DrPH Programme Director. Upon receipt of the draft manuscript, it was sent for peer review to one of the SPT members, Dr Kris Ebi (Professor of Global Health, Department of Global Health, School of Medicine and Public Health, University of Washington, USA) and colleagues from WHO‐PHE (Dr Diarmid Campbell Lendrum and Ms Mariam Otmani del Barrio).
Another systematic review was commissioned for the period 25 March – 30 November 2015, to be undertaken by Dr Kevin Bardosh, Research Fellow, University of Edinburgh and University of Florida: The value, options and pathways for using community‐based adaptation strategies to reduce vulnerability to VBDs under climate change conditions in resource‐limited settings. Two additional systematic reviews were commissioned for the period 03 April – 31 August 2015. The topics for this review are: a) Health and climate change in dryland socioecological systems, and b) Health, biodiversity, traditional knowledge and climate change adaptation. These reviews are being undertaken by Dr Bruce Wilcox, a disease ecology expert based at Mahidol University, Bangkok, Thailand.
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Programmatic objective 2. Build capacity for inter‐disciplinary policy‐oriented research and stimulate critical thinking, cross‐collaboration and research networking
Capacity building workshops. The capacity building workshops are annual events for the TDR‐IDRC Research Initiative since the research projects were implemented in 2013. The 2015 workshop was organized as a back‐to‐back event with the Scientific Forum. Through oral and poster presentations, the Scientific Forum served as the venue to showcase and present progress of each of the research projects to a wider audience, outside of the network of researchers that are part of the research initiative.
Capacity building ‐ students. The initiative currently supports the training and capacity building of forty‐ nine students who are registered in either the Masters, Doctorate or Post‐doctoral Fellowship programmes in their respective universities.
Experts/facilitators. The Initiative is currently engaged with experts that span the wide range of expertise in the following areas: vulnerability assessment; VBD transmission dynamics, vector ecology and VBD burden; climate/weather data linked with VBD data over time and space; characterization of the socio‐ecological systems in time and space (includes gender‐based analysis and economics of adaptation); monitoring & evaluation, emerging scenarios for community‐based adaptations and resilience (research uptake); knowledge‐sharing platform; and communications strategy. The experts/facilitators interact formally with the research teams through the capacity building workshops and the data‐consultation forum. Other occasions for interaction are also possible through informal exchanges by online communications (by emails) as well as through the knowledge‐sharing platform, VBD‐environment.org.
Web‐based knowledge‐sharing platform. VBD‐environment.org, launched in July 2014, is the web‐based platform for sharing, learning and interacting via a shared repertoire of resources (e.g., tools, experiences, ways of addressing challenges, reports, etc.). Platform development activities included the following: development of a web‐based application; and hosting, administering, and maintenance support for the platform. The current version of the web‐based platform has a combined membership of 141 users composed of 6 Special Project Team (SPT) members (4%), 23 experts/facilitators (16%) and 112 researchers (80%). The knowledge‐sharing platform consists of both ‘public’ and ‘private’ spaces for sharing, engaging and interacting within the network. The public space consists of an About us section with pages for Background and Rationale, Research Teams, Facilitators and Partners. The private space contains several sections: Events, External Resources, Background Documents/Reports related to online processes Capacity Building Workshop resources (shared files for presentations and photographs).
Site visits. Visits to research study sites by the TDR Site Visit Team were completed in 2015 for the purpose of monitoring and assessment and to ensure that project implementation is on‐track.
Publications. Hargrove J and SF Ackley. 2015. Mortality estimates from ovarian age distribution of the tsetse fly Glossina pallidipes Austen samples in Zimbabwe suggest the need for new analytical approaches. Bulletin of Entomological Research. In press. Ackley SF, F Liu and JW Hargrove. 2015. A dynamic modelling technique for estimating adult female mortality from ovarian dissection data for the tsetse fly G. pallidipes Austen samples in Zimbabwe. PLoS NTD. In press. Vale G and S Torr. 2014. Surveillance and sampling of disease vectors. OIE Scientific and Technical Review, Vol 34 (1). Hargrove JW and MO Muzari. 2015. Artificial warthog burrows used to sample adult and immature tsetse (Glossina spp) in the Zambezi Valley of Zimbabwe. PLoS NTD in press.
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Hargrove JW and MO Muzari. 2015. Nutritional levels of pregnant and postpartum tsetse (G. pallidipes Austen) captured in artificial warthog burrows in the Zambezi Valley of Zimbabwe. Phys Entomology. In press. Kajunguri D, JW Hargrove, R Ouifki, JYT Mugisha, PG Coleman and SC Welburn. 2014. Modelling the use of insecticide‐treated cattle to control tsetse and Trypanosoma brucei rhodesiense in a multi‐ host population. Bulletin of the Mathematical Biology. 76:673‐696 Vale GA, JW Hargrove, P Solano, F Courtin, JB Rayaisse, MJ Lehane, J Esterhuizen, I Tirados and S Torr. 2014. Explaining the host‐finding behaviour of blood‐sucking insects: computerized simulation of the effects of habitat geometry on tsetse fly movement. PLoS NTD. 8(6): e2901. Vale GA, JW Hargrove, A Chamisa, IF Grant and SJ Torr. 2015. Pyrethroid treatment of cattle for tsetse control: reducing its impact on dung fauna. PLoS NTD. DOI:10.1371/journal.pntd.0003560. Vale GA, J Hargrove, M Lehane, P Solano and S Torr. 2015. Optimal strategies for controlling riverine tsetse flies using targets: a modelling study. PLoS NTD. In press. Torr SJ and GA Vale. 2015. Know your foe: lessons from the analysis of tsetse fly behaviour. Trends in Parasitology. 31(3):95. Shaw APM, I Tirados, C Mangwiro, J Esterhuizen, MJ Lehane, SJ Torr and V Kovacic. 2015. Costs of using ‘tiny targets’ to control Glossina fuscipes fuscipes, a vector of Gambiense sleeping sickness in Arua District of Uganda. Submitted for publication. Shaw APM, Wint GRW, Cecchi G, Torr SJ, Mattioli RC, Robinson TP . 2015. Mapping the benefit‐cost ratios of interventions against bovine trypanosomiasis in Eastern Africa. Manuscript in preparation.
Plans for 2016 In 2016, this programme’s activities will mainly involve the completion of implementation of the five research projects. Evidence on the impacts of changing VBD‐risks, environmental exposure and social vulnerabilities under climate change and associated health outcomes will be assessed and characterized amongst the communities that are part of this programme. Decision‐making and support processes and tools for health impact assessment (related to VBDs) of specific climate‐change adaptation interventions will be developed and evaluated among vulnerable populations and fragile ecosystems. Capacity and network among scientists and relevant stakeholders will be established including a cadre of young researchers from African countries.
Activities centred on research uptake (and implementation of a communications strategy contributing to research uptake) are also planned in 2016. This includes a planned Climate and Health Colloquium in New York with a pre‐Colloquium meeting of research team leaders to discuss research results, research uptake process, scientific publication preparation (special journal issue) and plans for research dissemination.
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Strategic Development Funds SDFV.3: Laying the groundwork for the establishment of a new VES research initiative on Environmental health services for the prevention and control of vector‐borne diseases in the Southeast Asian and Western Pacific regions.
Context and rationale The overall purpose of this SDF project is to lay the groundwork and preparations well in advance of the implementation of a new proposed research initiative on health and environment to be implemented in the Southeast Asian and Western Pacific regions. This project addresses the following objectives:
1. Identify the country‐specific needs and opportunities in the Southeast Asian and Western Pacific regions that are relevant to environmental public health (with special focus on VBDs); 2. Identify gaps and priority research areas that will inform the development of a call for proposals for the new research initiative; 3. Support the publication of a commissioned report on the linkage between health (VBDs in particular) and environment covering, but not limited to, the conceptual framework (principles and systems thinking), the scope, multi‐stakeholder participation (including communities), transdisciplinarity, social and economic interactions, equity, sustainability, and use of environment‐friendly and green technologies.
Progress in 2015 For the first objective, VES collaborated with ASEAN NDI (Association of South East Asian Nations Network for Drugs, Diagnostics, Vaccines and Traditional Medicines Innovation ‐ http://www.asean‐ndi.org/) to conduct the consultative workshop. This meeting was held as a pre‐conference workshop during the 2015 Global Forum in Manila, Philippines on 24‐27 August 2015.
Plans for 2016 Plans are underway to achieve Objective 2. An expert panel with diverse expertise and experience on VBDs and the environment will convene for a meeting during the first quarter of 2016. This expert panel will be tasked to consider the output from the consultative workshop as a basis for their discussions as they identify research gaps and prioritize research for the region. A draft call for proposal applications is an expected output from the expert meeting.
7. Workstream on emerging challenges
Expected Result 1.3.6: Assessment of insecticide resistance mechanisms in malaria vectors and their impact on control failure in Africa, Asia and Latin America.
Context and rationale Control of malaria vectors relies heavily on insecticide‐treated nets (ITNs) and indoor residual spraying (IRS). The success of these control methods is threatened by resistance of the malaria vectors to insecticides.
There are two activities in this expected result.
In the first study, the main goal is to assess the effect of insecticide resistance mechanism(s) on malaria vector control tools in Benin, Mali and Nigeria with different epidemiological settings using long‐lasting insecticide nets (LLINs) or indoor residual spraying (IRS). Existing data on insecticide resistance and
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detection of underline resistance mechanisms is being compiled from specific settings. Ownership and utilization of LLINs and IRS and community perceptions of their effectiveness are investigated followed with assessment of entomological and parasitological parameters in areas with and without insecticide resistance. Data to be generated from this study could inform control policy and improve knowledge on IRS/LLINs performances in areas where malaria vectors have developed different mechanisms of resistance to insecticides.
The second activity was developed in collaboration with the Global Malaria Programme of WHO. LLINs, IRS and Larval Source Management (LSM) are core supplementary interventions in malaria control and are highly efficacious against susceptible malaria vectors when implemented well. However, malaria transmission can persist even when LLINs and/or IRS are effectively implemented and malaria vectors are susceptible to the insecticides used. This may be due to a combination of vector and human behaviours/bionomics which compromise the deleterious effect of the control measures such as early and/or outdoor biting of mosquitoes, and human activity away from protected houses at peak biting times. From a geographical perspective, residual malaria has been reported across numerous transmission settings with several species implicated, such as Anopheles arabiensis in Africa, Anopheles dirus in Asia, Anopheles albimanus and Anopheles darlingi in the Americas. Much of the current knowledge on vector biology and malaria transmission has been obtained through small‐scale studies in few countries and often at single sites and time points, despite the potential for spatial and temporal variability.
This project is designed to provide information on the magnitude of residual malaria transmission in different epidemiological settings, and to identify through standardized protocols the main factors driving that transmission, including social behaviours or activities that increase human‐vector contact, environmental changes such as climatic changes that may alter mosquito behaviour including resting, and feeding preferences, or changes in mosquito species composition.
Progress in 2015 For the first activity, the report after one year of research was expected for January 2016. This report has been received and is now under review.
For the second activity, a Call was issued in March and after external review by an ad‐hoc committee, the following proposals were selected for funding:
Residual malaria hotspots in Peru and Brazil: setting the stage for testing improved, Dionicia Gamboa Vilela (PI), study sites in Brazil and Peru, from WHO Americas Region. Understanding residual transmission for sustainable malaria control and enhancement of elimination efforts in Africa, Joseph Mwangangi (PI), study sites in Kenya, Cameroon and Ethiopia, from WHO Africa Region. Residual Malaria Transmission in the Greater Mekong Subregion (GMS) ‐ Studies to examine its magnitude and identify its causes, Jeffrey Hii (PI), study sites in Thailand and Viet Nam, from WHO South‐East Asia Region and the Western Pacific Region. Understanding human, parasite, vector and environmental interactions driving residual malaria transmission in Papua New Guinea, Moses Laman (PI), study sites are in Papua New Guinea from WHO Western Pacific Region. Where and when is residual malaria transmission taking place? Investigating magnitude and drivers of persistent Plasmodium infections in East and West Africa, Fredros Okumu (PI), study sites in Burkina Faso and Tanzania from WHO Africa Region.
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Plans for 2016 At the end of 2016, a workshop will be held with all teams to draw the main conclusions, plan the publications in peer review journals, advise and adapt the policy recommendations and discuss research outcomes. These studies may form the baseline scientific evidence for larger projects on more specific topics including the impact of new vector control tools.
Strategic Development Funds SDFV.2. Implementation of a regional network on surveillance, diagnostic and vector control of vector‐borne emerging diseases in the Caribbean region (2015).
Context and rationale The Caribbean region is a hot spot for the emergence and re‐emergence of vector‐borne diseases on the American continent. For example, the first epidemic of dengue in the Americas occurred in 1981 in Cuba, and has spread all over Central and South America, causing millions of clinical cases and thousands of deaths. At the end of 2013, Chikungunya virus was detected on the island of Saint Martin and is now expanding throughout the Caribbean as well as Central and South America. Preventing these emergences is challenging. The Caribbean region is characterized by scattered territories showing a great diversity of environmental and social and economic conditions and it includes one very low‐income country and several middle‐ and high‐countries, with weak connections existing between the territories. The challenge is thus to facilitate the implementation of a network between territories to exchange surveillance information on the circulating VBDs, to share facilities for diagnostics and to collaborate on vector control and research topics such as insecticide resistance, including standardization of technologies and training. Many contacts exist between TDR and Caribbean institutions, and TDR has a long working history with the Pan American Health Organization (PAHO). All groups are aware of the necessity to develop the regional exchanges from a public health and also a research perspective.
The overall objective of this initiative, in partnership with PAHO, is better prevention and control of VBDs through a regional network. This network is expected to conduct surveillance and diagnostics, share data and facilities, and carry on collaborative research on an integrated vector control approach, in particular for the management of insecticide resistance. Two workshops are being held in two different countries in the Caribbean region, one on surveillance and diagnostics of emerging vector‐borne diseases and one on vector control and research.
Progress in 2015 A consortium of institutions led by the Caribbean Public Health Agency (CARPHA), and including the Instituto de Medicina Tropical “Pedro Kourí” from Cuba, the Ross University School of Veterinary in Saint‐Kitts and the Pasteur Institute of Guadeloupe, was selected and a workshop on surveillance and diagnosis of emerging diseases was held in Trinidad in December.
Plans for 2016 A second workshop on vector surveillance and control will be held in Cuba. There will be a report on the workshop proposals and results, with recommendations on how to implement a Caribbean network, and a plan or proposal for future collaboration.
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Strategic Development Funds SDFV.4. Development of a platform for distance learning course on vectors and vector‐borne diseases for low‐ and middle‐income countries (2015).
Context and rationale Vector‐borne diseases (VBDs) are at the top of public health concerns in low‐ and middle‐income countries (LMICs). Their control usually includes medical, environmental and social approaches and thus requires interdisciplinary research not easily found in very specialized institutions. The academic and professional education on VBDs and vectors is currently scattered among public and private universities and institutions and some topics are redundant while others are non‐existent or very difficult to find.
Following preliminary discussions and visits with some institutions and training centres, gaps and needs were identified. Several European institutions (in France, Portugal, Spain and the UK) and North American (California, Colorado, Florida, Texas) are offering courses on epidemiology, specific topics of medical entomology, virology, bacteriology and parasitology. However, the content is not harmonized, mostly corresponds to the expertise of the teachers and is strongly oriented to the institutional research priorities and not to LMIC needs. In Africa, Asia and Latin America, a few courses are developing, but are restricted to a limited number of topics, usually based on the health priorities of the hosting country, with a strong budget limitation. Masters and PhD programmes are specialized, so that holders of this degree may not be able to carry on research on an unexpected public health emergency. Those looking for specific courses have no identified global source, tailored to their language needs.
Consequently, the need for a more harmonized and visible platform of courses for general and specialized topics in the field of VBDs is strong and consistent with the TDR strategy for promoting research and capacity building on vectors, environment and society.
Expected outputs of the proposal: a report on the mapping of all important courses on vectors and VBDs that focus on the needs of LMICs, proceedings of the meeting with the stakeholders and proposal for a harmonized platform of courses, and a Web‐based platform that provides a listing of all available online VBD courses worldwide.
Progress in 2015 A consultant was hired in September for the mapping, the selection was made, and the Instituto de Higiene Tropical de Lisboa was contracted for the organization of the workshop.
Plans for 2016 The workshop was held 15‐16 February 2016.
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Strategic Development Funds SDFV.5. Selection of a consortium of institutions for the organization of a workshop and commissioned reviews to develop an international network on surveillance of insecticide resistance and alternative methods of vector control for vectors of emerging arboviruses.
Context and rationale The control of insects/arthropod vectors of emerging diseases in poor countries relies mainly on the use of chemical insecticides. As an example, for the control of vectors of arboviruses such as dengue and chikungunya, the use of larvicides and/or space spraying are the primary control tools, even if community‐based source reduction of breeding sites is largely promoted. However, this almost unique vector control approach is strongly impaired by the development of resistance among the target vectors. Insecticide resistance can be chemical, physiological and behavioural, highlighting the large scale of evading mechanisms the vectors can develop. The current knowledge and research gaps on the resistance of vectors of arboviruses at an international level is currently not organized into a network, which does not facilitate the dissemination of information on the subject. The household insecticides market, estimated at over US$ 8 billion, may also have contributed to the development of resistance. On another hand, the insect pests in agriculture have been the target of the same chemical methods in the past and in recent years. Because the development of resistance was threatening the food production, other technologies and methods have been developed to protect crops. These new methodologies include a large array of approaches, from the high‐standard technologies such as genetically transformed insects/plants to agro‐eco‐systems, with different types of tools such as trapping, collecting and diverting from, based on insect physiology, mating behaviour, feeding preferences and others.
This project, in coordination with WHO’s Neglected Tropical Diseases Department, uses commissioned reviews from experts, followed by a more focused workshop, where scientists from both public health and agriculture can interact and exchange their experience and develop recommendations for research and implementation priorities and needs. The reviews should cover monitoring of resistance for the vectors of emerging arboviruses and alternative methods for vector control and help generate an international network.
Progress in 2015 A call was issued in September to select a consortium of institutions for the organization of a workshop and the commissioned reviews. A Consortium of institutions working on insecticide resistance, led by Institut de recherche pour le développement (IRD) in Thailand and including more than 20 institutions worldwide, was selected in November 2015 after the review of applications by a panel of external experts.
8. Workstream on gender equity
Strategic Development Funds SDFV1. Improving the careers of women research scientists in infectious diseases of poverty (TDR‐wide activity, 2014‐2015).
Context and rationale Gender biases (such as having full responsibility for care giving within the family) often affect the career paths of women working in research. Drop‐out rates are high and re‐entering science after a break is difficult. Within infectious disease research, women scientists are commonly under‐represented in early career positions as fellows, associates and assistants, and particularly at mid‐level and senior levels, such
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as principal investigators. The consequence is fewer women in leadership and decision‐making positions in science and research institutions and little movement in improving the position of women in science.
A focused TDR‐wide activity to improve the careers of women research scientists in infectious diseases of poverty was launched in 2014. An international call for proposals to develop, describe or test a concept that could address some of the challenges and barriers women face in establishing and maintaining careers in health research drew more than 60 concept notes.
Progress in 2015 Following review by an independent panel of experts, nine projects were selected (http://www.who.int/tdr/news/2015/studies‐women‐researchers/en/), providing a portfolio on Africa:
Ms Elizabeth AKINYI OCHOLA, Kenya This project builds on a network of female scientists with deep experiences in tropical parasitic disease research, who mentor and provide short‐term training to help women enter into the research field. Twenty female final year biomedical science students from 2 public universities in western Kenya were selected for a 5‐day workshop on infectious diseases and how they affect women. They received group and personalized training in how to conduct research in low‐ and middle‐income country settings, research ethics, report writing and using research for improved healthcare, followed by mentoring.
Doctor Jacqueline AZUMI BADAKI, Nigeria This study examined the professional challenges and cultural barriers women face in establishing and maintaining careers in health research in different socio‐cultural settings in Nigeria. It provided a landscape of research capability of women scientists on infectious diseases of poverty; detailed and harmonised documentation on the barriers and facilitators of career development for Nigerian women scientists; and a proposed strategy for reducing drop‐out rate among women scientists.
Professor Oumou Younoussa BAH‐SOW, Guinea This project, titled "DARE" (OSER in French), focused on strengthening the capacity of Guinean women researchers in ethics and research methodology. Fifty women attended a 10‐day training to produce a research protocol for submission to a national ethics committee.
Dr Pauline BYAKIKA‐KIBWIKA, Uganda Increasing the numbers and ensuring full participation and career success of women scientists in all roles in infectious disease medicine and research is the goal of this project. A career development and mentorship programme was established at Makerere University College of Health Sciences that included a peer network, supportive institutional environment with an onsite childcare centre, sponsorship/scholarship opportunities, and short courses that helped develop leadership skills.
Dr Atupele KAPITO‐TEMBO, Malawi This project takes a multi‐level approach in Malawi. At the individual level, women were invited to workshops to develop their personal development plans and provide tools to track their achievement. At the peer level, a national network of women was established to support and motivate, and a report on the gaps and needs of women scientists was developed and submitted for policy recommendations at the national level. At the institutional level, academic institutions were assessed for gender inequality issues and this was reviewed with senior administration for potential changes, in line with the national policy recommendations.
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Professor Rose LEKE, Cameroon A consortium of women scientists was created to support and encourage the growth of Cameroonian women in health research careers. Women with less than 3 years of research experience were invited to apply for a 5‐day institute to meet and hear from prominent Cameroonian women scientists and to receive training in fund raising, project management time management, communication, collaboration and partnerships. Mentorships and networks were set up that follow the institute.
Professor Francine NTOUMI, Republic of the Congo Encouraging young women to go into research was the focus of this project, which established a regional Excellence Network of Central Africa (CANTAM) of 9 research institutions in the Republic of the Congo. Gender issues and factors that hinder young women in high school or college to become interested in careers in science or biomedical research were analysed. The network developed a platform for exchange and support and also organized a lecture by eminent women scientists of the country.
Dr Sitan TRAORE, Mali An Inter‐Agency Network for Research Support of Women (RARF) was created to provide guidance in research, training and aid for research funding. The network was open to researchers (men and women) representing public and private institutions and infectious disease health research in the country. Women peers helped mentor women through short‐term training.
Professor Aster TSEGAYE ABEDE, Ethiopia This project provided training, mentorship, role modelling and networking. A workshop for female academicians from five universities and a research institute in different regions was held on research methodology, grant writing, self‐esteem, work‐family balance, power point preparation, manuscript writing and effective communication. Men and women mentors supported the women through the use of face‐to‐face meetings and google group discussions, and a new database of women researchers and academicians was made available at a national conference.
TDR created a dedicated website for this work on Women in Science, with significant background research and links to the individual projects: http://www.who.int/tdr/capacity/gender/en/
Plans for 2016 TDR will continue to enhance the web portal and knowledge platform for this work. With additional funding, TDR would expand on this successful portfolio by strengthening the network of Women Scientists in Africa and develop similar regionally focused portfolios, such as for Latin America, the Caribbean and Asia.
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Strategic Development Funds SDFV6. Development of a training course for capacity building on gender‐based analysis in vector‐borne disease research using an innovative global classroom approach
Context and rationale There has been growing awareness on the value of gender studies in development, such as for family planning. However, the uptake of gender mainstreaming and analysis has been slow and uneven in other areas of public health. Vector‐borne diseases have yet to benefit from the incorporation of gender awareness and sensitivity in gender‐responsive intervention and control programmes. Incorporating gender analysis in vector‐borne disease research requires technical capacity among researchers. This technical capacity is limited, especially in the disease endemic countries. Thus, capacity building in this area is a gap that needs to be filled.
VES, together with the TDR unit Research Capacity Strengthening (RCS) and the WHO Department of Public Health, Environmental and Social Determinants of Health (PHE), have solicited expressions of interest for the development of this training course from TDR’s officially‐designated Regional Training Centres (RTCs). These RTCs, located in low‐ and middle‐income countries, collaborate with TDR for the implementation of various skill‐building courses and train‐the‐trainer programmes to promote good health research practices to other institutions in their respective regions.
Progress in 2015 During the Fourth Technical Meeting of the RTCs in Geneva on 6 February, the concept note for the development of this training course for gender‐based analysis was presented to five RTCs: 1) International Centre for Medical Research and Training (CIDEIM) in Cali, Colombia (established in 2009); 2) Gadjah Mada University (GMU) in Jogyakarta, Indonesia (established in 2009); 3) Astana Medical University (AMU) in Astana, Kazakhstan (established in 2009); 4) Research Institute for Tropical Medicine (RITM), Manila, Philippines (established in 2010); and 5) School of Public Health (SPH), University of Ghana, Accra, Ghana (established in 2014).
The School of Public, University of Ghana was selected to develop this course based on its institutional capacity and track record and relevant expertise. It has developed a gender and health course, which is currently offered as part of its regular graduate and undergraduate programmes. The course uses evidence‐based approaches to provide in‐depth understanding of how sex and society, nature and nurture, chromosomes and environment interact to determine who is well or ill, who is treated or not, and who is exposed or vulnerable to ill health. Additionally, other courses are taught with gender and health dimensions, focusing specifically on women’s health and men’s health. To further validate/confirm SPH’s expertise in this field, one of SPH’s faculty was invited to participate as a facilitator/trainer during the annual capacity building workshop (for African researchers in the vector‐ borne diseases/climate change portfolio, held 15‐16 July).
The development of this training course started in August 2015 and is currently ongoing.
Plans for 2016 A draft course outline is expected by February 2016. Pilot testing of the course among the researchers in the TDR‐IDRC Research Initiative is expected to commence by June 2016.
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9. Proposed new activities and expected results for 2016‐2017 and forward
Environmental change and vector‐borne diseases
Environmental health services for the prevention and control of vector‐borne diseases in South‐ East Asian countries (Undesignated funds, start 2016). Biodiversity loss and vector‐borne diseases (Strategic Development Funds, to be developed during 2016). Expected outcomes Policies and strategies influenced by new evidence about climate and environmental change impact on VBDs (2012‐2016) Policies and strategies influenced by new evidence about environmental health services that can prevent and control vector‐borne diseases in SE Asia (2016‐2017) Policies and strategies influenced by new evidence about biodiversity loss impact on infectious diseases in poor countries (2016‐2017)
Emerging challenges in the prevention and control of vector‐borne diseases
Alternative methods to control vectors of diseases in poor countries with a special request to work on Sterile Insect Technique (SIT) against the dengue vectors (Strategic Funding, start in 2016) Expected outcomes Guidelines for SIT into special settings.
Community and social dynamics
Social innovation in health service delivery applied to the prevention and control of infectious diseases (currently ER.5, 2014‐2017). Urban health issues in the prevention and control of vector‐borne diseases (Undesignated funds, start in 2016). Expected outcomes The application and usefulness of social business/social entrepreneurship for the prevention and control of infectious diseases of poverty demonstrated and substantiated through framework development, landscape analysis and research (2014‐2016) Policies, strategies and public health practice influenced by new evidence about urban health (2015‐2016).
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Gender equity and vector‐borne diseases
Extension of the training course for capacity building on gender‐based analysis in vector‐borne disease research using an innovative global classroom approach (start in 2015). Expected outcomes Policies, strategies and public health practice influenced by new evidence about gender in the control of infectious diseases in poor countries (2015‐2016).
Expected Results VES Main Work Stream Objectives
Environmental Changes Impact
Evidence on the effects of climate and environmental changes on vectors 1.3.3 Vector‐borne diseases and climate change in Africa and vector‐borne diseases; decision‐support processes and tools for health impact assessment
1.3.7* Control of vector‐borne diseases in SE‐Asia through environmental measures Policies and strategies influenced by new evidence about environmental health services that can prevent and control vector‐borne diseases in SE Asia Emerging Challenges
Assessment of insecticide resistance mechanisms in malaria vectors and 1.3.6 Impact of insecticide resistance on malaria control and residual malaria their impact on control failure in Africa. Investigations on burden and causes of Residual malaria Prevention of vector‐borne diseases and emerging fevers in fragile health 1.3.9* systems in West Africa
Social and Community Dynamics
1.3.5 Research on social innovation to enhance healthcare delivery Evidence on the utility of social entrepreneurship for the prevention and control of infectious diseases of poverty
1.3.10* Urban health interventions for control of vector‐borne diseases Policies, strategies and public health practice influenced by new evidence about urban health Gender Equity
1.3.8* Training course for gender data‐analysis in vector‐borne diseases Policies, strategies and public health practice influenced by new evidence about gender in the control of infectious diseases in poor countries * New expected results for 2016‐2017
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10. 2014‐15 financial implementation
2014-15 implementation TOTAL UD DF
Approved Implementation Implementation Approved Implementation Implementation Approved Implementation Implementation Approved Approved Approved ER revised planned at 31 Dec 2015 rate against revised planned at 31 Dec 2015 rate against revised planned at 31 Dec 2015 rate against VES Expected results budget ($60m) budget ($60m) budget ($60m) costs (Oct‐14) (Exp + Enc) planned costs costs (Oct‐14) (Exp + Enc) planned costs costs (Oct‐14) (Exp + Enc) planned costs
Operation Activities VES
Evidence improved community access to health interventions in 1.3.1 800,000 652,335 832,037 128% ‐ ‐ 149,537 800,000 652,335 682,500 105% Africa Improved dengue and Chagas disease control through innovative 1.3.2 100,000 13,800 13,800 100% ‐ 13,800 2,205 16% 100,000 ‐ 11,595 ecosystem management and community‐directed interventions Evidence of population health vulnerabilities to vector‐borne 1.3.3 2,600,000 3,245,971 2,793,929 86% ‐ ‐ ‐ 2,600,000 3,245,971 2,793,929 86% diseases and adaptation under climate change conditions Implementation research in support of the WHO Global Strategy for 1.3.4 1,010,000 550,000 403,150 73% 810,000 550,000 402,796 73% 200,000 ‐ 353 Dengue Prevention and Control Social entrepreneurship for the prevention and control of infectious 1.3.5 1,840,000 920,000 853,721 93% 920,000 920,000 853,721 93% 920,000 ‐ ‐ diseases of poverty Assessment of insecticide resistance mechanisms in malaria vectors 1.3.6 2,000,000 1,050,000 605,175 58% 1,500,000 1,050,000 605,175 58% 500,000 ‐ ‐ and their impact on control failure in Africa VES Operations 8,350,000 6,432,106 5,501,812 86% 3,230,000 2,533,800 2,013,434 79% 5,120,000 3,898,306 3,488,378 89%
2014-15 implementation TOTAL UD DF
Approved Implementation Implementation Approved Implementation Implementation Approved Implementation Implementation Strategic Development Fund (SDF) Approved Approved Approved ER revised planned at 31 Dec 2015 rate against revised planned at 31 Dec 2015 rate against revised planned at 31 Dec 2015 rate against budget ($60m) budget ($60m) budget ($60m) Expected results costs (Oct‐14) (Exp + Enc) planned costs costs (Oct‐14) (Exp + Enc) planned costs costs (Oct‐14) (Exp + Enc) planned costs
Operation Activities SDF 3
VES Activity 0 890,000 627,304 70% 890,000 627,304 70%
IIR Activity 0 403,383 300,633 75% 403,383 300,633 75%
RCS Activity 0 951,621 958,090 101% 951,621 958,090 101%
One TDR Activity 0 495,000 408,804 83% 495,000 408,804 83% SDF Operations 2,720,000 2,740,004 2,294,831 84% 2,720,000 2,740,004 2,294,831 84% ‐ ‐ ‐
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11. 2016‐17 revised planned costs
In January 2016, one of TDR’s major donors announced that their contribution to development programmes would decrease by 30% to address the current immigration situation. Anticipating a possible decrease from other donors, TDR cautiously decided to revise its income forecast accordingly with a reduction of US$ 5 million undesignated funds (from US$ 35 million to US$ 30 million). As salaries and operational costs are fixed costs, the reduction of US$ 5 million undesignated funds has been implemented across the operations planned costs. Contingency revised planned costs have been developed reflecting a decrease of 30% of the operation budget undesignated funding of US$ 45 million budget scenario planned costs (from US$ 16.1 million to US$ 11.1 million). This led to a decrease of (i) US$ 1.2 million of the strategic development fund planned costs (no new projects until new funds become available); (ii) US$ 0.9 million for the planned costs of the Implementation and Intervention Research area; (iii) US$ 0.6 million for the planned costs of the research for Vector and Environment and Society area; and (iv) US$ 2.2 million of the Research Capacity Strengthening and Knowledge Management area planned costs. Balance of funds unspent in 2014‐2015 has been carried over to 2016‐2017 and delayed activities will be implemented against it.
$45M Scenario $40M reduced plan 2014-15 commitments Revised planned costs
UD revised encumbered 2014-15 DF UD UD DF Total reduction UD in 2014-15 delays
Research on vectors, environment and 1,600,000 2,400,000 (600,000) 1,800,000 314,000 920,000 3,034,000 1,600,000 4,634,000 society (VES) (450,000) Environmental Changes Impact 700,000 1,100,000 (450,000) 650,000 - - 650,000 700,000 1,350,000 Vector-borne diseases and climate change in 1.3.3 400,000 300,000 (300,000) - - - 400,000 400,000 Africa Control of vector-borne diseases in SE-Asia 1.3.7 300,000 800,000 (150,000) 650,000 650,000 300,000 950,000 through environmental measures Emerging Challenges 900,000 300,000 - 300,000 240,000 770,000 1,310,000 900,000 2,210,000
Impact of insecticide resistance and residual 1.3.6 500,000 300,000 - 300,000 240,000 770,000 1,310,000 500,000 1,810,000 malaria on malaria control Prevention of vector-borne diseases and 1.3.9 emerging fevers in fragile health systems in 400,000 - - 400,000 400,000
West Africa Social and Community Dynamics - 930,000 (130,000) 800,000 - - 800,000 - 800,000
Research on social innovation to enhance 1.3.5 630,000 (130,000) 500,000 500,000 500,000 healthcare delivery
Urban health interventions for control of vector- 1.3.10 300,000 - 300,000 300,000 300,000 borne diseases
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$45M Scenario $40M reduced plan 2014-15 commitments Revised planned costs
UD revised encumbered 2014-15 DF UD UD DF Total reduction UD in 2014-15 delays
Gender Equity - 70,000 (20,000) 50,000 - - 50,000 - 50,000
Training course for gender data-analysis in 1.3.8 70,000 (20,000) 50,000 50,000 50,000 vector-borne diseases
2014-15 delays - - - - 74,000 150,000 224,000 - 224,000
Evidence improved community access to health 1.3.1 74,000 74,000 74,000 interventions in Africa Implementation research in support of the WHO 1.3.4 Global Strategy for Dengue Prevention and 150,000 150,000 150,000
Control
Strategic Development Fund (SDF) - 1,150,000 (1,150,000) - 688,000 391,100 1,079,100 - 1,079,100 IIR 82,000 103,100 2.2 Malaria Genome Data sharing 8,100 2.3 Data modelling fellowship 32,000 Piloting TDR grants (Control Academic 2.4 50,000 collaboration) 2.5 SDF Ebola 95,000 RCS 397,900 - 3.4 EDCTP Ebola Research 297,900 3.5 RCS in (No Suggestions) countries in Africa 100,000 VES 198,500 263,000 1.2 SDF Gender 85,000 30,000 1.3 SDF Vector control 200,000 1.4 Caribbean Health Network 101,000 20,000 1.5 Environ public health 13,000 1.6 Platform for VBD courses 12,500 One TDR 9,600 25,000 4.1 Women's Careers 10,000 4.4 Report HTM Cluster 9,600 15,000
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12. TDR funding in 2015
Preliminary figures
Core contributors Amount ($)
Belgium 2 038 043 China 55 000 Cuba 2 500 Germany 816 993 Ghana 75 000 Japan 200 000 Luxembourg 1 176 421 Malaysia 25 000 Norway 1 177 024 Panama 7 000 Sweden 5 221 175 Switzerland 1 972 826 Thailand 46 339 Turkey 5 000 United Kingdom of Great Britain and Northern Ireland 3 816 794 World Bank 1 250 000 World Health Organization 1 800 000
Contributors providing specific project funding Bill & Melinda Gates Foundation 1 967 103 Royal Tropical Institute (KIT) 24 194 United Nations Development Programme (UNDP) 474 902 United States of America 607 175
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Annex 1
Addressing comments and suggestions from first SWG (February 2015)
Session on VES streams of research
Recommendations from this session include: • Continue the inclusion of gender equity issues across all research and training activities. • Ensure the participation of the main stakeholders since the planning stages, conducting and analysis of research and capacity building projects • Explore better schemes to present the interactions among the components of the stream of research.
VES Follow up: • Gender equity issues are now taken into account as much as possible across all research and training activities. • Participation of the main stakeholders since the planning stages, conducting and analysis of research and capacity building projects is promoted and requested through each Call for applications and included in the review process. • Better schemes to present the interactions among the components of the stream of research are an on‐going process within VES activities.
Research on social and community dynamics
Recommendations from this session include: • Work closely with government agencies to promote collaboration between researchers and control programmes. • Identify the extent of the impact of the research process and products on control activities. • Collaboration and dialogue with government agencies, including ministries and control and health services is systematically sought in all portfolios, including in Access Africa, the scaling‐up project and in social innovation.
VES follow‐up: • New calls are developed with closer interactions with government agencies to promote collaboration between researchers and control programmes. • Identification of the extent of the impact of the research process and products on control activities is on‐going. • Collaboration and dialogue with government agencies, including ministries and control and health services, is now systematically sought in all portfolios, including in the project “Evidence for improved community access to health interventions in Africa” (ER 1.3.1) the scaling‐up project (ER 1.3.4) and in social innovation (ER 1.3.5).
Emerging challenges
• In summary – and as a comment rather than recommendations – the SWG felt that all the projects were worthy, and that the role of SWG was to explore how it can support the VES team to make the projects better. There was concern about the coherence of the projects with the TDR strategy. Also, as a cross‐cutting issue, the integration of partners and policy makers in all programmes needed to be looked at.
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Environmental changes impact of infectious diseases
Recommendations from this session include: • SWG highlighted the need to consider human mobility as this may compromise research outcomes and impact.
VES follow‐up: • Human mobility surveillance and indications will be included in all projects.
Gender equity
Recommendations from this session include: • Clearly, a long term strategic plan is needed in the development of this training programme, including regional capacity building
VES follow‐up: • VES secretariat agrees and has involved the TDR Regional Training Centres in this activity.
Ebola activities
Recommendations from this session include: • VES could include the CDI initiative within a longer‐term strategy. This may include emergency preparedness, early warning and surveillance.
VES follow‐up: • This activity is developed in close partnership with the TDR Implementation and Intervention Research (IIR) Unit.
Comments and discussion from second SWG (October 2015)
The following items were discussed: Congratulations to the coherence between TDR strategy, objectives, and the portfolio of activities. This was underlined also in the context of the comprehensive presentation of VES. Translation to policy – where are we? This discussion focused on Chagas and dengue activities in Latin America. A discussion evolved around the meaning of “translation to policy,” and the relationship of this to process, for example, developing an innovative integrative approach, or only about ‘hard’ results. It was suggested that “scaling up research” might be an appropriate wording. It was suggested that an interim term be developed in the context of “bridging the gap”. Capacity building is important and welcome, especially in entomology; capacity building programs already supported within TDR could support this further. The efforts need to be long‐term, as already illustrated in many countries. Capacity building needs to be integrated into research in all TDR portfolio. It would be useful for calls for proposals to draw attention to capacity building, but this should be an option, not as an exclusion criteria. However, it appeared that clarity was needed around capacity building, including whether our interest is in training researchers or building the capacity of communities. Urban health research capacity building is also welcome, especially in low‐ and middle‐income countries.
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Environmental changes and impact on infectious diseases
This research stream encompasses five research projects concerned with environmental change (including climate change) on malaria, schistosomiasis, human African trypanosomiasis and Rift Valley fever, as follows: Social, environmental and climate change impact of vector‐borne diseases (malaria and schistosomiasis) in arid areas of Southern Africa (Botswana, South Africa and Zimbabwe). Early warning systems for improved human health and resilience to climate sensitive vector‐borne diseases (malaria and Rift Valley fever) in Kenya. Predicting vulnerability and improving resilience of the Maasai communities to vector‐borne infections (trypanosomiasis): an EcoHealth approach in the Maasai Steppe ecosystem (Tanzania). Human African trypanosomiasis: alleviating the effects of climate change through understanding human‐vector‐parasite interactions (Tanzania, Zimbabwe). Vulnerability and resilience to malaria and schistosomiasis in northern and southern fringes of the Sahelian belt in the context of climate change (Cote d'Ivoire and Mauritania).
Preliminary results are available, with further analysis and plans for publication underway. The following activities are now planned: • Data analysis and data integration for the five research projects, with technical support from experts/facilitators; • Feedback to communities and other stakeholders; • Publications from the five research projects; • Plans for a special issue of a scientific journal; • Commissioned reviews in a WHO publication; • Research uptake activities; communications strategy to contribute to research uptake; • Participation of research teams to the Climate and Health Colloquium, organized with IRI, May 2016, Columbia University, New York, USA; • Participation of research teams to the One Health EcoHealth 2016 Convention, 4‐7 Dec 2016, Melbourne, Australia.
Discussion The discussion included specific questions around the influence of climate change on specific vectors and epidemiology of disease, as in the case of human African trypanosomiasis. Technical questions arose regarding the decline of Glossinidae in different ecological contexts, as well as questions around the timelines of project interventions and possible national control programme (and other programme) interventions.
Projects should be able to analyse the interaction between the diseases’ transmission and meteorological data, but no inferences could be established with climate change. Data collected from vector abundance and distribution are scarce and time too limited to establish any association. Many publications on climate change and changes in vector habitat were using preliminary data and the time frame was too short for any firm evidence. Bernadette Ramirez indicated that some of the research teams had historical data that could be used while others have generated data on the seasonality of VBDs in the context of the changing environment. The analysis of research data will therefore be framed in the context of a changing climate wherein seasonal transitions of VBDs can be used to model climate change impacts.
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Research on social and community dynamics
There are four objectives: Enhanced access to control interventions through community engagement for the prevention of major vector‐borne diseases and other poverty‐related diseases in Africa. Design and implement community‐based ecosystem management and environmentally friendly vector control interventions for the prevention of dengue and Chagas disease. Assess the implementation and scale‐up of community‐based dengue vector control interventions in urban agglomerations of the Caribbean and Latin America. Development of a global urban health approach.
The Social Innovation in Health Initiative (SIHI) is underway, and 25 innovations have been selected from Africa, India, and Latin America. These case study areas were selected as illustrating innovative sustainable health care delivery for infectious diseases of poverty, in the context of the Sustainable Development Goals (SDGs). A major stakeholder meeting with experts in social innovation will be held in December 2‐4, 2015 in Annecy and Geneva to help to accelerate and amplify the impact of community‐ based social innovation in healthcare delivery systems and identify research gaps.
The programme on Urban Health is still being developed, and will build on the findings of scoping reviews. A call for proposals was issued and seven proposals were received, to be reviewed by select members of the SWG and other external reviewers.
Discussion There was extensive discussion on the Social Innovation in Health Initiative (SIHI), including how the case studies were developed and implemented. Emphasis was placed on the exploratory and descriptive nature of this work, but that since this is an expanding research area, a clear recommendation on the way forward will be needed.
There was discussion on policy derived from the work on community engagement for dengue prevention and control in Latin America. The general opinion was that there was value in demonstrating how interventions could be scaled up but that there is no intention to directly influence policy.
Emerging challenges
Presentation This research stream includes projects on: Insecticide resistance and malaria o The project is ongoing and the first report will be available soon. Residual malaria o Five projects have been selected and are ongoing. Network on emerging diseases in the Caribbean o A network collaboration has been selected and two workshops for the development of the network are planned.
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Surveillance of insecticide resistance and alternative methods for the control of vectors of emerging arboviruses o A call has been issued for consortium of institutions on surveillance and alternative vector control methods Distance learning course on vectors and vector‐borne diseases for Low‐ and Middle‐ Income Countries o Mapping and workshop organization is underway.
Discussion The discussion raised the following points: For the Caribbean Network a clear exit strategy is needed. For the development of the platform on distance learning, in order to ensure its long‐term sustainability, the platform should be developed through TDR. It is important to know the long‐term role of TDR in this effort and again, clear exit strategy needs to be elucidated. Currently there is no information on who will host the platform after it is developed, and TDR is undertaking a search for a good partner institute to take on this role. The first activity will be mapping of existing courses on vectors worldwide, in four languages. A consultant has been hired to carry out this initial mapping exercise. An institution in Portugal will be contracted to host a workshop where the network members will identify the most important courses. TDR’s role will include providing support to research projects related to this platform. It was agreed that concerns raised about the WHO definition of ‘residual malaria’ should be raised with the SPT for that area of work. The discussion was centred on the implications for the projects. These projects are dealing with refractory malaria, but not addressing residual transmission foci determinants.
Gender equity
Presentation Two research projects are underway in this stream of research: Concepts to improve careers of women scientists (all TDR) (2014‐2015) Gender‐based analysis (2015‐16)
It was emphasized that TDR has a longstanding history in promoting gender research including: 1979‐1991: Steering Committee for Social and Economic Research 1991‐1994: Women and Tropical Diseases 1994‐1997: Task Force on Gender and Tropical Diseases Gender and Tropical Resource Papers series 1997‐1999: Task Force on Gender‐Sensitive Interventions 2000‐2007: Steering Committee on Social, Economic and Behavioural Research Gender‐based capacity strengthening Training and re‐entry grants to encourage women researchers and gendered research Career Development Fellowships
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The underlying concept is based on WHO definitions:
Within WHO, systematic integration of gender, equity and human rights principles in all WHO work, so that women and men, across the lifecycle, have equal opportunities to achieve their full health potential, there is enhanced fairness in the distribution of health and health service resources across populations, and greater health outcomes are achieved through the advancement of the right to health.
Concepts to improve careers of women scientists (all TDR): Nine institutions have been selected and the activities are ongoing.
Gender‐based analysis
General objective: To develop and pilot test a training course on gender‐based analysis for vector‐borne disease research, using an innovative global classroom approach.
Specific objectives: To develop a training course on gender based analysis To pilot test the course and evaluate the feasibility of its implementation through the TDR‐RTC model.
The School of Public Health in Accra, Ghana has been selected for this part of the portfolio.
Discussion Extended funding is not available for continued support to improve the careers of women scientists (all TDR), and the SWG will need to advise on how it can be sustained. For the gender‐based analysis course, the SWG suggested that a peer review process be included during the development of this curriculum.
One TDR activities and cost‐cutting activities
Presentation and Discussion The other activities of TDR – outside VES – were presented. In discussion, the importance of VES to interact with other TDR areas, especially in relation to the alumni‐grantees network, was emphasized. VES members asked about a strategy to obtain equity for researchers in less developed areas, who would not be included in the census of alumni. It was suggested that women in the network should be profiled, in order to contribute to gender equity goals.
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Activities in collaboration with WHO departments
Presentation and discussion Areas of collaboration were presented, specifically with the Global Malaria Programme, the Programme on Health and Environment and the Programme on Neglected Tropical Diseases. As reflected in discussion showed, these collaborations are very powerful and can be still strengthened.
As particular requests, VES SWG members recommended that: Further entomological studies should be undertaken, including in relation to insecticide resistance in dengue vectors A one‐off meeting to identify research needs for dengue was suggested (as an update of the TDR 2006 Scientific Working Group) Collaboration on “best practice” documentation for study design and outcome measures of entomological studies would be valuable.
Discussion and recommendations of day 1 The discussion centred on: 1) social innovation, 2) capacity development, 3) research translation to policy, 4) climate change, 5) gender and 6) knowledge management.
For capacity development and gender, it became clear that both items should be “cross cutting” in all VES activities, although the discussion focused on gender: The two streams of the gender programme should be integrated knowledge of gender studies generated through the projects to improve the careers of women scientists and gender‐based analysis should not be lost It would be desirable to find funding for continuity The activities to improve the careers of women scientists are centred in Africa. It is important to continue this in other regions. A more global approach and regional representativeness should be introduced Gender as a cross‐cutting issues should be introduced into the alumni process Gender should continue to be emphasized in all TDR activities. However this should not compromise good science and the absence of gender analysis in project proposals should not exclude funding a priori when the objectives do not require gender analysis. It was agreed that the importance of continuing funding for gender (improving careers of women scientists and gender‐based analysis) should be presented and debated at STAC meeting.
New activities 2016 – 2017
Presentation The following new projects were presented: Strengthening of the environmental health component of the portfolio in SEARO and WPRO, with a focus on new technologies and built on ongoing collaboration with ASEAN. A workshop for consultation has already been held. A research gaps defining exercise is planned and an expert panel is in the process of being created.
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For the rest of the VES portfolio, no new elements were suggested. Follow‐up activities included: Insecticide resistance and malaria – follow up is planned to define research gaps Residual malaria – summary and publications are planned Network on emerging diseases in the Caribbean – follow up is planned, with the network actively defining the research agenda and funding opportunities Platform for courses on vectors and vector‐borne diseases for Low‐ and Middle‐ Income Countries – follow up is planned with a possible “standard curriculum development” Urban Health ‐ Implementation research is being planned on multiple vector‐borne diseases, including water and sanitation. The research agenda will be defined by the scoping reviews: these are in the selection process Biodiversity loss studies ‐ a summary is planned with an expert workshop Ebola studies ‐ no funds have been identified; the aim is still to find funding to enable country‐led research projects
Changes in administrative procedures have been introduced, including clarifying eligibility and evaluation criteria in calls for projects. For applications, both the DataCol system and paper application are currently possible. However, the template in DataCol does not provide options for consortia. The template needs adaptation to allow for different possibilities and different application processes.
Discussion A few technical issues were clarified for each presentation. The new projects have an external advising structure with different panels for 1) designing the call, 2) selecting the proposals, and 3) follow up.
Summary recommendations from SWG
General recommendations The SWG noted that overall there was a very good progress with the individual projects – especially the involvement of multiple stakeholders, involving policy makers. Members praised the coherence between TDR strategy, objectives, and the portfolio of activities.
Capacity building is a major strategic axis and can be further strengthened, in collaboration with the TDR capacity training unit. What is meant by capacity building needs to be clarified, however, as it can refer either to training researchers or to building the capacity of communities.
Gender issues are well represented as a cross‐cutting issue, For specific research, it was recommended that: The two streams of the gender programme be integrated. Knowledge of the gender studies programmes (Concepts to improve careers of women scientists and Gender‐based analysis) should not be lost. It is desirable to try to find funding for continuity, so that these activities are ongoing. A more global approach and regional representativeness should be introduced. Gender as a cross‐cutting issue should be included in the alumni project. TDR has many senior female alumni, women who undertook PhDs with TDR support and now hold senior positions, and profiling them provides a way to highlight pathways for women scientists.
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Gender should continue to be emphasized as a cross‐cutting issue in all TDR activities, without compromising good science and not as a way of excluding studies.
Translation to policy: The SWG commends VES for its efforts to provide evidence for control programmes, a necessary step for translation to policy. VES supports projects that attend to gender, provide opportunities to strengthen research capacity, and considers the translational potential of the proposed work. VES also supports the involvement of relevant stakeholders, including communities, policy makers, and control programme staff, although there is room for improvement. VES should consider elements of translation to policy in all projects, including stakeholder involvement, however the absence of these elements should not exclude projects from funding.
Further recommendations Research gaps may need identifying, through a gap analysis exercise. Biodiversity and climate change research streams could be merged. Interaction with other WHO departments is commendable and shows the value of this approach. Long‐term strategies should be introduced, including with respect to gender and capacity training. This can be addressed simply, if all projects are looking into further steps/options.
Specific items For the Caribbean Network, a clear exit strategy needs to be formulated. For the Vector‐Borne Disease platform, a clear exit strategy needs to be formulated. For the ‘residual malaria’ projects, the epidemiological settings of the projects should be better defined; this concern should be raised with the SPT of the projects. A one‐off meeting for research needs mapping for dengue was suggested, which would update the TDR 2006 Scientific Working Group). Collaborate on “best practice” documentation for study design and outcome measures of entomological studies.
Recommendations to STAC The SWG recommends that STAC consider: Research mapping exercise (gap analysis) for VES, specifically for future research streams. Linking capacity training better between the TDR units. Continuation with activities to improve the careers of women scientists, gender‐based analysis and related activities, including maintaining gender analysis and training as cross cutting strategies in the next TDR business cycle.