Research on Vectors, Environment and Society

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Annual Report 2015

Research on Vectors, Environment and Society

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TDR/VES/16.1

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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

Society): Evidence‐based policies and practices on access to interventions, community‐based vector control, climate and environmental change impact on vector‐borne diseases adopted and used by countries

By 2017, 75% of the innovative knowledge, new/improved solutions or implementation strategies developed are successfully applied in developing countries

1.3.1. Evidence for improved community access to health interventions in Africa

By 2015, 8 studies published on the uptake of community‐directed interventions approach Progress: 23 studies published

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

By 2014, 8 studies completed and disseminated Progress: 16 studies published

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

By 2015, situation analyses completed in five settings

Progress: Reports on the situation analysis in 7 countries available. Launch of a web‐platform for knowledge‐sharing with 10 studies published.

1.3.4. Improved urban vector control methodologies for dengue prevention and control in three countries of Latin America and the Caribbean

By 2015, research evidence provided for the scaling up of community‐based interventions

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 the prevention and control of infectious diseases of poverty

By 2015, concept developed, landscape analysis conducted and case studies compiled

Progress: Landscape analysis performed. 25 case studies selected and on‐going.

1.3.6. Assessment of insecticide resistance mechanisms in malaria vectors and their impact on control failure in Africa, Asia^, Latin‐America^*

By 2015, link established between vector resistance to insecticides and malaria control failure in Africa, 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 COMMUNITY DYNAMICS

Expected Result 1.3.1: Evidence for improved community access to health interventions in Africa

Outputs:

Research reports, publications and strategies to strengthen primary health care, focusing on fever management of severe childhood illnesses in peripheral settings.

By 2015, 6 studies published

Community research on implementation of HMM+ strategy for enhanced 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 Community Health Workers (CHWs), including testing of innovative and sustainable options.

By 2014, 6 reviews/studies published

Realist review completed and published in online manual on community 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 Community Case Management (iCCM) of malaria and pneumonia, focusing on mortality.

By 2015, 3 country studies published

 Two studies (Ghana, Uganda) published in 2012, publication on 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

interventions

By 2014, 8 systematic reviews on community‐based interventions (CBI) for 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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Outputs:

Cross‐disciplinary research framework for eco‐bio‐social (EBS) studies and toolkit for EBS research

By 2014, EBS framework developed in Latin America

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 dengue prevention and control in three countries of Latin America and the Caribbean Urban health approach developed

By 2014, scaling‐up of dengue vector control developed in 4 Latin America countries

 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 targeted interventions

By 2015, 4 country studies completed

 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 for the prevention and control of infectious diseases of poverty

By 2017, the application of social entrepreneurship for the prevention and 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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Outputs:

Landscape analysis of: i) existing social entrepreneurship initiatives for the prevention and control of infectious diseases of poverty; ii) their success, challenges, and lessons learnt; and iii) overall social entrepreneurship stakeholder environment

By 2015, publication of a web‐based report

 Landscape analysis completed

 Landscape analysis of social innovation in the United Nations system commissioned

 Major publication on social innovation in health care delivery planned for 2016

Concept paper and public health based framework related to the application of social entrepreneurship to the prevention and control of infectious diseases of poverty

By 2016, publication of report and peer reviewed journal articles Case study research under way.

Forum for social entrepreneurship on infectious diseases of poverty launched

By 2015, Forum held successfully

Major forum held December 2‐4, 2015, in Annecy and at WHO, Geneva.

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

By 2017, 10 countries adopted the methods and tools developed

Outputs:

Complex social‐ecological conditions of water systems in African drylands identified and characterized for their potential impact for VBDs; VBD risks assessed under various exposure conditions and vulnerability context;

knowledge and scientific evidence generated about the impact of climate change on health.

By 2014, research evidence provided

The 5 research projects are ongoing in 7 African countries (Botswana, Côte d’Ivoire, Kenya, Mauritania, South Africa, Tanzania and Zimbabwe) about malaria, schistosomiasis, HAT and RVF.

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 environmental related risks

By 2015, a community of practice established

A web‐based knowledge‐sharing platform, VBD‐environment.org, was Launched in July 2015.

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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 CHALLENGES

Expected Result 1.3.6: Assessment of insecticide resistance mechanisms in malaria vectors and their impact on control failure in Africa, Asia^, Latin‐

America^*

By 2017, recommendations and policies for better implementation of malaria control trough LLINs and IRS taking into account insecticide resistance evolution.

Outputs:

New scientific information on insecticide resistance mechanisms generated to fill critical knowledge gap

By 2017, publication of the study results in a peer review journal.

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 failure estimated

By 2017, publication in peer review journal.

New scientific information on burden and entomological, as well as social

causes of residual malaria available

By 2017, publication in peer review journal, policies and recommendations adapted.

SDFV.2: Implementation of a regional network on surveillance, diagnostic and vector control of vector‐borne emerging diseases in the Caribbean region.

By 2016, establishment of a network for surveillance and diagnostics of emerging diseases in the Caribbean region.

 This output and its corresponding target are part of the US$ 60 million budget scenario.

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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 diseases of poverty (TDR‐wide activity).

By 2016, 9 case studies on how the careers of women scientists can be improved.

Outputs:

Research reports, publications and strategies to improve the careers of women scientists

Report with cross‐site analysis on activity portfolio of 9 sites throughout Africa being published on the TDR website.

SDFV6: Development of a training course for capacity building on gender‐

based analysis in vector‐borne disease research using an innovative global classroom approach

By 2016, training course on gender‐based analysis developed.

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.

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.

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.

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.

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.

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

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.

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

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.

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.

Research on Vectors, Environment and Society

Annual Report 2015