Vectors, Environment and Society

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Annual Report 2016

Vectors, Environment and Society

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VES Annual Report 2016

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TDR/VES/17.1

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Acronyms list

AFRO WHO Regional Office for Africa

ASEAN Association of Southeast Asian Nations

ASEAN NDI Association of Southeast Asian Nations – Network for Drugs, Diagnostics, Vaccines and Traditional Medicine Innovation

BUSE Bindura University of Science Education, Zimbabwe CARPHA Caribbean Public Health Agency

CDC Centers for Disease Control and Prevention ClimDev-Africa Climate for Development in Africa Initiative COP-21 Conference of Parties -21

EBS eco-bio-social

ER Expected Result

ERC Ethics Review Committee

GFCS Global Framework for Climate Services H-NAP Health National Adaptation Plans

iCCM integrated Community Case Management

IDRC International Development Research Centre ( Canada)

IRI International Research Institute for Climate and Society at Columbia University, New York, USA

IRS Indoor Residual Spraying

IT Information Technology

ITNs Insecticide-treated nets JCB TDR Joint Coordinating Board

JOOUST Jaramogi Oginga Odinga University of Science and Technology, Bondo, Kenya KPI Key Performance Indicator

LLIN Long lasting insecticide treated net LMICs Low- and middle-income countries LSM Larval Source Management

KU Kenyatta University, Nairobi, Kenya NDCs National Determined Contributions

NMAIST Nelson Mandela African Institute of Science and Technology, Arusha, Tanzania PAHO Pan-American Health Organization

PHE (WHO) Public Health, Environmental and Social Determinants of Health PHE (AFRO) Protection of Human Environment

PI Principal investigator

RCS-KM TDR unit on Research Capacity Strengthening – Knowledge Management

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|5 RTC Regional Training Centre

RVF Rift Valley fever

SACEMA South African Centre for Epidemiological Modelling and Analysis, University of Stellenbosch

SDF Strategic Development Funds SDG Sustainable Development Goal

SEAR / SEARO WHO South-East Asian Region / WHO Regional Office for South-East Asia SPH School of Public Health, University of Ghana

SPT Special Project Team

STAC Scientific and Advisory Committee if TDR SU Sokoine University, Morogoro, Tanzania SWG Scientific Working Group

TDR Special Programme for Research on Tropical Diseases UAME Université Abdel Malek Essaadi, Maroc

UAO Université Alassane Ouattara, Bouake, Côte d’Ivoire UB University of Botswana, Botswana

UC University of Cambridge,

UCSF University of California – San Francisco, USA UDS University of Dar es Salaam, Tanzania

UFHB Université Félix Houphouet Boigny, Abidjan, Côte d'Ivoire UFS University of the Free State, South Africa

UKZN University of KwaZulu-Natal, South Africa

UN United Nations

UNK University of Nairobi, Kenya

UNA Université Nangui Abrogoua, Abidjan, Cote d’Ivoire

UNFCCC United Nations Framework Convention for Climate Change US University of Stellenbosch, Stellenbosch, South Africa USAID United States Agency for International Development USt University of Strasbourg

USTM Université des Sciences et Techniques de Médecine, Nouakchott, Mauritania USA United States of America

UZ University of Zimbabwe, Zimbabwe VBD Vector borne disease/s

VES TDR unit on Vectors, Environment and Society

WHO – HQ World Health Organization Headquarters in Geneva, Switzerland WMO World Meteorological Organization

WPR/WPRO WHO Western Pacific Region / WHO Regional Office for the Western Pacific

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Introduction

The Vectors, Environment and Society (VES) unit was created in 2011 to specifically address issues across diseases and sectors to improve the health and well-being of the most vulnerable populations affected by vector-borne diseases. The unit supports research on new vector control interventions and their implementation, as well as builds research capacity and networks.

The main research topics include vector ecology and biology, vector control technologies, community-based interventions, as well as environmental and climate change impacts. VES objectives and activities are organized in four working areas (Figure 2), in line with the United Nations Sustainable Development Goals (SDGs) that began 1 January 2016. To take into account the multi-faceted dynamics of economic, social and environmental determinants of health, the supported research/network projects are implemented through a holistic approach, in the context of diseases transmitted by vectors. All VES expected results have strong links and are interdependent.

Figure 2. VES main work streams with their expected results (ERs)

These areas were developed following wide consultation with WHO partners such as the Global Malaria Programme, Neglected Tropical Diseases Department, Public Health and Environment and the regional offices in the Americas, Africa, South-East Asia and the Western Pacific. Additional input came from a TDR Forum with stakeholders either from public and private, national and international institutions, and discussions with WHO and external partners, experts, stakeholders, funders and countries representatives. JCB, STAC and Scientific Review Committee provided final reviews and approval.

This report covers the 2016 VES activities and achievements, expected outputs (ERs) in 2017, and proposals for the 2018-2019 biennium and associated budgets. Within each working area, the objective, expected results, funding and progress are presented, and the main objectives and outcomes are summarized into tables. The recommendations of the VES Scientific Working Group (SWG) held in October 2015 are also presented and addressed point by point.

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Objectives

The four working areas of the VES activities are presented as main objectives. Included are the ongoing and terminated ERs, and the projects funded by Strategic Development Funds (SDF).

Proposals for new ERs are provided in the chapter on future plans. Details of outcomes, outputs and indicators are provided in the ER database appendix.

Objective 1: Analyse and mitigate the impact of the environmental changes on the transmission of infectious diseases, in particular vector-borne diseases, to advise and implement recommendations and policies to prevent adverse effects and increase resilience of the populations. This objective includes 2 ERs and one SDF activity: ER 1.3.3, SDFV.3 and ER 1.3.7.

Objective 2: Develop and implement new approaches to face emerging challenges such as the impact of insecticide resistance on vectors, support research activities to better understand what control and elimination programmes face to achieve their goals, and support country and regional networks to prevent and better prepare for infectious disease emergencies. This objective includes 1 ER and 3 SDF activities: ER 1.3.6, SDFV.2, SDFV.4 and SDFV.5.

Objective 3: Study the social and community dynamics, to understand how all levels of a community participate in preventing disease transmission, and can be actively involved in the control of the vector-borne diseases. This objective includes 5 ERs: ER 1.3.1, ER 1.3.2, ER 1.3.4, ER 1.3.5, ER 1.3.10.

Objective 4: Improve the gender balance and ethical approaches in research activities for the prevention and control of infectious diseases. This objective includes one ER and one SDF: ER 1.3.8 and SDFV.1

Key achievements in 2016

• A special issue of the Journal of Clinical Infectious Diseases on the improvement of care for children under five was published in early December 2016. “Malaria in Highly Endemic Areas:

Improving Control Through Diagnosis, Artemisinin Combination Therapy, and Rectal Artesunate Treatment” demonstrates TDR-supported projects have significantly reduced the number of severe malaria cases in the participating countries.

• Community-based vector control interventions in urban and rural settings were deployed in several Latin American countries against dengue and Chagas disease. These strategies were developed by TDR funded projects and presented at the TDR-sponsored forum to inform and improve vector and disease control strategies in endemic countries.

• Research evidence is informing the development of decision-support processes and tools to build resilience among the most vulnerable populations in dryland Africa. About 50 scientific articles were published from the projects on climate change.

• A directory of the courses of medical entomology worldwide has been developed and put into use, and the main findings of the commissioned review was published in Memorias do Instituto Oswaldo Cruz.

• Twenty-three case studies on social innovation in health care delivery were completed and made available online, as part of TDR’s Social Innovation in Health initiative to provide more evidence on what works and what does not in this area.

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Progress in 2016 and planned future activities

Within the 4 objectives presented above (Figure 2), VES is supporting 15 projects among ten ERs and five SDFs. Among the ERs, two were completed in 2015 (1.3.1 and 1.3.2), one will be ending in 2016 (1.3.4), one has been cancelled (1.3.9) and five are ongoing (1.3.3, 1.3.5, 1.3.6, 1.3.7, 1.3.8 and 1.3.10). Among the five SDF projects, three have been completed (SDFV.1, SDFV.2 and SDFV.3) and two are on-going (SDFV.4 and SDFV.5). Table 1 provides an overview of this work, and a narrative on each of the projects follows.

The planned future activities will include, if approved, two new ERs:

Environmental changes

ER 1.3.11 Multi-sectoral approach for the control of malaria and VBDs Gender equity and vector-borne diseases

ER 1.3.12 Gender responsive health interventions Table 1: VES workplan overall progress

Expected results and deliverables by outcome Indicators, targets and contribution to KPI¹ Environmental change impact: communities benefit

from enhanced research capacity and from adoption of tools meant to increase resilience to vector-borne diseases under climate change conditions

By 2017, new tools used by communities in 13 countries in Africa and Asia

1.3.3. Research on vector-borne diseases and climate change in Africa: i) knowledge and scientific evidence generated about the impact of climate change on health; ii) research capacity built for knowledge translation; iii) communities-of-practice established; iv) MSc and PhD training organized within the funded projects

By 2016, web-based training materials developed and made available to researchers About 50 articles were published in peer review journals that inform the development of decision-support process and tools available A web-based knowledge-sharing platform, VBD-environment.org, was launched 1.3.7. Evidence for control of vector-borne diseases

in South-East Asia through environmental measures:

i) concerns and risks identified, characterized and assessed; ii) community-centred adaptation strategy developed and implemented for access to

environmental health support services; iii) benefits assessed and monitored

By 2017, six categories of new tools available for communities, including community interventions, environmental interventions, vector surveillance, mechanical vector control, biological vector control and classical vector control

Selection process of the funded projects expected in March 2017

1 See http://www.who.int/tdr/publications/about-tdr/strategy/Framework2014_flyer_page.pdf?ua=1

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|9 Expected results and deliverables by outcome Indicators, targets and contribution to KPI¹ Emerging challenges: countries using new knowledge

on insecticide resistance, residual malaria and emerging fevers

By 2017, at least six countries using the new knowledge and research evidence to inform policy and practice

1.3.6. Evidence on the impact of insecticide resistance and residual malaria on malaria control:

i) new scientific information on insecticide resistance mechanisms generated to fill critical knowledge gaps;

ii) link between insecticide resistance mechanisms and malaria control failure established; iii) estimation of the burden of residual malaria and first insight of the causes

By 2017, impact of resistance mechanisms on control failure established in six African countries and estimation of burden of residual malaria completed in at least three countries Projects ongoing with collection of data and analysis of results

1.3.9. Prevention of vector-borne diseases and emerging fevers in fragile health systems in West Africa: research evidence generated by funding institutions in countries

By 2017, evidence generated from five research studies

This ER has been cancelled Social and community dynamics: new knowledge on

social innovation and community-based vector control interventions disseminated and used by communities in countries

By 2017, at least four new countries applying innovative knowledge on social innovation and/or interventions for community-based vector control

1.3.5. Research on social innovation to enhance health care delivery: i) new knowledge disseminated;

ii) Global South Social innovation in Health Network launched; iii) fellowship programme sustained to support innovative frontline organizations

By 2017, reports on case study evaluation and research disseminated, capacity strengthening programme implemented and social

innovation network supported

• 23 social innovation case studies in Asia, Africa and Latin America completed and published

• Call for collaborative research on social innovation led by LMICs issued; 4 research institutions selected to become social

innovation research hubs (Asia, Africa, Europe)

• Web-based platform maintained to disseminate knowledge and practice

• Convening of donors and institutions funding health research to share

knowledge/experience and explore ways to promote and support social innovation research

1.3.10. Urban health interventions for control of vector-borne diseases: i) intervention “packages”

developed; ii)awareness of local enterprises for business opportunities created; iii) community awareness and attitudes regarding house protection achieved; iv) systematic literature reviews about human mobility in urban areas and its impact of disease transmission

By 2017, large scale housing protection against vectors initiated in four pilot cities (two in Asia and two in Latin America)

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Expected results and deliverables by outcome Indicators, targets and contribution to KPI¹ Gender equity: institutions implemented the gender

analysis training course By 2017, at least two institutions and 40 individuals have used the course to enhance their ability in addressing gender equity in their activities

1.3.8. Training course for gender data-analysis in vector-borne diseases: training course on gender- based analysis using an innovative global classroom approach

By 2016, training course tested and implemented

Pilot training course started in 2016 in Medical School of Ghana, and evaluation will be done after one year

Other expected results and Strategic Development Fund projects that were not part of the 2016-2017 core portfolio of projects

ER 1.3.1: Promoting research for improved

community access to health interventions in Africa (Part of 2014-2015 project portfolio)

8 systematic reviews published

ER 1.3.2: Improved Chagas and dengue disease control through innovative ecosystem management and community-directed interventions

(Part of 2014-2015 project portfolio)

EBS framework developed in Latin America 15 studies completed and published

ER 1.3.4: Eco-bio-social research in support of the WHO Global Strategy for dengue prevention and control

Studies completed in 3 countries and final technical reports available

SDFV.2: Implementation of a regional network on surveillance, diagnostic and vector control of vector- borne emerging diseases in the Caribbean region (Part of 2014-2015 project portfolio)

Workshop held in Trinidad in December 2015 and in Saint-Kitts-and-Nevis in May 2016 Four working groups are close to being created

SDFV.4: Development of an online platform for courses on vectors and Vector-Borne Diseases for low- and middle-income countries

Workshop held in Lisbon in February 2016, commissioned review published in MIOC in November 2016

Directory of courses available on demand SDFV.5. Organization of a workshop and

commissioned reviews to develop an international network on vector control in emerging arboviruses (Part of 2014-2015 project portfolio)

WIN website launched in May 2016 Workshop held in Brazil in December 2016, with presentation of commissioned reviews

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Objective 1: Environmental changes

Analyse and mitigate the impact of the environmental changes on the transmission of infectious diseases, in particular vector-borne diseases, advise and implement recommendations and policies to prevent adverse effects and increase resilience of the populations.

This objective includes two ERs implemented in different regions in Africa, South-East Asia and the Western Pacific.

Expected result 1.3.3: Population health vulnerabilities to VBDs: increasing resilience under climate change conditions in Africa

Lack of knowledge on the impacts of climate change on VBDs, especially in the vulnerable dryland areas of Africa, remains a serious obstacle to evidence-based health policy change. There is increased policy attention and commitment to climate and health in Africa.

This research programme, undertaken with designated funding from the International Development Research Centre (IDRC), Canada (covering the period 2012-2017), focuses on a particular health threat, vector borne diseases (VBDs) in the broader development context of human vulnerability to climate change. The overall goal of this research programme is to generate evidence through a shared analytical framework to enable development of innovative strategies to reduce VBD-related human vulnerability and to increase resilience of African populations to such VBD-related health threats. In addition, this research programme is expected to contribute new knowledge, develop research capacity, enhance collaboration and develop policy advice products that can be used throughout Africa.

There are five research projects in this joint initiative; all projects are currently in the fourth year of their implementation (see below – Table 2. List of research projects). The projects, led by researchers from research institutions in Botswana, Cote d’Ivoire, Kenya, Mauritania, South Africa, Tanzania and Zimbabwe, and in collaboration with national control services, are focused on addressing the following VBDs: malaria, schistosomiasis, human African trypanosomiasis and Rift Valley fever. The projects provide 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 individual research projects are managed in three phases: a) Phase 1 - to describe and characterize the complex socio-ecological system in African dryland water systems, not only for their environmental, social and climate change aspects but also VBD transmission dynamics and disease burden, b) Phase 2 - to investigate the changing context of the environmental, social, economic and climate change conditions and its impact on VBD transmission and burden, and c) Phase 3 - to develop community based adaptation strategies and decision-support processes and tools for reducing population health vulnerabilities to VBDs. All projects are currently on-track. This includes engagement with communities and stakeholders, assessing vulnerability, determining the temporal trends on the burden of VBDs, generating preliminary climate and meteorological data and systematically characterizing the socio-ecological system.

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Table 2. Impact of climate change on vector-borne diseases and resilience of the most vulnerable populations in Africa projects

Project title Vector-borne disease/s (and study sites) Principal Investigator Social, environmental and

climate change impact of vector-borne diseases in arid areas of Southern Africa

Malaria and schistosomiasis Moses Chimbari, College of Health Sciences, University of Kwazulu-Natal, Durban, South Africa

• Botswana (3 villages in Ngarange and Shakawe)

• South Africa (Mgedula, Ndumo and Makanis)

• Zimbabwe (Makwe and Byuma in Gwanda district)

Early warning systems for improved human health and resilience to climate sensitive vector-borne diseases in Kenya

Malaria and Rift Valley fever Benson Estambale, Jaramogi Oginga Odinga University of Science and Technology, Bondo, Kenya

• Kenya (Kabarnet town in Baringo County)

Predicting vulnerability and improving resilience of Maasai communities to vector-borne infections:

an ecohealth approach in the Maasai Steppe ecosystem

African trypanosomiasis Paul Gwakisa, Nelson Mandela African Institute of Science and Technology (NMAIST), Arusha, Tanzania and The Genome Science Centre and Department of Veterinary Microbiology and Parasitology, Faculty of Veterinary Medicine, Sokoine University of Agriculture, Morogoro, Tanzania Tanzania (Oltukai village in Monduli district

located between Manyara Ranch and Lake Manyara National Park; Loiberserit village in Simanjiro district adjacent to the

southeastern border of Tarangire National Park)

Human African trypanosomiasis:

alleviating the effects of climate change through understanding the human- vector-parasite

interactions

African trypanosomiasis John Hargrove, South African Centre of Excellence in Epidemiological Modelling and Analysis (SACEMA), University of Stellenbosch, South Africa

• Zimbabwe (Rekomitjie Research Station located in Mana Pools National Park, Zambezi Valley, Mashonaland West Province; and Vuti village located on the fringes of the wildlife areas)

• Tanzania (Villages in the Ikorongo- Grumeti area to the west of the Serengeti National Park) Vulnerability and

resilience to malaria and schistosomiasis in northern and southern fringes of the Sahelian belt in the context of climate change

Malaria and schistosomiasis Brama Kone, Centre Suisse de Recherches Scientifiques en Côte d’Ivoire, Abidjan, Côte d’Ivoire

• Cote d’Ivoire (Korhogo)

• Mauritania (Kaedi)

The ecohealth approach used for this climate and health research programme provides the projects with a holistic and integrated multidisciplinary and intersectoral base. To reduce transmission of vector-borne diseases, an understanding of the environment is key. The ecohealth approach is expected to facilitate the generation of evidence of the determinants of VBD risks (transmission and disease burden in relation to exposure and vulnerability) to assess the impact of climate, environmental and social changes on population health vulnerabilities and to develop risk management strategies leading to increased adaptation and resilience with the engagement of communities.

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|13 The integrative approach is also crucial for this research activity which is not meant to be a standard epidemiological, parasitological, entomological, or prediction/warning system research, but more of a research for policy and action, to support and complement country plans of action and for development. Consequently, it is expected to deepen our understanding of the connectedness of the different areas in the risks of vector-borne diseases through interactions between researchers of different expertise. Moreover, it has highlighted the significance of a dynamic working collaboration and knowledge sharing environment which involves different disciplines and developmental sectors.

Contrary to traditional research approaches that address in isolation issues related to VBD risks (transmission and burden) and exposure (human-vector contact), this approach addresses all of the other components of the ecosystem, e.g. environmental conditions determining exposure and population vulnerability determined by socio-economic and socio-cultural conditions. Consequently this approach will contribute to a better understanding of the impacts of social, environmental and climate change on VBDs in Africa, and to improving the ability of African countries to adapt to and reduce the effects of these changes in ways that benefit the most vulnerable populations. These insights can have a crucial function in defining locally relevant and appropriate interventions.

This ecohealth project is aligned with the implementation of various global mechanisms and sustainable goals such as the UN Sustainable Development Goals, the WMO (World Meteorological Organization) Global Framework of Climate Services (GFCS) for coordinated actions for the enhancement of the quality, quantity and application of climate services; the UNFCCC (United National Framework – Convention on Climate Change), the International Health Regulations for the improvement of the capacity of countries to respond to public health threats; and the Climate for Development in Africa Initiative (ClimDev-Africa) for overcoming climate information gaps, for analyses leading to adequate policies and decision-making. The outcomes from the research are expected to contribute to the Libreville Declaration on Health and Environment in Africa, the Luanda Commitment and the Framework and Plan of Action for Public Health Adaptation to Climate Change in the African Region.

Furthermore, this project is enhancing the missions of both TDR and IDRC to improve population health and well-being. With this research initiative, TDR and IDRC continue their collaboration on ecohealth and vector-borne diseases which was initiated in 2003 with the fight against diseases of poverty for the improvement of public health in least developed countries.

A Special Project Team, established in 2012, provides technical support to TDR for the implementation of this research programme.

The research initiative is being implemented in collaboration with the IDRC, the WHO-HQ Department for Public Health and Environment (PHE), the AFRO Programme for the Protection of Human Environment and the International Research Institute for Climate and Society at Columbia University, New York, USA.

Progress in 2016

All five projects have completed their thirdyear of implementation. The projects have completed their data collection activities and their work has progressed well into data analysis and integration.

• Phase 1 of implementation (Assessment and characterization of complex socio-ecological systems) – the research projects have completed work towards characterization of the burden of VBD in the context of socio-demographic situation and change, stakeholder

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analysis across various sectors, land use and water resource management, and the state of climate

• Phase 2 of implementation (Assessment of risks through investigation of threats from vector-borne diseases under climate change conditions) – potential impact on vector ecology and distribution, vector bionomics, transmission dynamics and vector-parasite- human host interactions; disease burden; associated health outcomes including spatial distribution, seasonality and variability as well as longer-term trends of disease burden

o Also contributing to Phases 1 & 2 in the generation of new knowledge and evidence are the scientific publications as well as the commissioned systematic reviews that are currently being undertaken. Capacity building efforts were also advanced through the capacity building workshops, technical support from experts/facilitators, the web-based knowledge-sharing platform, the site visits, capacity building in communities, capacity building for students, and capacity building for ethics in research and gender-based data analysis.

• Phase 3 of implementation (Developing strategies for VBD risk management, population health vulnerability reduction and increased resilience) – currently underway

o Research uptake: activities are under way to facilitate the use of research evidence by policy-makers, practitioners and other partners. Research teams are currently preparing their synthesized research evidence and engaging sectoral partners (in health and environment) on discussions for a common understanding of the value of the research evidence to inform policy and practice decisions.

New evidence and knowledge continue to be generated. Publications are also available from most of the projects. In addition, presentations were made at scientific symposia in 2016.

o Health and Climate Colloquium (8-10 June 2016, Palisades, New York, USA): The International Research Institute for Climate and Society (IRI) and the Mailman School of Public Health, Columbia University, convened this event.

The Health and Climate Colloquium report can be found using this link: http://features.iri.columbia.edu/healthclimatecolloquium2016#chapter- 1389146

o 28th Annual Conference of the International Society for Environmental Epidemiology (1-4 September 2016, Rome): Symposium on Climate change and Health in Africa:

Challenges with Water-Related and Vector-borne Diseases. For more information on ISEE 2016, please follow this link - http://www.isee2016roma.org/

Gender balance

• Members of Special Project Team : 57% men (4 experts), 43% women (3 experts) out of a total of 7

o Chair – man

o Members – 3 men, 3 women

• Composition of research teams: Of the 112 researchers that are currently part of this network, 84 are men (75%), and 28 are women (25%).

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• First author in publications: 73% men (22 papers) and 26.66% women (8 papers) out of 30 publications

o Project A – 11 publications (7 men, 11 women) o Project B – 1 publication (0 men, 1 woman) o Project C – 1 publication (0 men, 1 woman) o Project D – 16 publications (14 men, 2 women) o Project E – 1 publication (1 man, 0 women)

• Students: 55.9% men (33 students) and 44.1% women (26 students) out of 50 students.

o Project A – 20 students (11 men, 9 women) o Project B – 8 students (5 men, 3 women) o Project C – 5 students (2 men, 3 women) o Project D – 14 students (7 men, 7 women) o Project E – 12 students (8 men, 4 women)

Remaining challenges

o Timely planning and organization of the Research Uptake meeting (2017).

o Timely publication of the Special Journal Issue about VBDs and Climate Change.

o Effective communication of research outcomes, including preparation of policy briefs to decision-makers and other relevant stakeholders.

o Generate additional funding in support of the projects to ensure research will be taken up by the health and environment sectors and communities in the African countries where the research was undertaken.

Leverage

o Collaborations with the International Research Institute (IRI), Columbia University, WHO PHE and WHO AFRO/PHE, have positively widened the network for the dissemination of new data and new knowledge generated by the projects.

Plans for 2017

The activities to be undertaken (until end of July 2017) are as follows:

o No cost extension of the TDR-IDRC Research Programme until July 2017

o Online review process for SPT review of programme portfolio (November-December 2016)

o Participation of researchers to One Health EcoHealth 2016, 3-7 December 2016, Melbourne, Australia

o Publication of a supplement in a peer-reviewed/open access scientific journal (Infectious Diseases of Poverty): draft manuscripts in preparation, target publication date: 2nd quarter 2017

o Organization of the Scientific Forum and Research Uptake Meeting (April 2017, Brazzaville, Republic of Congo); co-organized with WHO AFRO PHE

o Launching of a mapping interface product on the Maasai project using Google Earth (April 2017)

o Continue expanding the reach and audience of VBD-environment.org through newsletters, project updates and dissemination of publications

o Submission to IDRC of TDR Final Technical and Financial Report, July 2017 o Scaling up of the use of tools for community-based adaptation:

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 Upscaling or vertical scale-up from the local community level to use lessons learned from local change processes to inform decision-making at higher administrative and organizational levels for wider-reaching impact.

 Horizontal scale-up (a.k.a. scaling-out): Community-based adaptation can be expanded over a larger geographical area, wherein the expansion could involve a larger number of new but replicated community-participatory initiatives based on the initial intervention.

 Opportunity for research/training on developing new services and models to better address social issues around adaptation.

Expected result 1.3.7: Environmental prevention and control of vector-borne diseases and infectious diseases in South-East Asia

Every year more than one billion people are infected and more than one million people die from VBDs. VBDs also cause significant hardship and misery to affected populations. Many VBDs are prevalent in SEA and WP regions. These include, among others, mosquito borne diseases (e.g. malaria, dengue, Chikungunya, Japanese encephalitis, lymphatic filariasis, Zika), sandfly-borne disease (kala-azar) and snail-transmitted disease (e.g. schistosomiasis), although there may be other lesser known VBDs.

The purpose of this new initiative, Collaborative Research on Health and the Environment in the South East Asian and Western Pacific Regions: Innovative socioecological strategies for the prevention and control of vector borne diseases, is to stimulate collaborative research that would have a positive, transformative impact on health outcomes for populations challenged by VBDs within the context of an ever changing environment (including climate change) and within a framework of a complex socioecological system. It is being implemented in collaboration with the Association of Southeast Asian Nations – Network for Innovation (ASEAN NDI).

This research programme envisions a health supportive environment that can adequately and appropriately address the challenges of vector-borne diseases in these areas, especially those with inadequate health infrastructure. Building a health supportive environment ensures that intervention approaches are developed through coordinated multisectoral joint action and community empowerment. This research programme will support and contribute to the use, uptake and adoption of VBD control/prevention products (such as innovative tools, solutions and delivery mechanisms and approaches to significant VBD challenges) that are preventative and sustainable.

Progress in 2016

Expert panel consultation. As a follow up to the Regional Consultation on Health and Environment (Global Forum on Research and Innovation for Health, 24-27 August 2015), TDR, in collaboration with ASEAN NDI, organized an expert panel consultation on Health and Environment 5-6 April 2016 in Manila, Philippines. The expert panel is composed of seven members with expertise and experience that span the following: globalization and geography of health and disease, public health and development, health and environment (including climate change), ecology, community based conservation, forest transitions, urban planning, equity and gender, and vector borne diseases. The expert panel is expected to work closely with VES for the identification of gaps, opportunities and priority research and training areas on health and environment, with a particular focus on how environmental public health services can contribute to the prevention of vector borne diseases. The objectives of the expert panel consultation are to: a) brainstorm on the elements that may contribute to a transdisciplinary framework for a new research initiative on Health and Environment

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|17 for the control and prevention of VBDs in the SEA and WP regions; b) provide expert opinion on resilient/sustainable technologies, adaptive capacity building and community participatory approaches, linking policy to practice through multisectoral collaboration and transdisciplinary research; c) discuss options for a draft call for proposals; and, d) agree on ways forward for the implementation of the new research initiative. The expert committee also serves as the Special Project Team.

• Call for proposals. The call was launched on the TDR website in August

2016: http://www.who.int/tdr/grants/en/; http://www.who.int/tdr/grants/SEA_WPR_envir onment_VBD_call_final.pdf?ua=1; http://www.who.int/tdr/annex-1-framework-health-and- environment.pdf ).

The deadline for submission of proposals was 15 October 2016. Twenty-eight notices of intention to apply were received; 16 full proposals were received by the deadline. The proposals came from lead research institutions in China (2 proposals), India (4), Lao Peoples Democratic Republic (1), Malaysia (5), Sri Lanka (1) and Thailand (3).

• Review of proposals. The review of proposals by the SPT covered the period 25 October – 26 December 2016.

• Draft publications. Manuscripts in preparation

o Paper documenting the consultation process (Global Forum, expert committee meeting) leading to the identification of gaps, opportunities and priority research and training areas on Health and Environment in the SEA and WP regions.

Commissioned review on public health interventions, with emphasis on vector- borne diseases and related threats and the population health vulnerabilities that result from the changes in the socio-ecological systems (including climate change) in the SEA and WP regions.

Leverage created from this project

ASEAN NDI Secretariat has contributed funding and human resources in support of this research initiative, particularly for the organization/conduct of the consultation meetings and documentation of the consultation process. ASEAN NDI will likewise partner with TDR in supporting capacity building activities relevant to the projects to be funded by this initiative.

Publications that have come out of this work:

Manuscripts in preparation

o Paper documenting the consultation process (Global Forum, expert committee meeting) leading to the identification of gaps, opportunities and priority research and training areas on Health and Environment in the SEA and WP regions.

o Commissioned review on public health interventions, with emphasis on vector- borne diseases and related threats and the population health vulnerabilities that result from the changes in the socioecological systems (including climate change) in the SEA and WP regions.

Related news

Planning for new health and environment research in the east, 18 April

2016: http://www.who.int/tdr/news/2016/new-health-environ-research-east/en/

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Gender balance

Members of Special Project Team: 57% men (4 experts), 43% women (3 experts) out of a total of 7 o Chair – man

o Members – 3 men, 3 women

Remaining challenges

Timely completion of proposal review process, development of research protocols for approval of ethics review committee (WHO and local committees) to ensure that implementation of the projects will commence by the first quarter of 2017.

Plans for 2017

The activities to be undertaken are as follows:

• Grantees selected by January 2017

• Project protocol developed and submitted for approval by WHO ERC (Ethics Review Committee) and national institutional review boards by March 2017

• 2^nd – 4^th quarter 2017: implementation of projects

Objective 2: Emerging Challenges

Develop and implement new approaches to face emerging challenges such as the impact of insecticide resistance on vectors, support research activities to better understand which gaps control and elimination programs have to face to achieve their goals, and support countries networks to prevent and be better prepare to infectious diseases emergencies.

Expected result 1.3.6: Evaluation and improvement of malaria control policies through study of the impact of insecticide resistance on LLINs and IRS efficacy, and preliminary analysis of the burden and causes of residual malaria.

Six research projects are included in this ER, and all projects are focused on better understanding how to support malaria control and elimination.

The activity was developed in collaboration with the Global Malaria Programme of WHO. LLINs, IRS and Larval Source Management (LSM) as supplementary measures are core interventions in malaria control and are highly efficacious when implemented well against vectors susceptible to the insecticides. However, resistance of the malaria vectors to insecticides threaten the success of malaria elimination, and malaria transmission can also 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. Residual malaria has been reported across numerous transmission settings with several species implicated.

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|19 The WHO Global Malaria Programme has emphasized that there is a strong need for new tools and strategies to address residual malaria, in low- to high-transmission areas. The development and optimization of these tools necessitates a clearer understanding of the magnitude of the problems.

Two important questions are thus arising: i) what is the contribution of residual transmission to the overall burden of malaria; and ii) what are the causes of the residual malaria transmission?

The rationale of the project is therefore to first provide information on: i) the impact of insecticide resistance on LLINs efficacy; and ii) the magnitude of residual malaria transmission in different epidemiological settings, identifying 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.

A call was issued in March 2015 to select research applications with the following objectives: i) to produce updated data from selected settings of low- to high-malaria transmission on the magnitude of residual malaria; and ii) to produce scientific evidence on the causes of this residual malaria through investigations of entomological, social and environmental determinants. These studies are forming the baseline scientific evidence for larger projects on more specific topics, including the impact of new vector control tools. After external review by an ad-hoc committee, the following proposals were selected for funding:

Project 1: Understanding the impact of insecticide resistance on the efficacy of IRS and LLIN in 3 ecological settings of Mali (PI: N. Sogoba, Mali), 2 year project, started in 2015.

Control of malaria vectors relies heavily on insecticide-treated nets (ITNs) and indoor residual spraying (IRS). The success of these control methods seems to be threatened by the development of resistance in malaria vectors. However, scientific evidence is needed to confirm this. The objective of this study is to analyse the effect of developed mechanisms of resistance to insecticides by malaria vectors on the performance of existing malaria vector control tools (LLINs and IRS) in three different epidemiological settings in Mali, Benin and Nigeria. The study is being implemented through a comprehensive compilation of existing data on the dynamics of insecticide resistance, control tools ownership and utilization, community perceptions on the effectiveness of control tools, assessment of entomological and parasitological parameters. The effects of intervention type (i.e. LLIN/IRS, IRS and control) on the entomological and parasitological outcomes will be assessed by fitting: i) logistic regression models on binary or binomial outcomes (e.g. sporozoite rates, HBI, parous rates, proportion of mosquitoes with endophagic behaviour, parasitaemia positivity); ii) multinomial models for categorical outcomes (e.g. vector composition); and iii) negative binomial models for counts (e.g. vector densities, malaria incidence rates). Intervention type will be treated as a categorical covariate. The models will be formulated within the Bayesian framework and fitted in Openbugs.

This study should contribute to: (i) improved malaria vector control strategies through appropriate selection of insecticides for IRS/LLINs and improved sensitization information for increasing net utilization; (ii) increased knowledge on IRS/LLINs performances in areas where malaria vectors have developed different mechanisms of resistance; and (iii) knowledge on the operational effect of insecticide resistance mechanisms on IRS and LLINs and best resistance management strategies.

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Progress in 2016

Conclusions of the mid-term report:

During the first year of the project and for each of three countries included in the study, which are Mali, Nigeria and Benin, the following activities were achieved:

• Study area characterization.

• Review of the dynamics of insecticide resistance in Anopheles populations.

• Review of the acceptability and performance of LLINs in areas of resistance.

• Investigation of the insecticide resistance mechanisms in the studied areas.

Plans for 2017

The second year of the project the following activities will be performed:

• Monitor entomological, parasitological, and socio-anthropological indices of LLINs/IRS efficacy in the selected study sites (with and without insecticide resistance).

• Compare the performance of LLINs and IRS on entomological indices (vector longevity, Human Biting Rate and Extrinsic Incubation Period) and malaria prevalence in areas where the mosquitoes exhibit either knock-down resistance or metabolic resistance mechanisms or both.

Project 2: Residual malaria hotspots in Peru and Brazil: setting the stage for testing improved (PI: D. Gamboa, study sites in Peru and Brazil). One year project, started first quarter 2016.

Project 3: Residual Malaria Transmission in the Greater Mekong Subregion (GMS) - Studies to examine its magnitude and identify its causes (PI: Jeffrey Hii, study sites in Thailand and Vietnam).

One year project, started first quarter 2016.

Project 4: Where and when is residual malaria transmission taking place? Investigating magnitude and drivers of persistent Plasmodium infections in East and West Africa (PI: Fredros Okumu, study sites in Burkina Faso and Tanzania). One year project, started first quarter 2016.

Project 5: Understanding residual transmission for sustainable malaria control and enhancement of elimination efforts in Africa (PI: Joseph Mwangangi, study sites in Kenya, Cameroon and Ethiopia).

One year project, started first quarter 2016.

Project 6: Understanding human, parasite, vector and environmental interactions driving residual malaria transmission in Papua New Guinea (PI: Moses Laman, study sites are in Papua New Guinea).

One year project, started second quarter 2016.

Progress in 2016

Mid-term reports have been received for projects two, three and four. The objectives are well in line with the plan, and first results on mosquito biting behaviour, as well as human behaviour, and use of LLINs are provided. These preliminary results are being analysed to make a hypothesis on the causes of residual malaria.

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|21 Plans for 2017

Further results of the dynamics of the malaria transmission are expected, and will be analysed with entomological and social data to better understand the causes of the residual malaria in the different regions. Final and technical reports expected for all projects, mid-2017.

An international workshop will be supported and organized by VES to be held in September 2017 in one of the countries to present the overall results and make recommendations for policies.

Leverage created from this project: Project four has received supplementary funding from the United States Agency for International Development (USAID) to extend the research activities in Zanzibar. Leverage not yet determined for the other projects.

Gender balance

Percentage of women in the research teams: Overall 62% (22) of men and 38% (13) of women Project 1: 4 men (100%)

Project 2: 2 women (100%) Project 3: 3 men (100%)

Project 4: 6 men and 4 women (60% and 40%) Project 5: 3 men

Project 6: 7 men and 6 women (53% and 47%)

Publications that have come out of this work: none yet.

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

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, which has now spread 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 regional exchanges from both a public health and research perspective.

The overall objective of this initiative is better prevention and control of VBDs through a regional network. TDR funded Caribbean Public Health Agency, which has partnered with the Pedro Kouri Institute of Cuba, the international Institute Pasteur Network and the Ross University School of Veterinary Medicine in Saint Kitts and Nevis, to host two workshops to stimulate the formation of a Caribbean network.

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Progress in 2016

The second workshop (the first was held in 2015 and reported in last year’s annual report) was held in May 18-23, 2016 in Saint-Kitts and Nevis. It focused on vector surveillance, control, monitoring and insecticide resistance in the Caribbean Region.

Two cross-cutting themes, research and capacity building, were identified by workshop participants and related activities are being carried out using a multi-country approach, through collaborations forged because of the project.

The network comprises four Working Groups – Surveillance, Laboratory, Clinical Management and Vector Control, from which subject matter experts are being integrated from the Caribbean countries and research institutions. The research activities being developed by the working groups fit within the framework of the regional agenda for vector-borne diseases. TDR continues to provide mentorship support, and forwards requests and opportunities to the network from persons who are interested in VBDs in the Caribbean. The final and technical report is expected end of November 2016.

Plans for 2017

Launch of an official Caribbean Network, with country signature for participation, tentatively planned in Cuba in August 2017. Fundraising is planned to support collaborative research projects within the Caribbean Network.

Leverage created from this project: The Caribbean network has received financial support from several agencies including the Centers for Disease Control and Prevention (CDC) in the United States, the Caribbean Community and the European Union (€5 million). The network has attracted attention and contacts have been made both indirectly and directly to the Caribbean Public Health Agency (CARPHA) by researchers, funding agencies and manufacturers of vector control products through the network. Inter-country exchanges, including the attachment of vector control personnel on short-term training programmes have also been facilitated through the network.

Gender balance: The PIs in the consortium of institutions were 2 men and 2 women (50% and 50%).

Publications that have come out of this work: planned publication in Q2 2017.

Related news

New Caribbean network publishes resources and research recommendations

http://www.who.int/tdr/news/2016/carribean_net_resources_res_recommend/en/

Framework proposed for formal Caribbean network

http://www.who.int/tdr/news/2016/caribbean-network-framework/en/

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SDFV.4: development of a platform for distance learning course on vectors and vector- borne diseases (VBD) for low- and middle-income countries (LMIC).

Among the health priorities of LMICs, vector-borne diseases are at the top of public health concerns.

The control of VBDs 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 vector-borne diseases 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. Institutions in Europe (in the UK, France, Spain and Portugal) and North America (Florida, California, Colorado, Texas) offer courses on epidemiology and 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 institutional research priorities and not to LMIC needs. In Africa, Latin America and Asia, 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.

A more harmonized and visible platform of courses for general and specialized topics in the field of VBDs has been identified. This project is designed to bring stakeholders together to map all important courses on vectors and VBDs that focus on the needs of LMICs, and provide this online.

Progress in 2016

The commissioned review on courses of medical entomology worldwide was available in January 2016. The Instituto de Higiene Tropical de Lisboa was contracted to organize a stakeholder workshop that was held in Lisbon in February 2016. The main finding of the commissioned review was published in Memorias do Instituto Oswaldo Cruz in November 2016. A directory of the courses worldwide is being built, and will be regularly updated.

Plans for 2017

The proceeds of the workshop held in Lisbon in February 2016 will be published. Fundraising is planned to develop an online platform where the information of the courses can be available.

Gender balance: The PIs of the two activities funded through this project were 4 men and 2 women (66% and 33%).

Publications that have come out of this work: planned publication in Q2 2017.

Related news

Development of one platform for all courses on disease vectors

http://www.who.int/tdr/news/2016/platform-courses-on-disease-vectors/en/

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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.

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 larvicide 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 on the resistance of vectors of arboviruses and its impact across countries is not well known. The household insecticides market, estimated at over US$ 8 billion, may also have contributed to the development of resistance. On the other hand, the insect pests in agriculture have been the target of the same chemical methods in the past and in recent years. However, 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 panel of approaches, from the high- standard technologies such as genetically transformed insects/plants to the more environmental friendly approaches such as 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. The monitoring of resistance for the vectors of emerging arboviruses, as well as the review of alternative methods for vector control, could begin with commissioned reviews from experts, followed by a more focused workshop, where scientists from both the public health and agriculture could interact and exchange their experience. The reviews should help generate an international network, and workshop should develop recommendations for research and implementation priorities and needs.

Progress in 2016

The Worldwide Insecticide Network (WIN) and its website were launched in Montpellier France in May 2016, with more than 25 participating countries. The Workshop of the Worldwide Insecticide Network was held in Rio de Janeiro in Brazil in December 2016.

Plans for 2017

The proceedings of the workshop that was held in December 2016 in Brazil will be published, as well as the commissioned reviews (five papers expected).

Leverage created from this project: The WIN network has received financial support from several agencies including CDC, Institut de Recherche pour le Développement and private industries. The network has attracted attention and new institutions are joining and bringing support in different forms.

Gender balance: The executive Committee of the WIN Network includes 6 men and 4 women (66%

and 33%).

Vectors, Environment and Society

Annual Report 2016