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A trial of a pneumococcal conjugate vaccine (PCV) coordinated by Greenwood (LSHTM) and conducted in Gambian infants, showed a significant reduction in invasive pneumococcal disease, severe pneumonia, hospital admissions and deaths in vaccinated children. These results played an important role in encouraging WHO to recommend the introduction of a PCV into the routine immunisation programme of all countries with a high child mortality. Fifty-one GAVI eligible countries have now introduced, or made a commitment to introduce, a PCV into their routine infant immunisation programme with the consequent saving of many young lives.
Research conducted by LSHTM has informed the delivery of a 30-year WHO strategy aimed at reducing the devastating burden of liver cancer in Africa and least developed countries in other regions. Studies evaluating the effectiveness of the Gambia Hepatitis Intervention Study (GHIS) - the only randomised trial of a hepatitis B vaccine with a disease endpoint in Africa - have shaped current WHO policy recommendations for vaccinations against the virus, enabling WHO to advise against the need for a booster programme, and protecting governments in the less developed world from significant additional expenditure.
Research performed by the University of Oxford has led to increased protection against meningococcal meningitis, through childhood immunisation in the UK and internationally. Around 600,000 infants each year receive meningococcal vaccines, which prevent up to 1,000 cases of meningitis per annum. Research into the immune responses to polysaccharide conjugate vaccines has changed policy by leading to the introduction of new meningococcal C vaccines in early childhood and booster vaccination in adolescents. Oxford University research has also led to the planned use of vaccines against serogroup B meningococcal disease, which have been licensed and recommended for the prevention of disease in high-risk individuals, and broader use is under consideration.
Research at LSHTM has been central to the introduction of the Hib vaccine in developing countries. School staff were involved in the 1990s Gambia Hib vaccine trial, which demonstrated the impact of Hib vaccine on pneumonia. Through their work on the subsequent Hib Initiative, their research was instrumental in speeding up evidence-based decision-making for Hib vaccine introduction in a number of countries, mainly in Asia and Africa. The project has been an outstanding success, with Hib vaccine now introduced into 71 of the 73 countries eligible for GAVI Alliance support.
Clinical Trials undertaken by the Oxford Vaccine Group led to the recommended immunisation of three million UK children during the 2009 H1N1 influenza pandemic. This research was also used to inform World Health Organization (WHO) global policy. The 2009 H1N1 influenza pandemic, or "Swine Flu", was first identified in April 2009 and declared a pandemic by the WHO in June 2009. After acquiring two novel flu vaccines for the 2009 H1N1 influenza virus, the UK government approached the Oxford Vaccine Group to provide paediatric data on the safety of each vaccine. Rapidly recruiting 943 children to the study, the Group delivered essential data to the Department of Health prior to the onset of the winter influenza season. In August 2010, the WHO declared the H1N1 pandemic over.
LSHTM researchers have developed four computer models to help decision-makers make evidence-based choices about new vaccines and vaccine schedules. These models analyse the public health impact and cost-effectiveness of different options under different assumptions and scenarios on a country-by-country basis. They are used by national immunisation managers and key decision-makers, international committees and partner organisations (e.g. the Global Alliance for Vaccines and Immunisation and the Bill & Melinda Gates Foundation). LSHTM's researchers have built on this research for WHO, informing global recommendations on vaccine timing and schedules.
Since its discovery in the 1980s, avian metapneumovirus (AMPV) has spread in poultry populations worldwide with major adverse health and food security implications for commercial chickens and turkeys. Research at the University of Liverpool (UoL) led to the registration of a live vaccine in 1994 which has played a global role in AMPV control, thereby safeguarding the supply of poultry meat and eggs. Recent research and development at the UoL has identified key control measures, relating to vaccine application, vaccine selection, efficacy and safety, which have had a significant impact on poultry health and consequently, poultry producers and consumers. In particular, demonstration that live AMPV vaccines can revert to virulence, that vaccine type applied influences field protection and that continuous use of a single vaccine can influence circulating field strains, has resulted in UoL leading policy making with regard to current AMPV vaccine protocols.
Research carried out by LSHTM into the effects of male circumcision on HIV prevention has led to important policy recommendations by WHO and UNAIDS, the joint UN Programme on HIV/AIDS. The research showed a strongly reduced risk of HIV infection among circumcised men, and modelling studies estimated that male circumcision programmes in 13 priority countries in Africa could avert 4m HIV infections by 2025. Members of the research team serve on key international advisory groups, and these results have been widely used to underpin international policy guidelines.
Globally the most important cause of encephalitis (inflammation and swelling of the brain) is the mosquito-borne Japanese encephalitis virus (JEV), which causes an estimated 70,000 cases annually across Asia. Although vaccines were developed years ago, their uptake in Asian countries has been hampered through lack of disease burden data, a consequence of poor surveillance, complicated diagnostics, and insufficient knowledge about disease outcomes. Research at the University of Liverpool has addressed each of these areas in turn, to overcome the roadblocks in vaccine implementation. The University of Liverpool (UoL), through its leading role on all the relevant WHO committees groups and meetings, has ensured that its research findings are translated through to impact by supporting new vaccination programmes across Asia. By 2013 vaccination had begun in 11 new countries, and the vaccine had reached more than 200 million people. The public health benefits, estimated from a health economic modelling study, are 854,000 cases and 214,000 deaths avoided, with an associated saving across Asia of US$ 1.024 billion.
Research by Professor Grassly and colleagues at Imperial College on the epidemiology of poliovirus and the efficacy of new vaccines has played a critical role in the thinking and strategy of the Global Polio Eradication Initiative (GPEI). This research has supported the introduction of new vaccines, guided the timing and location of vaccination campaigns and influenced polio `endgame' policy. This is documented in the GPEI Strategic Plan 2010-2012, where Imperial research informed 2 of the 4 `major lessons' concerning poliovirus epidemiology described in the executive summary that led to changes in the programme. The research has also informed our understanding of mucosal immunity induced by oral poliovirus vaccines, and led to two clinical trials of the potential role of inactivated vaccine to boost mucosal immunity. Results from one of these trials were used to support the recent World Health Organisations (WHO) recommendation for universal vaccination with inactivated vaccine following the switch to bivalent oral vaccine in routine programmes.