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Supporting decision-making on the introduction of Haemophilus influenzae type b (Hib) vaccine in low- and middle-income countries

Summary of the impact

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.

Submitting Institution

London School of Hygiene & Tropical Medicine

Unit of Assessment

Public Health, Health Services and Primary Care

Summary Impact Type

Health

Research Subject Area(s)

Medical and Health Sciences: Public Health and Health Services

Controlling the hepatitis B virus in Africa and preventing unnecessary expenditure

Summary of the impact

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.

Submitting Institution

London School of Hygiene & Tropical Medicine

Unit of Assessment

Public Health, Health Services and Primary Care

Summary Impact Type

Health

Research Subject Area(s)

Medical and Health Sciences: Clinical Sciences, Medical Microbiology, Public Health and Health Services

Encouraging adoption of new children’s vaccines through the development of methods for decision support modelling

Summary of the impact

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.

Submitting Institution

London School of Hygiene & Tropical Medicine

Unit of Assessment

Public Health, Health Services and Primary Care

Summary Impact Type

Health

Research Subject Area(s)

Medical and Health Sciences: Medical Microbiology, Public Health and Health Services

UOA01-25: Effective Design Development and Evaluation of Meningitis Vaccines

Summary of the impact

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.

Submitting Institution

University of Oxford

Unit of Assessment

Clinical Medicine

Summary Impact Type

Health

Research Subject Area(s)

Medical and Health Sciences: Clinical Sciences, Immunology, Medical Microbiology

Rotavirus Vaccine Evaluation and Introduction in Africa

Summary of the impact

Rotavirus is the leading cause of acute gastroenteritis in infants and young children worldwide, causing 500,000 deaths annually. Prof Cunliffe at the University of Liverpool (UoL) has conducted rotavirus studies in Malawi since 1997, including descriptive epidemiology and the first clinical trial of a human rotavirus vaccine in Africa. Based upon the results of this clinical trial in Malawi, where vaccination was shown to reduce severe rotavirus disease caused by diverse strains by 50%, a global recommendation for rotavirus vaccine use was issued by WHO in 2009. African countries are now introducing rotavirus vaccines into their childhood immunization schedules with introduction in Malawi in 2012.

Submitting Institutions

University of Liverpool,Liverpool School of Tropical Medicine

Unit of Assessment

Clinical Medicine

Summary Impact Type

Health

Research Subject Area(s)

Medical and Health Sciences: Clinical Sciences, Medical Microbiology

UOA01-10: Preventing the Spread of H1N1: Immunisation Trials in UK Children

Summary of the impact

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.

Submitting Institution

University of Oxford

Unit of Assessment

Clinical Medicine

Summary Impact Type

Health

Research Subject Area(s)

Medical and Health Sciences: Clinical Sciences, Immunology, Medical Microbiology

Evidence to Support Use of New Vaccines and Vaccination Strategies by the Global Polio Eradication Initiative

Summary of the impact

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.

Submitting Institution

Imperial College London

Unit of Assessment

Public Health, Health Services and Primary Care

Summary Impact Type

Political

Research Subject Area(s)

Medical and Health Sciences: Immunology, Public Health and Health Services

Informing policy and decision-making on vitamin A supplementation for mothers and children

Summary of the impact

Vitamin A deficiency (VAD) is a major public health problem in low- and middle-income countries with young children and pregnant women particularly at risk. Over the last 20+ years LSHTM researchers have carried out a series of definitive trials in collaboration with the Ghana Health Service to evaluate the impact of different vitamin A supplementation (VAS) strategies on maternal and/or child survival. Findings have had major impacts on national and global VAS programmes and influenced WHO guidelines on VAS in: infants and children 6-59 months of age; infants 1-5 months of age; postpartum women; and pregnant women.

Submitting Institution

London School of Hygiene & Tropical Medicine

Unit of Assessment

Public Health, Health Services and Primary Care

Summary Impact Type

Health

Research Subject Area(s)

Medical and Health Sciences: Paediatrics and Reproductive Medicine, Public Health and Health Services

Evaluating and introducing pneumococcal conjugate vaccines (PCV) into the UK infant immunisation programme

Summary of the impact

A programme of work undertaken jointly between the UCL Institute of Child Health (ICH) Vaccine Evaluation Laboratory headed by Professor David Goldblatt and the Health Protection Agency (now Public Health England [PHE]) led by Professor Liz Miller, has led directly to the introduction of pneumococcal conjugate vaccines (PCV) into the UK infant immunisation schedule. These vaccines have reduced the burden of invasive disease in the UK saving many lives and reducing morbidity from these devastating infections. This work has also provided the evidence for other countries to introduce PCV with fewer than the originally recommended doses, thus improving cost effectiveness and hastening the implementation of these vaccines worldwide. Goldblatt has also contributed to a WHO programme to roll out PCV in developing countries; by July 2013 this programme had vaccinated around 10 million children.

Submitting Institution

University College London

Unit of Assessment

Clinical Medicine

Summary Impact Type

Health

Research Subject Area(s)

Medical and Health Sciences: Public Health and Health Services

Scaling up insecticide treated net coverage: evidence to support strategic policy decisions and investment

Summary of the impact

A comprehensive body of research into the effectiveness, cost and distribution of long-lasting insecticidal nets (LLINs) by LSHTM has made a major contribution to the reduction of malaria-related mortality between 2008 and 2013, especially among children in Africa. The research formed the basis of a radically altered strategic approach to combating malaria by WHO and other agencies, and led to the roll-out of malaria campaigns based around LLINs in several African countries. LSHTM research into the technology of LLINs, which also contributed to these developments, is described in a separate case study.

Submitting Institution

London School of Hygiene & Tropical Medicine

Unit of Assessment

Public Health, Health Services and Primary Care

Summary Impact Type

Health

Research Subject Area(s)

Medical and Health Sciences: Public Health and Health Services

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