1. How do we maximise the benefits of current EPI vaccines? (schedules, modifiable factors, non-specific effects)
    2. How do we protect novel populations with vaccination? (pregnant women, neonates, HIV-infected adults, TIV in women & children)
    3. What is the efficacy of novel candidates for existing  vaccine targets?(rotavirus)
    4. Do we need vaccines for the control of RSV, Norovirus, Group B Streptococcus and Group A streptococcus in Malawi?
  • Pneumococcal and rotavirus vaccines have been shown to be efficacious, but we are failing to see the maximal public health benefit of these products:

    • no significant herd protection from pneumococcal conjugate vaccines after 4 years of use,
    • waning protection against Rotavirus disease in second year of life,
    • emergence of pneumococcal non vaccine serotypes and rotavirus subtypes not prevented by vaccination.
    Additionally NTS (identified in Salmonella group), Influenza, RSV and pyogenic Streptococcal infection all have or are close to having vaccine constructs available for detailed study.
    1. a. Longitudinal studies on pneumococcal carriage and disease,
      b. molecular epidemiology of pneumococcal and rotavirus burden, 
      c. large scale (0.5million population) observational studies of vaccine effectiveness and scheduling, 
      d. fellowships on risk factors for sub-optimal response to enteric vaccines (RV and polio) . 
      e. Measuring and modelling key pneumococcal transmitters in whole populations (Karonga).
    2. a. Inactivated influenza vaccine trials in toddlers and impact of malaria and helminth co-infections on response.
      b. Cohort and case –control studies of the burden and severity of influenza and other respiratory viruses in HIV-infected adults and the interaction with pneumococcus.
      c. Disease burden and severity studies in pregnant women and neonates, infantile diarrhoea, paediatric respiratory infections. Sampling studies to identify the best means to identify rheumatic fever.
    3. a. RV3-BB phase 2 RCT
    4. a. Establish solid platform for burden of disease studies (eg RSV) and for recruitment of pregnant women to be ready for future phase 3 trials (g RSV)
  • One of the rare few sites in Africa with strong longitudinal bacteriological and viral surveillance for almost 20 years. Malawi data used to inform GAVI applications, WHO guidelines and several national guidelines on use of rotavirus and pneumococcal vaccines – JCVI, ACIP and IDSA. Work at MLW led to major findings on PCV7 in HIV-infected adults (French, NEJM), first RCT of RV1 in Africa (Cunliffe, NEJM) which led to global policy change at SAGE; first effectiveness study of RV1 at EPI schedule following roll-out in Africa (LnID)