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 there are important ways that the public health benefits of vaccination can be maximized. Examples:
    • Malawi has not experienced ubstantial herd protection from pneumococcal conjugate vaccines
    • We are observing waning of vaccine protection against rotavirus disease in the second year of life
    • Pneumococcal non vaccine serotypes and entirely novel rotavirus genotypes have emerged in Malawi following vaccine introduction.
    New vaccines in development - such as salmonella vaccines, Group B Streptococcal vaccines, RSV vaccines - could also substantially reduce the burden of disease in Malawi and warrant 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 and rotavirus transmitters in whole populations.
    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)
  • We are one of the rare sites in Africa with strong longitudinal bacteriological and viral surveillance for almost 20 years. Malawi data was 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). Our work has led to large grants from the Gates Foundation, the WHO and other international consortia.