The VAnguard project seeks to investigate the structural, social and biological factors that impede the impact of vaccines in vulnerable communities in Africa, with the aim of developing integrated strategies to address them.
Through our strong community engagement arm, we work among muti-level groups in communities in Uganda and Kenya with low vaccine uptake and/or a high prevalence of parasite infections and malnutrition, factors that could reduce their capacity to respond positively to vaccines. In partnership with UVRI(Uganda) and KEMRI|Wellcome Trust (Kenya) we carry out interventions both in laboratories and communities aimed at exhaustively identifying the causes of such low vaccine uptake. Our studies also contribute to the knowledge base about the actual impact of the COVID-19 pandemic on vaccine programmes.
VAnguard is about strengthening collaborations between national and international stakeholders to identify social and biological factors that impair vaccine impact in African communities. We also aim at developing integrated strategies and recommendations to fully achieve vaccine impact, and to contribute to health equity in Africa.
Who we are
We are a multidisciplinary Group made up of the London School of Hygiene & Tropical Medicine (LSHTM), East African partners at the forefront of building vaccine research capacity in the region: the Uganda Virus Research Institute (UVRI, Joint Lead) and Kenya Medical Research Institute (KEMRI) Wellcome Trust Research Programme (KWTRP). The Medical Research Council (MRC)/UVRI and LSHTM Uganda Research Unit (MUL), a close, on-campus partner of UVRI. We also collaborate with colleagues from Makerere University, Uganda Christian University (UCU), the Ugandan and Kenyan Ministries of Health (MoH) and expert collaborators.
What we do
Through mixed methods, we are engaging with communities and analysing biological samples to address these objectives.
- Investigate biological drivers and mechanisms of population differences in vaccine response
- Understand how structural, social and biological determinants of vaccine response interrelate to determine vaccine impact
- Identify and model integrated strategies to inform development of future interventions to optimize vaccine impact among vulnerable populations
Through multidisciplinary teams with members from each country; comprising of experts and trainees in biological and social science and community engagement, are working with communities and implementation stakeholders to generate a sustainable, collaborative research culture and facilitate sustainable pathways to research impact.
Using data and samples from our current trials in Uganda (on effects of infections) and Kenya (on nutritional factors), we are identifying “biomarkers” which can be measured in blood samples. These can show whether responses to vaccines are likely to be poor.
We are building capacity of early and mid-career scientists through having them lead thematic and study management work packages. We are also co-supervising PhD students; cross-cutting leadership, research and research-management training, and vaccinology and modelling training modules. All this is aimed at supporting personal and institutional capacity strengthening for vaccinology in Africa.
These are the outcomes we are looking forward to:
- New knowledge on interacting factors that determine vaccine impact,
- New strategies for optimising vaccine impact for vulnerable communities
- Strengthened capacity for multidisciplinary impactful vaccine research in Africa.
PhD students supported under VAnguard
| Name of fellow | Nationality | Institution | Field of study |
|---|---|---|---|
| Henry Karanja | Kenyan | KEMRI Wellcome Trust Research Programme | Immunology |
| Esther Awuor | Kenyan | KEMRI Wellcome Trust Research Programme | Social Sciences |
| Flavia Zalwango | Ugandan | Uganda Virus Research Institute | Social Sciences |
| Robinah Nalwanga | Ugandan | Uganda Virus Research Institute | Mathematical modelling |
| Ludoviko Zirimenya | Ugandan | MRC/UVRI & LSHTM Uganda Research Unit | Immunology |
| Agnes Natukunda | Ugandan | MRC/UVRI & LSHTM Uganda Research Unit | Statistics |
| Bridgious Walusimbi | Ugandan | MRC/UVRI & LSHTM Uganda Research Unit | Immunology |
Building bridges: community engagement on Koome Island
Written by Winnie Eoju; Social Science Research Assistant, VAnguard Project
Introduction
Our journey to Koome Island, which is located on the waters of Lake Victoria, was an experience that blended anticipation, discovery, and profound connection. We embarked on a mission to identify key structural factors affecting vaccine uptake in vulnerable communities, with the goal of empowering residents through shared learning and collaboration. This is a tale of our enlightening journey, the challenges we faced, and the invaluable insights we gained through immersive community engagement.
Setting sail: The journey begins
The early morning departure was accompanied by a mix of nervousness and excitement. As the boat's engine roared to life, a wave of anxiety washed over me, amplified by an empty stomach and an overly tight life jacket. However, the calmness of the lake and the light-hearted conversations among our team members gradually eased my nerves.
Our team comprised four dedicated ladies—Dr. Annette Kezaabu (Co-work package lead), Miss Flavia Zalwango (PhD fellow), Miss Laureen Kahunde, our communication officer, and myself—and three supportive men—the coxswain, his assistant, and Raymond Muganyizi, the project Finance and Administration officer. The boat was laden with two weeks' worth of work materials and personal supplies; everything we needed to make the trip count.
Tales from the lake
As we glided across the calm waters, the coxswain and his assistant entertained us with captivating stories of the islands. One such was the tale of an island in Koome where women are forbidden, with dire consequences for those who dare to set foot there. Dr. Kezaabu playfully challenged this myth, expressing her desire to visit and test its validity.
These stories, including accounts of snake-inhabited islands and Koome's history as a prison island during Kabaka Mutesa I's reign (the name deriving from "Kkomera," meaning prison in Luganda), enriched our journey, providing cultural context and a deeper appreciation for the island’s history.
Arrival and initial engagements
We arrived at the landing site at 1:30 PM, we were greeted by three motorcycles ready to transport us to our lodging. Although our plans to meet with local officials that afternoon didn’t pan out, because as our fieldwork explained how unpredictable island logistics can be, especially when water conditions turn rough, and the last thing he wanted was to have participants gathered for a meeting without our team, we remained positive. This little insight reminded us of the unique challenges of working in such an environment, where weather and water levels can throw a curveball at any moment. However instead of feeling down about it, we quickly decided to make the most of our time.
Dr. Kezaabu jumped at the chance to visit nearby households and Koome Health Centre III, sparking friendly conversations about vaccines and everyday life on the island. It turned out to be a fantastic opportunity to connect with the community in a more personal way. As evening rolled in, Dr. Kezaabu and Raymond, hopped on the motorcycles and headed off to the boat that was docked at the shores, leaving the three of us to dive into community engagement over the next few days. With a sense of adventure in the air, we were excited to continue our work and connect with the locals and share some laughs along the way.
Engaging with local leaders
The next morning, we gathered for a meeting with local council and religious leaders, skilfully organized by our local fieldworker. The turnout was fantastic, showcasing the community's enthusiasm to collaborate and chat about important health issues. The Local Council III chairman warmly introduced our team before we dove into our presentation on vaccination programs. What followed was a spirited question-and-answer session filled with engaging discussions that revealed both support and some hesitations regarding certain vaccines. The energy in the room was infectious, making it clear that everyone was eager to contribute to the conversation.
Community Barazas
To get a better sense of the community's perspectives, we organized "Barazas" (community meetings). The turnout was great with around 35 enthusiastic attendees, both men and women, eager to listen and share their experiences and concerns.
The Baraza turned into a lively platform for open discussion, covering a variety of topics beyond health, including social dynamics and daily challenges. As the meeting wrapped up, we enjoyed some shared refreshments and light-hearted interactions that truly reinforced the sense of community and mutual respect. Community members expressed their gratitude for having the chance to voice their thoughts. This highlighted how important it is to keep these conversations going for ongoing collaboration.
Exploring Koome Island's landscape and lifestyle
The island is a vibrant lush of greenery and colourful wooden homes, many sporting solar panels and TV antennas, symbolizing a mix of traditional living and modern aspirations.
While building proper sanitation facilities can be a bit tricky due to high water tables and weak soils, the community faces these challenges with resilience. The weak soils also means that wooden houses are the norm, as transporting sturdier materials from the mainland can be quite the logistical puzzle.
The local diet is hearty, mainly consisting of cassava, sweet potatoes, beans, and fish. Although fish is the main source of proteins in the Island, in an interesting twist, some folks associated it with dental cavities—a topic for some fun nutritional education.
Our visit coincided with the rainy season, bringing along its own set of challenges like intense thunderstorms and an increase in snake activity.
Reflections and insights
Our time in Koome Island community was truly eye-opening, giving us a glimpse into the complexities of healthcare acceptance, social dynamics, and the everyday challenges the residents face. Tackling vaccine hesitancy is no small feat; it requires thoughtful communication strategies that resonate with the community's fears and misconceptions. That’s why regular community forums, like Barazas, are so important—they help build trust, understand what the community needs, and encourage collaborative solutions.
Improving healthcare facilities, emergency response, and sanitation facilities is key to boosting overall health outcomes and quality of life. Respecting the unique cultural and social contexts of these communities, is essential for designing effective health interventions.
Conclusion
Our journey to Koome Island was an opportunity to listen, learn, and forge lasting friendships with the community members. The experiences we gathered truly highlighted the importance of genuine community engagement in bridging gaps and fostering sustainable health improvements.
As we waved goodbye to the peaceful shores of Koome, we left with a renewed commitment to support and collaborate with the locals, ensuring that our health initiatives are not only responsive to their needs but also rooted in mutual respect and understanding.
Enhancing health information access: The NIHR-MRC/UVRI/LSHTM Wikipedia editing workshop
By Laureen Kahunde VAnguard Communications Officer
In a bid to diversify channels of dissemination and enhance access to research findings, The VAnguard team in Uganda organised a Wikipedia editing workshop that was facilitated by Adam Harangozo, a Wikipedian-in-residence with the NIHR. The NIHR has so far expanded over 400 articles on Wikipedia making the sharing of research results much easier and more accessible especially for the NIHR-funded research.
This workshop, which was held online, brought together over 50 staff members and researchers from the MRC/UVRI/LSHTM unit in Uganda, partners from Uganda Christian University, Makerere University and the KEMRI Wellcome Trust Research Programme in Kenya. All united by a shared goal: to improve the quality and accessibility of health information on Wikipedia. This initiative is in line with NIHR's commitment to public engagement and knowledge dissemination, ensuring that the latest research and evidence are readily available.
The main objectives of the workshop were to equip participants with the skills needed to edit and contribute effectively to Wikipedia and this would lead to enhancing and expanding specific health-related articles.
The workshop also aimed at making high-quality health information more accessible to the public as well as fostering a collaborative environment among researchers, staff, and the communities they serve.
Participants contributed to a range of important health topics during the workshop, working on articles that addressed key areas related to different on-going NIHR-funded research projects. These contributions have helped improve the depth and accuracy of information available on Wikipedia. Some of this information can be found in these articles: Helminthiasis, Malaria, Vaccine efficacy, Social determinants of health, Vaccine hesitancy, Vaccine equity, BCG vaccine, Hepatitis B vaccine, Measles vaccine
Participants gained valuable skills in Wikipedia editing, learning how to navigate the platform, adhere to its guidelines, and contribute meaningful content. This skill set empowers them to continue making valuable contributions to public health information.
Feedback from participants was positive, with many expressing a newfound appreciation for Wikipedia's role in public health education. There is a strong desire among participants to continue contributing, and plans are already in place for future workshops to build on this momentum and cover additional topics.
This initiative not only improves the quality of information available to the public but also strengthens the bond between researchers, healthcare professionals, and the communities they serve.
As the NIHR continues to explore the potential of Wikipedia for dissemination, we look forward to more initiatives like this one that bridge the gap between research and public knowledge, ultimately contributing to a healthier and more informed society.
Differences in vaccine responses across populations present a key challenge in global health, affecting the development of effective vaccines and their equitable impact. Responses have often been seen to be poorer in low-income countries, especially rural settings. The Population Differences in Vaccine response ( POPVAC ) clinical trials, a series of landmark studies recently published in The Lancet Global Health, investigated these differences with the aim of contributing to better understanding of this phenomenon. Funded by the UKRI/Medical Research Council, these trials ran from 2018 to 2022 and focused on how environmental factors and chronic infections shape immune responses among adolescent schoolchildren in Uganda.
Urban–Rural differences in vaccine responses in Uganda
The first major finding was that responses to several vaccines differed markedly between urban and rural settings within Uganda. POPVAC Trial A was conducted in the Koome Islands of Mukono District, a region heavily impacted by schistosomiasis. POPVAC Trial B was conducted in rural Jinja district where malaria is highly endemic, and POPVAC C was conducted in urban Entebbe Municipality. However, no causal link was established between schistosome or malaria exposure and the variations in vaccine response, suggesting that other factors play a significant role in these differences.
Vaccine response in Schistosomiasis-endemic regions
POPVAC Trial A examined whether treating schistosomiasis with praziquantel could improve immune response to vaccines. Findings showed that praziquantel treatment improved the BCG vaccine response, although the effects on other vaccines were less pronounced. These insights suggest that it would be worth investigating whether sustained control of helminth infections could help to enhance vaccine efficacy.
Malaria’s influence on vaccine responses
POPVAC Trial B tested whether intermittent preventive treatment (IPT) for malaria using dihydroartemisinin–piperaquine could enhance immune responses to vaccines. IPT is an effective way to prevent malaria in high-risk groups. Although IPT successfully reduced malaria prevalence, it did not significantly improve vaccine responses. One possible explanation is that effects of malaria on a person’s immune system may be long-lasting, pointing toward a need for further research on the cumulative effects of long-term malaria control on vaccine efficacy. As well, other exposures found in rural malaria-endemic settings may also impact vaccine-induced immune responses.
BCG revaccination in urban environments
POPVAC Trial C, conducted in Entebbe, assessed the impact of BCG revaccination on immune responses to unrelated vaccines among urban adolescents, hoping that it might lead to improved responses. However, the study found that BCG revaccination did not boost immune responses to other vaccines.
“Together the studies highlight the complex factors at play in low-income settings and the importance of tailoring vaccine strategies to specific environmental contexts.” Says Professor Alison Elliott, POPVAC Principal Investigator.
Building on POPVAC
The findings from the POPVAC trials have sparked a series of new studies aimed at deepening our understanding of vaccine responses in various health and environmental contexts. Each of these follow-on studies continues to explore how complex biological and social factors impact immunization outcomes, advancing efforts to develop tailored vaccine approaches that can more effectively serve diverse communities.
In particular, the NIHR Global Health Research on Vaccines for Vulnerable People in Africa (VAnguard study) – which gave follow-on support to POPVAC – addresses both biological and social factors that impact vaccine efficacy in African communities. With a focus on strengthening vaccine impact across diverse populations, VAnguard aims to deliver comprehensive, actionable strategies that empower local communities, advance public health and support equitable vaccine outcomes.
These studies continue to address unique challenges in vaccine research and enhance its capacity to boost public health for vulnerable populations in Africa and globally.