Grand Challenges is a family of initiatives fostering innovation to solve key global health and development problems. Each initiative is an experiment in the use of challenges to focus innovation on making an impact. Individual challenges address some of the same problems, but from differing perspectives.
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Brazil and Pakistan Data-Driven Ecosystem for COVID-19 Preparedness, Equity and Vaccine Surveillance
Vinicius de Araujo Oliveira of Fiocruz in Brazil will develop a framework for the re-use of large clinical and administrative datasets to enable comparative analysis of COVID-19 vaccine safety and effectiveness in Brazil and in Pakistan, with colleagues at Shaukat Khanum Memorial Cancer Hospital and Research Centre there, to improve pandemic responses and promote data-driven evidence generation in the Global South. Monitoring vaccinations across different settings is crucial for containing pandemics. However, comparative analysis of large health datasets in different scenarios is challenging due to concerns around safety and reproducibility and the loss of the context in which the data was collected, which can affect research results. They will adapt data science standards and tools to different local health system scenarios and run individual and joint vaccine effectiveness analyses for the two countries to assess compatibility and reproducibility of the findings. They will also build a public data visualization dashboard for health managers and policymakers to monitor the pandemic, particularly in vulnerable populations.
FAIR and CARE Principles for a Multi-Country Electronic Medical Record Cohort
Vincent Cubaka of Partners In Health in the U.S. will build robust data governance structures to enable the utilization of electronic medical records from multiple countries for research purposes to improve health. So-called FAIR (Findable, Accessible, Interoperable, Reusable) data principles enhance the value of personal medical records for research, and CARE principles were developed to protect the owners of these data. However, the rigidity of these principles can create conflicts, which can make it difficult, for example, to open access to datasets across different countries. To address this, for their current project studying the impact of COVID-19 on chronic care patients across four low- and middle-income countries, they will develop data governance structures and set-up a multi-country community oversight committee to enable full access by researchers to appropriately de-identified individual-level data on a suitable platform.
Integrated Surveillance of NTDs Through the Blood Donation Program in Kenya
Wyckliff Omondi from the Ministry of Health in Kenya will integrate a neglected tropical disease (NTD) surveillance program into the national blood donation program as a more cost-effective mechanism to monitor lymphatic filariasis and other endemic NTDs in Kenya. Kenya is on course to eliminate lymphatic filariasis using mass drug administration programs. Certifying regions as disease-free requires careful post-treatment assessments. To support this, they will work with the Kenya National Blood Transfusion Service, which collects, tests, and distributes blood across the country, to collect small, normally discarded blood samples from regional centers and test them for lymphatic filariasis, dengue and chikungunya in their central laboratory. As well as supporting eradication efforts, this routine testing will provide an early warning system by identifying distribution patterns and prevalence of dengue and chikungunya, which have histories of outbreaks in coastal regions.
Innovations to Enhance Implementation of Trachoma Intervention in Tanzania
Innocent Semali of Hubert Kairuki Memorial University in Tanzania will design a more effective strategy for eliminating trachoma in the nomadic Maasai communities in Tanzania. Trachoma is a bacterial disease and a leading cause of blindness. Globally, there are around 84 million sufferers, mostly in sub-Saharan Africa. In Tanzania, the standard control strategy, which involves mass drug administration of azithromycin, eliminated trachoma from most districts. However, the strategy has largely failed in nomadic populations for unclear reasons. To identify those reasons, they will work towards building a partnership with a Maasai community and relevant stakeholders and use interviews and surveys to document their perceptions and behaviors around the standard trachoma interventions. This information will be used to understand the failure of the previous interventions and, together with the communities and stakeholders, to develop new strategies for testing in two villages using a mixed methods approach.
Pakistan and Brazil Data-Driven Ecosystem for COVID-19 Preparedness, Equity and Vaccine Surveillance
Haroon Hafeez of Shaukat Khanum Memorial Cancer Hospital and Research Centre in Pakistan will develop a framework for the re-use of large clinical and administrative datasets to enable comparative analysis of COVID-19 vaccine safety and effectiveness in Pakistan and in Brazil, with colleagues at Fiocruz there, to improve pandemic responses and promote data-driven evidence generation in the Global South. Monitoring vaccinations across different settings is crucial for containing pandemics. However, comparative analysis of large health datasets in different scenarios is challenging due to concerns around safety and reproducibility and the loss of the context in which the data was collected, which can affect research results. They will adapt data science standards and tools to different local health system scenarios and run individual and joint vaccine effectiveness analyses for the two countries to assess compatibility and reproducibility of the findings. They will also build a public data visualization dashboard for health managers and policymakers to monitor the pandemic, particularly in vulnerable populations.
Antimicrobial Resistance Data Center for Madagascar and Burkina Faso
Luc Samison of Centre d'Infectiologie Charles Mérieux - University of Antananarivo in Madagascar will support more responsive and resilient antimicrobial resistance (AMR) surveillance systems in Madagascar and Burkina Faso by building a data science center for the electronic collection, analysis and dissemination of data. They will develop and refine data collection tools and sharing processes to promote multi-disciplinary collaborations and strengthen data governance and standards. These will be applied to detecting multi-drug resistant Escherichia coli and Enterobacteriaceae in several settings including pregnant women, hospitalized patients, chickens and surface water. They will also develop new tools and processes to provide stakeholders with strategic AMR indicators in real-time to support decision-making. This project will also support data-centered health research on AMR surveillance and can be applied to a range of pathogen surveillance settings in other low- and middle-income countries.
Malaria Modelling Field-Strengthening: Nigeria
Chijioke Kaduru of Corona Management Systems in Nigeria will strengthen malaria mathematical modeling capability and capacity in Nigeria by building a fellowship program for field epidemiologists and current doctorate students in epidemiology. The program will be embedded within the Nigeria Field Epidemiology Training Program (NFETP), which is managed and coordinated by the Nigeria Centre for Disease Control. The NFETP serves to strengthen and coordinate Nigeria’s ability to respond to public health events through training public health leaders in interventional epidemiology and developing institutionalized and sustainable public health workforce capacity, and its graduates participate in priority disease control programs, including for malaria and neglected tropical diseases. The new fellowship program is expected to increase the number of Ph.D. level-trained mathematical modelers with malaria expertise based in Nigeria and localize modeling expertise to support the National Malaria Elimination Program.
Malaria Modeling Field-Strengthening: MaModAfrica
Wilfred Ndifon of the African Institute for Mathematical Sciences - Next Einstein Initiative Foundation in Rwanda together with Luc Djogbénou from the Université d'Abomey-Calavi, Benin, and Jeanine Condo from the University of Rwanda, will collaborate with academic institutions, operational partners and national malaria control programs (NMCPs) from Benin, Rwanda, Senegal, Burkina Faso, Mozambique, Côte d'Ivoire, Switzerland, Australia, Kenya and Ghana to create a sustainable ecosystem of mathematical modelers, translational specialists, and decision-makers to support malaria interventions in Africa. They will develop curricula in modeling, epidemiology, and infectious disease biology for MSc and PhD students. They will also bridge the gap between academic modeling and the operational needs of NMCPs across English, French and Portuguese-speaking countries by developing targeted training for researchers and NMCP staff. This cultural shift in educational approaches is designed to teach the language of data scientists while focusing research on providing data-driven evidence relevant for policy making.
A Learning Health System for Improved Data Use for HIV/AIDS Response
Damazo Kadengye of the African Population and Health Research Center in Kenya will establish a functional Learning Health System to promote the exploration of population health data from multiple sources to improve public health responses to infectious diseases in sub-Saharan Africa. Utilizing the data revolution to generate new knowledge is crucial for achieving global health targets, but there is a lack of suitable tools and limited access to data from different sources. They will integrate multiple large HIV/AIDS datasets from 11 longitudinal population cohorts in East Africa and develop an organizational architecture that enhances data discoverability and promotes responsible open data sharing, supporting collaborations between healthcare professionals, policy makers and researchers. They will also train scientists to produce data-based evidence using data science tools and predictive statistical models and to work with policy makers at local and national levels.
Malaria Modeling Field-Strengthening: WAMCAD
Yaw Asare Afrane of the University of Ghana will build malaria modeling capacity in West Africa by training a critical mass of modeling scientists across multiple career stages to work closely with national malaria control programs (NMCPs). They will strengthen infrastructure and faculty in existing laboratories, provide technical training and support, and promote modeling as a PhD program in universities. They will also develop mathematical modeling curricula in malaria and NTDs in multiple languages and adapted for each country, which will be freely available online. In addition, they will build an anglo-franco-lusophone West African consortium of modelers, epidemiologists, parasitologists, and NMCPs, to share expertise and support NMCP priorities, and ultimately to sustain reductions in malaria burden.
Malaria Modeling Field-Strengthening: MMALA
Sheetal Silal of the University of Cape Town in South Africa will establish the Malaria Modeling and Analytics: Leaders in Africa (MMALA) program to promote the training and career development of a critical mass of African malaria modelers that can support decision making of national malaria control programs (NMCPs). They will increase the number of PhD-trained mathematical modelers with malaria expertise in sub-Saharan Africa institutions, and foster relationships with NCMPs from Angola, Botswana, Eswatini, Mozambique, Namibia, South Africa, Zambia, Zimbabwe, Benin, Cameroon, and Ghana including providing literacy training workshops. Twelve PhD candidates will be selected and provided with complementary coursework, research skills development, and secondment opportunities at their local NMCPs. They will also hold regional and central events to help build networks and share expertise across this cohort of modelers and develop an open web resource for malaria.
Malaria Modeling Field-Strengthening: ACoMVeC
Charles Wondji of the Centre for Research in Infectious Diseases in Cameroon will establish the African Consortium in Modeling for Effective Vector Control (ACoMVeC) together with seven research institutes across the continent, bringing together African scientists and northern partners in the U.S. and United Kingdom to help improve malaria control. They will train 15 PhD level modelers at both French- and English-speaking African universities in transmission dynamics modeling, coding compartmental models using R or Python, statistical methods, understanding uncertainty, and using models for policy. These modelers will investigate several independent projects including modelling the impact of insecticide resistance on malaria transmission. They will also set up technical advisory groups to help national malaria control programs identify key operational research projects for modeling and effectively leverage modeling approaches to facilitate decision making.
Nature-Inspired Identification of Novel Antivirals with Distinctive Mechanisms of Actions: Case of HIV and SARS-CoV-2
Fidele Ntie-Kang, a computational chemist at the Department of Chemistry, University of Buea in Cameroon, will establish a state-of-the-art drug discovery regional center for Central Africa that utilizes natural products from across the continent to identify new antiviral drugs suitable for resource-limited regions. Dr. Ntie-Kang is a pioneer in harnessing the diverse African flora for drug discovery purposes. His research group is building an online natural products database, which contains compounds isolated from plants, fungi, corals and bacterial species growing in Africa. He will set up a unique team of synthetic organic chemists, natural product chemists, computational chemists, microbiologists, biochemists and artificial intelligence experts, and build an open access pan-African library of naturally occurring compounds and a cloud-based computing platform. The team will combine virtual and in vitro screening techniques to identify natural compounds targeting the SARS-CoV-2 spike protein and the HIV Vpu protein, as well as promoting HIV latency-reversal. They will also train students to expand research capacity, and transfer the knowledge and technology developed during the project to other research institutes.
Enhancing Prediction of Adverse Pregnancy Outcomes in Africa Through Partnerships and Innovation
Annettee Nakimuli, Associate Professor of Obstetrics and Gynaecology and Dean of the School of Medicine at Makerere University in Uganda, will identify predictors of adverse pregnancy outcomes in Ugandan women with a focus on Great Obstetrical Syndromes (GOS), such as pre-eclampsia, to help develop context-relevant interventions for prevention and treatment. Dr. Nakimuli is an internationally-recognized research leader in maternal health for Africa. She performed the first genetic case-control study on pre-eclampsia among indigenous Africans, and identified different biological factors to those found in European studies, which helps explain the higher incidence. Building on her experience setting up cohort studies, she will prospectively collect biological samples and clinical data from a large cohort of 4,000 women throughout their pregnancies at Kawempe and Mulago Hospitals in Kampala to identify predictive biomarkers, and establish a biobank and database to facilitate future research. She will also implement artificial intelligence for data analysis to identify relevant socio-epidemiological, clinical, and biological features that contribute to the development of Great Obstetrical Syndromes.
Investigating the Immune Kinetics of COVID-19 Vaccine Responses Between European and African Populations
Yaw Bediako, Founder and Chief Executive Officer of Yemaachi Biotech and researcher at the West African Centre for Cell Biology and Infectious Pathogens in Ghana, will bring together African biotech and academia with the Francis Crick Institute to provide important insights into how vaccines can be designed to work more optimally among African people. The African continent has the highest infectious disease burden in the world but almost no capacity for vaccine development or testing. Instead, most vaccines are tested in healthy Caucasian adults in high income countries, and many have lower efficacy among African populations. Dr. Bediako studies immune function in African populations and is devoted to building research capacity in Africa. He developed and successfully deployed the first national SARS-CoV-2 variant tracker on the continent, which displayed the distribution of viral variants in real-time. He will perform a prospective cohort study, and use molecular, cellular, and data-analysis approaches to investigate if the cellular and humoral immune responses to the AstraZeneca COVID-19 vaccine differ between Ghanaian and UK populations, and identify the effect of host genetic diversity on vaccine response. These data will support more rational vaccine design among African populations.
Genomics for Infectious Diseases Control and Epidemics Preparedness
Abdoulaye Djimde, President of the Pathogens genomic Diversity Network Africa (PDNA), will work to better prepare Africa to fight infectious diseases and tackle those of the future. Dr. Djimde’s research group uses molecular and genetic approaches to study malaria, and their results have supported policy decision-making in Mali and the West Africa sub-region. His work on anti-malarial resistance led to a change in first-line therapy, and his group also serves as a training ground for many scientists in Africa. Recognizing the importance of collaborative research across the continent for studying infectious diseases, he established PDNA, which is an African-led research network spanning sixteen countries. PDNA investigates the genetic diversity of human pathogens to inform disease control and elimination strategies. He will set up a PDNA Pathogens Genomics Institute in Mali equipped with genetic and molecular epidemiology infrastructure. The Institute will train the next generation of scientists, and study the emergence and spread of malaria, SARS-CoV-2, and anti-microbial resistance, and identify novel pathogens. They will also focus on engagement with communities and health policy makers across the member countries to support public health on the continent.
Integrating Malaria Molecular Epidemiology into Routine Surveillance in Kenya
Isabella Oyier, Associate Professor and Head of Bioscience at the KEMRI-Wellcome Trust Research Programme in Kenya, will establish a national malaria molecular surveillance platform that is integrated into the Division of National Malaria Programme (DNMP) to directly translate research into policy. The malaria burden in Africa is no longer declining due to the emergence of new variants that are undetectable by standard diagnostics and resistant to the frontline antimalarial drug. Dr. Oyier, a leader in malaria molecular epidemiology, is committed to eradicating malaria in Africa. She pursues a collaborative approach by sharing resources across laboratories and partnering with key stakeholders to ensure research impacts policy. This approach enabled her to make critical contributions to the genomics surveillance and testing efforts during the COVID-19 pandemic in Kenya. She will establish a national data repository and a working group to develop a sustainable next-generation sequencing platform that can be easily implemented across malaria-endemic regions where sentinel health facilities will be established to collect samples. She will also build user-friendly bioinformatics pipelines to examine parasite genetic diversity and the distribution of resistance markers, and to present actionable data for policy decision-making.
Rapid Interventions to Save Newborn LivEs (R.I.S.E)
Mainga Hamaluba, Head of Clinical Research at the KEMRI-Wellcome Trust Research Programme in Kenya, will develop a pragmatic adaptive trial platform to evaluate key interventions for improving child survival in East Africa in real-life routine practice conditions as a faster and lower-cost alternative to traditional randomized controlled trials. Dr. Hamaluba has led a wide-range of complex clinical trials, including oversight of a complement of COVID-19 prevention and vaccine trials. She will use newborn care and hypoxic-ischaemic encephalopathy (HIE; also known as birth asphyxia) as a case study for the platform. HIE is the leading cause of admission in a network of Newborn Units in Kenya and causes severe neurological disabilities in survivors. Leveraging an existing and unique clinical surveillance framework and biobank at her institute, she will conduct a pragmatic platform adaptive randomized controlled trial of three licensed treatments to evaluate their effect on newborn survival. She will also establish procedures to increase the speed, rigor, and adaptability of regulatory approval protocols for clinical trials, and focus on training and mentorship of local healthcare workers in clinical research.
Leveraging Bacterial Genomics for Health Solutions in Africa
Iruka Okeke, Professor of Pharmaceutical Microbiology at the College of Medicine, University of Ibadan in Nigeria, will develop sequence-based methods and leverage genomics data to jumpstart the development of diagnostics and vaccines for neglected bacterial pathogens in African settings. Professor Okeke has devoted her career to studying neglected enteric bacteria that can cause potentially fatal bloodstream and diarrheal infections. She recognizes the power of genomics approaches to improve surveillance and better define pathogen virulence. She has been developing lower-cost and simpler methods to traditional culture-based techniques for detecting difficult-to-culture bacterial pathogens directly from blood samples in minimally-equipped laboratories. These methods incorporate nanopore sequencing together with target enrichment by the CRISPR-Cas9 system for rapid, direct-from-specimen diagnosis and genomic surveillance. She will adapt these methods for identifying a range of pathogens directly from stool, urine, and other clinical samples. She will also grow a community of experts to support this project by training African scientists in molecular science and bioinformatics.
Implementation of Pharmacogenomics Testing for Effective Care and Treatment in Africa
Collen Masimirembwa, Professor and founding President and Chief Scientific Officer of the African Institute of Biomedical Science and Technology (AiBST), Zimbabwe, will generate a research and innovation ecosystem, including training scientists and establishing centers of excellence in genomic medicine research, for the sustainable development of genomic and pharmaceutical medicine capability in Africa. Dr. Masimirembwa is on a mission to achieve world-class drug discovery and development capability in Africa. In 2002, he founded AiBST in Zimbabwe, and over the last ten years has organized a series of drug discovery and development courses across the continent to introduce the subjects and contextualize them for Africa. He will establish three centers of excellence in Zimbabwe, Kenya, and Nigeria to help launch an R&D biotechnology industry in Africa by forging partnerships with relevant stakeholders and training industry-focused scientists. He will also perform a prospective, multi-center clinical trial across several countries to determine the effectiveness of pharmacogenetic testing in reducing the incidence of adverse drug reactions and increasing treatment efficacy in African populations.
Vaginal Microbiome Research Consortium for Africa (VMRC4Africa)
Jo-Ann Passmore, Associate Professor of the University of Cape Town in South Africa, will pilot the formation of the vaginal microbiome research consortium in Africa (VMRC4Africa) by establishing a network of researchers and centers of excellence for conducting research and clinical trials to promote women’s health across the continent. Dr. Passmore uses immune biomarkers and microbial-based approaches to study HIV and HPV pathogenesis and prevention in African women. Her work identified genital tract inflammation as a major predictor of HIV risk and pathogenesis, and revealed that inflammation reduces the efficacy of the anti-retroviral drug tenofovir, which is used to treat HIV. Her laboratory is a South African center of excellence in HIV prevention and she is committed to nurture and mentor young African researchers. She will establish the necessary infrastructure for African researchers to document the changing composition of the vaginal microbiota, beginning with South African and Kenyan women. They will use sequencing and build a biorepository to help identify health-promoting <em>Lactobacillus</em>-dominated microbiota in different geographic regions. These could be co-formulated into live biotherapeutic products to treat genital tract inflammation for women globally.
The African Data and Biospecimen Exchange - Facilitating Equitable Data and Biospecimen Sharing, and Resolving Barriers to Data and Biospecimen Sharing in Africa
Nicki Tiffin, Professor at the University of the Western Cape, South Africa, will build an online platform – the African Data and Biospecimen Exchange – to facilitate equitable, ethical, and transparent data and biospecimen sharing on the continent, and promote research collaborations to improve health. Sharing biospecimens and data such as human genomics and pathogen sequencing data for use by other scientists is critical to sustain research in Africa. However current barriers that preclude sharing include high costs, the need for specialized formatting, and legal limitations for sensitive data. Dr. Tiffin has worked extensively across multiple health research domains, built research networks and collaborators across Africa, and is passionate about the effective use of health data in scientific research. She will build a platform for uploading standardized resource meta-data to reduce overhead costs, and provide practical guidance and online templates for sharing sensitive datasets. She will undertake a consultative process with domain experts to produce the design and functionality of the platform.
Evaluation of the Vaginal Microbiome and Metabolomic Profiles in Adverse Pregnancy Outcomes in a Kenyan Population
Moses Obimbo Madadi, Clinician-Scientist and Associate Professor at the University of Nairobi, Kenya, will form a coalition of researchers and develop tools to study the vaginal microbiome and metabolites during pregnancy to help identify predictive biomarkers and intervention strategies for improving pregnancy outcomes in Kenya. Africa carries a high burden of severe pregnancy complications such as stillbirths and neonatal deaths. To address this, Dr. Madadi is leveraging his broad experience in clinical, basic, and epidemiological research to establish a unique niche of translational research to support the health of women in Kenya and around the world. He will perform a prospective cohort study at four hospitals in Nairobi by collecting clinical data and vaginal samples from over 1200 pregnant women. He will use next-generation sequencing to analyze microbial communities, and metabolomic profiling to identify predictive and diagnostic signatures of adverse pregnancy outcomes. These data will be used to develop artificial intelligence-assisted prediction models that could be used as valuable screening tools to identify at-risk pregnancies for early interventions.
Rapid Clinical Sampling, Pooling and Targeted Deep Sequencing of Malaria Parasites: A Novel Model for Effective Malaria Molecular Surveillance
Anita Ghansah, Senior Research Fellow at the Noguchi Memorial Institute for Medical Research at the University of Ghana, will build a cost-efficient malaria molecular surveillance system with high spatial and temporal resolution that covers the entire country. Dr. Ghansah is an internationally-trained genetic epidemiologist. Recognizing the power of genomics and bioinformatics approaches for bolstering malaria surveillance in Ghana, she has been a pioneer of bioinformatics training in the country. She introduced expertise for genotyping molecular markers of drug resistance, which led to a change in the national policy on first-line treatment of malaria. She will build the relevant personnel and infrastructure capacity for this project, and lead a research team and staff effort to rapidly monitor key molecular markers of drug and diagnostic resistance in blood samples from malaria patients using high-throughput sequencing and bioinformatics approaches. This will produce country-wide, near real-time surveillance data to better inform the control and elimination efforts of the National Malaria Control Program of Ghana.
Strategic Domestic Resource Mobilization (DRM) Models for Financing Sustainable Priority Research and Development (R&D) in Rwanda and Kenya
Vincent Okungu, Researcher at the University of Nairobi in Kenya, will develop sustainable financing models to boost domestic funding for research and development (R&D) in East Africa. R&D is routinely underfunded in Africa, with the continent producing around 2% of the research output yet accounting for 15% of the global population. Dr. Okungu is a senior health economist whose passion is to see the development of resilient health systems in Africa. He has directed several health sector projects, including a national strategy for non-communicable diseases, together with the Ministry of Health, to guide resource mobilization and investments in Rwanda. He will investigate R&D financing by governments in two study countries, Kenya and Rwanda, and design creative approaches to motivate policymakers to increase budgets, as well as identifying high impact health programs such as vaccine development that could attract investments from public and private sources. He will also leverage knowledge from other sectors to learn how best to mobilize domestic finances for R&D and explore new sources of tax revenues. He aims to establish a mechanism for financing at least one priority R&D project agreed upon by public and private stakeholders in Kenya and Rwanda.
Strengthening Nigeria's Surveillance System for Malaria Elimination by Integrating Molecular and Genomic Data
Ify Aniebo, Senior Research Scientist and Principal Investigator at the Health Strategy and Delivery Foundation in Nigeria, will integrate molecular and genomics data for tracking drug resistance and disease transmission to strengthen malaria elimination efforts in Nigeria, which has one of the highest global burdens. Dr. Aniebo is a molecular geneticist working on malaria drug resistance, and is acknowledged as one of her country’s top young health leaders. She is also devoted to empowering the next generation of African females into the sciences. To achieve her goal of eradicating malaria, she has created partnerships with scientists and policy makers within and outside Nigeria. Leveraging these partnerships, including Nigeria’s National Malaria Elimination Program, she will conduct a cross-sectional survey in households across the country and collect around 10,000 blood samples from children aged 6-59 months during the wet season when there is high malaria transmission. These samples will be subjected to next generation sequencing to investigate the prevalence and genetic diversity of the malaria pathogen across different regions, and the presence of drug resistance. She will also build a reporting tool and dashboard to present the data and directly support decision making.