Researchers at the Yale School of Public Health and the Yale Global Health Leadership Initiative, in collaboration with international peers, have received Grand Challenges Explorations grants from the Bill & Melinda Gates Foundation for innovative research.
One of the grants, awarded to the Oswaldo Cruz Foundation (Fiocruz) in Brazil and overseen by Federico Costa, a Yale School of Public Health associate professor adjunct and principal investigator, will be used to study potential disease outbreaks using genomics.
The other grant, on which Erika Linnander, director of the Yale Global Health Leadership Initiative serves as co-principal investigator, funds a new approach to improving immunization rates in Cameroon and Ethiopia.
The Grand Challenges initiative inspires thinkers worldwide to explore creative solutions to persistent global health and development challenges. The grant process is highly competitive. Of approximately 1,700 applications this round, only 56 grants were awarded worldwide.
Each grant recipient receives an initial award of $100,000. Successful projects have the opportunity to receive follow-up funding of up to $1 million. To receive funding, research teams need to demonstrate a bold idea in one of seven critical global heath and development topic areas.
Detecting Disease in a Global ’Hot Spot’
Three YSPH researchers - Department Chair and Professor Albert Ko, Assistant Professor Nathan Grubaugh and Adjunct Mitermayer Reis - are co-investigators on the Fiocruz grant, which will fund the testing of new rapid diagnostic tools and next-generation metagenomic sequencing approaches to identify emerging pathogens in Salvador, Brazil.
The researchers are also collaborating with the Federal University of Bahia (Institute of Collective Health and School of Medicine). They say their innovative process has the potential to be replicated worldwide.
"By comparing the sequenced pathogen genomes to existing public databases, we can determine if it is related to endemic strains, if it was imported, or if it is a potentially new pathogen," said Grubaugh, a member of the Yale Institute for Global Health.
Grubaugh and Costa, who has worked extensively with Fiocruz and major hospitals in Salvador, will lead implementation of the project along with Yale postdoctoral student Joseph Fauver. Along with his longstanding affiliation with Fiacres, Reis is also a professor at the UFBA School of Medicine. Costa shares an affiliation with UFBA as well.
By comparing the sequenced pathogen genomes to existing public databases, we can determine if it is related to endemic strains, if it was imported, or if it is a potentially new pathogen.
Salvador is a perfect city in which to run the tests, the researchers said. The metropolitan area with nearly 3 million inhabitants was ground zero for the Zika epidemic in 2015 and its tropical climate, rapid urban growth and social inequities make it a prime "hot spot" for the introduction and spread of vector-borne pathogens.
Improving Immunizations in Cameroon and Ethiopia
The second Grand Challenges Explorations grant funds an innovative approach to expanding immunizations in Cameroon and Ethiopia by enlisting the support of existing community networks and institutions.
Sylvie Kwedi-Nolna, a researcher and lecturer at Cameroon’s University of Yaoundé School of Medicine, serves as project leader in Cameroon. Kidest Nadew, GHLI country director, will be helping to lead the project in Ethiopia. The team was one of only10 select Grand Challenges Explorations grant recipients invited to an innovation bootcamp/accelerator conference in June for intensive planning and networking sessions.
The team will use the Gates funding to engage popular Rotating Savings and Credit Associations or ROSCAs as a way to spur demand for routine immunizations in areas with low immunization rates. The project will use a guided "human-centered design" approach to build local interest and autonomy in implementing novel ways to drive up demand for vaccinations.
"By using a human-centered design, we are hoping to create a structure for the ROSCAs themselves to identify possible approaches to increasing immunization," said Linnander, who is also a researcher and lecturer at the Yale School of Public Health. Once the most innovative and practical approaches are identified, those programs will be monitored and tested to see if they have potential for broader cross-cultural applications globally.
While ROSCAs may appear in title to be strictly financial institutions, they play a much more diverse role in countries in Africa, Asia, and Latin America. These local institutions are powerful social networks that serve in many ways as social supports for local communities, particularly for women, where they may assist with everything from funeral and wedding planning to births, childcare and other family needs.
"Everyone knows children need to be vaccinated, but when you look at the data, you see there are still gaps in coverage," said Kwedi-Nolna. "So, we came up with the idea of working with local communities because that’s where the children are. We felt that if we could collaborate with them and guide them, we could find innovative solutions to address these gaps."
While ROSCAs clearly influence health behavior in local communities, they have not been used prospectively to generate demand for health services such as routine immunizations, the researchers said.
"One of the things that is innovative about this is that rather than building something new, we are using an existing internal infrastructure that is very strong and something people already are tapping into," said Kali Bechtold, program manager at the Yale Global Health Leadership Initiative.
Kwedi-Nolna said initial discussions about the idea with local ROSCA representatives have been positive.