‘Beyond the Pandemic: The Impact of COVID-19 Research Response in Low- and Middle-Income Countries’

12 January, 2023

Daniela Toale, Chantel Jones and Lucy Lawrenson

On 13 December 2022, UKCDR’s COVID CIRCLE Researcher Community (CCRC) hosted a virtual conference that brought together those researching COVID-19 across the globe, funders that have supported COVID-19 research, and other global health and research for development stakeholders to discuss the impacts of the COVID-19 research response in low- and middle-income countries (LMICs).  

The conference featured live presentations and poster presentations from researchers working across multiple disciplines, showcasing their research and its impact, as well as considering lessons learnt and next steps. In addition, a session with UK-based funders reflected on and discussed how the COVID-19 pandemic has influenced decisions about future funding for emergency response research, particularly in LMIC settings. 

Below is a summary of learnings from event.

Session One: Hearing from the Researchers (Pt 1.)  

Watch all presentations from this session here

Presentation One
SARS-CoV-2 in an African birth cohort – a prospective study through four waves of the pandemic

The research presentations were kicked off by Professor Heather Zar. Her study aimed to investigate illness and serological responses in children and mothers in a birth cohort, the Drakenstein Child Health study, through four waves of the pandemic.  

Key findings included:  

  • Protection against COVID-19 in children was not due to cross-reactive antibodies to seasonal human coronaviruses (sHCoVs);  
  • There was little disease but a very high incidence of infection – very high seroprevalence in mothers & children increasing over time; 
  • Higher S-original levels of antibody thresholds were needed for protection from variants of COVID-19, and the highest levels were needed for the Omicron variant; 
  • Hybrid immunity (natural infection + single vaccination) provided the highest levels of protection against the Omicron variant;  

In future work, Professor Zar will investigate mechanisms of protection, the duration of protection, and T-cell immunity. She will also compare the results of this study with those of a hospitalised cohort of children with COVID and non-COVID pneumonia, looking as well at long-term outcomes, to help us understand the virus.  

Find out more about the study here and read this most recent publication.  

This project was funded by UKRI MRC and NIHR and is part of the Global Effort on COVID-19 (GECO) Health Research Call. 

  • Professor Heather Zar

Presentation Two
POETIC: Provision of Essential Treatment in Critical Illness in COVID-19

For this presentation, we heard from Dr Tim Baker, Dr Karima Khalid and Dr Carl Otto Schell

Essential Emergency and Critical Care (EECC) is the basic, low-cost care required by critically ill patients, such as oxygen and iv-fluids, and the system-wide requirements for their provision. This project aimed to generate knowledge and guide COVID-19 responses towards scalable strategies for increased survival in critical illness.   

The study found:  

  • At a hospital level in Tanzania and Kenya, most resources for EECC were available; however, in the wards, 44% of EECC resources were missing; 
  • EECC costs $17-21USD per day and is very cost-effective at $23-28 USD per DALY (disability-adjusted life year) averted. This is similar to malaria treatment or emergency obstetric care;  
  • COVID-19 responses were not coordinated, system-wide or sustainable; thus, the system remains vulnerable to the next emergency; training and procurement of equipment are necessary but not sufficient as an overall solution.  

Regarding impact, initial modelling suggests that EECC could avert one million deaths a year. Following the sharing of findings with decision-makers, stakeholders and clinicians, a national strategic plan for EECC is being set up in Tanzania and Zanzibar. The project plans to have effective coverage of EECC across 200 hospitals in Africa. Future research plans include running bottleneck studies, developing context-appropriate modular interventions, and running a cluster step-wedge RCT.  

Find out more about the study here and read this key publication.  

This project was funded by the Wellcome Trust.  

  • Dr Tim Baker, Dr Karima Khalid and Dr Carl Otto Schell

Presentation Three
Tracking COVID-19 in the Philippines:  Developing and Implementing Genomic Surveillance Across the Country’s Public Health Network

Our third presentation came from Dr Timothy Dizon.

Only 8% of over 13 million COVID-19 sequences shared globally are from LMICs. Genomic surveillance (GS) was a powerful component of the pandemic response as it enabled the characterisation of circulating viruses and helped identify sources of introductions as well as global and local transmission patterns. This project set up GS and response capacity in the Philippines to help inform infection control at local and regional levels. Before the project, there was a lack of equipment and expertise for whole-genome sequencing in the Philippines, sequence capacity was limited, and there were no GS and referral systems in place. This project was impactful as it changed these norms.

The team will continue and extend SARS-CoV-2 routine sequencing in future work. Dr Dizon also seeks to:

  • Expand SARS-CoV2 GS to other pathogens;
  • Expand the genomic consortium to include other institutions within and outside the Philippines’ Department of Health;
  • Continue the dialogue with stakeholders and policymakers.

Find out more about the study here.

This project was funded by UKRI MRC and NIHR and is part of the Global Effort on COVID-19 (GECO) Health Research Call. 

  • Dr Timothy Dizon

Session Two: Hearing from the Researchers (Pt 2.)  

Watch all presentations from this session here

Presentation Four
DialCOVID: Remote mitigation through telephone symptom surveillance in refugee settlements in Uganda 

Session Two kicked off with a presentation from Dr Kelli O’Laughlin and Dr Timothy Muwonge.

This study set up a free telephone hotline in refugee settlements in Uganda that uses interactive voice response (IVR) technology to rapidly collect and disseminate information in a humanitarian setting. The hotline was provided in ten languages.  

The study collected COVID-19 testing data and characteristic information, as well as data on knowledge and risk perceptions, ability to adhere to preventative measures, and barriers/facilitators to prevention and control measure adoption for refugees.

The study found:   

  • Participants adopted prevention strategies but risk perception and adoption of risk mitigation strategies decreased over time;   
  • Participants were generally favourable of COVID-19 vaccines;  
  • Barriers to adoption of control measures were unique to the refugee settlement context (inc. resource scarcity, high house density, and necessity to leave the home to attend to survival needs), which prevented isolation and quarantining;  
  • COVID-19 negatively impacted income generation, food security, social interactions, and contribution to incidents of child marriage and teenage pregnancies.  

An IVR platform can be used to rapidly collect and disseminate information in many languages and difficult-to-reach places with the Dial-COVID tool being adapted for other applications such as routine surveillance and/or during future outbreaks of other transmissible diseases.  

Find out more about the study here and read their research snapshot.  

This project was funded by the Elrha Research for Health in Humanitarian Crises (R2HC).  

  • Dr Kelli O’Laughlin and Dr Timothy Muwonge

Presentation Five
MAP at Home: Online mental health and psychosocial support through the arts in Rwanda

The conference’s fifth presentation was delivered by Dr Ananda Breed and Dr Chaste Uwihoreye.

This project aimed to research the prevention of, response to, and awareness of mental health and promotion of psychosocial well-being among youth, families and community members through an innovative arts-based, culturally informed approach, responsive to the needs of participants (both practitioners and users).

Activities and impact of this project include:

  • A co-produced psychosocial module and online curriculum;
  • The integration of MAP at Home into health centres and district hospitals;
  • Additional training delivered to mental health workers, rehabilitation centres, health institutions, and prisons;
  • The ‘Continuing Professional Development (CPD) Programme’ developed and launched in partnership with the University of Rwanda to embed MAP into their School of Medicine.

MAP at Home has set up memorandums of understandings with the Rwandan Ministry of Health, Ministry of Education, Hospitals and Schools to integrate the methodology into existing systems and activities. They have also secured additional funding through a Wellcome Trust Discovery project called Healing Through Evaluation, Arts and Learning (HEAL).

Visit the MAP at Home website, its Gateway to Research page and the project’s most recent publication.

This project was funded by the UKRI GCRF/Newton Fund Agile COVID-19 Rapid Response Award.

  • Professor Ananda Breed and Dr Chaste Uwihoreye

Presentation Six
Access to medicines and care during COVID-19: findings from the medicines retail sector in Uganda

Dr Eleanor Hutchinson and Dr Freddy Kitutu provided the final researcher presentation.

Their research focused on how the COVID-19 public health response shaped the supply of, and access to, treatment in the medicines retail sector (MRS) in Uganda. It also looked at how policy can be adapted to ensure continuity of safe access to essential medicines during this and future outbreaks. This is particularly important given that up to 80% of Ugandans seek care for fever in the MRS.

The study seeks to create policy change at the national and district level and ensure that the MRS are included in discussions at this level. Alongside data collection activities, the project held workshops with a diverse range of stakeholders and undertook multiple dissemination activities.

The project will host a final workshop to focus on how to create a better framework/structure to include MRS during pandemics. A PHIND grant has been secured to develop a complex intervention trial with drug shop vendors. The collaboration between Dr Hutchinson and Dr Kitutu will continue as Dr Kitutu is a visiting fellow at the Department for Global Health and Development, LSHTM.

  • Dr Eleanor Hutchinson and Dr Freddy Kitutu

Funder Perspectives & Next Steps Workshop  

The conference’s workshop included a panel discussion, with representation from Wellcome, Elrha, UKRI Medical Research Council (MRC), and UK Department of Health and Social Care (DHSC). The session was Chaired by Dr Alice Norton, COVID CIRCLE Research Lead.

Each representative provided a high-level summary of their funders’ vision for the future of COVID-19 research and, more widely, pandemic and emergency research. The discussion was framed around three questions:

  • What do the research community and funders think are and/or will be the lasting legacies of COVID-19 research funding?
  • What elements of the COVID-19 pandemic funding landscape should be saved or continued without the COVID-19 focus?
  • What should researchers and funders keep in mind if the need for rapid research arises again due to a new emergency?

It was acknowledged that funders were able to rapidly pivot their work to set up efforts to respond to COVID-19 at the start of the pandemic.

Several key insights were highlighted:

  • There needs to be flexible mechanisms in place that allow funders and research to pivot quickly, as was required during COVID-19. Having more flexibility built into projects will mean that objectives can be adapted and components added;
  • Existing strong and established partnerships were key to the rapid COVID-19 response. Pre-positioned partnerships were best placed to respond, i.e., teams who are positioned to do the work and engage the stakeholders through their existing connections;
  • There is a need to strengthen research capacity in LMICs and the UK, to continue to fund high-quality, policy-relevant, and impactful research.
  • Alignment of the research portfolio to previously agreed global research agendas (e.g. World Health Organisation (WHO) Research Roadmap and UN Research Roadmap for the COVID-19 Recovery) and locally identified priorities were key.
  • Some research questions became more relevant than others, due to shifts in the pandemic landscape (e.g., vaccine development occurred as the pandemic progressed). However, funding to study diseases and for research into the knock-on impacts is equally important, e.g., food insecurity, as well as more preventative projects.
  • There is a need to move from response to prevention, by generating predictive and preventative knowledge to act on;
  • Research use was sometimes limited because it had limited generalisability and applicability. Impact was not a given just because the research was rapid. More support for research impact is needed to ensure there is the capacity for uptake;
  • There were positive shifts in power dynamics in research teams during the pandemic, with researchers having more authority to act. Principles such as community engagement and involvement and equitable partnerships should continue to be promoted in research;
  • Data must be used better;
  • There were sometimes delays during studies, such as data collection taking a long time, projects taking longer than expected, and research populations having different priorities from those of the research studies they were involved in.

The Q&A section of the workshop raised questions regarding pre-existing inequalities and whether these had been exacerbated by research during the COVID-19 pandemic. Research funders acknowledge the disproportionate impact of negative events and circumstances on less privileged populations, and emphasised that it is crucial that bodies such as the WHO set up frameworks that funders can ensure are being responded to by the research that they fund. The purpose of the event was to showcase research that had taken place in LMICs, giving a voice to less advantaged populations through the research process.

Maggy Heintz, UKCDR Executive Director, highlighted UKCDR and ESSENCE on Health’s Four Approaches to Supporting Equitable Research Partnerships Report published in September 2022.

The workshop discussion also raised the the question of how funders can take the principle of flexibility forward. MRC and UKRI saw very positive impacts of flexibility and related support to grant-holders, especially given the nature of rapid research pivoting at the start of the pandemic. The GECO  scheme was highlighted as an example of a very flexible and broad funding scheme. MRC’s regular conversations with grant holders and Principal Investigators were also identified as having been impactful and will be key to future work.

Further insights can be found here:

Opening and Closing Sessions
  • Watch the opening session here
  • Watch the closing session here

Poster Presentations

Ten poster presentations were exhibited at the conference, each highlighting outputs, research impact and lessons from the experience of conducting research during and for a pandemic, with a view to informing future research and emergency preparedness in global health and beyond.

Some posters also have accompanying videos. Posters and videos can be viewed below:

A huge thanks to everyone who attended our event, all presenters, Chairs, and the COVID CIRCLE Researcher Community funders.

Join us for our final COVID CIRCLE event, ‘Virtual dialogue: Utilising the lessons learnt from the COVID-19 pandemic, what are the future directions for epidemic- and pandemic-related research?’

Thursday, 19 of January, 12:00 – 13:30 [GMT].

Sign up and find more information here!

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