This work will deliver a review of cost estimates for the regional / global (supranational) activities needed to improve health security preparedness and protect the world from health emergencies like epidemics and pandemics. Working in collaboration with the World Health Organization (WHO) and academic partners at Duke University, this project will deliver evidence to inform new WHO guidance and policy recommendations, Government of Twenty (G20) negotiations, and related policy negotiations prior to the 75th World Health Assembly and beyond. The COVID-19 pandemic has highlighted the need for such work, with experiences over the past two years showing the importance of health security preparedness across country, regional and supranational levels. This work will complement ongoing WHO efforts to detail cost estimates for country-level resource needs for such preparedness activities. In doing so, this research will address five key issues related to determining cost estimates for pandemic preparedness and response reform: 1) Locating current and future budget / costing requirements at supranational and regional levels; 2) Detailing 'supranational' from 'regional' and 'national' activities; 3) Address the key knowledge gap around efficiency and effectiveness at the interface between national, regional and supranational levels; 4) Locate activities contributing to 'global common goods for health', and; 5) model subsystem investment prioritization strategies that can best realize these common goods for health in pandemic preparedness and response.

The availability of effective malaria vaccines is a historic landmark, “a breakthrough for science, child health and malaria control” that “could save tens of thousands of young lives each year” [WHO 2021]. But substantial implementation challenges need to be addressed to realise this potential. In many areas where malaria vaccines will soon be introduced, EPI coverage is suboptimal, especially in the second year of life. Introduction of malaria vaccines is also an opportunity to strengthen delivery of basic vaccines because a) additional immunisation visits will be required to administer 3 doses of malaria vaccine between the ages of 5 and 9 months and a fourth dose at about 2 years, and b) in areas with highly seasonal malaria, annual intensification of vaccine delivery may be advantageous to optimize malaria impact, both providing opportunities for catch-up of other vaccines, and c) recognition of the importance of malaria may lead to be less mistrust of malaria vaccines, as observed during pilot implementations; such positive attitudes could be leveraged to promote vaccination in general. The purpose of this project is to support national immunization and malaria programmes in 14 countries in West and Central Africa with highly seasonal malaria, to optimize delivery and uptake of malaria vaccines, and to exploit the opportunities to strengthen delivery of other vaccines. This will be achieved through a programme of implementation research, adapting delivery approaches to local situations, and sharing information about what works best. The project, which builds on a network of 13 countries that was established through the EDCTP-funded OPT-SMC project, coordinated by the University of Thiès in Senegal, the LIH, TDR, LSHTM, CAPM, MMV and WHO, will provide grants and technical assistance to national programmes to enable them to monitor vaccine introduction and identify barriers to uptake, and develop, implement, and evaluate strategies to address these barriers.

Between 2010 and 2050, the number of people aged 60 and over is expected to increase by one and a quarter billion, reaching 22 per cent of the world's population. Of these, 81 per cent will be living in low and middle income countries (LMICs). There is an urgent need to identify policies that are effective in promoting the health, economic security and quality of life of older people in these countries. We should not assume that policies working reasonably well in high income countries will suit the circumstances of poorer ones. To date, research on older people in LMICs has been limited by a lack of reliable data. The World Health Organisation has sought to fill this gap by conducting a set of large surveys of older people's health and wellbeing in six LMICs: China, Ghana, India, Mexico, the Russian Federation and South Africa. Together, these countries already account for 36% of the world's 60+ population. This is an unprecedented data source, which promises to generate highly significant insights for policy-makers and researchers. The research team have conducted preliminary analysis of the data and this study would enable them to extend their work. We propose to focus our analysis on three key themes. (i) What effect does receiving a pension benefit have on older people's health and wellbeing? Policy for older people in LMICs is heavily focussed on providing pensions. It is assumed that, as well as ensuring their economic security, this will help them pay for health services and consequently improve their health. Yet the evidence for this is not always clear. For example, South Africa has a generous pension scheme but poor health outcomes for older people. We will conduct a systematic analysis of pensions, health and wellbeing, assessing the extent to which they are linked in the different SAGE countries. This will inform policy-makers about the relative importance of pensions and other policies, such as the upgrading of basic health services. (ii) Hypertension is a major cause of serious illness, including stroke, heart disease and dementia. Preliminary analysis of the new WHO data base has revealed large variations in the prevalence of hypertension across LMICs. There are also large variations in the extent that people are aware of these conditions and are receiving effective treatment for them. Our study will explore the reasons for these national variations in awareness and treatment, as well as for variations within countries. This will be done by more detailed analysis of the WHO data, combined with additional information obtained from documentary sources and interviews key informants in the SAGE countries. We will pay particular attention to the policy implications of these variations. (iii) How people experience later life is strongly influenced by previous life effects, but our precise knowledge of these effects is limited. WHO SAGE includes large amounts of information about older people's past lives, including their parents' education and occupational status. We will use this data to analyse life course effects and compare them across the SAGE countries. This will improve knowledge about how earlier life interventions may enhance wellbeing in old age. The research project will include a large element of dissemination and engagement with policy-makers, including meetings in each of the study countries.

Information about SARS-CoV-2 levels circulating in the community is an essential part of developing an effective strategy to prevent the further spread of COVID-19 globally. Testing of individuals is time consuming, costly and currently does not capture a large proportion of the population. Wastewater monitoring of SARS-CoV-2, shed in faeces from infected individuals, including asymptomatic cases, provides an alternative approach. It has distinct benefits, obviating community sampling bias, and providing a cheap, non-invasive process to determine the level of infection in a large community within a single sample. However, this method cannot be directly implemented in many developing regions where wastewater is released into the environment without any treatment. Such pollution raises concerns about the environment-based transmission of the disease, which has not been studied. Our project aims to assess the prevalence of COVID-19 in two sub-Saharan countries, South Africa and Nigeria, using wastewater-based epidemiology and environmental surveillance. We will measure SARS-CoV-2 RNA concentrations to investigate the spread of COVID-19 at a community level. We will also assess the occurrence of other, common and emerging virus strains (e.g. enteroviruses, measles and influenza) to evaluate the effect of lockdown measures on the transmission of viral diseases. We will also determine the health risks associated with polluted environments using infectivity assays and determine the most common SARS-CoV-2 variants circulating in each country using environmental metaviromics. Working alongside public health stakeholders, our findings will allow enhanced decision making on the containment of COVID-19 and achieving UN Sustainable Development Goals 3, 6 and 11.

There are major gaps in surveillance of climate change and health in the EU and globally, making it difficult to track health burdens and policy outcomes. The HIGH Horizons project, over four years, involves 5 partners in the EU, 3 in Africa and 2 international organisations (WHO and UNICEF). It centres on pregnant and postpartum women, infants, and health workers, groups heavily affected by climate change. We quantify and monitor direct and indirect health impacts of extreme heat; test a personalised Early Warning System (EWS); and implement integrated adaptation-mitigation actions in health facilities. Analyses of heat impacts and data science predictive modelling using data from Sweden; Lazio Italy, and health facilities in Kenya and South Africa underpin all activities. These analyses and systematic reviews inform testing and selection of global, EU and national indicators. Analyses also inform cut-off thresholds for EWSs, stratified by risk groups. A smartphone app (ClimApp-MCH) will deliver warnings and setting-specific messages, co-designed locally. The app will be evaluated among 200 mothers and infants in Sweden, South Africa and Zimbabwe, from antepartum through 12 months of infant age. Simultaneously, we will document impacts of heat exposure on health worker wellbeing, health, productivity and quality of care, including through time-motion studies. Modifications to health facilities will be co-designed and modelled to reduce heat exposure for health workers and to limit facilities carbon emissions. Health worker outcomes and facility emissions will be compared pre- and post-intervention. Analyses weighing costs and benefits cut across all activities. Throughout we will disseminate project findings to relevant stakeholders, prioritising EU and global policy makers and leveraging existing networks. The final set of indicators on climate change and maternal, newborn and child health will be released in a WHO, UNICEF and UNFPA guidance document. In order to optimise synergies, avoid overlaps and increase the impact of the projects selected for funding from the call HORIZON-HLTH-2021-ENVHLTH-02-03 (Health impacts of climate change, costs and benefits of action and inaction, Horizon Europe projects 101057843 HIGH Horizons, 101057131 CATALYSE, 101057764 BlueAdapt, 101057690 CLIMOS, 101057554 IDAlert and 101057739 TRIGGER), the projects will form a cluster. Common cluster activities will include the following: 1 . Common kick-off meeting of the six projects, to be organized in cooperation between DG R&I and the cluster; 2. Annual cluster meetings and periodic report of joint activities (delivered at each reporting period); 3. Common dissemination and communication activities, including a common dissemination and communication strategy for the cluster, cluster web portal and visual identity, cluster brochure, cluster newsletters, stakeholder list, Shared individual Data Management Plans between cluster partners, Policy Strategy of the cluster, including joint policy briefs and Scientific strategy of the cluster. The penholder and project responsible for each joint deliverable will be decided in the document setting out the Modalities for Implementation of the Cluster to be agreed on during 2022. 4. Thematic workshops/trainings on issues of common interest to be defined in the context of the scientific strategy of the cluster; 5. Working groups on topics of common interest (e.g., data management, communication and dissemination, science-policy link): to be defined in the context of the scientific strategy of the cluster;