Growing up in Bangladesh where several infectious diseases transmitted by helminths (worms) take a large health toll, Tilak Chandra Nath has always been fascinated with the challenges of addressing diseases of poverty.
During his postgraduate training as a TDR-supported fellow at the Universitas Gadjah Mada (UGM) in Indonesia in 2016, he studied parasitic diseases, focusing on helminths, and he is currently using his knowledge to advance a One Health approach to eliminating those diseases in his home country.
After graduating as a biologist, Ezra Valido’s interest in infectious diseases took him to work in a rural, poor community in the eastern Philippines, where he headed public health programmes on tuberculosis, measles, dengue and chikungunya.
Valido’s community was devastated in 2013 by Typhoon Haiyan, one of the most powerful tropical cyclones ever recorded. From that, he gained experience working in the aftermath of a disaster, including how to prevent waterborne diseases and sanitation-related illnesses.
As a TDR-supported fellow, also at UGM in 2017, Valido’s research project focused on how willing people were to take doses of the dengue vaccine in poor communities in the Philippines’ Quezon City. His initial plan was to focus on how the vaccines were rolled out. But this had to be shelved after community and media outrage based on misinformation about the vaccine led the government to cancel its vaccination plans.
TDR’s postgraduate training programme on implementation research
Both Nath and Valido were part of a special postgraduate training programme focused on implementation research, based at UGM’s Faculty of Medicine, Public Health and Nursing, located in Yogyakarta.
The programme, involving students from both WHO’s South-East Asia and Western Pacific Regions, is supported by TDR, a global programme for research on diseases of poverty,hosted by the World Health Organization (WHO) in Geneva, and co-sponsored by the United Nations Children’s Fund (UNICEF), the United Nations Development Programme (UNDP), WHO and the World Bank.
UGM is part of TDR’s global postgraduate training scheme network, developed over the past eight years to boost the skills of future research leaders.
The initiative focuses on building students’ skills in implementation research, a fast-growing field that supports the identification of system bottlenecks to delivering health services and approaches to addressing them. It is particularly useful in low- and middle–income countries where many health interventions do not reach those who need them the most.
One of the two partner institutions in Asia Pacific is UGM, where the initiative is co-ordinated by Professor Yodi Mahendradhata, Dean of Research and Development at the Faculty of Medicine, Public Health and Nursing.
Involved from the start
Mahendradhata is proud of the fact that UGM was involved from the start - back in 2015 – in TDR’s fellowship scheme as well as in the parallel development of course content for implementation research. So he feels considerable ownership over how it has evolved.
“It wasn’t just about receiving the tools and the toolkits, but being involved very early on in the development of the implementation research course, and that is what we particularly appreciate from TDR,” said Mahendradhata. “We learned a lot from participating in the development process, and that gives us a sense of ownership.”
His university has also developed and piloted lessons on implementation research as a part of a TDR-supported Massive Open Online Course (MOOC), enabling researchers in places like Nepal and Myanmar to participate in virtual training, with UGM as the hub.
Critical and relevant
Valido is sanguine about how he had to shift the focus of his research on a new dengue vaccine from examining the standard parameters of mass rollout to focusing on the vaccine’s acceptability in one city, Quezon, the biggest city in the Philippines.
Sanofi Pasteur’s Dengvaxia vaccine was approved in the Philippines in December 2015, and the government started to roll it out to primary school children in 2016. However, in late 2017, Sanofi issued a statement reporting that, in rare cases, the vaccine could increase the risk of severe dengue illness in children who had never had the disease if they contracted the virus after being vaccinated. A public outcry followed, and the health department suspended the vaccine programme soon afterwards.
“While we were conducting the research, an update on the vaccine information caused a media frenzy which eventually led to its suspension and eventual cancellation,” he says. “We had to change the research and eventually looked at the change in the acceptability of the vaccine pre- and post-controversy.”
“The programme teaches you to be critical and relevant, and I had to change my research to remain relevant,” Valido says.“At the time, the Philippines was the only country implementing mass dengue vaccination in schools.”
Dengvaxia has since been approved in a number of countries, including the US – but only for people clinically proven to have had dengue in the past.
Valido enjoyed the opportunity to dissect the Filippino government’s plans for the vaccine’s implementation, focusing on “strategic actions, context and health system thinking.”
New insights into managing parasitic diseases
Meanwhile, Nath’s research into parasitic diseases gave him new insights into how they can be both managed and prevented.
“In developed countries, most parasitic diseases have been either eradicated or controlled, but the scenario is quite different in lower-income countries, where many diseases remain a serious constraint to public health safety,” says Nath.
“Through the TDR training programme,” he says, “I learned to investigate the problems in preventing these diseases in greater detail and pave the way to find an implementable solution for policy-makers to mitigate the burden.”
Preparing for the future
Following his studies at UGM, Nath continued his research training, completing a PhD in Medicine from the Chungbuk National University, in Korea, in the area of One Health. He is now an Associate Professor in the Department of Parasitology at Sylhet Agricultural University in Bangladesh.
In a sense he has come full-circle - bringing knowledge amassed through years of study abroad back to his home country to ponder issues that he wondered about since his youth.
“I am now actively engaged with helminthiasis elimination and biobanking of parasites projects,” says Nath, who is currently also the director of Bangladesh’s Parasite Resource Bank, where he is investigating the interactions between human, animal, and environmental parasites, following the One Health approach.
Meanwhile, Valido is working on the biomedical aspects of infectious diseases as a post-doctoral researcher at Swiss Paraplegic Research, where he is exploring the interaction of microbiomes and the spinal cord. He started this work while completing his PhD in Health Sciences at the University of Lucerne in Switzerland.
Few scientists understand the biomedical aspects of infectious diseases and “the complexity of public health designs to improve health programmes, guide health policies and identify key health infrastructure,” Valido observes. The TDR training helped him to build that interdisciplinary skill set.
This is the first article in a series on TDR’s research capacity strengthening programme - building skills of public health researchers, implementers, health practitioners and policy-makers in the fast-developing field of implementation research for improving uptake of effective health interventions.
