Creating evidence for novel tuberculosis vaccine introductions: a mathematical modelling approach

Despite being an ancient disease, tuberculosis (TB) remains a leading cause of death from infectious disease worldwide. A new TB vaccine, M72/AS01E, has shown considerable promise in clinical trials. Should this vaccine be approved, global and country decision makers do not know the optimal strategies to deploy it, nor what the
interaction of the introduction with other vaccine programmes and other non-vaccine TB control efforts will be. This knowledge is essential for decision makers considering if, how, and when to introduce the vaccine.

Optimal strategies will vary substantially depending on when and how the vaccine is deployed, the country's epidemiology and heath system, the planned future changes to other TB control efforts, and other factors. Using mathematical modelling, this project will therefore help countries to decide which implementation strategies to use to introduce a novel vaccine against the killer disease tuberculosis - or whether to consider introduction at all.

This project will extend an existing state-of-the-art mathematical model of
tuberculosis - developed and programmed in R - to identify optimum strategies for vaccine deployment. In particular, the project will focus on investigating how best to deploy vaccines and dynamically adapt vaccine strategies in "alternative futures", where vaccines against other diseases and non-vaccine TB control options (e.g., new drug treatments, or better diagnostics) are also introduced in different combinations and to different target groups. Simulating alternative scenarios can also yield an understanding of how variations in socio-economic conditions affect the expected success of the potential vaccination programme versus baseline scenarios of either no vaccination or BCG-only vaccination, which is the old vaccine currently in use. Applying advanced statistical methods to map out more the more nebulous, approximate and shifting nature of real-world scenarios offers the opportunity to develop both my quantitative and interdisciplinary skills for translational purposes with practical implications.

The evidence from this work will support countries in their TB vaccine introduction decision making and will be disseminated in policy briefs, publications, conference presentations and via policy networks (WHO, CTVD, Stop TB, country TB programmes).