Swiss TPH 2019 Annual Report by Swiss TPH

ANNUAL REPORT 2019

WHAT’S INSIDE 3 Preface 6 Future Perspectives 10 Facts & Figures 17 In Retrospect 22 Insights 35 Key Areas of Activity 45 Committees & Departments 55 Finances

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PREFACE

“Together, we will come out of the crisis stronger and continue to make strides in improving global health” On a sunny afternoon in April 2020, the sky outside my office window is clear and I can hear the birds chirping overhead. Instead of the usual roaring of engines and airplanes, it is eerily quiet. The Swiss TPH buildings are deserted, as most of the employees and students are working from home. Welcome to the COVID-19 era: the world is facing a pandemic that none of us have ever witnessed before. Several million people have been infected with the coronavirus SARS-CoV-2 and two hundred thousand people deceased. In many countries, the pandemic has brought existing health systems to their limits and put a huge drain on the global economy. For 75 years, Swiss TPH has remained committed to improving people’s health and well-being through a unique combination of excellence in research, education and services. This vision still holds true today – perhaps more than ever! Without exception, our employees, students and partners abroad are going the extra mile to ensure that our core activities can continue. We are rotating shifts in the laboratories, pursuing research from home, delivering teaching through e-learning means, and staying connected to one another with digital tools.

Today, solidarity is key, and has been at the heart of Swiss TPH since its foundation in the midst of the Second World War. Swiss TPH is contributing to the public health response of the COVID-19 crisis at a local, national and international level. This includes strengthening existing partnerships and fostering new ones, and continuing with our mission to make the world a healthier place as we have done before the pandemic, and will continue to do after. Selected highlights in 2019 While the pandemic has dominated 2020 thus far, let us take a moment to reflect on 2019, when everything was considerably quieter, yet far from boring. Important milestones were reached, as summarised in the section “In Retrospect” on pages 17 – 21. In June 2019, an unforgettable moment occurred: the ground-breaking ceremony for our new building “Belo Horizonte” in Allschwil took place. Representatives from the municipality, the cantonal governments of Basel-Stadt and BaselLandschaft, the Rectorate of the University of Basel and the R. Geigy Foundation joined the festive event. Thanks to the terrific efforts of the project team and the commitment and dedication of our stakeholders, the project is well on track.

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Preface In December 2019, we organised our largest symposium ever, “Climate Change and Health”. As a novel feature, keynote speakers from Australia and the United States delivered their presentations through live-streaming technology. Hence, the symposium made a deliberate contribution to minimising carbon dioxide emissions and acted as a precursor to the digital shift in education and teaching, which was accelerated during the COVID-19 crisis (see pages 22 – 25). Scientists at Swiss TPH pursued work on the over-prescription of antibiotics in young children in low- and middle-income countries, a major driver in the spread of antimicrobial resistance (see pages 26 – 28). We also highlight an important anniversary: it has been ten years since the former Institute for Social and Preventive Medicine of the University of Basel was integrated into the former Swiss Tropical Institute to become Swiss TPH, thus uniting unmatched expertise under a single roof (see pages 30 – 33).

SDG 4 “Ensure inclusive and equitable quality education and promote lifelong learning opportunities for all” (see page 15). To further sharpen our focus and enhance our impact, we submitted our new 4-year strategy (2021 – 2024) to the State Secretariat for Education, Research and Innovation and the two cantons, Basel-Stadt and Basel-Landschaft. The strategy sets the direction for the coming years, providing clear guidance to further advance our mission of improving the health and well-being of people around the globe. The COVID-19 pandemic reminds us that we can only overcome challenges through partnership. I would like to thank everyone for your hard work, innovation, creativity and solidarity in these challenging times. Together, we will come out of the crisis stronger and continue to make strides in improving global health.

Taking science to impact for sustainable development Working across research, education and services is indeed what makes Swiss TPH unique: our ability to take science to impact. Once a discovery is made, we validate in real-world settings, which is facilitated through our existing partnerships and global network. We then apply the rigorously validated research to strengthen health systems and shape policy, adding plenty of passion along the way. Our people are our single most important asset – we are proud of them and portray a handful throughout this report (see pages 29, 34, 54 and 58). We also sat down with our two newest members of the Board of Governors – Ariane Bürgin and Cornelia Staehelin – to talk about their view on the past, present and future of Swiss TPH (see pages 6 – 8). Improving health and well-being All of our activities contribute to the 2030 Agenda for Sustainable Development and we constantly monitor our project and programme portfolio to align with the 17 Sustainable Development Goals (SDGs). In 2019, our 281 projects in 129 countries contributed to all 17 SDGs. In particular, we contributed to SDG 3 “Ensure healthy lives and promote well-being for all at all ages” but also considerably to SDG 17 “Revitalize the global partnership for sustainable development” and

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Prof. Dr. Jürg Utzinger Director, Swiss TPH

Preface

→ Jürg Utzinger on the road from Taabo to Abidjan, Côte d’Ivoire on 16 June 2019.

→ Construction site of new Swiss TPH building “Belo Horizonte”, conformed to Swiss Federal Office of Public Health standards.

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FUTURE PERSPECTIVES Increased Female Representation in Swiss TPH’s Board of Governors Ariane Bürgin and Cornelia Staehelin joined Swiss TPH’s Board of Governors this year. We sat down with them to discuss research partnerships, Swiss TPH’s new strategy and the challenges that lie ahead. How do you see your role as a member of the Board of Governors? Ariane Bürgin: “I represent the canton, so I am an ex officio member. This means that I am not responsible for scientific matters. My role is to critically examine the financial situation and strategic direction of Swiss TPH and to advocate for conditions that allow Swiss TPH to carry out its vision and fulfil its mandate. However, it is not possible to do this properly without some level of identification with Swiss TPH’s goals and activities, so I am happy that their mission is something that I can fully stand behind.” Cornelia Staehelin: “From 2008 to 2010, I led a project on the interaction between HIV and parasitic worm infections. This took place within the HIV cohort at the Ifakara Health Institute in Tanzania. Since then, I have worked with other organisations, primarily in West Africa, so I have an idea of how challenging research partnerships can be in the field. As president of the Swiss Expert Society for Tropical and Travel Medicine FMH, I also know about the needs of our medical clients and partners in Switzerland. It is these two areas of expertise in particular – research in the field and the perspective of Swiss medical professionals – that I can contribute to the Board of Governors.”

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As new members of the Board of Governors, you join with a fresh perspective of Swiss TPH. What would you say is the defining feature of the institute? Cornelia Staehelin: “For decades, Swiss TPH has built up partnerships with scientists, decisionmakers and populations around the globe, primarily in Africa and Asia, which makes Swiss TPH unique and has proved to be a great asset today. Especially nowadays, where big data is becoming more important, Swiss TPH’s network is priceless, as it is not just big data that you need, you also need to translate and implement the data for use in the healthcare systems of countries in the southern hemisphere.”

“Knowledge is generated by working with local people, which is also relevant for the healthcare systems in Switzerland and other wealthy countries” Ariane Bürgin

Future Perspectives

Ariane Bürgin: “Swiss TPH is a fascinating institute. It has an above-average level of third party funding for a research, teaching and service institute and is successfully engaged in improving healthcare systems in impoverished countries. This combination – having a high level of self-funding in a field that is not predestined for profits – is something I find exceptional. What also impresses me is Swiss TPH’s equitable working relationships with partner institutions in various countries. Knowledge is generated by working with local people, which is also relevant for the healthcare systems in Switzerland and other wealthy countries.”

“For decades, Swiss TPH has built up partnerships with scientists, decisionmakers and populations around the globe, which makes Swiss TPH unique”

In June 2019, Swiss TPH approved its new strategy for 2021 – 2024. It lays out three strategic goals: scientific excellence, taking science to impact and mutual learning for sustainable development. Which of these three goals do you feel most committed to? Ariane Bürgin: “The nice thing about these goals is that they cannot be separated from one another. It is about the interaction between all three. Scientific excellence is needed in order to make an impact, but any other institute conducting practical research would proclaim these goals as well. What makes Swiss TPH special is its third strategic goal: mutual learning in the field and the application of this mutually developed knowledge for sustainable development.” Cornelia Staehelin: “For me, scientific excellence is a prerequisite for improvements in the healthcare system. However, this requires partnerships and relationships with local people. Swiss TPH's Director Jürg Utzinger and his predecessor Marcel Tanner are masters of this kind of relationship management. They deal with people on equal terms, devoid of academic arrogance.”

Cornelia Staehelin

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Future Perspectives

A strategy is a tool for preparing for the future. What are the future challenges facing Swiss TPH? Ariane Bürgin: “Moving Swiss TPH to Allschwil will bring a lot of advantages. Employees will be working together under one roof, and it offers the opportunity to have good working relationships with other life science institutions at the BaseLink site. My only concern is the stability of the financial situation as Swiss TPH still obtains 80% of its funding from competitive grants. There is also uncertainty about future financing from the federal government. Over the next few years, we will be very busy addressing the topic of core financing to provide a stable basis for the future.”

Cornelia Staehelin: “The move to Allschwil certainly has great potential, but we also need to be aware of the risks. The Travel Clinic team for instance, who will stay at the Socinstrasse location, will be a bit isolated from the rest of Swiss TPH. Therefore, I would advocate for stronger collaboration between the medical and diagnostics team and the University Hospital Basel (USB). One could continue running joint projects, for instance on vaccinations, using the wonderful space at the Socinstrasse location while also bringing the doctors’ highly specialised knowledge into clinical practice at the USB.”

Ariane Bürgin

Cornelia Staehelin

Since August 2019, Ariane Bürgin has been the Head of Higher Education for the Canton of Basel-Stadt, where she previously served as Deputy Head. After studying philosophy and history in Basel and Berlin, she worked as a research assistant on the National Research Programme 35 “Women in Law and Society – the Way to Equality” and as a lecturer in the philosophy departments at the University of Basel and the University of Zurich. In 2006, she received her doctorate in philosophy from the University of Basel. While working at the Department of Education in 2014, she received her teaching diploma for baccalaureate schools and taught philosophy at the Gymnasium Leonhard baccalaureate school.

Cornelia Staehelin was born in South India and spent the first decade of her life there. She later attended school in Switzerland, ultimately studying medicine in Basel. After finishing her degree, she received clinical training in internal medicine, infectious diseases, and tropical and travel medicine, qualifying as a specialist in these fields. She has a master’s degree in International Health from Swiss TPH/the University of Basel. Since 2011, she has been a senior physician at the University Hospital of Bern, where she is in charge of travel and tropical medicine as well as vaccinations. She has served as president of the Swiss Expert Society for Tropical and Travel Medicine FMH since 2017.

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Future Perspectives

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FACTS & FIGURES Swiss TPH aims to improve the health and well-being of people with our partners in 281 projects in 129 countries.

817 Employees at Swiss TPH

240

Employees based abroad in 40 countries

735 Postgraduate students

> 10 projects > 5 projects > 1 project

Swiss TPH offices

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Facts & Figures

16,500

610

Pre- and post-travel consultations at the Travel Clinic

Employees based in Basel

129

Countries in which we work

Nations represented at SwissÂ TPH

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Facts & Figures

Swiss TPH is a world-leading institute in global health, with a particular focus on low- and middle-income countries. By uniquely combining research, education and services, we aim to improve the health and well-being of people through a better understanding of disease and health systems and by acting on this knowledge.

Innovation → Validation → Application

Discover novel diagnostics, drugs and vaccines develop new approaches and tools

Generate evidence in the field under real-world conditions

Integrate new treatments and approaches into policy and health systems

Swiss TPH works across a value-chain, from innovation and validation to application. Innovations such as new diagnostics, drugs and vaccines or approaches and tools are rigorously validated in real-world settings and applied and integrated into health systems and policies.

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Facts & Figures

The five departments at Swiss TPH work across three fields – research, education and services – to improve health globally.

EPIDEMIOLOGY AND PUBLIC HEALTH

MEDICAL PARASITOLOGY AND INFECTION BIOLOGY MPI studies diseases of poverty and develops diagnostics, drugs and vaccines to combat them

EP H

I P M

EPH studies health and diseases in relation to their social, ecological and genetic determinants

Research

S CIH

vic

MED provides clinical and diagnostic services for travellers and conducts clinical research in low-resource settings

S er

MED

MEDICINE

a ti o

Improving Health

EDUCATION AND TRAINING

SWISS CENTRE FOR INTERNATIONAL HEALTH

ET offers local, national and international training programmes and courses at graduate and postgraduate levels

SCIH provides policy advice, project design and management in the area of national and global health

The Department of Administration supports all operations of Swiss TPH through Finance and Controlling, Human Resources, Informatics, Infrastructure and Project & Grant Service.

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Facts & Figures

Scientific reach: 480 peer-reviewed publications spanning topics such as infectious diseases and parasitology to immunology and microbiology. PUBLIC, ENVIRONMENT & OCCUPATIONAL HEALTH

INFECTIOUS DISEASES

TROPICAL MEDICINE

PARASITOLOGY

ENVIRONMENTAL SCIENCES & ECOLOGY

MICROBIOLOGY

PHARMACOLOGY & PHARMACY

SCIENCE & TECHNOLOGY

IMMUNOLOGY

GENERAL & INTERNAL MEDICINE

HEALTH CARE SCIENCES & SERVICES

CHEMISTRY

RESPIRATORY SYSTEM

OTHER TOPICS

Distribution of research areas of Swiss TPH publications in 2019, according to the Web of Science (accessed May 2020).

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Facts & Figures Contributing to the Sustainable Development Goals The 2030 Agenda for Sustainable Development with the 17 Sustainable Development Goals (SDGs) provides a compass to tackle the global challenges we face, including those related to poverty, inequality, climate and health. Swiss TPH is committed to the achievement of the SDGs, placing

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particular emphasis on SDG 3 “Ensure healthy lives and promote well-being for all at all ages” and Universal Health Coverage (UHC). With our research projects and service mandates, we contribute to all of the SDGs.

1 2

14 13 12 11

10 9 8 7

5 3

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IN RETROSPECT FEBRUARY Pfizer Prize for Researchers at Swiss TPH Kristina Keitel-Hasler and Niklaus Labhardt from Swiss TPH received the Pfizer Research Prize, which is one of the most prestigious research awards for medicine in Switzerland. 24 outstanding researchers in five medical disciplines were awarded. The Basel-Landschaft State Government Council Visits Swiss TPH On 12 February, the Basel-Landschaft State Government Council visited Swiss TPH to gain a deeper insight into Swiss TPH’s areas of activity and the relocation to Allschwil by the end of 2021. The state treaty, which regulates joint ownership between Basel-Landschaft and Basel-Stadt, was established in 2017.

→ The Basel-Landschaft State Government Council visits Swiss TPH.

Swiss-Tanzanian Cooperation: Achieving Universal Health Coverage The Swiss Agency for Development and Cooperation together with Swiss TPH and partners gathered in Dar es Salaam, Tanzania on 12 – 13 February for a symposium to explore the role of social health insurance in achieving Universal Health Coverage.

APRIL New Project on Child Health in Tanzania Fondation Botnar awarded CHF 7 million for further deployment of electronic diagnostic and treatment tools based on algorithms, which will help clinicians to manage febrile children. The research project is led by Unisanté and the École Polytechnique Fédérale de Lausanne (EPFL), in collaboration with Swiss TPH and two research institutes in Tanzania: Ifakara Health Institute and the National Institute for Medical Research.

Two Decades of Swiss Leadership for New Malaria Medicines Swiss organisations reflected on a long history of successful collaboration for new malaria medicines. Switzerland’s leading role was strengthened with the establishment of the Medicines for Malaria Venture (MMV), the first product development partnership 20 years ago. Swiss collaboration has led to 11 approved anti-malarial medicines and helped to save more than 1.9 million lives globally.

MAY Swiss TPH Spring Symposium: Human Resources for Health 140 medical professionals and vocational training specialists shared their experiences and discussed the future of the training of doctors and nurses at the Swiss TPH Spring Symposium on 8 May. Ideas were exchanged on how to foster and strengthen self-directed continuous professional development programmes. → Participants at Swiss TPH Spring Symposium.

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In Retrospect

Farewell to Thierry Freyvogel A few days before his 90th birthday, Thierry Alfred Freyvogel-Jenny (4 May 1929 – 24 April 2019), former Director of Swiss TPH, passed away peacefully at home. We lost a sensitive, witty and socially engaged person, a respected colleague and dear friend. We remember his perceptive, humorous and consistent being and with it a vision for a better world.

Flu Prevention in Switzerland A nationwide survey of 97 organisations carried out by Swiss TPH showed that there was a shift from single, isolated activities, such as the vaccination of employees and patients, towards broader measures, which are more successful in preventing influenza. New Findings on Malaria Vaccine Protection by the malaria vaccine RTS,S is not only a matter of antibody quantity but also of quality. These were the findings of a study led by ISGlobal in collaboration with Swiss TPH and partners. The research showed for the first time that the higher the avidity of antibodies induced by the RTS,S vaccine, the greater the protection. The study was published in the peer-reviewed journal Nature Communications.

→ Thierry Freyvogel (right).

JUNE Reducing the Burden of Non-Communicable Diseases (NCDs) in Moldova The Government of the Republic of Moldova and the Swiss Agency for Development and Cooperation created the Healthy Life Project, implemented by Swiss TPH, with the aim to reduce NCDs. On 5 – 7 June, the 3rd International Conference on NCDs took place in Chisinau to address topics such as the improvement of primary healthcare.

One Third of Cambodians Infected with Threadworm Strongyloides stercoralis is a neglected threadworm that is endemic in many tropical and subtropical countries. In a nation-wide study in Cambodia, Swiss TPH scientists and partners found that nearly a third of the population is infected with S. stercoralis. The results were published in the peer-reviewed journal PLoS Neglected Tropical Diseases.

Swiss TPH Groundbreaking Ceremony On 21 June, the groundbreaking ceremony for the new Swiss TPH building took place at the BaseLink area in Allschwil. Representatives from the cantons of Basel-Landschaft and Basel-Stadt, the University of Basel, the R. Geigy Foundation as well as from the municipality of Allschwil attended the event to celebrate the beginning of the construction of “Belo Horizonte”, the new Swiss TPH headquarters.

→ Groundbreaking ceremony.

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In Retrospect

Interventions for Schistosomiasis Elimination in Zanzibar Schistosomiasis is a neglected tropical disease with a considerable impact on global health. Researchers from Swiss TPH, the Natural History Museum London and partners in Zanzibar published a study on interventions for schistosomiasis elimination in Zanzibar, which found that while schistosomiasis was eliminated as a public health problem in over 90 % of the study regions, transmission is not yet interrupted and reinfection occurs. Results were published in The Lancet Global Health.

Study Results Provide Basis for WASH Interventions In June, around 910,000 Rohingya refugees lived in Cox’s Bazar District in Bangladesh after having fled violence faced in Myanmar. In a project funded by UNICEF and coordinated by Swiss TPH, a study was conducted on WASH practices of the populations living in the refugee camp. This study supports UNICEF in the design and development of targeted WASH interventions, contributing to improved living conditions in the camp.

JULY Health Care and Management Graduate Ready to Improve Health The Health Care and Management (HCM) programme looked back on more than a quarter of a century of educating international health professionals. On 27 June, eighteen students from the 26th graduating class of the HCM course celebrated their achievement at the Basel City Hall, joining hundreds of alumni across the world who have launched careers in international health. Sébastien Gagneux receives Gardner Middlebrook Award Sébastien Gagneux from Swiss TPH and the University of Basel was honoured with the Gardner Middlebrook Lifetime Achievement Award for his research on tuberculosis. The prestigious award was presented to him on 30 June at the 40th Annual Congress of the European Society of Mycobacteriology in Valencia, Spain.

→ HCM graduates.

Changes in Mosquito Behaviour Could Result in Millions of Additional Malaria Cases A new study found that the proportion of outdoor mosquito bites in sub-Saharan Africa has increased, which could potentially lead to a substantial increase in malaria cases. The research was conducted by a group of international scientists, including scientists from Swiss TPH, and published in the journal Proceedings of the National Academy of Sciences of the United States of America.

AUGUST Malaria Mortality in Africa May Be Higher than Estimated Previous studies analysing malaria mortality in sub-Saharan Africa may have underestimated the true burden caused by this mosquito-borne disease. A study by Swiss TPH found that when taking into account indirect causes of death such as anaemia, the risk of death from malaria was up to 3.5 times higher. The results were published in the Nature research journal Scientific Reports.

Heatwaves Increase Emergency Admissions to Hospitals The summer of 2015, which after 2003 was the second hottest summer in Switzerland since temperature observation, caused more than 2,700 additional emergency admissions to Swiss hospitals. The most frequent causes were infectious diseases and diseases of the genitourinary system, as well as influenza and pneumonia. The study was published in the peer-reviewed journal Environmental Health.

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In Retrospect

SEPTEMBER Swiss TPH Scientist Awarded Research Grant Marloes Eeftens, Senior Scientist at Swiss TPH, was awarded a European Research Council (ERC) Starting Grant. The highly competitive grant supports 408 early-career researchers to build their own teams and conduct pioneering research. Eeftens’ research focuses on the effect of pollen on cardiorespiratory health and allergies.

Foundation Stone Laid for New Swiss TPH Building On 26 September, the foundation stone was laid for the new Swiss TPH building at the BaseLink area in Allschwil. After the groundbreaking ceremony on 21 June, the event is another important milestone in the construction of the new Swiss TPH headquarters.

OCTOBER Public-Private Partnership Launched to Develop New Drugs for Parasitic Worms A new consortium of research institutes, universities, not-for-profit organisations and pharmaceutical companies, which is led by Swiss TPH, has teamed up to develop novel drugs for infections caused by parasitic worms. These helminth infections are a debilitating group of diseases that includes river blindness, lymphatic filariasis, as well as infection with hookworm and whipworm, which together affect close to a billion people. Swiss TPH and PNGIMR: 30-Year Partnership On 13 September, Swiss TPH signed a new Memorandum of Understanding with the Papua New Guinea Institute of Medical Research (PNGIMR) to strengthen a decades-long partnership in the areas of research, capacity building and institutional development.

→ Swiss TPH leads a public-private partnership to develop new drugs for parasitic worms.

Emergency Ward in Tanzania Wins Else Kröner Fresenius Award Martin Rohacek from Swiss TPH and the Ifakara Health Institute received this year’s Else Kröner Fresenius Award for the establishment of an emergency ward for the St. Francis Referral Hospital in Ifakara, Tanzania. The Else Kröner-Fresenius-Foundation is dedicated to the promotion of medical research and supports medical-humanitarian projects. It is one of the largest German foundations promoting medicine.

NOVEMBER Claudia Schmutz Received Faculty Award at the University of Basel Claudia Schmutz from Swiss TPH received the Faculty Award from the Faculty Science at the University of Basel. With

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this award, the faculty honours her dissertation for its high quality and relevant contributions to the healthcare system.

In Retrospect

DECEMBER Improving Tuberculosis (TB) Screening in Remote Areas Swiss TPH and partners launched the 4-year TB TRIAGE+ project after signing a grant agreement with the European and Developing Countries Clinical Trials Partnership. TB TRIAGE+ will evaluate new diagnostic approaches to make active TB case finding more efficient and cost-effective in remote areas of southern Africa. Swiss TPH Winter Symposium: Climate Change and Health Climate change not only has an impact on the environment, but also significant effects on global health. What exactly these effects are and how to mitigate them were the questions addressed at this year’s Swiss TPH Winter Symposium. Experts from academia, public administration, international organisations and the private sector joined the pressing discussions around climate change and health from 5 – 6 December in Basel.

Swiss Support to Healthcare Provision in Romania From 2012 – 2019, Swiss TPH collaborated with the Swiss Agency for Development and Cooperation to assist in the Romanian integration process into the EU through health systems strengthening. Swiss TPH supported Romania through project facilitation that improved access to health and social services to vulnerable populations. Nicolas Brancucci Appointed Professor at the University of Basel Nicolas Brancucci from Swiss TPH was appointed the new Assistant Professor (with tenure track) for basic research in biology of infectious diseases of poverty at the University of Basel. He will also lead a newly created unit at Swiss TPH called “Malaria Host Interactions” which aims at gaining a better understanding of malaria host-parasite interactions.

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INSIGHTS “Climate Change is One of the Biggest Threats to Global Health” Climate change not only affects the environment, but also has significant consequences on global health. The World Health Organization estimates that approximately 250,000 deaths annually between 2030 and 2050 could be due to climate change – with vulnerable populations being the most affected. There is no more denying the effects of climate change; it is one of the biggest threats of this century. For over ten years, Swiss TPH has been addressing this by conducting research and guiding policy on climate change and health. Climate change is no longer a distant, future “There is no more denying the various effects that threat. It is here, now. The implications associ- climate change has and will have on health; it ated with it, which include rising sea levels, ex- is becoming one of the biggest threats to global treme weather events, water and food insecuri- health,” said Guéladio Cissé, Head of the Ecoty, heat stress, large-scale population migration system Health Sciences unit at Swiss TPH. “It is and emerging infectious diseases, are negatively now more important than ever that we continue affecting the health and well-being of popula- our work in relation to climate change to better tions around the globe. It is estimated that by protect the most vulnerable populations.” 2050, six billion people will be at risk of one or several of the “big seven” climate-related diseases: malaria, haemorrhagic fevers, schistosomiasis, human African trypanosomiasis, Chagas disease, leishmaniasis and onchocerciasis. In order to manage and mitigate these threats, health systems need to be prepared for changes that are already happening and allocate resources accordingly, and countries must work towards achieving net zero emissions. To support these efforts, Swiss TPH and partners conduct research linking climate science, disease trend forecasting and mitigation and adaptation strategies, in addition to advising policymakers on evidencebased health policies.

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“There is no more denying the various effects that climate change has and will have on health; it is becoming one of the biggest threats to global health” Guéladio Cissé, Swiss TPH Global warming poses an unacceptably high risk for population health

The Lancet Countdown 2018 report draws on expertise from climate scientists, mathematical modellers, economists, public health pro-

Insights

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Insights

fessionals and many others, and builds on decades of research. In it, the report concludes that climate change poses an unacceptably high level of risk for the current and future health of populations. It also shows that a lack of progress in reducing emissions threatens both human lives and the viability of national health systems, and that a widespread understanding of climate change as a central public health issue is crucial in order to accelerate a global response. While the evidence on the negative impact that global warming has on health exists and continues to grow, it is often difficult to encourage governments and policymakers to act accordingly. Addressing climate change requires actions put in place before any ‘doomsday warnings’ are proven true, which could lead to major economic disruptions; a move that countries are understandably hesitant to make. “We need to have more discussions about how policymakers can contribute to reducing CO2 levels, starting today, and how they should be preparing their communities and health systems to the impacts that climate change has on health. The WHO is contributing a lot by providing frameworks for strengthening the resilience of health systems to guide policymakers, but more has to be done,” urged Cissé. Climate change and health at Swiss TPH

Utzinger, Director of Swiss TPH. “Currently, the pace of climate change outweighs the urgency of the response; we must continue to work towards shifting this balance to better protect the health and well-being of populations worldwide.”

“Currently, the pace of climate change outweighs the urgency of the response; we must continue to work towards shifting this balance to better protect the health and well-being of populations worldwide” Jürg Utzinger, Director of Swiss TPH Winter Symposium: Climate Change and Health On 5 – 6 December, Swiss TPH brought together 400 experts from academia, public administration, international organisations and the private sector for the Winter Symposium “Climate Change and Health” at the Congress Center in Basel, Switzerland to discuss topics such as adaptation strategies, mitigation measures and frameworks for health system strengthening.

For over ten years, Swiss TPH has been working “If we do not continue to work on mitigation on the correlation between climate change and and adaptation measures, we are likely to push health. In addition to researching topics such as 100 million additional people into poverty and the effect of heat on health and modelling meth- we will not reach the Sustainable Development ods to estimate population’s exposure to pollut- Goals.” said Janine Kuriger from the Swiss Agenants, scientists at Swiss TPH also examine water cy for Development and Cooperation, who prequality and diarrhoeal diseases, the effects of sented at the symposium. airborne pollen on cardiorespiratory health, vulnerabilities of water and sanitation systems and more. In the fight against air pollution, Swiss TPH experts serve on committees and advisory boards, such as the WHO Air Quality Guidelines, to advance research and policies at the international level, and collaborate with local and national authorities to provide valuable information on air quality. “It is our responsibility to not only be a pioneer on climate-related research, but to also propel the discussions around climate change and health forward, starting at a population level and working our way up to a policy level,” said Jürg

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“If we do not continue to work on mitigation and adaptation measures, we are likely to push 100 million additional people into poverty and we will not reach the Sustainable Development Goals” Janine Kuriger, Swiss Agency for Development and Cooperation

Insights

Discussions and debates throughout the two-day event examined the effects of climate change beyond the linkage to extreme weather events but also its effect on water quality, water- and food-borne diseases, and diseases transmitted by vectors such as malaria. “Climate change affects chronic diseases, infectious diseases, mental health, food security and work productivity. The most relevant question for research is how to improve population health in the era of climate change,” said Martin Röösli, Head of the Environmental Exposures and Health unit at Swiss TPH. In order to minimise the carbon footprint of the event, the symposium brought many new features – including video conferencing and live streaming – reducing the ecological footprint of the event by an estimated 31 tons of CO2 emissions. “Even if everyone plays their part, ranging from individuals reducing their flying habits to policymakers taking part in global pacts such as the Paris Agreement, it may not be enough. This is why the climate movement asks that we do more. We must play our role from both an

institutional and personal perspective. We can and must do something about climate change, and no matter where you come from, you can make a difference too.” urged Cissé. Publications Cissé G [2019] Food-borne and water-borne diseases under climate change in low- and middle-income countries: further efforts needed for reducing environmental health exposure risks. Acta Tropica. 194: 181-188. Ragettli MS et al. [2019] Impact of the warm summer 2015 on emergency hospital admissions in Switzerland. Environmental Health. 18: 66. Röösli M & Cissé G [2020] Towards health for future. International Journal of Public Health. 65: 1-2.

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Insights

Antimicrobial Resistance on the Rise Research conducted by Swiss TPH in collaboration with the Harvard T.H. Chan School of Public Health revealed an alarming number of unnecessary antibiotic prescriptions in young children in low- and middle-income countries. Overuse and misuse of antibiotics contribute to an increased risk of Antimicrobial Resistance – one of the biggest global health threats of our time. Drug resistances are on the rise globally. Every ceive an antibiotic, although only in about 20 % year, around 700,000 people die due to infection of the cases the infection is due to a bacterial from drug resistant bacteria, viruses, fungi and infection. parasites. Without counter measures, experts estimate that by 2050, the annual death toll due “We knew children in low- and middle-income to drug resistance could increase to 10 million. countries (LMICs) are sick more often, and we knew antibiotic prescription rates are high in Antimicrobial Resistance (AMR) arises if micro-or- many countries. What we did not know was how ganisms such as bacteria, parasites or viruses sur- these elements translate into actual antibiotic exvive exposure to a drug that would normally kill posure,” said Günther Fink, lead author of the them. Strains that survive such exposure can study and head of the Household Economics and grow and spread while other strains get elim- Health Systems Research unit at Swiss TPH. inated through repeated drug treatment. AMR has led to the emergence of “superbugs”, which are exceedingly difficult or impossible to treat with existing medicines. Resistant microbes are found in people, animals, food and the environment (water, soil and air). They can spread between people and animals, and from person to person. AMR is not a new concept. Sir Alexander Fleming, who discovered the first antibiotic drug Penicillin nearly 100 years ago, warned the world about “playing thoughtlessly” with his gamechanging innovation. Indeed, the overuse and misuse of antibiotics are contributing considerably to AMR. Alarming antibiotic overprescription in children Previous studies have shown that antibiotics are overprescribed in many countries. In Tanzania, for instance, studies have shown that over 90 % of children who visit a health facility re-

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“The thoughtless person playing with penicillin treatment is morally responsible for the death of the man who succumbs to infection with the penicillin-resistant organism” Sir Alexander Fleming, Nobel Prize winner 1945

To shed light on the actual antibiotic exposure of children in LMICs, Günther Fink together with Valérie D’Acremont, Head of the Management of Fevers group at Swiss TPH, teamed up with colleagues at the Harvard T.H. Chan School of Public Health. The researchers analysed data from 2007 to 2017 from health facilities and household surveys in eight countries: Haiti, Kenya,

Insights

Malawi, Namibia, Nepal, Senegal, Tanzania and Uganda. On average 25 antibiotic prescriptions from birth through age five

The number of antibiotic prescriptions in early childhood varied from country to country: while a child in Senegal received approximately one antibiotic prescription per year in the first five years of life, a child in Uganda was prescribed up to 12. Results showed that antibiotics were administered in 81 % of cases for children with a respiratory illness, in 50 % for children with diarrhoea and in 28 % for children with malaria.

The study, published in December 2019 in The Lancet Infectious Diseases, found that children received, on average, five antibiotic prescriptions annually from birth through age five. “These numbers are truly alarming and up to five times Impact on the health of children higher than the already high levels observed in high-income settings.” said Fink. The vast ma- “Excessive antibiotic use also impacts the health jority of infections in this age group are of viral of these children. It destroys the natural gut floorigin and do not require an antibiotic treatment. ra, which is essential to fighting pathogens and building immune defences.” said D’Acremont. A Swiss TPH research project is underway to better comprehend the health impact of overusing antibiotics on children. “Understanding the concrete impact on individual children is crucial to achieve a policy change,” said Fink. His research team is currently comparing policies at a country level to identify best practices that lead to lower antibiotic prescription rates.

“The numbers are truly alarming and up to five times higher than the already high levels observed in highincome settings.” Günther Fink, Swiss TPH

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Insights Tackling resistance with digital health tools

Publications

The most decisive factor, however, are the doctors and health workers. “Training and supervision have the biggest effect on reducing unnecessary antibiotic prescriptions.” said D’Acremont. To that end, her research team at Swiss TPH and Unisanté in Lausanne developed an electronic point of care tool (e-POCT), which guides health workers through diagnosing and treating sick children.

Fink G et al. (2019) Antibiotic exposure among children under age five: A cross-sectional analysis of nationally representative facility and household surveys in 8 low- and middle-income countries. The Lancet Infectious Diseases. 20: 179-187.

“Training and supervision have the biggest effect on reducing unnecessary antibiotic prescriptions” Valérie D’Acremont, Swiss TPH Introducing e-POCT in health facilities resulted in improved clinical outcomes and a drastic reduction in the prescription of antibiotics from 95 % to 11 % according to a study conducted by Kristina Keitel-Hasler, Scientific Project Leader at Swiss TPH. The tool is being further enhanced to include artificial intelligence-based algorithms in collaboration with Unisanté, the École Polytechnique Fédérale de Lausanne (EPFL) and Tanzanian and Rwandan partners, with support from Fondation Botnar and the Swiss Agency for Development and Cooperation.

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Keitel K et al. (2017) A novel electronic algorithm using host biomarker point-of-care tests for the management of febrile illnesses in Tanzanian children (e-POCT): A randomized, controlled non-inferiority trial. PLoS Medicine. e1002411. D’Acremont V et al. (2014) Beyond malaria: causes of fever in outpatient Tanzanian children. New England Journal of Medicine. 370: 809-817.

“The training in family medicine in Tajikistan is a difficult one, but the reward makes it worth it; I am able to give back to my community to ensure that my family, friends and neighbours have access to the healthcare they need”

Insights

Asrorova Zahonoro, Nursing Student, Dushanbe, Tajikistan

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Insights

Looking Back: From the Swiss Tropical Institute to Swiss TPH Ten years ago, the former Institute of Social and Preventive Medicine within the University of Basel’s Faculty of Medicine was integrated into the Swiss Tropical Institute. Since then, topics such as air pollution, cardiovascular diseases and diabetes have been high on the agenda at Swiss TPH, as it is called today. Thanks to this step, Swiss TPH is in a unique position to offer comprehensive solutions for the health challenges of the 21st century. Read the interview with key people involved in Swiss TPH’s story: Nino Künzli, Nicole Probst-Hensch and Martin Röösli. Mr. Künzli, you and the Director Emeritus of the former Swiss Tropical Institute (STI), Marcel Tanner, carried out the integration of Institute of Social and Preventive Medicine (ISPM) 10 years ago. What has been achieved since then? Nino Künzli: “The integration has brought together two different traditions and sources of expertise under one roof. STI was especially strong in research on poverty-related diseases, such as malaria and sleeping sickness, as well as healthcare system research in African countries. ISPM was known for its public health research in the area of chronic diseases and their connection with pollutants in the environment, along with the establishment of biobanks in Switzerland and other health issues. As a result of the merger, we are now in a unique strategic position to tackle the global health challenges of the 21st century.” Why is this important? Nino Künzli: “There is still a risk of traditional infectious diseases such as malaria, tuberculosis and HIV/AIDS, but thanks to successful

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research, these infectious diseases can be treated more effectively. Other risks we face are that people are growing older, the disease burden is increasingly dominated by the consequences of environmental pollution, and a westernised lifestyle and non-communicable diseases such as diabetes are more prevalent. Such chronic diseases will – including COVID-19 – present the greatest challenges for healthcare systems in the future.” Will traditional infectious diseases be replaced by chronic diseases? Nicole Probst-Hensch: “No, but we are seeing a new challenge in co-morbidities and aging. Traditional and new infections appear with chronic diseases, which raises many new questions. The coronavirus, which mainly poses a danger to the older population, is a good example of this unhealthy combination. In addition, there has been little research, for instance, on the impact of malaria or parasitic worm infections on heightened blood pressure or diabetes or into the effect of extreme air pollution on the spread and treatment of infectious diseases.”

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Insights

Swiss TPH is increasingly working at the intersection of infectious diseases, chronic illnesses and environmental factors in low- and middle-income countries, but how has the integration of STI affected Switzerland as a research location?

In order to promote further research into non-communicable diseases, Swiss TPH and its partner network have invested in the development of longterm studies in Eastern Europe, Africa, South-East Asia and South America.

Martin Röösli: “Swiss TPH is better able to fulfil its mission today as a result of the integration ten years ago: it has been able to improve the health of populations not only at an international level, but also at the local and national levels. Swiss TPH plays an important role in Switzerland through the SAPALDIA (Swiss Cohort Study on Air Pollution and Lung and Heart Diseases in Adults) biobank, which is the first and largest biobank in Switzerland. It serves as the basis for the development of a national large-scale cohort and biobank, the Swiss Citizen Cohort. The data stored in the SAPALDIA biobank enables new findings on the prediction and prevention of chronic diseases like diabetes or Alzheimer’s, about co-morbidities in old age and about optimal health system management.”

Knowledge transfer to West Africa Swiss TPH recently built the first biobank in rural Africa in collaboration with the Centre Suisse de Recherches Scientifiques en Côte d'Ivoire (CSRS) and its former Director General, Bassirou Bonfoh. A long-term study in Taabo, a CSRS research location, is looking into the connection between diabetes, high blood pressure and infectious diseases. The physicians trained as part of the study examine and treat patients. Samples are stored and transported in refrigerated trucks to the national biobank at the Pasteur Institute in the city of Abidjan.

The first results of this particular study have shown that malaria and fever have an impact on high blood pressure. In order to be able to properly diagnose chronic diseases and collect dependA focus on chronic diseases and the able epidemiological data, a diagnosis should establishment of biobanks only be made when the patient is fever-free. At the same time that the integration of ISPM “This does not prove, however, that people with into STI was completed, Nicole Probst-Hensch, high or low blood pressure will later develop a the Head of the Department of Epidemiology greater risk for malaria infection,” notes Probstand Public Health at Swiss TPH, was called from Hensch. “It is precisely to answer questions such Zurich to Basel in autumn 2009. Marcel Tanner as these, that long-term data and samples are and Nino Künzli, were able to convince her and needed.” her team about the vision of Swiss TPH. With her as the main person overseeing the SAPALDIA Environmental research in South Africa study, the research agenda at Swiss TPH was expanded to include a focus on chronic diseases and expertise in biobanking. For nearly 30 years, SAPALDIA has been collecting complex life and health data from around 10,000 people from all over Switzerland. Thanks to this long-term study, we know, for example, the impact that smoking, nutrition, high blood pressure and stress have on the health of older people. These results have had a substantial impact on Swiss health policy. The study also made a critical contribution to the stringent legal limits on particulate matter that are in place in Switzerland today. At the international level, the results were included in the air quality guidelines issue by the World Health Organization.

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South Africa has become a focal point of environmental health research conducted by Swiss TPH in recent years. The country has been a focus of research and technical collaboration with Switzerland since 2007. The University of Basel and Swiss TPH function as a so-called “Leading House” for sub-Saharan Africa. In this context, the joint “Chair for Global and Environmental Health” was established five years ago at the University of Cape Town and Swiss TPH. “In addition to all its natural beauty, South Africa provides numerous opportunities for studying a range of environmental exposures,” said Martin Röösli, Head of Environmental Exposures and Health unit at Swiss TPH.

Insights

Major social inequality also results in differences in environmental quality. For example, it is not widely known that people living in the poorer townships view noise pollution as a serious problem. “We are trying to research the impact of noise on the health of township residents,” said Röösli. “There is a substantial amount of noise pollution from loud generators, from roads and from people themselves.”

While the Swiss political authorities base their decisions on scientific findings, the connection between science and politics is not as closely linked in South Africa. “It will be a major challenge to persuade the authorities in South Africa and get them to implement our findings,” said Martin Röösli. Only time will tell how successful efforts will be. But it is already clear that the research work performed by Swiss TPH and the University of Cape Town holds important findings for other African countries too.

In addition to noise, Röösli and his team focus on the effects of pesticide residue on human health. For instance, a research group recent- “South Africa is ahead of other sub-Saharan ly found residue from 53 different pesticides in countries in terms of its economic development. major agricultural areas in the Western Cape. A Therefore, questions about the health effects of long-term cohort study is now dedicated to ex- pesticides, noise, air pollutants, climate change amining the impact of this risk on the behaviour and electromagnetic radiation will also become and physical development of schoolchildren. more urgent in other African countries in a couple of years,” said Röösli. “If we are to tackle A model for other African countries these problems efficiently with the limited reTo date, the joint environmental research con- sources available, it is important to work togethducted by Swiss TPH and the University of Cape er to develop new and at times unconventional Town has been limited to establishing an epide- solutions.” miological basis. The next phase of the project will focus on improving human health through The fact that Swiss TPH will be able to make an targeted interventions. However, this will require active contribution to addressing topics such as politicians to do their part as well, which is no air pollution and climate change is due in part easy task in a country like South Africa. to the successful integration of the former ISPM into STI exactly ten years ago.

→ Marcel Tanner (left) and Nino Künzli (right) celebrate the integration of ISPM into STI, now known as Swiss TPH.

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“Air pollution is an important public health problem that is underresearched in subSaharan Africa. Because of Swiss TPH’s expertise in epidemiology, I joined the institute to study the joint effect of multiple air pollutants on cardiorespiratory diseases” Temitope Adebayo, PhD Student at Swiss TPH / University of Basel

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KEY AREAS OF ACTIVIT Y The diverse projects and initiatives at Swiss TPH are grouped into 13 key areas of activity (KAAs). In each KAA, we work across departments and along our value chain, from innovation and validation to application, to improve health globally. KAA-1

KAA-5 Basic Research in Infection Biology Innovative reasearchfor poverty-related diseases

KAA-2

KAA-10 Emerging Infectious Diseases Tackling viruses such as dengue, Ebola or Zika

Sexual and Reproductive Health and Gender Enabling access to sexual and reproductive health

KAA-6 Preclinical Research and Development Discovering and developing diagnostics, drugs and vaccines

Statistical and Mathematical Modelling Capturing and projecting health data

Personalised Health Research on cohorts and biobanks

KAA-12 Travel and Tropical Medicine Managing health risks of tropical diseases

KAA-8 Health in HumanEnvironment Systems Studying the impact of environmental factors on health

KAA-4 Molecular and Genetic Epidemiology Defining markers for disease control and surveillance

Health Systems and Policy Translating evidence and strengthening health systems

KAA-7

KAA-3 Clinical Research and Development Testing and monitoring new therapies in low-resource settings

KAA-11

KAA-9

KAA-13 Migration and Health Improving health of mobile populations and migrants

Society, Culture and Health Studying social and cultural determinants of health

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Key Areas of Activity

KAA-1

KAA-2

Basic Research in Infection Biology The biological research of pathogens and their transmission is one of the core activities of Swiss TPH. Basic research in infection biology focuses on poverty-related diseases such as malaria, tuberculosis, African sleeping sickness, parasitic worm infections and Buruli ulcer. The latest findings are used to develop new diagnostics, drugs and vaccines. Concentration and avidity of antibodies to different circumsporozoite epitopes correlate with RTS,S/AS01E malaria vaccine efficacy RTS,S/AS01E, the most advanced malaria vaccine to date, has shown consistent protection against malaria disease in African children. RTS,S/AS01E is based on the major surface protein, the circum-sporozoite protein (CSP) of Plasmodium falciparum sporozoites, formulated in AS01E adjuvant. Mechanisms or correlates of protection after RTS,S/AS01E vaccination in infants and children remain unclear. Swiss TPH and partners analysed serum CSP-binding immunoglobulin G (IgG) levels and binding avidity in 1028 vaccines from three African countries and found that quality and quantity of RTS,S/ AS01E induced antibodies are affected by age of vaccine, country and malaria pre-exposure. Both anti-CSP IgG concentrations and IgG avidity targeting distinct CSP-regions correlate strongly with protection against malaria. Dobaño C et al. [2019] Concentration and avidity of antibodies to different circumsporozoite epitopes correlate with RTS,S/AS01E malaria vaccine efficacy. Nature Communications. 10: 2174.

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Preclinical Research and Development Swiss TPH is one of the world’s leading institutes for developing new drugs, vaccines and diagnostic tests for diseases like malaria, tuberculosis and parasitic worm infections. In collaboration with partners, Swiss TPH makes a significant contribution to the development of new therapies. Life cycle maintenance and drug-sensitivity assays for early drug discovery in Schistosoma mansoni Drug discovery for schistosomiasis is still limited to a handful of academic laboratories worldwide, with only a few novel antischistosomal compounds being actively researched. Despite recent international mobilisation against the disease to promote antischistosomal drug discovery, setting up a drug-screening flow with schistosome parasites remains challenging. At Swiss TPH, the complex Schistosoma mansoni life cycle has been maintained in a laboratory setting for many years. In addition, Swiss TPH has a long-standing expertise in retrieving and culturing the parasites at their relevant life stages and evaluating drug effects of test compounds. To stimulate research on antischistosomal drug discovery, researchers from Swiss TPH shared this experience in an in-depth protocol. Lombardo FC et al. [2019] Life cycle maintenance and drug-sensitivity assays for early drug discovery in Schistosoma mansoni. Nature Protocols. 14: 461-481.

Key Areas of Activity

→ Swiss TPH employs state-of-the-art methodology in molecular biology, cell biology, biochemistry, in vitro cell culture, immunology, microbiology, genetics, population biology and bioinformatics.

→ Children playing in an open water body are at risk of acquiring a Schistosoma infection.

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Key Areas of Activity

KAA-3

KAA-4

Clinical Research and Development Swiss TPH is one of the world’s leading institutes for developing new drugs, vaccines and diagnostic tests for diseases like malaria, tuberculosis and parasitic worm infections. In collaboration with partners, Swiss TPH makes a significant contribution to the development of new therapies. Praziquantel phase II clinical trial Swiss TPH is part of the Pediatric Praziquantel Consortium, a partnership that is developing a pediatric praziquantel formulation for treating schistosomiasis in preschool-aged children. As part of the consortium, Swiss TPH participated in the phase II clinical trial in Côte d’Ivoire in S. mansoni infected children of different ages (ranging from three months to six years). The study confirmed the formulation (levo-praziquantel 150mg) and the dose that is being pursued by the Consortium until registration. Overall, 7,900 screening visits were conducted and 444 participants enrolled in the study. N’Goran E et al. [2019] Challenges and lessons from conducting a paediatric clinical trial in sub-Saharan Africa: the case of the praziquantel oral dispersible tablets phase II study in Côte d'Ivoire. Advances in Parasitology. 103: 75-89.

Molecular and Genetic Epidemiology Molecular and genetic epidemiology aims to investigate diversity, dynamics and evolution of pathogens, vectors, and human and animal populations and their interaction with the environment to generate evidence and metrics for improving health. It also develops tools for molecular monitoring of trials and interventions and strategies for reactive surveillance. What drives spatial and temporal patterns of genetic differences between malaria infections? Knowledge of how malaria infections spread locally is important for the design of targeted interventions aiming to interrupt malaria transmission and for the design of trials to assess the interventions. A study by Swiss TPH and partners developed a method to estimate the distances and patterns of the spread of Plasmodium falciparum malaria by fitting an individual-based simulation model to sparse parasite genotyping data. This is the first study which has attempted to estimate the spread and test hypotheses from malaria genotyping data with a low coverage of infections in a setting with moderate transmission. Malinga J et al. [2019] Investigating the drivers of the spatio-temporal patterns of genetic differences between Plasmodium falciparum malaria infections in Kilifi County, Kenya. Scientific Reports. 9: 19018.

→ The Consortium established a pediatric drug development programme, which includes preclinical development, clinical development, registration and access.

→ The spread of individual malaria infections ultimately shapes the pattern of malaria infection in the community.

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Key Areas of Activity

KAA-5

KAA-6

Emerging Infectious Diseases Swiss TPH has strengthened its expertise in diagnosing and investigating the clinical implications and spread of infections, such as Zika, Chikungunya and Japanese encephalitis. The aim of these activities is to develop new diagnostic products for clinical studies in various endemic regions, for rapid and safe diagnosis of travellers returning to Switzerland, and for establishing a monitoring system for pandemics. A novel lineage of ceftriaxone-resistant S.Typhi from India Antimicrobial resistance is an emerging problem in the treatment of infections with Salmonella Typhi. As a consequence of the resistance against first- and second-line antibiotics, ceftriaxone and azithromycin have been increasingly used in the treatment of S. Typhi. Consequently, resistance against these antibiotics have surfaced, rendering the S. Typhi extremely drug resistant, further hampering the antibiotic options available. A study by Swiss TPH and partners looked at the genome of a drug resistant S. Typhi strain from India and found it to be phylogenetically related to an XDR strain causing an outbreak in Pakistan. The study recommends close surveillance of antibiotic resistance in S. Typhi across southeast Asia and in travellers returning from these regions. Ranjit S et al. [2019] A novel lineage of ceftriaxone-resistant salmonella typhi from India that is closely related to XDR S. Typhi found in Pakistan. Clinical Infectious Diseases. ciz1204.

→ Swiss TPH specialists combine their knowledge and expertise to design innovative solutions.

Statistical and Mathematical Modelling Mathematical and statistical models can help us better understand the transmission and spread of communicable and non-communicable diseases and make it easier to assess the impact of health measures, such as introducing a new drug or vaccine. Research results are made available to decision-makers, donors and local health authorities and can help them to better target the limited financial resources in the healthcare system. Pharmacokinetic models Physiologically-based pharmacokinetic (PBPK) models are representations of drug absorption, distribution, metabolism and elimination in different organs of the body. They can be used to simulate novel drug formulations, alternative routes of administration, drug-drug interactions or drug disposition in groups for whom conducting clinical trials is challenging (e.g. children, pregnant women, etc.). A University Hospital Basel (USB) and Swiss TPH project has developed a general PBPK modelling framework and a tutorial on building PBPK models in Matlab©, which has been applied to model HIV drugs in older patients. Stader F et al. [2019] A comprehensive framework for physiologically based pharmacokinetic modelling in Matlab®. CPT Pharmacometrics and Systems Pharmacology. 8: 444-459.

→ Mathematical and statistical models help to better understand the spread of diseases.

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Key Areas of Activity

KAA-7

KAA-8

Personalised Health Swiss TPH researches various aspects of personalised health. Experts rely on genomic methods to develop new diagnostic products, to optimise vaccines and to better understand the interaction of pathogens and hosts. Environmental and exposome research links environmental and disease sensors with genomic biomarkers to investigate the causality of response relationships. Likewise, mathematical modelling and statistical prediction of disease and risk factor distribution benefit from the availability of large data sets and powerful computers. SAPALDIA citizen biobank Large, longitudinal studies are essential for capitalising on the research instruments provided by personalised health (e.g. omics markers and imaging markers) in order to improve the understanding and prevention of disease risks. Bio-specimens and images must be obtained from healthy citizens to test if novel biomarkers are useful in predicting diseases. The Swiss TPH led project SAPALDIA is the only Swiss-wide citizen biobank that has been ongoing for 30 years. Its data and biobank continue to contribute to the understanding of a healthy urban environment, healthy lifestyles and disease predicting genetics and other biomarkers.

Health in HumanEnvironment Systems Molecular and genetic epidemiology aims to investigate diversity, dynamics and evolution of pathogens, vectors, and human and animal populations and their interaction with the environment to generate evidence and metrics for improving health. It also develops tools for molecular monitoring of trials and interventions and strategies for reactive surveillance. Nutritional status and intestinal parasites among young children from pastoralist communities of the Ethiopian Somali region The burden of undernutrition and intestinal parasitic infections (IPIs) is high in children less than five years of age in the Somali Regional State of Ethiopia (SRS). A new study by Swiss TPH and partners assessed the nutritional status and its association with IPIs in 500 children under five years of age in the Adadle district and found that undernutrition was positively associated with Giardia intestinalis and age, but negatively associated with milk consumption. In addition, breastfeeding for six months and a higher food variety were associated with a reduced risk of anaemia. G. intestinalis and low nutritional adequacy of the diet seem to be contributing factors to the nutritional status and should be addressed with appropriate interventions. Osman K et al. [2019] Nutritional status and intestinal parasites among young children from pastoralist communities of the Ethiopian Somali region. Maternal & Child Nutrition. e12955.

→ SAPALDIA addresses environmental and health policy questions to guide evidence-based decisions in Switzerland.

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Key Areas of Activity

KAA-9

KAA-10

Society, Culture and Health Social position, cultural values and economic status influence health, which has important social and economic implications. Using this approach, researchers at Swiss TPH place a special focus on the health of the youth and the elderly. They seek to answer questions such as how can young women in Tanzania be helped to prevent unwanted pregnancies? How can societies in Africa and Asia improve social health protection for older people? Navigating fertility, reproduction and modern contraception in the Democratic Republic of the Congo Modern contraception has created new possibilities for reimagining reproductive norms and has generated new socio-cultural uncertainties in South Kivu province, Democratic Republic of the Congo. Using inductive analysis of women's reproductive narratives, a study from Swiss TPH and partners explored how women in a high fertility context encountered and integrated family planning and modern contraceptive education and services into their lives. Dumbaugh M et al. [2019] Navigating fertility, reproduction and modern contraception in the fragile context of South Kivu, Democratic Republic of Congo: ‘Les enfants sont une richesse’. Culture, Health & Sexuality. 21: 323-337.

→ Social, cultural and economic status influence health.

Sexual and Reproductive Health and Gender Swiss TPH is active in strengthening access to sexual and reproductive health services for women and men with a focus on young people, applying a gender and rights perspective. Research and implementation projects contribute to knowledge about sexually transmitted diseases and family planning, and to making pregnancies and births safe across all domains. In Switzerland, vaccination programmes, breastfeeding promotion, and the impact of midwife networks are investigated. JeuneS3 Since 2016, JeuneS3 (Santé, Sexualité, Sécurité) supports the implementation of the national life skills education programme in South and North Kivu, Democratic Republic of the Congo. By working with local partners, the programme helps establish a national curriculum to deliver sexuality education in 90 schools and in 40 out-of-school settings. Swiss TPH supports JeuneS3 through curriculum development, the creation of a pool of specialised trainers and teachers, school infrastructure improvement, providing teaching materials, quality controls and research as well as monitoring and evaluation mechanisms.

→ The aim of JeuneS3 is for young people, especially adolescent girls, to have the opportunity to make informed choices about their sexual and reproductive health rights.

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Key Areas of Activity

KAA-11

KAA-12

Health Systems and Policy Swiss TPH offers support to countries with insufficient healthcare provision. Experts develop and reinforce health insurance schemes for rural populations, draft IT solutions for improving treatment for patients, invest in strengthening primary healthcare and training healthcare professionals, evaluate development projects and monitor the allocation of money provided by the Global Fund in many countries in Africa and Asia. openIMIS initiative In the drive for Universal Health Coverage (UHC), Swiss TPH supports countries to develop health insurance schemes that are inclusive of the poor and other vulnerable groups. The design of insurance processes and support systems hold the key to transparent and effective schemes. Swiss TPH led the development of an innovative insurance management information system that employs the use of mobile phones to optimise enrolment, claims, renewal and feedback processes, which is now used in the openIMIS initiative.

Travel and Tropical Medicine Swiss TPH is one of the world’s leading centres for travel and tropical medicine. Approximately 15,000 travellers visit Swiss TPH every year to receive advice on disease risks in the tropics and subtropics or get vaccinations and approximately 1,500 ill-returning travellers receive treatment following their return. Experts search for disease carriers with state-of-the-art technology and extensive experience. Diagnostic samples are sent to Swiss TPH from all over the world because of the institute’s internationally recognised expertise. Don’t forget the past: a sleeping disease can be awakened Congenital malaria, which is the direct infection of an infant with malaria parasites from their mother prior to or during birth, is very rare in developed countries. A case study from Swiss TPH and partners examined a 24-day-old newborn at a hospital in Switzerland with a history of fever, reduced feeding and irritability, and confirmed that the child had Plasmodium vivax malaria, demonstrating that the maternal infection may lie dormant for years and cause a relapse during pregnancy. Congenital malaria should be considered a differential diagnosis when evaluating apparent septic newborns of immigrant mothers or mothers with a travel history to endemic countries. Frauchiger B et al. [2019] Don't forget the past: a sleeping disease can be awakened. Journal of Paediatrics and Child Health. 55: 854-856.

→ openIMIS offers an intuitive, user-friendly interface to manage the complex processes used in health protection schemes.

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Key Areas of Activity

KAA-13

Migration and Health The precarious situation of refugees, migrants and nomads makes them especially susceptible to disease. Swiss TPH researchers develop new concepts to improve the health of marginalised populations. Specialists work together with partners on activities which aim to achieve fairer health and social policies, such as health clinics for migrants.

agement include the development and implementation of digital tools. The project is led by Swiss TPH in close collaboration with the Centre de Support en Santé Internationale, the UN Refugee Agency and other partners in Chad.

SysRef: Digital System for Better Health Care Management of Refugees The SysRef project (Digital System for Better Health Care Management of Refugees), funded by the Stanley Thomas Johnson Foundation, aims to improve the quality of health for refugees and displaced people in Chad who are living in refugee camps. Measures to improve healthcare man-

→ Common health problems of refugees and displaced population groups are infectious diseases, malaria and malnutrition, as well as mental illnesses.

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46â&#x20AC;&#x192; Swiss Tropical and Public Health Institute

COMMIT TEES & DEPARTMENTS Directorate and Board of Governors Directorate

Board of Governors

Directorate

Dr. Andreas Burckhardt Chair, Chairman and Member of the Board of Governors, Bâloise Holding AG

Prof. Dr. Jürg Utzinger Director Matthias SchmidHuberty Administrative Director Prof. Dr. Nino Künzli Deputy Director (until March 2020)

Additional Members of the Managing Board Prof. Dr. Sébastien Gagneux Prof. Dr. Daniel Paris Prof. Dr. Nicole ProbstHensch Prof. Dr. Kaspar Wyss Deputy Director (as of April 2020)

Prof. Dr. Sabina De Geest Director, Institute of Nursing Science, University of Basel PD Dr. Monika Wenk Senior Director, Janssen Pharmaceutical Companies of Johnson & Johnson Prof. Dr. Didier Trono Full Professor, Swiss Federal Institute of Technology, Lausanne Christoph Tschumi Administrative Director, University of Basel Dr. Cornelia Staehelin Senior Physician, University Hospital Bern Dr. Ariane Bürgin Head of Higher Education, Cantonal Department of Education, Basel

R. Geigy Foundation: Foundation Board and Administration Dr. Doris Fellenstein Wirth Head of the Department for Vocational, Secondary and Higher Education, Basel-Landschaft Prof. Dr. François Chappuis Head of Tropical and Humanitarian Medicine Division, Geneva University Hospitals Dr. Nicole Schaad Observer, State Secretariat for Education, Research and Innovation, Bern Prof. Dr. Jürg Utzinger Director, Swiss TPH (ex officio) Matthias SchmidHuberty Secretary of the Board (ex officio) Administrative Director Swiss TPH

Prof. Dr. Marcel Tanner President of Foundation Board, Director Emeritus, Swiss TPH Jean Marc Joerin Vice-President of Foundation Board, Lawyer, Joerin Advokatur Dr. Lukas Meier Managing Director, R. Geigy Foundation Beat Berger Foundation Board Member, Managing Director, Berger Liegenschaften Stefan Mörgeli Foundation Board Member, Administrative Director Emeritus, Swiss TPH Bernadette Peterhans Foundation Board Member, Head of Professional Postgraduate Training, Swiss TPH Jürg Toffol Foundation Board Member, Architect, ETH SIA Prof. Dr. Jürg Utzinger Foundation Board Member, Director, Swiss TPH

Swiss Tropical and Public Health Institute 47

Committees & Departments

Organigramme 2020 Board of Governors

Directorate

Members from the cantons of Basel-Stadt and Basel-Landschaft, Swiss universities and the private sector

Director Jürg Utzinger

Chairman Andreas Burckhardt

Deputy Director Nino Künzli (until March 2020) Kaspar Wyss (as of April 2020) Department Heads Sébastien Gagneux, Nino Künzli Daniel Paris, Nicole Probst-Hensch, Kaspar Wyss Administrative Director Matthias Schmid-Huberty

Administration Administration Matthias Schmid-Huberty Deputy: Mathias Kronig Finances / Controlling Mathias Kronig Human Resources Iris Haueter Informatics Alain Bertolotti Infrastructure Ursina Müller Project & Grant Service Michael Käser

Departments Epidemiology and Public Health

Medical Parasitology and Infection Biology

Nicole Probst-Hensch Deputy: Jakob Zinsstag

Sébastien Gagneux Deputy: Till Voss

Biostatistics Penelope Vounatsou

Clinical Immunology Claudia Daubenberger

Chronic Disease Epidemiology Nicole Probst-Hensch

Helminth Drug Development Jennifer Keiser

Ecosystem Health Sciences Guéladio Cissé

Malaria Gene Regulation Till Voss

Environmental Exposures and Health Martin Röösli

Malaria Host Interactions Nicolas Brancucci

Health Interventions Christian Lengeler Household Economics and Health Systems Research Günther Fink Human and Animal Health Jakob Zinsstag Infectious Disease Modelling Thomas Smith Society, Gender and Health Sonja Merten

48 Swiss Tropical and Public Health Institute

Molecular Immunology Gerd Pluschke Parasite Chemotherapy Pascal Mäser Tuberculosis Research Sébastien Gagneux

Committees & Departments

Communications, Sabina Beatrice-Matter Security, Safety & Health, Marco Tamborrini, Alexander Knup Internal Audit, Vincent Bodeney, André Barbe

Swiss Centre for International Health

Medicine

Education and Training

Kaspar Wyss

Daniel Paris Deputy: Christian Burri

Nino Künzli Deputy: Axel Hoffmann

Health Systems Support Helen Prytherch

Clinical Operations Elisabeth Reus

Bachelor-Master-Doctorate Nino Künzli

Health Technology and Telemedicine Martin Raab

Clinical Research Klaus Reither

Library and Documentation Giovanni Casagrande

Diagnostics Sven Poppert

Professional Postgraduate Training Bernadette Peterhans

Systems Performance and Monitoring Odile Pham-Tan

Medical Services Andreas Neumayr Medicines Implementation Research Christian Burri

Teaching Technology and Didactics Axel Hoffmann

Organigramme valid April 2020 All Swiss TPH staff: www.swisstph.ch/staff

Swiss Tropical and Public Health Institute 49

Committees & Departments

Medical Parasitology and Infection Biology

Sébastien Gagneux, Head of MPI

The Department of Medical Parasitology and Infection Biology (MPI) investigates pathogens and their transmission pathways. Findings from this research flow into the development of new drugs, vaccines and diagnostics for neglected tropical and poverty-related diseases such as malaria, parasitic worm infections, Buruli ulcer, tuberculosis and sleeping sickness. Research on pathogen biology, hostpathogen interactions and immunity Researchers at MPI investigate the molecular and cellular mechanisms underlying pathogen reproduction and transmission. They also study molecules and processes that trigger an immune response and influence the course of the disease using various infection models and human samples from clinical studies. Research on pathogen development and transmission The specialists at MPI study how pathogens undermine the immune reaction of the host or develop resistances to drugs, and how these strategies influence the spread of the microbes. They analyse infection and transmission dynamics as well as the effects of health interventions such as vaccinations or therapies on the spread and population structure of pathogens. Development of drugs, vaccines and diagnostics Researchers also use their knowledge of pathogens and hosts to test selected drug and vaccine candidates in preclinical and clinical studies. They also develop new infection models to review new interventions.

Highlights in 2019 The research output of the department continues to be excellent on all fronts. The Clinical Immunology unit generated important new insights into the protective immune responses elicited by the most advanced malaria vaccine known as RTS,S that is currently being tested across several countries in Africa. This work was published in Nature Communications. The Tuberculosis Research unit documented how naturally occurring genetic diversity in tuberculosis bacteria influence the emergence of antibiotic resistance in work published in Molecular Biology and Evolution. Gerd Pluschke published the first book ever on the biology and epidemiology of Buruli ulcer. MPI was also highly successful in acquiring new research grants. In particular, Jennifer Keiser and her team successfully acquired 10 million Euros to build a consortium for the development of new treatments against parasitic worm infections. The Malaria Gene Regulation unit was granted a new project in the frame of a large PhD student training network. MPI’s sustained excellence in research and training is also reflected by the various awards that have been granted to some of its members.

50 Swiss Tropical and Public Health Institute

Mélanie Pellisson, a PhD student in the Parasite Chemotherapy unit, was awarded a prize for the best oral presentation at the EMBL International Malaria Conference BioMalPar in Heidelberg, and Sébastien Gagneux received the Gardner Middlebrook Award for Lifetime Achievement from the European Society of Mycobacteriology. Strategic areas and promotions Despite the recent retirements of Ingrid Felger and Hans-Peter Beck, who have during many years contributed significantly to the malaria research portfolio of Swiss TPH, malaria research remains a strong focus of MPI, in particular thanks to the recent recruitment of Nicolas Brancucci as Head of the newly created Malaria Host Interactions unit. He was also appointed Assistant Professor in basic malaria research at the University of Basel following a broad international search and rigorous recruitment process.

Committees & Departments

Epidemiology and Public Health

Nicole ProbstHensch, Head of EPH

The Department of Epidemiology and Public Health (EPH) conducts research on infectious and non-communicable diseases across the globe. Through broad, transdisciplinary knowledge, EPH develops and tests public health interventions and has biostatisticians and mathematicians who are among the top in their fields. EPH works cost-effectively with a gender-sensitive lens on social health protection for the people, and with the people, towards better health and well-being. Malaria and neglected tropical diseases: from vector to host to public health interventions The Infectious Disease Modelling unit maintained a high output of publications and successful funding for modelling to support strategy and portfolio management and the National Malaria Control Programme. The NETCELL project in Tanzania provided the basis for the High Burden High Impact malaria control strategy of the World Health Organization (WHO). In addition to ongoing activities in vector control, EPH successfully established a 3D video tracking system to quantify the effect of biocides on mosquito behaviour. In the frame of the UNITAID-supported CARAMAL project in Nigeria, The Democratic Republic of the Congo and Uganda, EPH established the largest community-based cohort study on severe malaria treatment. EPH performed ultrasound screening of 5,000 adults from Lao PDR and observed a very high prevalence of cholangiocarcinoma. The work was extended to Cambodia and Thailand. This partner network in southeast Asia also collaborates towards Schistosoma mekongi eliminiation. EPH is also leading an international and multidisciplinary group of scientists who are working on WHO guidelines for geospatial sampling designs for schistosomiasis. Environment and health EPH conducts spatio-temporal modelling to assess the impact of climate change on the burden of malaria and has leading roles in initiatives in the surveillance of mosquitoes in Europe. At the Swiss TPH Winter Symposium “Climate Change and Health”, Swiss TPH and international researchers presented their studies addressing climate-related health risks, vulnerabilities and impacts. Ten oversea speakers and two from Switzerland presented by video conferencing instead of travelling to Basel, saving 28 tons of CO2 emissions.

Social science, medical anthropology, and health systems research EPH led several publications by the NFP 74-funded Swiss vaccine hesitancy project and collaborated with the Swiss Federal Office of Public Health (FOPH) on projects to enhance vaccine uptake and to control food and waterborne diseases. EPH also produced the Swiss report on contraception mandated by the FOPH. Ethnographic research on aging with a focus on non-communicable diseases (NCDs) and corresponding elder care was continued in southeast Asia. EPH also assessed the burden of diabetes in Switzerland and proposed indicators for a surveillance programme, as well as began a research agenda on the control of Legionnaires’ disease funded by the Federal Food Safety and Veterinary Office (FSVO) and FOPH. Strategic areas

NCDs, vaccination, and reproductive health and social health protection. Swiss TPH researchers are trained on qualitative methodology, the life course perspective and ethnomedicine/-botany/-pharmacology. Promotions and organisational changes Marloes Eeftens was awarded two prestigious career grants: an ERC starting grant and an SNF Ambizione grant to study the health effects of pollen exposure. Tamsin Lee obtained a Marie-Curie Fellowship for her mathematical modelling approaches to improve the treatment of malaria. Sonja Merten, Mirko Winkler, Pie Müller and Sarah Moore were promoted to Assistant Professors/Senior Lecturers (Habilitation) at the University of Basel. Nicole Probst-Hensch was promoted to full professor in the medical faculty of the University of Basel. Manuel Hetzel replaced Blaise Genton as Deputy Head of unit. Brigit Obrist obtained the Teaching Excellence Award from the University of Basel.

EPH is expanding the 30-year old SAPALDIA cohort in Switzerland to become a larger regional and national cohort, as well as establishing mother-child cohorts in Lao PDR and Peru. The malaria transmission laboratory is now operational in Tanzania to enhance future collaborations on transmission blocking drugs and vaccines. The Jigjiga One Health Initiative, a capacity-building project on integrated approaches to the health of mobile pastoralists in the Somali Regional State of Ethiopia offers unique opportunities for studies on pain, migrant health or hunger. Mathematical modelling and analysis is a stronghold of EPH, which is applied to research domains ranging from malaria and neglected tropical diseases (NTDs) to environmental health. Advanced statistical modelling and Bayesian computation focuses on the analysis of very large, non-Gaussian, spacetime data. Societal processes, including gender and diversity dimensions, are at the core of several projects related to environmental health, NTDs,

Swiss Tropical and Public Health Institute 51

Committees & Departments

Swiss Centre for International Health

Kaspar Wyss, Head of SCIH

The Swiss Centre for International Health (SCIH) provides policy advice, project design and management across the fields of national, public and global health. With multi-disciplinary and multilingual teams in Switzerland and around the world, SCIH offers a broad range of technical and methodological expertise including strategic consulting, human-centred design, project implementation, policy advice, organisational assessments, implementation research and economic evaluations. Strengthening fragile health systems SCIH offers thematic expertise in global health and supports health systems development in countries with fragile health systems, focusing on Africa, Eastern Europe and Central Asia. Key areas include primary healthcare development, health financing, human resources development, health information systems, programme performance, health commodities management and digitalisation. SCIH also covers women, children and adolescent health as well as both non-communicable and neglected tropical diseases. With 60 collaborators in Basel and 150 abroad, SCIH staff works with partners to respond to local needs, tailoring its services to diverse contexts and countries. In the drive towards Universal Health Coverage (UHC) and the achievement of the Sustainable Development Goals (SDGs), SCIH works with a range of beneficiaries in countries such as Tanzania, Chad, Rwanda, the Democratic Republic of the Congo (DRC), Albania, Kosovo, Moldova, Ukraine and Tajikistan, amongst others, to improve the quality of care, increase health service coverage and community engagement, and ultimately improve health. Highlights in 2019 SCIH operates locally, nationally and internationally as a trusted partner and implementing agency in long-term mandates for the

Swiss, Dutch, German and French Governments. The existing portfolio, which has expanded with several new mandates, focuses on digital health, namely clinical decision support systems.

tored programme implementation relating to HIV/AIDS, tuberculosis and malaria control and elimination in fourteen portfolios; mainly in Francophone Africa and the Middle East region.

In health facilities in Rwanda, Tanzania, India, Kenya, Senegal and Myanmar, point-ofcare devices based on tablets, coupled with diagnostic tests, support clinical personnel in the diagnosis and care of patients. The introduction of clinical decision support systems in primary care is accompanied by implementation research activities in several instances to allow the tracking of effects on morbidity and mortality patterns and strengthen the evidence for new policies.

SCIH assisted with the programmatic quality assurance and improvement approach of the Global Fund by conducting quality assurance services for laboratory systems assessment in Angola and data quality review at the health facility level in the DRC.

In regards to health promotion in Switzerland, SCIH was mandated to develop the process and outcome evaluation of two major initiatives that embed health promotion into routine health services delivery. The evaluations focused on integrated services in the hospital setting in the canton Basel-Stadt, namely the identification and support to patients with depression and anxiety disorders, as well as the prevention of falls amongst the elderly. Services to the Global Fund, Gavi, the Vaccine Alliance, UNITAID and UNICEF SCIH continued to provide Local Fund Agent (LFA) services to the Global Fund and moni-

52 Swiss Tropical and Public Health Institute

On behalf of Gavi, the Vaccine Alliance, SCIH implemented a monitoring mandate through tracking the implementation of vaccination activities in Burundi, Niger and Côte d’Ivoire, as well as conducted monitoring reviews in Chad and Mali. For UNITAID, SCIH successfully conducted external evaluations, which focused on initiatives such as the Coalition Plus HIV/HCV Drug Affordability Project. For UNICEF, SCIH carried out the Immunization Supply Chain Tool Assessment related to identifying the next generation of the WHO and UNICEF Stock Management Tool and District Vaccine Data-Management Tool.

Committees & Departments

Medicine

Daniel Paris, Head of MED

The Department of Medicine (MED) comprises the Swiss Center of Excellence for Travel and Tropical Medicine, the National Diagnostic Reference Centre for Imported Parasitic Diseases and an expanding centre, which supports and performs clinical translational research to promote safe and regulatory approved treatments for patients. MED provides services in tropical and travel medicine and as clinically relevant research relating to drugs, diagnostics and vaccines for tropical and poverty-related diseases. Unique services and translational research MED services are thriving with ongoing high consultation numbers and a steady demand for specialised diagnostics in tropical and travel medicine. The acquisition of new projects has allowed MED to build its clinical research expertise in tuberculosis, HIV-medicine, management of febrile illnesses and migration medicine. MED provides teaching and training through courses and updates for traveller’s health, clinical training, diagnostic methodologies for health professionals and research participant safety such as Good Clinical Practice (GCP) for all academic and non-academic levels. Further, MED contributed to over 100 peer-reviewed publications this year and provides numerous graduate and postgraduate lectures and training courses at the University of Basel. Project and research highlights in 2019 Safety and Quality: To ensure participant and data integrity in clinical research, meeting standard requirements and regulatory compliance is key in evaluating new, effective and licensed medicines. The MED strategy aims to meet the highest quality standards in clinical research by providing project management, data management, monitoring and a broad coverage of clinical trial support at regulatory standards as a complete package. This approach has attracted large grants, led to successful completion of vendor audits, and positioned MED as a preferred service provider for industry partners. Genotyping: The advancement of pathogen genotyping for resistance markers to a quality controlled translational service-for-research has been highly successful, and is expanding further in a synergistic way between the service and research worlds.

Migration medicine: This new theme addressing the healthcare needs in migrants and asylum seekers has generated synergistic interactions within MED, across Swiss TPH and with international partnerships in countries affected by diseases of poverty. MED is focusing on the development of diagnostics, mental and reproductive health, access to vulnerable populations and dedicated training of staff. Large-scale research projects: MED is leading large projects including the development of clinical algorithms for child and adolescent health (DYNAMIC), the assessment of rectal artesunate to reduce malaria fatalities in children (CARAMAL) and community-based tuberculosis triage testing for hard-to-reach populations in Southern Africa (TB TRIAGE+). Strategic areas The team has completed the transition from paper-based to digital documentation in the out-patient department and is on its way to expand digitalisation to the travel clinic. MED has broadened the range of diagnostic tests from a focus on parasites to include viral and bacterial agents related to tropical diseases and travel medicine. In addition to routine diagnostics and diagnostic consultancies, MED offers quality control services and assay development for clinical trials of industrial partners, as well as provision of reagents to the Swiss Center of Quality Control.

Promotions and organisational changes Niklaus Labhardt received an SNSF Excellence Grant and an assistant professorship at the University of Basel. He has built a research group in Lesotho and has developed collaborations with the Ifakara Health Institute in Tanzania. Frederick Haraka completed a Cochrane meta-analysis on the impact of a new molecular tuberculosis test, the Xpert MTB/RIF, and directly informed global policy by presenting his results at the WHO-convened Guideline Development Group meeting in Geneva. The Diagnostic Center has implemented a modern and progressive Laboratory Information Management System to enhance the interaction with laboratories, promote customer satisfaction, optimise daily routine procedures and support high quality data management. Following the EFQM excellence model, Swiss TPH successfully took the first steps towards business excellence under the co-lead of ADMIN and MED. Swiss TPH was acknowledged by the Swiss Association for Quality with the certificate “Committed to Excellence”.

MED will continue to develop clinical research expertise in tuberculosis, HIV and management of fevers, as well as develop its capacity in clinical trials for malaria. Clinical statistics, data and quality management will be cultivated to meet the dynamic requirements, whereby strengthening collaborations and training of local staff at country level through clinical research partnerships remains a priority.

Swiss Tropical and Public Health Institute 53

Committees & Departments

Education and Training

Nino Künzli, Head of ET

The Department of Education and Training (ET) coordinates classes and programmes at Swiss TPH, the University of Basel and academic institutes around the world. ET received the mandate to develop the Graduate School of Health Sciences at the University of Basel as the future interfaculty multidisciplinary hub for over 340 health-oriented doctoral students – including PhD students at Swiss TPH.

Some 120 teachers educate bachelor, master and doctoral students and offer postgraduate courses to a global community of professionals. The Swiss TPH faculty supervises around 250 MSc, MD, PhD and postgraduate MAS theses. In 2019, a total of 735 professionals participated in 44 different postgraduate courses of up to 14 weeks duration. Offering stand-alone modules, which made the programmes more flexible, had a positive impact on the number of registrations. Highlights in 2019 After 12 years of hosting the secretariat of tropEd – the global network for education in international health – Swiss TPH moved this important coordination function to the Ludwig-Maximilians-Universität Munich. As a founding member of the network, Swiss TPH will remain a part of this unique association and will substantially contribute to the network’s success. A few months after the 10-year jubilee, a new cohort with 21 Master in Insurance Medicine participants was launched. The Swiss TPH library donated its large printed journals collections to the University of Basel library. The journal collection is now stored in the new “Kooperative Speicherbibli-

othek Schweiz” in Büron, Lucerne; the joint external storage of the main Swiss libraries. All journals will be soon available in the database of the Swiss Library Service platform which brings together the scientific information stored in libraries across Switzerland. With the transfer of the journals to Büron, the library is ready for the move to the new Swiss TPH building “Belo Horizonte” in Allschwil. An external evaluation of the Lugano Summer School in Public Health Policy, Economics and Management, jointly organised by The Swiss School of Public Health (SSPH+), Università della Svizzera italiana and Swiss TPH, achieved the mandate of the Swiss Agency for Development and Cooperation to have up to 38 scholarship fellows annually attend the Lugano Summer School. The fellows from low- and middle-income countries and colleagues from Europe and Switzerland benefited from an exchange with one another. The full implementation of the new course evaluation concept in the MSc Programmes was a major success. All surveys were organised online using the University of Basel’s EvaSys tool. With a grand average of >5.2 (Swiss system, 1 to 6) across all courses, Swiss TPH lecturers have again reached high standards.

54 Swiss Tropical and Public Health Institute

Strategic areas Besides the didactic support for teachers and facilitators, ET focused on the use of new technologies for classroom and distance teaching. Newly installed systems for tele-conferencing allowed for exams or thesis defenses with external examiners to be run virtually, contributing to reducing the carbon footprint of Swiss TPH. ET supported other departments in curriculum development, capacity development of local health staff and in fostering new strategies in the health sector of partner countries. Activities with partners continue, including with SSPH+ and its network of 12 Swiss universities and CARTA: the South-South-North initiative for strengthening research capacities in Africa through structured PhD education.

Committees & Departments

Administration

Matthias SchmidHuberty, Administration Director

Administration supports research, teaching and services as well as the staff at Swiss TPH with the following five units: Finances and Controlling, Infrastructure, Informatics, Project & Grant Service and Human Resources. The Administrative Directorate coordinates the activities of the units and advises the Director on strategic, legal and business management issues. The administrative functions Internal Audit, Organisational Development and Security are also part of the Administrative Directorate. Administrative Directorate Operating within a framework of strengthened integration, digitalisation and standardisation, the administrative units continued their work on a common service concept and on simplifying and communicating their internal support processes. Various administrative functions were established or expanded in 2019. Under the umbrella of organisational development and change management, Anna Späth coordinated projects related to the new building, “Belo Horizonte”, digitalisation and the accompanying internal transformation. Internal audit conducted multiple audits and management reviews in the field and in Basel, which made a significant contribution to efficiency, transparency and good governance. The HSSE functions (Health, Safety, Security and Environment) worked on international safety and security guidelines, trained employees in security and travel safety and created an integrated crisis concept. Finances and Controlling The Finance and Controlling unit supported the budgeting, financial management and annual financial statements for projects spread over 100 countries and a total volume of CHF 90 million. The year under review was characterised by digitalisation and the integration and reworking of the process landscape and core processes. Controlling was thus able to put its new digital budgeting and reporting tool into operation and take a step towards the digital processing of the budget process, efficiency gains and a contribution to transparency. Using the existing digital tools, over 16,000 invoices and 2500 payments were processed and around 800 cost centres were managed. Infrastructure 2019 saw great strides being made in the construction of “Belo Horizonte”. Many Swiss TPH employees took part in various working groups

to plan and implement the new building in Allschwil. Students at the University of Applied Sciences and Art Northwestern Switzerland (FHNW) worked on projects that yielded many creative ideas for the interior design of the building. Construction of the new building is proceeding on schedule. There have already been successfully completed calls for tender for over three-quarters of the construction of the new building, 80 % of which were awarded to suppliers in the Basel region. Progress continues to be made on the future management of “Belo Horizonte”. The Infrastructure unit was able to continue improving and building on its processes. The Technical Services team was responsible not only for the demanding task of maintaining labs, equipment, lecture halls and older buildings but it also created new workplaces by converting students’ rooms into office space. Informatics The Informatics unit takes care of ICT needs and IT support. It was involved in 270 projects and handled almost 12,400 tickets. The team implemented the migration to Windows 10 for the entire Swiss TPH infrastructure and renewed a large part of the IT fleet. A large number of tenders for the new building were initiated and evaluated. The Research IT & Digitization group was newly established, which put digitalisation high on the agenda by means of productive workshops across Swiss TPH. At the same time, the group offered concrete help to 30 projects to translate the research concerns to the IT infrastructure, software and application implementation.

TPH’s function as a “Leading House for Africa”, mandated by the State Secretariat for Education, Research and Innovation in collaboration with the University of Basel. In 2019, project and grants were supported and acquired at a high success rate, including EU Horizon 2020, ERC and SNSF. Valérie Verdier joined the unit in the role of Grant Manager and has already made a significant contribution to its activities. In the area of quality development, a milestone was reached with the certification of the EFQM label “Committed to Excellence”. Human Resources Human Resources (HR) was strengthened by implementing a career development policy and a new development plan. In addition, an e-learning platform for the Swiss TPH community was set up. The HR team was strengthened with Sonja Bühler in the role of recruiter. A total of over 60 positions were filled in 2019 and more than 2300 applications processed. As part of the implementation of the strategic goals, there was a strong focus on leadership development at top management level.

Project & Grant Service The Project & Grant Service unit maintains close ties to funding organisations and supports project leaders in their work with external partners. The unit coordinates, harmonises and continually improves Swiss TPH’s outgoing project applications and contracts. The Project & Grant Service is executing Swiss

Swiss Tropical and Public Health Institute 55

“Working at Swiss TPH is not only about the salary, but about helping people all over the world. Even if I was not working in research or development, my job was to create an optimal workplace for the employees to enable their best performance” Paul Haas, Former Head of Technical Services at Swiss TPH

56 Swiss Tropical and Public Health Institute

FINANCES Funding 2019

Funding 2018

Core funding

University of Basel

6.6

University of Basel

National Government

8.0

National Government

7.5

Canton Basel-Landschaft

3.6

Canton Basel-Landschaft

3.6

Canton Basel-Stadt

3.6

Canton Basel-Stadt (Swisslos-Fonds)

1.6

Subtotal

21.8

6.9

Canton Basel-Stadt

Deferred income New Building Belo Horizonte

– 2.5

Total core funding

19.3

21.4 %

Competitively acquired funds

2.0

Subtotal

21.6

Deferred income New Building Belo Horizonte

– 2.5

Total core funding

19.1

22.0 %

Competitively acquired funds

Research (e.g. SNSF and EU)

24.6

27.3 %

Research (e.g. SNSF and EU)

24.6

28.4 %

Services (e.g. SDC, Global Fund and BMGF)

36.8

40.7 %

Services (e.g. SDC, Global Fund and BMGF)

33.6

38.8 %

Education and Training (e.g. Postgraduate courses) Medical Services (e.g. Travel Medicine & Diagnostics) Other income

2.5 %

Education and Training (e.g. Postgraduate courses)

2.1

2.5 %

5.3

5.8 %

Medical Services (e.g. Travel Medicine & Diagnostics)

4.8

5.6 %

2.0

2.3 %

Other income

2.4

2.7 %

Total competitively aquired funds

67.5

78.0 %

Total funding

86.6

100.0 %

2.3

Total competitively aquired funds

71.0

78.6 %

Total funding

90.3

100.0 %

Competitively acquired 78.6 % Core contributions 21.4 % Medical Services

Competitively acquired 78.0 % Core contributions 22.0 %

Other income

Education and Training

Medical Services Core funding

Other income

Education and Training

CHF 90.3 Mio.

Core funding

CHF 86.6 Mio. Services

Services Research

Research

Swiss Tropical and Public Health Institute 57

Finances

Annual Accounts Income Statement

Financial statements established in accordance with Swiss GAAP FER 2019 in 1000 CHF

2018 in 1000 CHF

Income Self-managed income

69,357

76.8 %

65,282

75.4 %

Core funding from national and local governement

19,348

21.4 %

19,137

22.1 %

Other operating income

2033

2.3 %

2337

2.7 %

Change in unbilled services

– 415

– 0.5 %

– 141

– 0.2 %

90,323

100 %

86,615

100 %

– 51,499

57.0 %

– 50,241

57.8 %

Total income Expenditure Personnel expenses Material expenses

– 3918

4.3 %

– 3763

4.3 %

Depreciation of tangible assets

– 1231

1.4 %

– 1345

1.5 %

– 307

0.4 %

– 325

0.4 %

– 5059

5.6 %

– 4500

5.2 %

Amortisation of intangible assets Administrative expenses Other operating expenses

– 28,296

31.3 %

– 26,775

30.8 %

Total expenditure

– 90,310

100.0 %

– 86,949

100 %

Operating result

– 334

Financial result

– 222

Ordinary result

– 209

– 262

Other operating expenses

Total expenditure

– 209

– 262

Balance sheet

2019 in 1000 CHF

2018 in 1000 CHF

Assets Cash and cash equivalents

30,293

47.3 %

23,905

42.2 %

Receivables

21,517

33.6 %

17,819

31.4 %

4346

6.8 %

6168

10.9 %

353

0.5 %

212

0.4 %

56,509

88.2 %

48,104

84.9 %

Prepayments and accrued income Inventories Total current assets Non-current assets

7565

11.8 %

8573

15.1 %

Total non-current assets

7565

11.8 %

8573

15.1 %

64,074

100 %

56,677

100 %

5158

8.0 %

2649

4.7 %

Total assets Liabilities and equity Payables from goods and services Other payables Accrued liabilities and deferred income Short-term provisions Total current liabilities Long-term liabilities

940

1.5 %

880

1.6 %

38,030

59.4 %

35,953

63.4 %

1609

2.5 %

1217

2.1 %

45,737

71.4 %

40,699

71.8 %

792

1.2 %

435

0.8 %

Mortgages

1000

1.6 %

1500

2.6 %

Long-term provisions

1908

3.0 %

1698

2.9 %

Long-term deferred income Total non-current liabilities Equity Total liabilities

58 Swiss Tropical and Public Health Institute

8200

12.8 %

5700

10.1 %

11,900

18.6 %

9333

16.5 %

6437

10 %

6645

11.7 %

64,074

100 %

56,677

100 %

Finances

Swiss Tropical and Public Health Instituteâ&#x20AC;&#x192; 59

Finances

“I started working with Swiss TPH in 2009 and have stayed there to this day because of the professional and challenging work environment. The multidisciplinary teams I collaborate with work tirelessly together to drive positive change in health systems” Amadou Midou, Senior Expert Financial Officer at Swiss TPH, Cotonou, Benin

60 Swiss Tropical and Public Health Institute

Finances

Partners and Funders Core Funding

International Committee of the Red Cross (ICRC), CH

Canton Basel-Landschaft, CH

Kreditanstalt für Wiederaufbau (KfW), DE

Canton Basel-Stadt, CH

Medicines for Malaria Venture (MMV), CH

State Secretariat for Education, Research and Innovation (SERI), CH

Sanaria, US

University of Basel, CH

PATH, US United Nations Children's Fund (UNICEF), US

Research Funding Botnar Research Centre for Child Health (BRCCH), CH EU research grants (i.e. ERC, Horizon 2020, etc.), EU National Institutes of Health (NIH), US

World Health Organization (WHO), CH World Bank, US

Private Clients

Swiss National Science Foundation (SNSF), CH

Ares Trading S.A., CH

Swiss Personalized Health Network (SPHN), CH

Médecins Sans Frontières (MSF), CH

University of Basel, CH

CARE, CD Conseil Santé, FR

Foundations Bill & Melinda Gates Foundation (BMGF), US Clinton Health Access Initiative (CHAI), US Cordaid, NL Eckenstein-Geigy-Stiftung, CH * Fondation Botnar, CH Fondation Pasteur Suisse, CH Fondazione Adiuvare, CH Forlen Stiftung, CH *

Krebsliga, CH Lygature, NL Merck KGaA, DE Novartis Pharma AG, CH Rotarians Against Malaria (RAM), AUS Unisanté, CH Vital Strategies, US

Academic Partners

Freiwillige Akademische Gesellschaft (FAG), CH*

Biozentrum University of Basel, CH

Health Effects Institute, US

Centre de Support en Santé International (CSSI), TCD

Novartis Foundation, CH

Centre Suisse de Recherches Scientifiques en Côte d’Ivoire (CSRS), CIV

R. Geigy Foundation, CH

Eidgenössische Technische Hochschule Zürich (ETHZ), CH

Stanley Thomas Johnson Foundation, CH

École polytechnique fédérale de Lausanne (EPFL), CH

Uniscientia Stiftung, LI

Ifakara Health Institute (IHI), TZA

Unitaid, CH *

Johns Hopkins University, US

Walter Fischli Stiftung, CH *

Lao Tropical and Public Health Institute (Lao TPHI), LAO Papua New Guinea Institute of Medical Research (PNGIMR), PNG

Public Clients Switzerland

Swiss School of Public Health (SSPH+), CH

Amt für Ausbildungsbeiträge Basel-Stadt, CH

swissuniversities Development and Cooperation Network (SUDAC), CH

Amt für Umwelt und Energie Basel-Stadt, CH Federal Office of the Environment (FOEN), CH * Federal Office of Public Health (FOPH), CH Swiss Agency for Development and Cooperation (SDC), CH Federal Department of Defence, Civil Protection and Sport (DDPS), CH Kantonsspital Basel-Landschaft, CH

Public and Public-Private Clients International

University Hospital Tübingen, DE University of Heidelberg, DE University of Melbourne, AU University of Nebraska, US University of Oxford, UK University of Warwick, UK Universidad Peruana Cayetano Heredia (UPCH), PE

Drugs for Neglected Diseases initiative (DNDi), CH

The list shows Swiss TPH third-party funding partners making contributions of CHF 100,000 or more

European and Developing Countries Clinical Trials Partnership (EDCTP), NL

* = Less than CHF 100,000, but strategically important

Foundation for Innovative New Diagnostics (FIND), CH Gavi, the Vaccine Alliance, CH Global Fund to Fight AIDS, Tuberculosis and Malaria, CH

Swiss Tropical and Public Health Institute 61

Concept and edits: Danielle Powell Additional contributions: Sabina Beatrice-Matter, Lukas Meier, Jürg Utzinger, Department Heads Proofreading: Doris Tranter Layout and design: Neeser & Müller Pictures: Olivier Brandenburg, Thomas Breu, Christian Flierl, Joachim Pelikan, Danielle Powell, Thomas Schuppisser, Burckhardt+Partner AG and Swiss TPH staff Cover photo: Danielle Powell Printing: Gremper AG Copyright: Swiss TPH, 2020