Swiss TPH Annual Report 2018 by Swiss TPH

ANNUAL REPORT 2018

Worldwide Activities Our translational approach, from innovation and validation to application, enables us to bring novel diagnostics, drugs and vaccines directly to people and communities. Throughout, we pursue a spirit of mutual learning. In 2018, we worked with partners on 285 projects in over 130 implementing countries.

New understanding of parasite biology to interrupt malaria transmission (see page 19â&#x20AC;&#x201C;20).

> 10 projects > 5 projects > 1 projects SwissÂ TPH offices

Integrated intervention: better indoor air, clean drinking water and improved early child development in rural Andean Peru.

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

Improving quality of primary healthcare services in Albania.

Validation Generate evidence in the field under real-world conditions

Application Integrate new treatments and approaches into policy and health systems

Medical education and capacity building in Tajikistan (see page 30–32).

Mathematical modelling of transmission dynamics of parasitic worms in Lao PDR.

Improving primary healthcare through paper-based decision support tools in Côte d’Ivoire, Mozambique and Nigeria.

Validating fexinidazole as new treatment against sleeping sickness in the Democratic Republic of the Congo (see page 22–25).

New technologies to eliminate rabies in Chad (see page 26–29).

The 285 SwissÂ TPH projects contribute to the 17 UN Sustainable Development Goals 3.1

3.2

12 11

10 9 8 7 6 3.3 5

3.4

3.D 3.9

3.7 3.8

3.5

ANNUAL REPORT 2018

Content Preface 3 Facts & Figures

2018 in Retrospect

Insights 19 Key Areas of Activity

Committees & Departments 45 Finances 55

Introducing Swiss TPH in a Short Video The Swiss Tropical and Public Health Institute (Swiss TPH) is a world-leading institute in global health with a particular focus on low- and middle-income countries. Associated with the University of Basel, Swiss TPH combines research, services, and education and training at the local, national and international level. About 850 people from 80 nations work at Swiss TPH focusing on infectious and non-communicable diseases, environment, society and health as well as health systems and interventions.

Watch our new film: https://bit.ly/2YvqL2N *Info about QR-Codes on page 61

Preface “If Swiss TPH were an animal, what kind of animal would it be?” This question was asked to all project leaders at Swiss TPH. Can you guess which animal was mentioned most often? The elephant! The notion of an elephant is illustrated, for example, by the following quote: “Swiss TPH is like an elephant: it is strong, impressive and agile with an extraordinary memory and high sense of empathy and solidarity.” Of course, Swiss TPH is much more than a herd of elephants; it is a constellation of people who work passionately every day to improve global health. Doing so, in partnership, we contribute to the Sustainable Development Goals – and much more. What is in this report? Welcome to the Swiss TPH Annual Report 2018! For 75 years, we have pursued our mission to improve the health and well-being of people – locally, nationally and internationally – through excellence in research, education and services. The cover photo illustrates our spirit and way of working: no road is too dusty or unpaved and no sun is too hot for us to reach those in the most remote rural areas of the world. We improve health services for young mothers and their children, such as for Kiyange Rashid in Tanzania (page 12). Check out the four portraits of our employees and students who conduct their daily work in Basel (page 18, 34, 44 and 54). Keep reading! There are two interviews with long-standing Board of Governors members Sabina De Geest (page 6–7) and Didier Trono (page 8–9). There is more for everyone! Selected highlights in 2018 are summarised on page 13–17. Four insight stories are featured: epigenetics to deepen the understanding of malaria transmission (page 19–20), innovative partnerships to develop new drugs to improve patient management and control

of sleeping sickness (page 22–25), progress in the elimination of rabies using new technologies and modelling approaches (page 26–29), and medical education to improve the quality of care in Tajikistan (page 30–32). You can also review the progress of our cross-cutting key areas of activities (page 35–43), and get yourself acquainted with the latest developments in committees, departments and finances (page 45–59).

A substantial contribution to the Sustainable Development Goals Since 2017, reporting of our project portfolio includes the specific contribution of our research projects and service mandates to the Sustainable Development Goals (SDGs). Examining the 285 projects in more than 100 countries in 2018 revealed that all the 17 SDGs were addressed. As expected, SDG 3 – good health and well-being – was the most important SDG, making up approximately 50% of our activities. SDG 17 – strengthening partnerships – was in second position, followed by SDG 4 – quality education.

Swiss Tropical and Public Health Institute

Preface Excellence in research

Excellence in education

Swiss TPH pursued high-quality research in the fields of personalised, public, international and global health. Our research aims at discovering fundamental new insights at the intersection of infectious and non-communicable diseases, advancing basic science in poverty-related diseases, fostering discovery and rigorous validation of novel drugs, diagnostics and vaccines, and improving translational outputs and implementation of health interventions and treatments.

Swiss TPH continued to operate in a spirit of mutual learning for sustainable development. Indeed, our people are keen learners, educators and trainers. They share discoveries, innovations, practical experiences and knowledge with students and other partners. In turn, this process drives excellence in education and research and shapes innovation and sustainable development that contribute to the organisational learning of Swiss TPH, its partner institutions and the 2030 Agenda.

For the second year in a row, researchers from Swiss TPH published more than 500 articles in peer-reviewed literature. That is approximately two articles per working day! Infectious diseases, parasitology and tropical medicine remained key research areas, while public, environmental and occupational health was the second most important research area in terms of number of publications in 2018. We accompany many of our MSc and PhD students to bring their first studies to fruition in international literature. Hence, our professors, senior researchers and postdoctoral fellows act as mentors, motivators and career developers.

In addition to our education and training provided at the BSc, MSc and PhD levels, Swiss TPH conducted 45 postgraduate courses with almost 700 participants from all over the world. We were particularly delighted to witness growing numbers of postgraduate students in our oldest 8-week course that is one of the few still taught in German: “Internationale Zusammenarbeit und Globale Gesundheit”.

Excellence in services Swiss TPH provided a wide range of services focusing on strengthening health systems, improving healthcare in low- and middle-income countries, organising and monitoring clinical trials and providing travel advice. Around 15,000 travel and vaccination consultations were conducted in 2018, and our experts treated approximately 1,500 ill-returning travellers. In 2018, a new mandate on medical education reform in the Ukraine was assigned by the Swiss Agency for Development and Cooperation (SDC). Along with a number of other projects in Africa, Eastern Europe and Central Asia, SDC remained the single most important client in terms of financial volume. Services for the Global Fund in our role as Local Fund Agent were conducted in several countries in Africa and the Middle East, while our portfolio of activities in health facility and supply chain assessments were further expanded. Monitoring and mandates to track implementation of vaccination activities were conducted for Gavi in Africa and Asia. New major projects with Unitaid and the Stanley Thomas Johnson Foundation have been acquired and will be implemented from now onwards.

vides this foundation. Matthias Schmid-Huberty was elected the new Administrative Director as of 1 January 2018. It is impressive how quickly Matthiashas taken up important strategic roles and responsibilities. Finally, a few words about Swiss TPH’s largest project ever – our new building Belo Horizonte in Allschwil. It is with the utmost pleasure that I can summarise that everything went smoothly in 2018 thanks to the outstanding leadership and oversight by the project manager Stefan Mörgeli, his support team and the various committees with significant input by staff and the architects Kunz & Mösch and their team. The ground-breaking ceremony is scheduled on 21 June 2019 – join us for this event! I would like to thank Sabina Beatrice-Matter and her team for conceptualising this year’s report. Deepest thanks are addressed to all our staff and students for their daily commitment. Heartfelt thanks also to all our clients, colleagues and partners in Switzerland and abroad – it is a privilege to work with you and I very much look forward to our continued collaboration, partnership and friendship. Have a good read!

Administration Excellence in research, education and services requires sound support functions. The Department of Administration with its five units – Finances / Controlling, Human Resources, Informatics, Infrastructure, and Project & Grant Service – pro-

Prof. Dr. Jürg Utzinger Director, Swiss TPH

Swiss Tropical and Public Health Institute

Annual Report 2018

“Innovation means building bridges between science and the real world”

Sabina De Geest is Director of the Institute of Nursing Science and Chair of the Department of Public Health at the University of Basel. Since 2009, she has been a member of the Board of Governors at Swiss TPH. In this interview, she talks about scientific collaboration, innovation and Basel’s role in the field of public health. The Department of Public Health that you are chairing comprises the Institute of Nursing Science, the European Center of Pharmaceutical Medicine and associated institutions such as Swiss TPH that all collaborate with each other. Has the field of public health in Basel become somewhat confusing? “Not at all. For me, the diversity of players with their various scientific methods is precisely Basel’s strength as the premium public health location in Switzerland. I believe that solving health problems needs interdisciplinary approaches and perspectives. In addition, the individual institutions – with Swiss TPH undoubtedly the heavyweight with its 850 employees – work on the basis of a jointly developed strategy.” You joined the Board of Governors of Swiss TPH in 2009. What is it about Swiss TPH that fascinates you? “I’m especially fascinated by the culture of collaboration at Swiss TPH, one that extends beyond national borders. The institute cultivates an environment of dynamic cooperation that enables it to make a difference in society – which, at the end of the day, is what science is for.”

Is that also your definition of innovation? “No, innovation needs more than that. But collaboration is a foundation on which innovation can come about. This won’t happen, however, if researchers focus only on themselves and their list of publications, without reflecting on how the system can continue to develop.”

Sabina De Geest

So what does innovation mean for you? “For me, innovation means building bridges between science and the real world. People’s needs are central here, and this calls for a different scientific approach. Swiss TPH is a national and international beacon in terms of validating scientific innovations and applying them in real-life settings. The Institute of Nursing Science and Swiss TPH have a lot in common when it comes to this practice-based approach.”

Sabina De Geest, originally from Belgium, was appointed Switzerland’s first professor of Nursing Science in 1999. In addition to her impressive academic record, nursing is still her passion – and this is also reflected in the strong clinical focus of the study programme she runs in Basel. “Nursing is the business case of the future,” she says. People are getting older and older, and many of them live with one or more chronic diseases. Nursing is central when it comes to developing interdisciplinary care models that meet the needs of (older) chronically ill people and their families. Sabina De Geest completed her MSc and PhD in Medical Social Sciences at KU Leuven. She is a co-founder of the Swiss Transplant Cohort Study, a national cohort study that integrates large volumes of biomedical and genomic data in addition to patient-reported outcomes. De Geest is the recipient of numerous prizes and awards: she became a Fellow of the Royal College of Nursing in 2004, a Fellow of the American Academy of Nursing in 2006 and a member of the Swiss Academy of Medical Sciences in 2008, and holds the Collen-Francqui Chair at the University of Antwerp.

Swiss TPH will be moving to the BaseLink site in Allschwil in 2021 and also intends to attract other institutions with an aim to foster intensive exchange. As Director of the Institute of Nursing Science, aren’t you tempted to move this organisation there as well? “I’m a strong supporter of interdisciplinary collaboration. Clinical proximity to our academic service partnerships like the University Hospital Basel and Felix Platter Hospital is for us vital and practical because of education and joint appointments. Other collaborations such as the excellent one with Swiss TPH show that fortunately proximity is not the determining factor for success as this is a crucial cooperation for us.”

Swiss Tropical and Public Health Institute

Annual Report 2018

A Strategic Alliance between Swiss TPH and EPFL: Health Technology for Underprivileged Societies For many years, Swiss TPH and the École polytechnique fédérale de Lausanne (EPFL) have been linked through a strategic alliance of the State Secretariat for Education, Research and Innovation (SERI). Researchers from both institutions work together on scientific projects and exchange ideas about solutions in the field of global health. “Our common goal is to make health technologies work for economically disadvantaged countries,” says Didier Trono, former dean of the EPFL School of Life Sciences and member of the Board of Governors at Swiss TPH. A strategic alliance has been in place between Swiss TPH and EPFL since 2008. What does this alliance look like in an everyday context? “There is a wide variety of joint projects, particularly in the area of research into infectious diseases. The strategic alliance promotes the mutual exchange of ideas among researchers, although contact with their immediate neighbours at their respective locations is of utmost importance for both EPFL and Swiss TPH.” What links EPFL and Swiss TPH? “Swiss TPH and EPFL are natural partners due to their shared desire to develop new technologies and integrate them into the healthcare systems of regions throughout the globe that are economically disadvantaged. Perhaps in this respect, Swiss TPH is even closer to EPFL than it is to the University of Basel.”

Do the institutions also have similar scientific approaches? “Both institutions often take a very pragmatic approach to health problems. If you want to improve people’s health in African or Asian countries, you need to take the approach of a problem solver, rather than a sole research scientist.” How does EPFL stand to benefit from this partnership? “In terms of science per se, there is probably little that EPFL could not do. What EPFL is missing, however, is a partnership network in the southern hemisphere, which is something that Swiss TPH has been continuously building up over the past 75 years. If you want to successfully conduct research in these parts of the world, you cannot just turn up and say: ‘Hello! Here I am.’ You need the local population to trust you, and that only happens through long-term partnerships.”

Didier Trono

Joint projects between Swiss TPH and EPFL • Schistosomiasis, agriculture and migration in Africa: a joint economic and ecological analysis • African contributions to global health: circulating knowledge and innovations • Host-pathogen genomic interactions and their phenotypic impact in human tuberculosis • Macozinone (MCZ, PBZT-169) clinical trials against tuberculosis (working group on New TB drugs) • DYNAMIC: implementation of electronic diagnostic and treatment tools based on algorithms to manage febrile illnesses in children

When he reads the news in the morning, Didier Trono starts with the sports section, likely driven by the same intuition as the US Supreme Court Chief Justice Earl Warren, who once declared: “I always turn to the sports page first, which records people’s accomplishments. The front page has nothing but man’s failures.” Didier Trono himself also has an interesting motto: his stated goal is nothing less than to save the world. “With resolutions like that, you’re not overly disappointed if you don’t fully make it at the end of the day,” he says with a smile. Even if saving the world is a bit of a stretch, the scientific track record of the molecular biologist at EPFL is outstanding: in 1986, then a 29-year-old, he stumbled into the laboratory of Nobel Prize winner David Baltimore at Boston’s Massachusetts Institute of Technology (MIT). Baltimore is the co-discoverer of reverse transcriptase, an enzyme essential for the multiplication of retroviruses such as HIV. In 1990, Didier Trono founded an AIDS research centre at the Salk Institute in La Jolla, California. “Research is a bit like travelling through a terra incognita,” he said. “A scientist’s task is to slightly lift the veil of nature, and to try to repair some of its errors.” In 1996, his team developed lentiviral vectors, a gene transfer system based on HIV. This system allowed for the introduction of genetically modified material into human cells, enabling it to notably cure a variety of diseases through the genetic modification of hematopoietic stem cells. In 2004, Didier Trono was appointed to EPFL to develop its newly launched School of Life Sciences, which he headed until 2008. Today, he works in the field of epigenetics (see page 19–20) and is a member of the steering committee of the Swiss Personalized Health Network.

Swiss Tropical and Public Health Institute

Facts & Figures The Swiss Tropical and Public Health Institute (SwissÂ TPH) is a world-leading institute in global health, with a particular focus on low- and middle-income countries. By uniquely combining research, services, and education and training, we aim to improve the health and well-being of populations through a better understanding of disease and health systems and by acting on this knowledge.

Medical Parasitology and Infection Biology (MPI) Page 48

MPI studies diseases of poverty and develops diagnostics, drugs and vaccines to combat them.

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

Epidemiology and Public Health (EPH) Page 49

Research

MED provides clinical and diagnostic Services services for travellers and conducts clinical research in low-resource settings. Medicine (MED)

Page 50

Improving Health

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

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

Education and Training (ET) Page 51

Swiss Centre for International Health (SCIH) Page 52

Five departments working across research, services, and education and training The Department of Administration supports all operations of SwissÂ TPH with its expertise in Finance/Controlling, Human Resources, Informatics, Infrastructure and Project & Grant Service (see page 53).

466 Women

854 employees from 80 nations: a diverse, specialised and highly motivated workforce

388 Men

More than 800 employees and students work at Swiss TPH, focusing on infectious and non-communicable diseases, environment, society and health as well as health systems and interventions. Our expertise spans from the bench to the field, from basic to operational, from molecular to spatial, and from genes to health systems. On page 35–43, you will find an overview of our key areas of activities.

242 abroad 612 in Basel

Scientific reach: 527 peer-reviewed publications in 2018

Infectious diseases

Public, environment and occupational health

Parasitology

Tropical medicine Environmental sciences and ecology Pharmacology and pharmacy Science and technology – other topics Microbiology General and internal medicine Chemistry Health care sciences and services Immunology Respiratory system

Other topics

Distribution of research areas of Swiss TPH publications in 2018, according to Web of Science (accessed: May 2019)

Swiss Tropical and Public Health Institute

“ Having access to the Community Health Fund in Tanzania assists my family a lot – especially as a mother supporting her kids. I get faster, more reliable healthcare and access to quality hospitals, and for that I am grateful.” Kiyange Rashid, Kibaoni, Tanzania

Health Promotion & Systems Strengthening (HPSS) HPSS supports interventions in health promotion, health insurance, supply chain management and health technology maintenance.

Watch a film on HPSS to learn more: https://bit.ly/2Jy488H

2018 in Retrospect JANUARY Matthias Schmid-Huberty as New Administrative Director Matthias Schmid-Huberty was elected the new Administrative Director as of January 2018. Schmid-Huberty has numerous years of experience in management, administration and consulting in Switzerland, Africa and Asia. He succeeds Stefan Mörgeli, who successfully held this position for nine years. New Partnership to Accomplish Zero Leprosy Swiss TPH and numerous health organisations have come together to form a Global Partnership for Zero Leprosy. The partnership was launched to progress towards a world without leprosy. Swiss TPH represented the scientific community in the creation of this new partnership.

FEBRUARY Farewell Symposium for Reto Brun On the occasion of Reto Brun’s retirement, Swiss TPH honoured him with a farewell symposium on 23 February. Reto Brun is one of the most productive and cited scientists at the University of Basel. He was significantly involved in the development of new medicines for African sleeping sickness and malaria.

his outstanding contribution for a better understanding of the mechanics of combination therapy using several antibiotics at once against TB.

Matthias Schmid-Huberty

New Understanding of Parasite Biology Researchers at Swiss TPH made an important step towards a deeper understanding of how malaria blood stage parasites turn the switch to become transmissible to other humans. This knowledge is fundamental for future research aiming to interrupt malaria transmission. The results were published in the peer-reviewed journal Science (see page 19–20). Andrej Trauner Receives Swiss TB Award Andrej Trauner, a scientist at Swiss TPH, was one of the two winners of the 2018 Swiss TB Award on 24 March, World Tuberculosis Day. The Swiss Foundation for Tuberculosis Research recognised

Johann Schneider-Ammann, Bassirou Bonfoh and Jürg Utzinger

North-South Partnership 67 years after the foundation of the Centre Suisse de Recherches Scientifiques en Côte d’Ivoire (CSRS), Federal Councillor Johann Schneider-Ammann met with Bassirou Bonfoh, Director-General of CSRS and Jürg Utzinger, Director of Swiss TPH in Côte d’Ivoire.

Home-based HIV treatment in Lesotho

MARCH Successful Home-Based HIV Treatment Swiss TPH carried out a clinical trial in Lesotho that allowed patients to start HIV therapy at home without having to visit a distant clinic. The results show that home-based HIV testing and immediate treatment with antiretroviral therapy increases the number of patients treated as well as treatment success. The study has been conducted in collaboration with SolidarMed and the Government of Lesotho.

Swiss Tropical and Public Health Institute

2018 in Retrospect APRIL World Malaria Day On the occasion of the 10th World Malaria Day, Swiss Malaria Group members including Novartis, Syngenta, Clariant, Medicus Mundi Switzerland and Swiss TPH presented themselves on the Barfüsserplatz in Basel. They showcased their various efforts in malaria research and elimination to a wider public. World Malaria Day was an opportunity to display Basel’s longstanding history in the fight against this poverty-related disease. Smartphone Application Improves Child Health Swiss TPH took active part in the Geneva Health Forum on “Precision Global Health in the Digital Age” sharing its experience in digital health. Swiss TPH developed two smartphone-based tools: ALMANACH (Algorithms for the Management of Childhood Illnesses) and ePOCT (electronic Point-Of-Care Tool). ALMANACH is a tablet-based tool supporting clinical decision. ePOCT guides health workers through the consultation and integrates point-of-care laboratory tests for bacterial infections and severe diseases. Spring Symposium

Spring Symposium People from all over the world attended the Swiss TPH Spring Symposium in Basel entitled “Clinical Decision Support and Health Information Systems – Potential and Pitfalls of New Technologies”, which provided a unique platform for health system professionals and students to discuss and share experiences of technology-enabled healthcare with particu lar focus on low- and middle-income countries.

ePOCT improves child health in Tanzania

MAY Universal Health Coverage in Chad The PADS project in Chad of the Swiss Agency for Development and Cooperation (SDC) is being implemented by Swiss TPH in collaboration with local partners. The goal of PADS is to reduce maternal and child related morbidity and mortality with a focus on rural and nomadic populations. This project supports the Ministry of Public Health in Chad to establish Universal Health Coverage (UHC). UHC is key to make sure everyone has access to health services. Peter Odermatt Receives Award from the Government of Lao PDR Peter Odermatt received an award in recognition of his contribution to fighting parasitic worm infections from the government of Lao PDR. For the past 20 years, he participated in developing the postgraduate training programme in health and research and the control of parasitic worm infections. For two decades, Swiss TPH has been active in Lao PDR and has worked closely with the Lao Tropical and Public Health Institute (Lao TPHI).

JUNE Combatting the Asian Tiger Mosquito In the past few years, the Asian tiger mosquito appeared in the upper Rhine region. In June 2018, the project TIGER was launched, which aims to improve joint action to monitor and combat the Asian tiger mosquito. Together with pro ject partners from Germany and France, Swiss TPH supports the authorities in the management of invasive mosquitoes.

Asian tiger mosquito

Claudia Daubenberger Appointed Professor The University of Basel appointed Claudia Daubenberger, Head of the Clinical Immunology unit at Swiss TPH, as Professor of Infection Biology and Immunology within the Faculty of Science. Summer Symposium The Swiss TPH Summer Symposium brought together world leaders on clin ical research in resource-limited countries. The scientific conference invited researchers, drug development specialists and students to review and discuss future approaches to drug development.

AUGUST Call for Longer Parental Leave The Swiss Federal Coordination Commission for Family Affairs is calling for the introduction of a 38-week parental leave period, based on a scientific analysis carried out with the collaboration of Elisabeth Zemp Stutz at Swiss TPH. The results of the analysis show that a legally regulated parental leave not only has positive effects on the family, but also on companies, society and the economy of a country. In terms of parental leave, Switzerland performs very poorly among OECD countries.

SEPTEMBER Targeted Vaccination to Interrupt Rabies Transmission Although rabies is preventable and nearly eliminated in Europe, it continues to kill more than 60,000 people per year – mainly in Asia and Africa through dog bites. Swiss TPH researchers revealed that major outbreaks can be prevented when at least 70 % of dogs are vaccinated. A more targeted dog vaccination could lead the way to eliminate rabies by 2030 (see page 26–29).

JULY Mobile Phone Radiation Affecting Adolescents Memory Performance A study involving nearly 700 adolescents in urban and rural areas of Swiss-German speaking Switzerland shows that mobile phone radiation impairs memory performance. The study led by Swiss TPH discovered that radiofrequency electromagnetic fields may have a negative influence on the development of memory performance of specific brain regions exposed during mobile phone use. Nicole Probst-Hensch Appointed Senate Member of SAMS Nicole Probst-Hensch, Head of the Department of Epidemiology and Public Health at Swiss TPH, was selected to be a senate member of the Swiss Academy of Medical Sciences (SAMS) due to her exceptional scientific achievements in medicine.

Nicole Probst-Hensch

Air pollution and noise impact on health

New Mosquito Net Reduces Malaria Cases A new mosquito net could help millions of people to protect themselves against malaria according to a new study in the Lancet, which was supported by Swiss TPH through statistical design and data analysis. This new bed net has two active ingredients: a pyrethroid insecticide and an insect growth regulator, which is a better method for tackling malaria in areas where mosquitoes are resistant to the single chemical used in traditional bed nets.

OCTOBER Air Pollution and Noise Increase Risk for Heart Attack Air pollution and traffic noise increase the risk of heart attacks. Studies on air pollution, which do not take into account traffic noise, tend to overestimate the long-term effect of air pollution on heart attacks. Therefore, both exposures must be considered at the same time. These are the results of a study by Swiss TPH, which were published in the European Heart Journal.

Swiss Tropical and Public Health Institute

2018 in Retrospect NOVEMBER New Drug for Sleeping Sickness Fexinidazole is the first oral treatment that is effective for both stages of sleeping sickness. The European Medicines Agency’s (EMA) Committee for Medicinal Products for Human Use has adopted a positive opinion of the new drug. The approval is a result of clinical trials led by the non-profit research and development organisation Drugs for Neglected Diseases initiative (DNDi) and an application submitted by Sanofi. Swiss TPH contributed extensively to the development of this new drug (see page 22–25). Ten Years of Insurance Medicine For ten years, the University of Basel has offered a Master’s programme in Insurance Medicine, which is unique in Germanspeaking countries. For three years, the sponsorship has been at Swiss TPH. On 23 November, 22 students celebrated their graduation in the Basel City Hall. Daniel Paris Appointed Associate Professor Daniel Paris, Head of the Department of Medicine at Swiss TPH, was appointed Associate Professor for Tropical and Travel Medicine by the University of Basel. Paris is a renowned expert and researcher in the field of tropical and travel medicine especially in the areas of causes of endemic fevers, evaluations of diagnostic methods and research on rickettsioses. He succeeds Christoph Hatz. RBM Award The Roll Back Malaria (RBM) Partnership to End Malaria celebrated their 20th anniversary in Maputo, Mozambique. Swiss TPH was honoured for outstanding leadership and contribution. Konstantina Boutsika, scientific project leader at Swiss TPH, received the award on behalf of Christian Lengeler and Marcel Tanner at the celebration. Boutsika directs the RBM Partnership working groups on vector control, case management and multi-sectoral action.

Insurance Medicine graduation

SNIS and Swiss TPH Symposium Swiss TPH and the Swiss Network for International Studies (SNIS) invited ecologists, epidemiologists, public health specialists and civil society to discuss progress in sustainable development with an emphasis on health in the Sustainable Development Goals era. Experts from Switzerland and abroad came together in Basel to discuss and debate how to shape, implement and accelerate transformational actions to reach the 2030 Agenda. The Swiss Ageing Citizen Reference The Swiss Ageing Citizen Reference (SACR) is a huge value for researchers working in the field of personalised health, making existing data and biospecimens from 1,000 citizens in Switzerland available. Under the leadership of Nicole Probst-Hensch, the project builds on existing Swiss citizen cohorts such as SAPALDIA (Study on Air Pollution and Lung Disease in Adults).

DECEMBER

against pneumonia, diarrhoea and malnutrition in Peru. In memory of the biologist and founder of Swiss TPH, Rudolf Geigy, the Foundation gives this award every two years to young researchers who excel in the field of neglected tropical diseases. Winter Symposium The Swiss TPH Winter Symposium offered an attractive scientific programme on zoonoses control in human and animals. The two-day scientific conference involved lectures, discussions and debates on topics such as rabies control and elimination, salmonella and emerging viral zoonoses. New Drug Against Buruli Ulcer Swiss TPH researchers, together with colleagues from Singapore, have discovered a promising compound against Buruli ulcer, which may become an alternative to the existing treatment options. The neglected tropical disease leads to debilitating skin lesions, disabilities and stigmatisation. The results were published in the peer-reviewed journal Nature Communications.

Geigy Award to Stella Hartinger-Peña Stella Hartinger-Peña received the CHF 20,000 endowed R. Geigy Award. The R. Geigy Foundation of Swiss TPH honoured her contribution to the fight

Swiss Tropical and Public Health Institute

“Working at Swiss TPH gives me the opportunity to cover all aspects of medicine from research to prevention to therapy.” Esther Künzli, Clinical Consultant, Swiss TPH 18

Insights Epigenetics and Environmental Influences are Key Factors in Malaria Transmission Malaria parasites are masters of survival. As the health of their human host deteriorates, the blood parasites move increasingly into the infectious stage known as gametocytes. These cells can then be taken up by the mosquito and transferred to other humans. Researchers at Swiss TPH have now uncovered the molecular mechanisms by which the disease-causing blood stages of the parasite are transformed into infectious gametocytes. This discovery will, without doubt, have far-reaching consequences for the future development of new drugs. The last sentence is one that Till Voss, malaria specialist at Swiss TPH, does not enjoy using. “It is a cliché that forms an essential part of every message to the public,” he said wryly. But in this case he thinks it might just hit the This discovery will, without mark, as Voss and his team have doubt, have far-reaching solved a puzzle that has been consequences for the future taxing malaria researchers for decades: which are the mechanisms development of new drugs. responsible for converting the malaria parasites in human blood from the asexual to the sexual stage to ensure their transfer as gametocytes to other humans?

Epigenetic processes are key Till Voss and his team in the Gene Regulation unit have demonstrated that gametocyte production is regulated by epigenetic processes; by those mechanisms that prevent or activate gene expression without altering the information contained in the DNA. “We could simplify this by picturing a hallway with different doors. Some doors are locked and the rooms behind them inaccessible, while other doors stand open, leaving the way

free. Open doors may close, and closed ones open,” explained Voss. In other words, gametocytes have the same genome as the asexually reproducing blood stages from which the gametocytes develop. In the cells that are transformed into gametocytes, however, certain genes are activated that are inactive in the precursor cells. The two proteins HP1 and GDV1 play a key role in the activation of these genes. The former prevents the production of gametocytes, while the latter activates a molecular switch to facilitate gametocyte production. “We have known for decades that gametocytes form during the reproduction cycle of the blood parasites, but only now have we seen the mechanisms responsible,” said Voss.

Receptive to environmental influences The transformation from the asexually reproducing and disease-causing blood stages to transferable sexual stages does not take place according to a fixed programme. Researchers have been able to demonstrate that the parasite reacts flexibly to molecular signals from human blood, with

Epigenetics Epigenetics is the study of molecular mechanisms that prevent or activate gene expression without altering the information contained in the DNA. This process does not involve the nucleotide sequence of the DNA strand itself, but takes place “on top” of it (hence the prefix epi-, Greek for “over”). Thanks to epigenetics, cells are able to perform functions such as regulating – through the influence of external factors – when and to what extent certain genes are switched on and off. Epigenetics can therefore be seen as the link between environmental influences and genes.

Swiss Tropical and Public Health Institute

Insights the lipid LPC (lysophosphatidylcholine) playing a central role. This molecule helps the parasite to produce new cell membranes and to reproduce. If the concentration of LPC in the blood falls, which is often the case with infectious diseases, the parasite responds with increased gametocyte production. LPC, therefore, serves as an indicator for the parasite in regulating the transition to the infectious gametocyte stage, and thus ensuring transmission from person to person. “For the first time ever, we have been able to prove that the malaria parasite does not follow a fixed programme in the human body but reacts flexibly to environmental influences,” said biologist Nicolas Brancucci, a postdoctoral researcher at Swiss TPH.

A huge boost for drug development These findings will have far-reaching consequences for the future development of new drugs, providing a boost that is sorely needed as the tropical disease continues to cause 400,000 deaths worldwide every year. Most malaria drugs act against the asexual blood stages of the parasite, but not against the gametocytes. Treatment therefore primarily involves killing the reproducing parasite blood stage. The gametocytes continue to circulate in the blood for weeks, however, and – if absorbed by mosquitoes – can be transferred to other humans. “If we want to prevent the transmission of the disease, we have to develop compounds that fight gametocytes in a targeted approach,” said postdoctoral researcher Michael Filarsky at Swiss TPH. And the latest findings will make this possible. Thanks to the results achieved in research, it was possible to produce genetically manipulated parasites in Swiss TPH laboratories, which produce vast quantities of transferable gametocytes. This is an ideal backdrop in the search for drugs or vaccines that act specifically against this infectious stage of the parasite. “This basis will now enable us to search for molecules that effectively kill gametocytes, or prevent them from being produced in the first place,” said Voss. These developments have brought the team at Swiss TPH a huge step forward in the quest to find new methods to control the disease.

Top: Michael Filarsky and his colleagues uncovered the mechanisms by which blood stage parasites become transmissible to other humans. Bottom: The findings will also enable researchers to produce vast quantities of transferable gametocytes. Selected publications: Brancucci, N.M.B. et al. (2014) Heterochromatin protein 1 secures survival and transmission of malaria parasites. Cell Host & Microbe 16: 165–176. Brancucci, N.M.B. et al. (2017) Lysophosphatidylcholine regulates sexual stage differentiation in the human malaria parasite Plasmodium falciparum. Cell 171: 1532–1544. Filarsky, M. et al. (2018) GDV1 induces sexual commitment of malaria parasites by antagonizing HP1-dependent gene silencing. Science 359: 1259–1263.

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Fexinidazole – a Huge Step Forward in the Treatment of Sleeping Sickness In December 2018, the European Medicines Agency (EMA) recommended the compound fexinidazole as a new drug in the treatment of sleeping sickness. This decision marks another milestone in a long scientific journey in which Swiss TPH has played a central role. This journey began with a handful of guinea pigs, tied down in a box, surrounded by cages of tsetse flies. The flies proceeded to pierce into the guinea pigs’ skin with their proboscis and suck their blood. An unpleasant situation, and one that would no longer be possible in this form today. The “guinea pig sandwich” was the brainchild of Rudolf Geigy, founder of Swiss TPH in Basel. Through the use of cages, the zoologist succeeded in transporting live tsetse flies from faraway Congo back to Switzerland in 1945. Geigy was one of the first to breed the carriers of sleeping sickness in a European laboratory, paving the way for the Basel-based development of new drugs in the treatment of sleeping sickness.

An insidious disease While the “Geigy cages” are perhaps ethically questionable today, it is worth pausing for a moment to picture the zoologist in Africa over 70 years ago. He may be attempting to crawl through the savannah, armed with his binoculars, or he may be staring through his field microscope and marvelling at the perfect form of the smallest parasites. We do not know. What we do know is that the Second World War was not yet over. Geigy visited the French and Belgian colonies, met with scientists from other countries and attempted to resolve the most pressing scientific issues of his time. The tsetse fly, and the sleeping sickness it carried, caught Geigy’s interest. The tsetse fly can be found in a wide belt that stretches from the south of the Sahara into southern Mozambique,

taking in several countries of tropical Africa. At the time, the continent was seeing around 45,000 new cases of the infection each year, while this number has fallen to below 2,000 today. If left untreated, an infectious bite from a tsetse fly is highly likely to result in death. The sleeping sickness pathogen Trypanosoma brucei finds its way into the blood vessels and proceeds to multiply at an extremely rapid pace. In just a few years, it passes through the blood-brain barrier, continuing into the nervous system and causing sleep disorders and neurological problems. In most cases, infection is fatal.

Cultivation of parasites under laboratory conditions Caused by parasites that are experts in breaking down the defences of the human immune system, sleeping sickness cannot be managed by means of vaccination. These organisms are masters of transformation, constantly altering their surface structure. With this in mind, in the 1970s and 1980s, the former Swiss TPH researchers Reto Brun and Leo Jenni focused on developing new culture media for in vitro cultivation of trypanosomes and other single-cell organisms. This work laid the foundation for the institute’s subsequent success in international drug research.

Melarsoprol – a therapy with side effects This story could have also begun with the Zurich-born Ernst Friedheim, a specialist in tropical medicine who visited the French colony of Cameroon in 1932. He was obliged to watch as 800 sleeping sickness patients went blind after being treated with an excessively high dose of Atoxyl, and swore that he would devote his life to developing new drugs to treat the fatal disease. The kitchen of his apartment in Geneva was transformed into a laboratory. We do not know if he used his kitchen for cooking, but we do know the result of his

initiative – melarsoprol. It was approved in 1949 and went on to become the standard treatment for sleeping sickness. From today’s perspective, the arsenic derivative is highly problematic – it is administered as an injection that is extremely painful and, especially in rural regions of Africa, places high demands on hygiene. The drug’s main problem, however, is that 5 out of every 100 patients die during treatment as a result of an encephalopathy syndrome that “We realised we could takes the form of sudden convulsions only solve the problems and coma. Despite this, at the time it of neglected diseases if was the only substance worth using. we convinced the indus- In 2001, Christian Burri and his team try and the public sector at Swiss TPH developed a new therapy programme for melarsoprol. It shortto join forces.” ened the duration of treatment from 30 to 10 days, which was a significant advantage for both patients and their families. In 2004, it was introduced as the new standard therapy by the World Health Organization (WHO) – the severe side effects, however, remained unchanged.

tum to the development of drugs for use in the treatment of neglected diseases. “We realised we could only solve the problems of neglected diseases if we convinced the industry and the public sector to join forces,” recalls Marcel Tanner, Director Emeritus of Swiss TPH, who spent 10 years chairing the Board of DNDi. DNDi spurred Swiss TPH’s interest to search for new drugs to treat sleeping sickness. Alongside the development of new compounds to combat poverty-related diseases, the concept of “drug repurposing” also plays an important role, and drugs originally developed to treat other conditions are now being tested for their efficacy against sleeping sickness. The industry is providing access to its extensive substance libraries, and academic institutions such as Swiss TPH are testing the substances’ efficacy against the fatal trypanosomes. The search for drugs to treat neglected diseases was also given a stronger institutional basis in 2017 with the creation of a new professorship of Neglected Tropical Diseases (currently held by Jennifer Keiser) at Swiss TPH.

New public–private partnerships Since the turn of the millennium, new organisations such as the Drugs for Neglected Diseases initiative (DNDi), known as product development partnerships (PDPs), have brought new momen-

Swiss TPH was one of the first institutes to breed tsetse flies in a laboratory.

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Insights An effective combination therapy It was partnerships such as these that, from 2002 onwards, examined various approaches to finding a better treatment for sleeping sickness. Experience showed that many initiatives were termin ated without success after years of intensive work. One combination of two substances – each in itself relatively ineffective – brought partial success, however. It was a combination of the drug eflornithine, whose development for use in the treatment of cancer had been terminated, with nifurtimox, already in use for some time to treat Chagas disease, also known as American trypanosomiasis. In clinical trials carried out in a collaboration between DNDi, Swiss TPH and the pharmaceutical company Sanofi, over 95 % of patients were cured with this combination. Mortality rates during treatment fell from 5 % to below 1 %. The WHO placed the combination on its Model List of Essential Medicines, and it soon superseded the older melarsoprol. However, one significant disadvantage that prevents its large-scale use and is a major obstacle in the current efforts to eliminate the disease remains: eflornithine must be administered in 14 infusions, and treatment for four patients takes up a volume of one cubic metre – a particular logistical challenge in the remote rural regions of Africa.

Top: Life cycle of a tsetse fly, the carrier of sleeping sickness. Left: Clinical trials in resource-limited settings are a complex undertaking. Right: The number of new cases of sleeping sickness has been reduced to 2,000 per year.

Fexinidazole – a tablet for sleeping sickness Hopes have recently been raised by the compound fexinidazole, a member of the group of nitroimidazoles originally used to treat fungal diseases. DNDi launched the nitroimidazole project in 2005 together with its academic partners. Scientists from Swiss TPH identified fexinidazole as the most promising molecule from DNDi’s nitroimidazole library against trypanosomes, and researchers were able to demonstrate its tolerability in clinical trials. The benefit of the compound is that it can be taken as a tablet over a period of 10 days, eliminating the need for painful injections. What’s more, the drug can also be administered by less highly trained personnel in remote treatment centres. Oxaborole, another compound in the DNDi pipeline, would have an even more appealing profile – in this case, just one tablet would be sufficient to cure sleeping sickness. Reto Brun, founder of the Parasite Chemotherapy unit at Swiss TPH, is also convinced that “fexinidazole and oxaborole will be the drivers in our quest to eliminate sleeping sickness.” This would be a major milestone in a long scientific search for a new drug that began in the Congo with a “guinea pig sandwich.”

Selected publications: Burri, C. et al. (2000) Efficacy of new, concise schedule for melarsoprol in treatment of sleeping sickness caused by Trypanosoma brucei gambiense: a randomised trial. Lancet 355: 1419–1425. Geigy, R. (1948) Elevage de Glossina palpalis. Acta Tropica 5: 201–218. Kaiser, M. et al. (2011) Antitrypanosomal activity of fexinidazole, a new oral nitroimidazole drug candidate for treatment of sleeping sickness. Antimicrobial Agents and Chemotherapy 55: 5602–5608. Mesu, V. et al. (2018) Oral fexinidazole for late-stage African Trypanosoma brucei gambiense trypanosomiasis: a pivotal multicentre, randomised, non-inferiority trial. Lancet 391: 144–154.

DNDi – Swiss TPH: a successful partnership In the 1990s, when the drug pipeline for neglected diseases had almost dried up, Médecins Sans Frontières (MSF) joined forces with experts in the field to create the study group Drugs for Neglected Diseases. This group analysed the causes of the crisis, developed new strategies for the research and development of new drugs and launched the Drugs for Neglected Diseases initiative (DNDi). Financed by both the public and private sector, DNDi brings together the expertise of the pharmaceutical industry with that of academic partners like Swiss TPH. Researchers at Swiss TPH are involved in many key DNDi projects such as the development of a combination therapy (nifurtimox-eflornithine, NECT) for sleeping sickness and fexinidazole for the same disease or of new compounds for Chagas disease and leishmaniasis. Swiss TPH and DNDi were recently awarded a prestigious EU grant (Horizon 2020). Together, the institutions are working to establish a platform for developing new drugs for use in the treatment of parasitic worm infections.

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High-tech Sensors and Blockchain: New Avenues towards the Elimination of Rabies Rabies continues to kill approximately 60,000 people every year, mainly in Africa and Asia. In order to reach the goal to eliminate dog-mediated human rabies worldwide by 2030, integrated strat egies, political will and innovations are needed. Swiss TPH is at the forefront of rabies research; from devising high-tech sensors to track dogs in urban settings and employing new mathematical methodologies to investigating blockchain for improved access to post-exposure prophylaxis. Rabies is an infectious viral disease that is nearly always fatal once the virus has reached the brain of the infected person. Rabies is a zoonotic disease, meaning that the virus is transmitted from animals to humans. 99 % of human deaths are caused by transmission of the virus by dog bites. Rabies could be fully prevented given the availability of highly efficacious vaccines and human post-exposure prophylaxis (PEP). In large parts of Europe, rabies has been eliminated over the past three decades thanks to massive oral vaccination programmes of wild animals.

One Health – taking into account both humans and animals to tackle rabies Rabies can only be eliminated by applying a One Health approach, looking at improving the health and well-being of both humans and animals. Swiss TPH scientists have been working on rabies elimination in the sense of One Health, together with local partners in Africa for the past 20 years. “Unfortunately, we are currently facing a massive human rabies vaccine shortage globally,” said Jakob Zinsstag. “More than ever, we need a coordinated effort by all actors, including ministries of health, Gavi and research institutions to end rabies by 2030.”

More targeted and cost-effective approach to rabies elimination The global economic burden of dog-mediated rabies is estimated at USD 8.6 billion according to the World Health Organization (WHO). Major costs associated with dog-mediated rabies include loss in productivity due to premature death, cost of PEP and direct costs to the medical sector and bite victims. Studies conducted by Swiss TPH have shown that within 10 years, the cumulative cost of mass vaccination of dogs is lower than the cumulative cost of human PEP. According to Jakob Zinsstag, Head of the Human and Animal Health unit at Swiss TPH: “Well-coordinated long-term regional efforts in dog mass vaccination could lead to the elimination of dog rabies at significantly lower cost than the sustained provision of human PEP prophylaxis.”

A highly active dog versus a stay-at-home dog Both graphs show the same neighbourhood in N’Djamena, Chad. On the left, the GPS track of a highly active dog is depicted while on the right, the activities of a stay-at-home dog are shown. The red dots indicate the dogs’ homes.

Physics theory applied to epidemiology Indeed, studies have shown that it is feasible to eliminate dog-mediated rabies. Yet, is it necessary to mass-vaccinate all dogs in a certain setting, a mission that is costly and nearly impossible? Not necessarily, according to a study published by Swiss TPH last year. The scientists investigated how dogs in a certain neighbourhood are connected with each other and thus how likely they are to transmit rabies and cause an outbreak. “Statistical sampling from a network is challenging: what if the most interconnected dog is not part of the sample? Hence, to project the potential transmission of a disease, we have to understand the network of those who can transmit it,” said Mirjam Laager, who pursued her PhD at Swiss TPH supervised by Nakul Chitnis and now does her post-doctoral work at the University of Oxford. “To do so, we need to analyse all actual social interactions of all members in the network.” The method Laager and her colleagues applied is called percolation theory and stems originally from physics.

High-tech device to track dog's activities In practice, this meant tracking the location and contacts of 328 dogs in different neighbourhoods of N’Djamena, the capital of Chad, with newly

developed geo-located contact sensors. “We not only wanted to establish a contact network for each dog, but also to track the exact position of where dogs meet,” said Céline Mbilo, PhD student at Swiss TPH. To develop contact sensors that can also track global positioning system (GPS) data, the scientists worked with Bonsai Systems, a spinoff company of the ETH Zurich. The geo-sensor cages were produced using a novel 3D printer. The development of this new technology was funded by an R’Equip grant of the Swiss National Science Foundation.

Highly connected versus stay-athome dogs “We equipped all domestic dogs in the area of one square kilometre in three neighbourhoods of N’Djamena characterised by high, medium and low dog density with the geo-sensors,” said Mbilo. “We then tracked all activities and contacts of the dogs over a four-day period.” Results demonstrated considerable heterogeneity among dogs: while most had only little contact with other dogs, a few were highly interconnected. “A next step in the analysis of our data is to find out whether highly connected or active dogs share similar characteristics such as sex or neutering status which could favour a more targeted vaccination approach of such highly social dogs,” said Mbilo. “Furthermore, we would like to find out

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Insights whether there are specific meeting hotspots for dogs such as meat markets or waste dumps.” With the mathematical model, the researchers were able to demonstrate that major rabies outbreaks could be prevented when the WHO-recommended dog vaccination coverage of 70 % is achieved. However, a coverage of 70 % seems not to be sufficient to prevent minor “More than ever, we need outbreaks. “Our results suggest that a coordinated effort by endemic rabies in N’Djamena may all actors, including min- be explained by importation of raistries of health, Gavi and bies-exposed dogs into N’Djamena from outside the city,” said Mbilo. This research institutions to finding is further corroborated through end rabies by 2030.” an phylodynamic analysis of rabies virus strains from N’Djamena. “Humans may play an important role in the transmission of dog rabies when migrating or travelling together with their dogs,” according to Mbilo.

Outlook: blockchain to improve patient access to PEP Apart from preventing transmission from dogs to humans, human deaths can also be averted through improved access to quality PEP when a person is bitten. “On the one hand, supply chains are often inadequate in health systems. On the other hand, there is often insufficient communication between public and animal health services,” said Zinsstag. To address this issue, Swiss TPH scientists aim to test the potential of using a blockchain approach, coupled with an algorithm to ensure better access to PEP. “The blockchain technology would help control the communication flow between local health providers and health and veterinary authorities,” said Zinsstag. Furthermore, electronic health records of patients may contribute to improve patient compliance, secure patient access to free PEP and assure the vaccine supply chain as a whole within the investment strategy of Gavi, the Vaccine Alliance.

Network of a dog population in a selected neighbourhood of N’Djamena In the left panel, each node corresponds to a dog. In the right panel, each dot on the map corresponds to a home location of a dog. The colours correspond to the community in the network. The maps were generated using OpenStreetMap contributors.

Selected publications: Bourhy, H. et al. (2016) Revealing the micro-scale signature of endemic zoonotic disease transmission in an African urban setting. PLoS Pathogens 12: e1005525. Hampson, K. et al. (2019) The potential effect of improved provision of rabies post-exposure prophylaxis in GAVI-eligible countries: a modelling study. Lancet Infectious Diseases 19: 102â&#x20AC;&#x201C;111. Laager, M. et al. (2018) The importance of dog population contact network structures in rabies transmission. PLoS Neglected Tropical Diseases 12: e0006680. Zinsstag, J. et al. (2017) Vaccination of dogs in an African city interrupts rabies transmission and reduces human exposure. Science Translational Medicine 9: eaaf6984.

Blockchain and global health Blockchain is a decentralised and secured system for information transmission where information is stored on the computers of all participants in a distributed ledger. Its potential for electronic health registry and the assurance of drug and vaccine supply chains is currently assessed with and without reward systems.

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Improving the Quality of Care in Tajikistan through Medical Education With two-thirds of Tajikistan’s population living in rural areas, primary healthcare remains a critical component in the drive to make quality healthcare more accessible, with medical education playing a key role. The Swiss Agency for Development and Cooperation (SDC) Medical Education Reform Project, which is implemented by Swiss TPH, is committed to improving primary healthcare services and medical education in Tajikistan, ultimately contributing to the goal of Universal Health Coverage. Tajikistan: a country rebuilds Since Tajikistan gained independence in 1991, much has been done to move away from the heavily centralised and specialist-focused healthcare system that existed in the Soviet era, to a primary healthcare system that emphasises the concept of family medicine. As the country still grapples with rebuilding an economy that was devastated by a civil war that waged on until 1997, healthcare efforts also lag behind. Tajikistan is currently the poorest country in Central Asia with a dual burden of infectious and non-communicable diseases, with cardiovascular disease responsible for nearly 40 % of all deaths. Rural populations in particular often face healthcare barriers such as a lack of well-trained

Universal Health Coverage (UHC) UHC is a rallying call for the strengthening of health systems that deliver basic, quality care to the most vulnerable populations. A healthy society is a more resilient one – one where individuals are able to get an education, be productive at their workplace and lead a more prosperous life.

doctors and nurses, stock-outs of medicines and other supplies, and poor infrastructure, making quality treatment and care inaccessible. The Medical Education Reform Project (MEP) aims to strengthen the quality of primary healthcare in Tajikistan through the reform of undergraduate and postgraduate training and the introduction of new forms of continuous professional development to build a robust workforce of well-trained family doctors and nurses. The MEP works with the Ministries of Health and Education, the Republican Centre for Family Medicine, the Tajik State Medical University, Nursing Colleges and the Post Graduate Medical Institute, with inputs from the Institute of Nursing Science in Basel and the University of Calgary.

20 years of health system strengthening Switzerland has been supporting health system strengthening in Tajikistan for 20 years, with the last 10 years having a particular focus on medical education reform. The aim is to modernise the training of doctors and nurses by putting a greater focus on practical and clinical skills, communication techniques, and by providing early exposure to rural practice realities with students working directly with patients under the guidance of experienced colleagues – as is routinely done in Switzerland.

“The MEP has generated a wealth of knowledge and experience across undergraduate, postgraduate and continuous professional development that are highly relevant for other countries in “The past 20 years of the region – as well as in other countries where SDC is active like Albania and the Swiss involvement in Ukraine,” said Helen Prytherch, Head Tajikistan have been challenging yet incredibly of the Health Systems Support unit at Swiss TPH and project leader of MEP. rewarding.” “We will continue to use our expertise in capacity building from Switzerland and our experiences thus far in countries like Tajikistan, tailoring our knowledge to other countries and contexts.” To achieve the health-related Sustainable Development Goals, Switzerland promotes Universal Health Coverage (UHC) through activities that establish social protection mechanisms in health and advocate for access to quality healthcare. SDC in particular supports the financing and implementation of UHC-related projects in low- and middle-income countries, such as in Tajikistan. “The past 20 years of Swiss involvement in Tajikistan have been challenging yet incredibly rewarding after seeing the large impact made, especially in areas such as medical education reform. When implementing projects that address health system strengthening and strive towards the goal of UHC, we must bear in mind that obtaining political and financial commitment is critical for ensuring the longevity and sustainability of projects, such as the MEP,” said Corinne Demenge, Deputy Director of the Swiss Cooperation Office in Tajikistan.

Mobilizing a workforce through medical education reform Despite the high number of trained medical students from Tajikistan, rural areas continue to lack qualified family doctors and nurses, leaving the country ill-equipped to manage its dual burden of disease. This situation is compounded by the brain drain of skilled workers, as a high proportion of professionals migrate to Russia or other, more prosperous countries in search of better opportunities to support themselves and their families. In response to this, the MEP implemented not only undergraduate and postgraduate courses, but also an additional year of medical training to promote practical skills, and a two-year specialty training in family medicine called the Post-University Speciality Training Programme (PUST). PUST involves the graduates working directly in clinical practice under the mentoring of experienced family doctors. PUST has been completed by 105 residents, with all deployed to work as family doctors in rural districts. “The training to become a family doctor 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,” said Shamsiya Davlyatova, a former medical student who went through six years of training and completed the PUST to become a family doctor.

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Insights Bringing the knowledge back home Shamsiya Davlyatova is a young medical doctor who grew up in a village called Rudaki in Tajikistan with a population of 15,000 people. Davlyatova was raised in a close-knit community and “I am able to give back to had a keen interest in medicine, which my community to ensure was sparked by observing the family doctors in her community. “I was often that my family, friends inspired by the family doctors who and neighbours have access to the healthcare knew their patients and their families so well,” remembers Davlyatova. “They they need.” were a part of our lives and were better equipped to serve, as they knew the family history and could often identify problems at a much quicker rate than specialist doctors.”

A daunting, yet manageable challenge As the percentage of people living in rural areas is rising at a faster rate than in urban areas, providing healthcare to the rural population remains an immense challenge. Through the strengthening of primary healthcare and the building of a workforce of well-trained doctors and nurses, the MEP contributes to the improvement of health outcomes in Tajikistan and acts as a model for other countries working towards achieving UHC through medical education.

Other projects on medical education reform at Swiss TPH Albania The Health for All Project (HAP) in Albania, funded by SDC and implemented by a Consortium led by Swiss TPH with Terre des Hommes and Save the Children, aims at improving the health of the vulnerable groups in Diber and Fier, through improved primary healthcare service and health promotion activities.

After an intensive six years of training and an additional two years in PUST at the Tajik State Medical University, Davlyatova returned to her home of Rudaki to become a family doctor. “I’m having my own territory to serve patients – an area with 2,000 people. I have the opportunity to become just like the doctors that I grew up with, and give back to the community that raised me,” said Davlyatova. “Now, I work hard to stay up-to-date by taking part in peer groups, so that I’m able to exchange ideas with my fellow doctors.” Peer groups are a sustainable model of continuous education that the MEP has promoted to allow family doctors and nurses to discuss clinical and other difficulties from their everyday practice in an informal setting.

Ukraine The Medical Education Development Project (MED), funded by SDC and implemented by Swiss TPH, provides quality care to the Ukrainian population by improving the medical education system for the primary healthcare workforce. The main task is to support the overall health system reform with appropriate human resources development.

Family Medicine in Tajikistan Improving health through the reformation of medical education.

Watch a video on medical education reform in Tajikistan: https://youtu.be/d4zGFmjiqj8

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“I have been collaborating with Swiss TPH for 27 years with a focus on environmental epidemiology and ecosystem health. I am impressed by the consideration Swiss TPH shows its partners abroad, the spirit of collaboration and the investment placed in people.” Guéladio Cissé, Head of the Ecosystem Health Sciences unit, Swiss TPH 34

Key Areas of Activity The broad variety of projects and initiatives of SwissÂ TPH are currently bundled into 13 key areas of activity (KAA). 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 #2

KAA #3

Basic Research in Infection Biology

Preclinical Research and Development

Clinical Research and Development

Innovative reasearch for poverty-related diseases

Discovering and developing diagnostics, drugs and vaccines

Testing and monitoring new therapies in low-resource settings

KAA #4

KAA #5

KAA #6

Molecular and Genetic Epidemiology

Emerging Infectious Diseases

Statistical and MathÂ ematical Modelling

Defining markers for disease control and surveillance

Tackling viruses such as dengue, Ebola or Zika

Capturing and projecting health data

KAA #7

KAA #8

KAA #9

Personalised Health

Health in HumanEnvironment Systems

Society, Culture and Health

Studying the impact of environmental factors on health

Studying social and cultural determinants of health

KAA #10

KAA #11

KAA #12

Sexual and Reproductive Health and Gender

Health Systems and Policy

Travel and Tropical Medicine

Translating evidence and strengthening health systems

Managing health risks of tropical diseases

Research on cohorts and biobanks

Enabling access to sexual and reproductive health KAA #13

Migration and Health Improving health of mobile populations and migrants

Swiss Tropical and Public Health Institute

Key Areas of Activity KAA #1

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 drugs, vaccines and diagnostics. Buruli Ulcer: Promising New Drug Candidate Against a Forgotten Disease Buruli ulcer is a neglected tropical disease resulting in debilitating skin lesions, disabilities and stigmatisation. The current antibiotic treatment is long and has severe adverse events. Researchers from Swiss TPH, together with colleagues from Singapore, have discovered a highly effective compound against Buruli ulcer, which has the potential to become a powerful alternative to the existing treatment options.

Scherr, N. et al. [2018] Targeting the Mycobacterium ulcerans cytochrome bc₁:aa₃ for the treatment of Buruli ulcer. Nature Communications 9: 5370.

A promising new drug candidate may improve treatment options for Buruli ulcer patients.

KAA #2

KAA #3

Preclinical Research and Development

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 contribution to the development of new therapies. Human Monoclonal Antibody and Structureguided Approaches to Malaria Vaccine Development A new study highlights the isolation of a novel class of human monoclonal antibodies from malaria pre-exposed Tanzanian adults. These antibodies recognise a novel, conserved, highly vulnerable site on the parasite surface protein. The understanding of the antibody and the target binding structure provides the foundation for next-generation, structure-guided approaches to malaria vaccine development. Tan, J. et al. [2018] A public antibody lineage that potently inhibits malaria infection through dual binding to the circumsporozoite protein. Nature Medicine 24: 401–407.

In clinical studies, experts develop and validate new drugs, vaccines and diagnostic products to aid in the fight against poverty-related diseases such as sleeping sickness, malaria and tuberculosis. Swiss TPH has extensive expertise in designing, implementing and monitoring clinical studies, especially in lowincome countries. By adhering to the highest ethical, scientific and technical standards, clinical researchers ensure patient safety and reliable research data. Pioneer Clinical Trial Aims to Find Improved Treatment for Tuberculosis Tuberculosis (TB) is one of the deadliest infectious diseases in the world. Treatment is complex especially in the case of multidrug-resistant TB. Patients in low-resource countries in particular often lack access or do not complete the treatment regimen. TB PRACTECAL is a clinical trial that aims to find an improved course of treatment for drug-resistant TB. The trial is run by Médecins Sans Frontières and supported by Swiss TPH, the London School of Hygiene and Tropical Medicine and other partners.

TB PRACTECAL A pioneer clinical trial for drug-resistant tuberculosis.

Visit the TB PRACTECAL web page to learn more: https://bit.ly/2Y6M7m1

The interaction of monoclonal antibody MGG4 with the novel vulnerable site on the circumsporozoite protein 1.

Pharmacy staff preparing drug kits in Nukus, Uzbekistan.

Swiss Tropical and Public Health Institute

Key Areas of Activity KAA #4

KAA #5

Molecular and Genetic Epidemiology

Emerging Infectious Diseases

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 interven tions and strategies for reactive surveillance. New Findings on Diagnostic Tools for Malaria Elimination To eliminate malaria, it is important to identify the extent of asymptomatic carriers of malaria parasites and to target them through interventions to stop the transmission of the disease. A study by Swiss TPH assessed multiple diagnostic tests intended to support malaria elimination and found that molecular tests are needed for thorough identification of potential malaria transmitters. Rapid diagnostic tests (RDTs), including a novel ultra-sensitive RDT, are less suitable as they failed to identify 59 % of all individuals who carry Plasmodium falciparum transmission stages. Hofmann, N. et al. [2018] Assessment of ultra-sensitive malaria diagnosis versus standard molecular diagnostics for malaria elimination: an in-depth molecular community cross-sectional study. Lancet Infectious Diseases 18: 1108–1116.

Collection of blood samples in school children in Madang province, Papua New Guinea.

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. New Test for Better Understanding of the Severity of Dengue Fever Dengue is a mosquito-borne tropical disease caused by any one of four closely related dengue serotypes. An estimated 390 million dengue infections occur annually, with about 96 million resulting in flu-like illness and in some cases, potentially lethal severe dengue. A new study developed an immunological test that determines which type of dengue serotypes is present in the patient, more easily than previous genetic tests. In the future, this test may help to better understand and predict why some dengue patients develop severe dengue. Furthermore, the test will facilitate the monitoring of the spread of serotypes in human populations. Röltgen, K. et al. [2018] Development of dengue virus serotype-specific NS1 capture assays for the rapid and highly sensitive identification of the infecting serotype in human sera. Journal of Immunology 200: 3857–3866.

Dengue can be spread by several species of female Aedes mosquitoes.

KAA #6

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. Transmission Dynamics of the Parasitic Worm, Opisthorchis viverrini A study developed models of the transmission dynamics of the worm parasite, O. viverrini. Using data from two island communities in southern Lao PDR, the analysis showed that although cats and dogs contribute to transmission, only humans are necessary to maintain transmission. Therefore, interventions targeting humans such as mass drug administration, improved sanitation, safe fish production or behaviour change campaigns could be sufficient to eliminate O. viverrini.

BĂźrli, C. et al. [2018] Mathematical analysis of the transmission dynamics of the liver fluke, Opisthorchis viverrini. Journal of Theoretical Biology 439: 181â&#x20AC;&#x201C;194.

Dogs and cats contribute to the transmission of O. viverrini.

Swiss Tropical and Public Health Institute

Key Areas of Activity KAA #7

KAA #8

Personalised Health

Health in HumanEnvironment Systems

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. EXPOsOMICS Project The EXPOsOMICS project aims to personalise the assessment of external and internal air pollution exposure for a better understanding of health effects. The air pollution effects on health are studied at the molecular level to better understand how inhaled pollutants lead to diseases such as asthma or cardiovascular diseases. The exposome concept refers to the totality of environmental exposures, and is a novel approach to studying the role of the environment in human disease. Jeong, A. et al. [2018] Perturbation of metabolic pathways mediates the association of air pollutants with asthma and cardiovascular diseases. Environment International 119: 334–345.

Polluted air, electromagnetic radiation and noise influence our health and can lead to cardiovascular diseases or diabetes. Current research projects highlight topics such as One Health and climate change to understand health from a holistic perspective. Swiss TPH adopts a systemic approach to make health links from the molecular level to the social domain. Transportation Noise: a Neglected Global Health Burden In low- and middle-income countries, noise annoyance and noise sensitivity are not commonly investigated. A new study aims to assess the annoyance and sensitivity to noise in 364 adults living in informal settings in South Africa and to compare it with a similar study conducted in Switzerland. Findings show that noise exposure considerably affects people living in informal settlements and hence, noise should be considered when improving the housing conditions. Sieber, C. et al. [2018] Comparison of sensitivity and annoyance to road traffic and community noise between a South African and a Swiss population sample. Environmental Pollution 241: 1056–1062. Sieber, C. et al. [2018] Land use regression modeling of outdoor noise exposure in informal settlements in Western Cape, South Africa. International Journal of Environmental Research and Public Health 14: e1262.

Mostafavi, N. et al. [2018] Acute changes in DNA methylation in relation to 24 h personal air pollution exposure measurements: a panel study in four European countries. Environment International 120: 11–21. Turner, M. et al. [2018] Exposomics: final policy workshop and stakeholder consultation. BMC Public Health 18: 260.

Preparing study participant’s blood samples for biomarker analysis.

Researchers set up noise and air pollution measurement devices in Khayelitsha, Cape Town, South Africa.

KAA #9

KAA #10

Society, Culture and Health

Sexual and Reproductive Health and Gender

Social position, cultural values and economic status influence health, which has important social and economic implications. Using this approach, researchers 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?

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 a well-founded knowledge of sexually transmitted diseases and of family planning worldwide, and to making pregnancies and births safe across all domains. In Switzerland, vaccination programmes, breastfeeding promotion and the impact of midwife networks are investigated.

Maternal and Child Health in Chad In the central African country Chad, women and children suffer from many diseases such as malaria or respiratory infections. Since 2014, the Support Project for the Health Districts in Chad – Yao and Danamadji (PADS) has been implemented to support the health system in strengthening the quality of care and health administration capacity. The project focuses on maternal and child health services and closing the gap between health services and the nomadic population, notably by implementing the One Health concept.

PADS Closing the gap between health services and the nomadic population.

Cultural Apprehensions towards Contraceptive Side Effects Contraceptive side effects (SE) are often portrayed as unproblematic trade-offs for pregnancy prevention, though little attention is given to socially-rooted rationales for feared and experienced SE. Through interviews conducted with people from Burundi and the Democratic Republic of the Congo, a new study suggests that in rural contexts of poverty, uncertainty and power inequities are legitimate concerns stemming from actual or anticipated bodily symptoms located in the embodied life circumstances. Schwarz, J. et al. [2018] “So that’s why I’m scared of these methods”: locating contraceptive side effects in embodied life circumstances in Burundi and eastern Democratic Republic of the Congo. Social Science and Medicine 220: 264–272.

Watch a film on PADS to learn more: https://bit.ly/2wbdu2A

PADS aims to improve access to health services in particular for nomadic populations.

Woman in South Kivu on her way to the health facility.

Swiss Tropical and Public Health Institute

Key Areas of Activity KAA #11

KAA #12

Health Systems and Policy

Travel and Tropical Medicine

Swiss TPH offers support to countries with insufficient healthcare provision around the world. Experts develop and reinforce health insurance schemes for poor rural populations, create IT solutions for improving treatment for patients, invest in strengthening primary health care 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. A Complementary Health Supply Chain in Tanzania Access to healthcare is often determined by the availability of medical supplies. To supplement medicines and supplies that are out of stock at the Medical Stores Department in Tanzania, Swiss TPH developed the Jazia Prime Vendor System (Jazia PVS) in collaboration with partners. Jazia PVS is a unique public private partnership with the objective to procure complementary health commodities to improve the availability of medicines in Tanzania. Between 2011 and 2018, mean medicine availability in the pilot region increased by over 40 %.

Jazia Prime Vendor System A public private partnership with the aim to improve the availability of medicines in Tanzania.

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 approxi mately 1,500 ill-returning travellers receive treatment following their return. Experts search for disease carriers with state-of-the-art technology and their extensive experience. Diagnostic samples are sent to Swiss TPH from all over the world because of the institute’s internationally recognised expertise. Fever amongst Returning Travellers Besides diarrhoea and skin problems, fever is the most common symptom of travellers returning from tropical and subtropical areas. Knowledge of regional occurrences and the geographical distribution of infectious diseases is particularly important in identifying which tropical diseases may be causing a fever amongst returning travellers from the tropics, which is why the medical doctors at Swiss TPH wrote an article to assist Swiss general practitioners with their diagnosis. Neumayr, A. et al. [2018] Fieber bei Reiserückkehrern. Swiss Medical Forum 18: 345–354.

Visit the Jazia PVS website to learn more: https://bit.ly/2LmHP8v

Jazia PVS aims to address the problem of medicine stock-outs in Tanzania.

A) Malaria B) Relapsing fever-borreliosis C) East African trypanosomiasis D) Chagas E) Redwater fever F) Filariose

KAA #13

Migration and Health The precarious situation of refugees, migrants and nomads make them especially susceptible to disease. SwissÂ TPH researchers develop new concepts to improve the health of marginalised populations. Specialists in Basel work together with partners on activities which aim to achieve fairer health and social policies, such as health clinics for migrants. Effective Diagnosis of Schistosomiasis among Migrants Refugees from Eritrea make up the majority of sub-Saharan African migrants in Switzerland. Most are infected with schistosomiasis before arrival. Schistosomiasis is a neglected tropical disease affecting 250 million people, with 200 million living in Africa. Diagnosis through a urine rapid test is crucial to effectively screen and treat the disease before it becomes severe. Findings show that a point-of-care circulating cathodic antigen urine test is valuable for screening, but it is not suitable for routine follow-up after treatment.

Neumayr, A. et al. [2019] Performance of the point-of-care circulating cathodic antigen (POC-CCA) urine cassette test for follow-up after treatment of S. mansoni infection in Eritrean refugees. Travel Medicine and Infectious Disease 28: 59â&#x20AC;&#x201C;63.

Schistosomiasis is transmitted through infective larvae that penetrate the skin of humans during contact with water.

Swiss Tropical and Public Health Institute

“I have been at Swiss TPH for 34 years and it never gets boring. The daily challenge of balancing routine with the unforeseeable, getting to know people from different nations, working in teams, meeting people that visit our institute; all this and more is the reason I have worked here for so long.” Yvette Endriss, Manager of the Central Lab, Swiss TPH 44

Committees & 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 Schmid-Huberty Administrative Director Prof. Dr. Nino Künzli Deputy Director

Additional Members of the Managing Board

Prof. Dr. Sabina De Geest Director, Institute of Nursing Science, University of Basel PD Dr. Monika Wenk Janssen Operations, Bern Joakim Rüegger Head, Higher Education, Cantonal Department of Education, Basel-Stadt

Prof. Dr. Sébastien Gagneux Prof. Dr. Daniel Paris

Prof. Dr. Didier Trono École polytechnique fédérale de Lausanne

Prof. Dr. Nicole Probst-Hensch Prof. Dr. Kaspar Wyss

Christoph Tschumi Administrative Director, University of Basel Prof. Dr. med. Werner Zimmerli Member of the Board of Governors, Kantonsspital Basel-Landschaft

R. Geigy Foundation: Foundation Board and Administration Dr. Doris Fellenstein Wirth Head, Stab Hochschulen, Kanton Basel-Landschaft Prof. Dr. med. François Chappuis Medical superintendent, Tropical and Humanitarian Medicine, Hôpitaux Universitaires Genève Dr. Nicole Schaad Observer, State Secretariat for Education, Research and Innovation, Bern Prof. Dr. Jürg Utzinger Director, Swiss TPH (ex officio) Matthias Schmid-Huberty Secretary of the Board (ex officio) Administrative Director Swiss TPH

Prof. Dr. Marcel Tanner President of the foundation board, Director Emeritus, Swiss TPH Jean-Marc Joerin Vice-president of the foundation board, Lawyer, Joerin Advokatur Ulrich Wasser Managing Director Dr. Lukas Meier Deputy Managing Director Beat Berger Managing Director, Berger Liegenschaften Bernadette Peterhans Head, Professional Postgraduate Training, Swiss TPH Jörg Schwarzenbach Vice-president, Board of Governors, Aquila & Co. AG Jürg Toffol Architect, ETH SIA Prof. Dr. Jürg Utzinger Director, Swiss TPH

Swiss Tropical and Public Health Institute

Commitees & Departments

Organigram 2019 Board of Governors

Directorate

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

Director Jürg Utzinger Deputy Director and Department Head Nino Künzli Department Heads Sébastien Gagneux, Daniel Paris, Nicole Probst-Hensch, Kaspar Wyss Administrative Director Matthias Schmid-Huberty

Administration

Departments

Administration

Epidemiology and Public Health

Medical Parasitology and Infection Biology

Matthias Schmid-Huberty

Nicole Probst-Hensch Deputy: Jakob Zinsstag

Sébastien Gagneux Deputy: Till Voss

Finances / Controlling Mathias Kronig

Biostatistics Penelope Vounatsou

Clinical Immunology Claudia Daubenberger

Human Resources Iris Haueter

Chronic Disease Epidemiology Nicole Probst-Hensch

Gene Regulation Till Voss

Informatics Alain Bertolotti Infrastructure Ursina Müller Project & Grant Service Michael Käser

Ecosystem Health Sciences Guéladio Cissé Environmental Exposures and Health Martin Röösli 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

Helminth Drug Development Jennifer Keiser Molecular Diagnostics Ingrid Felger Molecular Immunology Gerd Pluschke Molecular Parasitology and Epidemiology Hans-Peter Beck Parasite Chemotherapy Pascal Mäser Tuberculosis Research Sébastien Gagneux

Communications Sabina Beatrice-Matter

Security, Safety & Health Marco Tamborrini Alexander Knup

Swiss Centre for International Health

Medicine

Education and Training

Kaspar Wyss

Daniel Paris Deputy: Christian Burri

Nino Künzli Deputy: Axel Hoffmann

Clinical Operations Elisabeth Reus

Bachelor-Master-Doctorate Nino Künzli

Clinical Research Klaus Reither

Library and Documentation Giovanni Casagrande

Diagnostics Sven Poppert

Professional Postgraduate Training Bernadette Peterhans

Health Systems Support Helen Prytherch Health Technology and Telemedicine Martin Raab Systems Performance and Monitoring Odile Pham-Tan

Medical Services Andreas Neumayr Medicines Implementation Research Christian Burri

Teaching Technology and Didactics Axel Hoffmann

Organigram valid 1.05.2019

All Swiss TPH Staff For up-to-date information and to see all our staff, please visit: www.swisstph.ch/staff

Swiss Tropical and Public Health Institute

Committees & Departments

The Departments Medical Parasitology and Infection Biology Head: Sébastien Gagneux

The Department of Medical Parasitology and Infection Biology (MPI) researches pathogens and their transmission pathways. MPI develop new diagnostics, drugs and vaccines against neglected tropical and poverty-related diseases such as malaria, parasitic worm infections, Buruli ulcer, tuberculosis and sleeping sickness. Activities in 2018 ranged from basic research in the laboratory to the validation of new therapies in clinical field studies. Researching the biology of pathogens, host-pathogen interaction and immunity Researchers study the molecular and cellular mechanisms underlying pathogen survival, transmission, and host-pathogen interaction. They study the factors that trigger an immune response and influence the disease using various infection models and human samples from clinical studies. By improving our understanding of these biological processes, researchers help tackle poverty-related diseases such as malaria, tuberculosis, sleeping sickness, dengue fever, Buruli ulcer and parasitic worm infections. For example, the group led by Till Voss recently identified new molecular mechanisms that play an important role in the transmission of the malaria pathogen Plasmodium falciparum. This important discovery was published in the renowned journal Science in 2018 (see page 19–20).

Research on pathogen development and transmission MPI specialists study how pathogens undermine the immune reaction of the host or develop resistances to drugs, and how these strategies influence the spread of microbes. By using different approaches in molecular epidemiology, they analyse the dynamics of infection and transmission and the impact of health interventions, such as vaccinations or therapies, on the spread and population structure of pathogens. In 2018, Ingrid Felger’s group developed a new method that makes it possible to detect malaria parasites

even in the smallest amounts in the bloodstream of infected people. This work was published in the peer-reviewed journal Lancet Infectious Diseases.

Development of diagnostics, drugs and vaccines Researchers also use their knowledge of pathogens and hosts to develop new diagnostics and test selected potential compounds and vaccines in preclinical and clinical studies. They also develop new animal and infection models to review interventions in cooperation with numerous

international institutions, including long-standing partners in disease-endemic countries. For example, Jennifer Keiser’s study group was able to show high efficacy of a triple drug therapy against hookworm and whipworm infections in a clinical trial in school-aged children in Lao PDR. This clinical trial was published in the Lancet Infectious Diseases.

Epidemiology and Public Health Head: Nicole Probst-Hensch

The focus of research in the Department of Epidemiology and Public Health (EPH) is on promoting the well-being and health of people from birth to old age. The projects have a strong focus on primary prevention. The activities range from research on existing data through complex mathematical modelling to the construction of large long-term studies and biobanks. Public health interventions ensure that people worldwide benefit from the scientific findings. For the researchers, no distance is too far. In 2018, EPH published about 60 % of the more than 500 scientific publications of Swiss TPH and was in the lead of 140 of them. Approximately half of the research funds were acquired by EPH staff.

Environment and health Swiss TPH is one of the world’s leading institutions in environmental research. Swiss data on causes of death have shown that traffic noise is associated with an increased risk of heart attacks. Research results indicated a possible effect of mobile phone radiation on memory in adolescents. Our increasing environmental research activities in countries with lower incomes showed that on days with high air pollution, more children are hospitalised in Hanoi for lung infections. On the occasion of a workshop at Swiss TPH, an international panel of experts evaluated the use of satellite data for the acquisition of an external exposome. Together with biomarkers, these novel methods keep the long-term study SAPALDIA competitive, which has been financed by the Swiss National Science Foundation for more than 25 years. Its fourth phase was completed in 2018.

Society, health systems and health A major focus of EPH’s research is on women. Projects in the Democratic Republic of the Congo and Burundi once again emphasised the

importance of taking social-cultural aspects into account when promoting family planning. Health surveys in the vicinity of a copper mine in Zambia showed that the percentage of births in a health centre of women who tested for HIV could be improved with accompanying measures. A large intervention study in Zambia achieved impressive improvement in early childhood development through support measures for education at the family level. Similar research activities in Peru were recognised in 2018 with the R. Geigy Award.

Infectious diseases Surveys were conducted in various countries on the incidence and distribution of important infectious diseases: intestinal parasites in Nepal, malaria infections in Tanzania, and hepatitis A and Legionella in Switzerland. Work in the field of malaria prevention underlined the continuing efficiency of insecticide-treated nets despite emerging resistances. Framework conditions for the development of new insecticides for indoor mosquito control were developed. With the help of intervention packages and mathematical modelling, researchers in EPH are working to combat infectious diseases, which threaten the health of poorer populations. These include malaria, parasitic worm infections and rabies. In 2018, important studies illustrated which aspects

of the parasite, the drug or the vaccination, the implementation of an intervention or the healthcare system are involved in determining whether a disease can be successfully controlled.

Non-communicable diseases In 2018, researchers at EPH contributed to important findings in the field of chronic lung diseases. They underline the importance of combating obesity and physical inactivity. A survey in Lao PDR revealed a high burden of diabetes, which cannot be explained by common risk factors. This shows the importance of EPH’s research activities on the double burden of communicable and non-communicable diseases on populations in poorer countries.

Strategically strengthening the mental health sector Mental health has an important influence on the development and course of cardiovascular diseases. A longitudinal study on depression in patients with heart disease in Palestine was completed. The alarmingly high rate of depression shows how important it is to integrate mental healthcare into chronic disease care. Comparable projects have therefore been initiated in Switzerland and Kosovo.

Promotions In 2018, important steps were taken for the future of EPH and for the continued successful implementation of major programmes. Sonja Merten habilitated and was elected as the new Head of the Society, Gender and Health unit. She succeeds Elisabeth Zemp Stutz, who retired after many years of successful work. Manuel Hetzel was officially confirmed as the designated successor to Christian Lengeler, Head of the Health Interventions unit and Melissa Penny as the designated successor of Thomas Smith, Head of the Infectious Disease Modelling unit.

Swiss Tropical and Public Health Institute

Committees & Departments

Medicine Head: Daniel Paris

The Department of Medicine (MED) encompasses the “Swiss Center of Excellence for Travel and Tropical Medicine”, the “National Diagnostic Reference Centre for Imported Parasitic Diseases” and an expanding centre for clinical translational research. MED provides clinical services and research, which promotes synergistic interactions between clinical, diagnostic and research personnel in the field of application, validation and implementation of drugs, diagnostics and vaccines for tropical and poverty-related diseases. Overview and strategic areas 2018 has been a challenging but productive year for MED. The new structure combining clinical services and research in five separate units has proven itself effective. New staff was employed in almost every unit, and the establishment of a department-wide quality management system and a dedicated clinical statistics and data management group has led to multiple cross-cutting interactions within MED and at an institutional level. Recent emphasis on HIV and migration medicine has led to an expansion of these research themes at MED, which operates predominantly in resource-limited settings. MED continues to be active in teaching and training, with numerous courses and updates for travellers’ health, clinical training, diagnostic methodologies in tropical and geographical medicine for health professionals and good clinical practice (GCP) for all academic and non-academic levels. In addition, MED participates in regular lectures and training courses at the University of Basel.

Unit overview The Medical Services unit remains in a prominent position providing pre-travel advice, post-travel clinical care, therapeutic services for patients, as well as consultancies on tropical infectious diseases for medical practitioners and hospitals all over Switzerland. Approximately 15,000 travel and vaccination consultations are provided annually during the travel medical consultation hours, and approximately 1,500 ill-returning travellers are treated annually during the ambulatory consultation hours. In addition, around 200 patients are cared for by primary doctors within the integrated internal practice. The unit is an accredited training centre for physicians training for the medical specialist titles of General Internal Medicine or Infectious and Tropical and Travel Medicine, and contributes to clinical teaching in tropical and travel medicine at various pre- and postgraduate courses and is engaged in clinical

research projects locally and abroad. Recently the establishment of a joint position with the Department of Health, Canton Basel-Landschaft has complemented the unit’s portfolio. The Diagnostic Services unit, which comprises the National Diagnostic Reference Centre for Imported Parasitic Diseases, is nationally and internationally renowned for its expertise in diagnosing human parasitic diseases (EN ISO/IEC 17025 accredited) and annually receives more than 50,000 clinical samples from Switzerland, Europe and beyond. In recent years, the unit’s traditional focus on serology has extended by developing and accrediting molecular diagnostics for a wide range of parasitic and tropical diseases. With the recent integrated molecular genotyping service, the unit is now also progressively extending its services towards research. The Clinical Operations unit consists of a well- established team with international expertise in managing, assisting, conducting and monitoring clinical trials for drugs, diagnostics and vaccines as a contract research organisation. Serving both commercial and academic clients, the unit is strengthened by new quality and data management services and collaborations with pharmaceutical companies, non-governmental organisations and academic institutions. The Clinical Research unit conducts academic clinical trials on new drugs, vaccines and diagnostic products in humans, carries out studies on clinical epidemiology and health services, and performs translational research at the intersection of animal and human health. Currently major efforts on advancing clinical tuberculosis research at MED involve close interactions with MPI and partners from the Ifakara Health Institute (IHI) in Tanzania. The Medicines Implementation Research unit aims to strengthen equitable access to and improve the use of drugs, vaccines and diagnostic

products in humans through the investigation of shortcomings at the scientific, operational and regulatory levels. The unit follows the two main research streams medicine implementation and drug and vaccine safety, which are aligned with the activities of the MED, MPI, EPH and SCIH departments. Together, the clinical research units interact synergistically to provide evaluation, application and validation of innovative and relevant interventions ranging from the Phase I to Phase IV trials and implementation studies.

Promotions and organisational changes In 2018, three MED units underwent a change in leadership. Clinical services is now led by Andreas Neumayr (Chief Medical Officer), diagnostics by Sven Poppert (FAMH) and clinical operations by Elisabeth Reus. Daniel Paris, Head of the Department of Medicine, was appointed Associate Professor for Tropical and Travel Medicine at the University of Basel.

Education and Training Head: Nino Künzli

The Department of Education and Training (ET) coordinates one of the three strategic areas of the institute, namely learning and capacity building. ET delivers classes, courses and programmes at Swiss TPH, the University of Basel and institutes of higher education around the world. This year, ET embraced didactic developments, as well as blended and online learning tools, while the library remained a hot-spot for students and staff alike. The library is a learning and resource centre and supports teaching, learning and research by providing access to electronic and print information for staff members and students. In the library, students can individually learn and exchange. The library staff has been heavily engaged in planning the new learning spaces in the innovative library environment of the new building in Allschwil. The teaching responsibilities in the Medical School were challenged by the continued increase in medical students assigned to the University of Basel. With over 200 students, the attractive courses in public health research (Bachelor year 1) and the visits of psycho-social institutions (Bachelor year 3) consisted of tutored group work for 4–5 students, which required the coordination of around 50 groups of students to provide an attractive learning experience. Some 120 teachers train BSc, MSc and PhD students and offer postgraduate courses to a global community of professionals. ET supervises around 250 MSc, MD, PhD and postgraduate MAS theses. More than 75 % of the 4,800 in-class lecturing hours provided by Swiss TPH staff are also provided to the University of Basel’s BSc, MSc, PhD and postgraduate offers. Despite the expansion of the MSc from 90 to 120 ECTS and the doubling of the in-class lecturing load, Swiss TPH looks back at a smooth and successful teaching record. In addition, 45 postgraduate courses were conducted, covering 295 in-class course days with 698 participants from around the world.

Strategic area highlights To further develop and adapt the portfolio of the professional postgraduate training programmes, regular discussions took place to capitalise on synergies amongst the different offerings and build on institutional strengths. The conclusion was to streamline the educational offers into three main tracks: global public health, administration and management in health, and clinical trainings.

Didactics for the future The roadmap of the Teaching Technology and Didactics unit prioritised the development of internal and external didactic support. The electronic learning platform offers training components around didactics for projects and curriculum development for Swiss TPH staff and external clients, as well as eLearning for important internal topics. Efforts for closer cooperation with partners, especially the University of Basel, TropEd, SSPH+ and the CARTA network in Africa advanced.

Course evaluation cycle for excellence in teaching Under the lead of Marco Waser and Melanie Wirz, ET implemented an agile and standardised evaluation concept for all MSc courses led by Swiss TPH. As a next step, the concept will be scaled up to all courses offered by Swiss TPH. The new model is lean, fast and transparent. With the support of ET, future evaluations will be scheduled in advance. All surveys are organised online using the University of Basel’s tool, EvaSys. Short questionnaires are the annual default

while longer, lecture-specific evaluations will be conducted every three years or upon request. Within 24 hours, teachers and supervisors receive the full analyses. The implementation phase confirmed very high response rates and enthusiastic feedback from teachers for the prompt delivery of results, which assists teachers in discussing issues with students. Teachers can also get needs-based support to further strengthen the teaching.

Organisational changes In light of the development of the University of Basel Graduate School Health Sciences, the coordination of its nucleus – the PhD Program Health Sciences – has moved to Swiss TPH. The internal organisation of PhD tracks at Swiss TPH have been streamlined with Christine Mensch, who now leads the ET PhD student office. Bachelor and Master level courses led by Swiss TPH for the University of Basel Science and Medical Faculty are now coordinated by Pascal Gschwind, who joined ET in 2018. Swiss TPH chairs the Non-African partners of the consortium of African Research training, CARTA. Barbara Bürkin is the contact point, coordinating all Swiss TPH contributions to this PhD and graduate fellowship programme. In 2018, Nino Künzli assembled for the first time the Non-African partners to discuss with the CARTA leaders the future mode of collaboration. The PhD student research commission, coordinated by Marco Waser, now supports the PhD tracking and monitoring work by Rebekka Hirsbrunner from the Library team.

Swiss Tropical and Public Health Institute

Committees & Departments

Swiss Centre for International Health Head: Kaspar Wyss

The Swiss Centre for International Health (SCIH) provides policy advice, project design and management in the area of national, public and global health. Hosting multi-disciplinary teams in Switzerland and around the world, SCIH offers a broad range of services including backstopping, economic evaluations, operations research, organisational capacity assessments and performance monitoring and controlling. Strengthening fragile health systems SCIH supports health systems development in fragile countries with a focus on Africa, Eastern Europe and Central Asia. Expertise of SCIH includes: adolescent health, health promotion and community health, family medicine and integrated care, district management, human resource development, supply chain management, health insurance, and digital health innovations. By improving quality of care and increasing the coverage of health services, SCIH reaches a large number of beneficiaries in countries such as Tanzania, Chad, Albania, Kosovo, Moldova and Tajikistan, amongst others, contributing to the achievement of Universal Health Coverage and the Sustainable Development Goals.

Highlights in 2018 SCIH continued to operate as a trusted partner and implementing agency in long-term mandates for the Swiss, Dutch, German and French governments. In 2018, a new mandate focusing on Medical Education Reform in the Ukraine was entrusted to SCIH by the Swiss Agency for Development and Cooperation (SDC). This mandate allows for strengthening of primary and secondary healthcare services, as well as

quality improvements and increased financial, cultural and geographical accessibility of health services for the population, in particular the most vulnerable. In the area of digital health, ALMANACH (Algorithm for the MANagement of Acute CHildhood illnesses) has shown high potential in improving quality of care for children. In partnership with health authorities and services providers in Nigeria and with the International Committee of the Red Cross (ICRC), ALAMANACH has been rolled out to more than 400 primary healthcare services, thereby making an essential contribution to children’s health. SCIH contributed to the implementation of a community health insurance scheme to informal sector workers and rural populations and developed the Insurance Management Information System (IMIS), which was tested in Tanzania, Nepal, Cameroon, the Democratic Republic of the Congo and Chad. IMIS has shown great success in improving the efficiency and transparency of insurance management and forms the basis of the Global openIMIS Initiative. The initiative is jointly funded by SDC and the German Federal Ministry for

Economic Cooperation and Development (BMZ), and coordinated by the Deutsche Gesellschaft für Internationale Zusammenarbeit (GIZ), which commissioned Swiss TPH and consortia with two new mandates for the initiative in 2018. For the Swiss Federal Office of Public Health, SCIH completed and contributed to various mandates such as an analysis of influenza vaccination practices at cantonal level and outbreak investigations of food-borne disease such as salmonella and listeriosis. The results have allowed for optimisation of influenza prevention, as well as ensuring a timely response to potential disease threats.

Services to the Global Fund, Gavi, the Vaccine Alliance and Unitaid SCIH continued to provide Local Fund Agent (LFA) services to the Global Fund and monitor programme implementation related to HIV/AIDS, tuberculosis and malaria control in 14 portfolios, mainly in Africa and across the Middle East. In addition, SCIH assisted in the programmatic quality assurance and improvement approach of the Global Fund by conducting Health Facility Assessments in Sudan, Côte d’Ivoire, Congo Brazzaville, Niger and Bangladesh, as well as a supply chain assessment in Côte d’Ivoire. On behalf of Gavi, the Vaccine Alliance, SCIH also implemented a monitoring mandate to track the implementation of vaccination activities in Burundi, a technical assistance mandate in Bangladesh to improve immunisation within urban poor, a midterm evaluation of health system strengthening support in Mali, and a review of the contribution of Gavi’s health system investments. On behalf of Unitaid, SCIH conducted external evaluations.

Administration Head: Matthias Schmid-Huberty

The Department of Administration supports the management of Swiss TPH, the heads of departments and units as well as the staff of Swiss TPH with five service units: Finance/ Controlling, Infrastructure, Informatics, Project & Grant Service and Human Resources. The administrative director coordinates the activities of the units and advises the director on strategic, legal and business issues. Administrative management The treaty between the cantons of Basel-Landschaft and Basel-Stadt regarding the joint sponsorship of Swiss TPH was further consolidated in the second year. Matthias Schmid-Huberty became the new Administrative Director at Swiss TPH in January. 2018 was thus marked by getting acquainted with the institute and by consolidation within the administration department. The first efforts made were in leadership, fundraising and travel organisation. The department heads developed a common understanding of leadership, a fundraising concept was drawn up, and the standardisation of travel services was promoted. The analysis in the areas of risk management and internal audit will have an impact in the coming years. The administrative units continued to work on finding a common understanding of service and on the standardisation, simplification and communication of internal support processes.

Finance/Controlling With a turnover of over CHF 86 million, Swiss TPH covered around 78 % of the funds in 2018 from competitively acquired third-party funding from foundations and private or public clients. 22 % of the funds came from core contributions from the public sector, which are based on performance agreements. Almost 60 % of the total expenditure is used for personnel costs. The year under review was marked by the further digitisation of financial processes and the integration and increased activity of the internal audit function. With Vincent Bodenez, the project accounting team was strengthened by the addition of an experienced auditor. International payment transactions and the preparation of financial reports, which must take into account the different rules of our partners, remained challenging.

Infrastructure In addition to the demanding maintenance of the Swiss TPH buildings on Socinstrasse, 2018 also required many efforts on the new building project Belo Horizonte. Following the successful

completion of the preliminary project in June 2018, the focus was on the construction project and planning, which was completed on time with the building application. The employees were heavily involved in various working groups for the successful planning of the new building in Allschwil. Ursina Müller, an experienced facility manager with construction experience, was recruited to head the Infrastructure unit, with the focus on planning for the move in late 2021, and managing Belo Horizonte.

contribution as Grant Manager. In 2018, Swiss TPH implemented the “Leading House for Africa” mandate by the State Secretariat for Education, Research and Innovation (SERI), readily delegated by the University of Basel. Jasmina Saric is responsible for this support function, together with the head of the unit and the director of Swiss TPH. In recent years, the travel safety concept was developed and the associated implementation of guidelines and emergency plans were solidified. In 2018, Alexander Knup took over responsibilities within the directorate.

Informatics The Informatics unit takes care of institutional Information and Communication Technologies (ICT) and Information Technology (IT) support. Several new tools in the area of data acquisition and patient data systems were successfully integrated. Together with the IFKO, a research IT strategy was developed and Claudia Saupper was recruited for the new position “Research IT and Digitalisation”. The network and server availability remained very high at over 99 %. The unit was involved in 121 projects and handled almost 9,000 IT support tickets. The team also prepared the migration to Windows 2010 and rolled out new e-communication tools and hardware. This was accompanied by a constant consolidation of the software portfolio, in which 463 software products were managed and evaluated.

Human Resources 2018 was marked by the consolidation of human resources management and support. Christian Rohland, a proven HR management professional, joined the HR administration team. Support at the strategic human resources management level was strengthened with the development of a career development policy. A paternity leave of two weeks was introduced, and accumulated holidays and overtime could be further reduced. The administration of the various formats of employment contracts with different conditions in the area of social insurance and taxes remains complex. The business partners were involved in over 60 recruitment processes, processing nearly 2,000 applications and supported the management in the implementation of the strategic goals.

Project & Grant Service The Project & Grant Service unit (PGSU) maintains close contact with donor organisations and supports project managers in preparing project proposals in cooperation with external partners. Project proposals originating from Swiss TPH are harmonised and continuously improved. The unit is also responsible for contract management of all project contracts, and contributes to institutional quality development. PGSU activities were expanded to include the grant management of collaborative projects. It is therefore gratifying to note that a major EU multi-partner project was secured in 2018, with Swiss TPH acting as the consortium leader. Miriam Bolz made a significant

Swiss Tropical and Public Health Institute

“Swiss TPH provided me with an environment that nurtured my curiosity in health systems. I enjoyed working on my thesis with the support of experts and colleagues who provided international perspectives. I look forward to using the lessons from my studies on decentralisation to improve health sector governance in my home country of the Philippines and other settings.” Harvy Joy Liwanag, PhD Graduate, Swiss TPH 54

Finances Funding 2018

Funding 2017 Mio CHF

Core funding

Mio CHF

Core funding

University of Basel

6,9

University of Basel

7,1

National Government

7,5

National Government

7,8

Canton Basel-Landschaft

3,6

Canton Basel-Landschaft

3,6

Canton Basel-Stadt (Swisslos-Fonds) Canton Basel-Stadt Subtotal

1,6 2,0 21,6

Canton Basel-Stadt (Swisslos-Fonds) Canton Basel-Stadt Subtotal

1,6 2,0 22,1

Deferred income New Building Belo Horizonte

–2,5

Deferred income New Building Belo Horizonte

–3,2

Total core funding

19,1

Total core funding

18,9

22,0%

Competitively acquired funds

22,0%

Competitively acquired funds

Research (e.g. SNSF and EU)

24,6

28,4%

Research (e.g. SNSF and EU)

26,1

30,4%

Services (e.g. SDC, Global Fund and BMGF) Education and Training (e.g. Postgraduate courses) Medical Services (e.g. Travel medicine & Diagnostics) Other income Total competitively aquired funds

33,6 2,1 4,8 2,4 67,5

38,8% 2,5% 5,6% 2,7% 78,0%

Services (e.g. SDC, Global Fund and BMGF) Education and Training (e.g. Postgraduate courses) Medical Services (e.g. Travel medicine & Diagnostics) Other income Total competitively aquired funds

31,6 2,3 4,5 2,3 66,8

36,9% 2,7% 5,3% 2,7% 78,0%

Total

86,6

100%

Total

85,7

100%

Competitively acquired

Core contributions

Competitively acquired

Core contributions

78,0 %

22,0 %

78,0 %

22,0 %

Other income

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

Medical Services (e.g. Travel medicine & Diagnostics) Core funding

Education and Training (e.g. Postgraduate courses)

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

CHF 86,6 Mio.

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

Research (e.g. SNSF and EU)

Core funding

Education and Training (e.g. Postgraduate courses)

CHF 85,7 Mio.

Research (e.g. SNSF and EU)

Swiss Tropical and Public Health Institute

Finances

Annual Accounts Income Statement Income Self-managed income Core funding from national and local governement Other operating income Change in unbilled services Total income Expenditure Personnel expenses Material expenses Depreciation of tangible assets Amortisation of intangible assets Administrative expenses Other operating expenses Total expenditure Operating result

2018 in 1000 CHF

2017 in 1000 CHF

65 282 19 137 2 337 –141 86 615

75,4 % 22,1 % 2,7 % –0,2 % 100 %

64 104 18 900 2 268 472 85 744

74,8 % 22,0 % 2,6 % 0,6 % 100 %

–50 241 –3 763 –1 345 –325 –4 500 –26 775 –86 949 –334

57,8 % 4,3 % 1,5 % 0,4 % 5,2 % 30,8 % 100 %

–52 916 –3 960 –1 322 –307 –4 379 –22 318 –85 202 542

62,1 % 4,6 % 1,6 % 0,4 % 5,1 % 26,2 % 100 %

Financial result Ordinary result

72 –262

–190 352

Extraordinary result Overall results

0 –262

0 352

2018 in 1000 CHF

2017 in 1000 CHF

Balance Assets Cash and cash equivalents Receivables Prepayments and accrued income Inventories Total current assets

23 905 17 819 6 168 212 48 104

42,2 % 31,4 % 10,9 % 0,4 % 84,9 %

23 435 16 823 5 096 115 45 469

41,7 % 29,9 % 9,1 % 0,2 % 80,9 %

8 573 8 573

15,1 % 15,1 %

10 743 10 743

19,1 % 19,1 %

Total assets

56 677

100 %

56 212

100 %

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

2 649 880 35 953 1 217 40 699

4,7 % 1,6 % 63,4 % 2,1 % 71,8 %

3 077 1 490 36 335 1 618 42 520

5,5 % 2,7 % 64,6 % 2,9 % 75,7 %

435 1 500 1 698 5 700 9 333

0,8 % 2,6 % 2,9 % 10,1 % 16,5 %

432 1 500 1 652 3 200 6 784

0,8 % 2,7 % 2,9 % 5,7 % 12,1 %

6 645 56 677

11,7 % 100,0 %

6 908 56 212

12,2 % 100,0 %

Non-current assets Total non-current assets

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

Financial statements established in accordance with Swiss GAAP FER

Swiss Tropical and Public Health Institute

Finances

Funding Partners and Clients Core Funding

Public Clients Switzerland

Canton Basel-Stadt, CH

Amt für Ausbildungsbeiträge Basel-Stadt, CH

Canton Basel-Stadt (Swisslos-Fonds), CH

Amt für Umwelt und Energie Basel-Stadt, CH

Canton Basel-Landschaft, CH

Bundesamt für Sport (BASPO), CH

University of Basel, CH

Federal Department of Defence, Civil Protection and Sport (DDPS), CH

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

Federal Food Safety and Veterinary Office (FSVO) Federal Office for the Environment (FOEN), CH Federal Office of Public Health (FOPH), CH

Research Funding EU research grants (e.g. ERC, Horizon 2020, etc.) University of Basel, CH State Secretariat for Education, Research and Innovation (SERI), CH Swiss National Science Foundation (SNSF), CH Commission for Technology and Innovation (CTI), CH

Federal Statisical Office (FSO), CH Finanzverwaltung Kanton Bern, CH Gesundheitsförderung Schweiz, CH Kantonale Verwaltung Basel-Landschaft, CH Kantonsspital Basel-Landschaft, CH Regio Basiliensis, CH SUVA, CH Swiss Agency for Development and Cooperation (SDC), CH Swiss Federal Laboratories for Materials Science and Technology (EMPA), CH Swiss Network for International Studies (SNIS), CH

Foundations

Volkswirtschafts- und Gesundheitsdirektion, Basel-Landschaft, CH

Bill & Melinda Gates Foundation (BMGF), US CDC Foundation, US Clinton Health Access Initiative (CHAI), US Cordaid, NL Forlen Stiftung, CH Fondation Botnar, CH Fondation Pasteur Suisse, CH Freiwillige Akademische Gesellschaft (FAG), CH Gemeinnützige Stiftung Symphasis, CH Gottfried und Julia Bangerter-Rhyner Stiftung, CH Hella-Langer-Stiftung, DE Janggen-Pöhn Stiftung, CH Medicor Foundation, LI Medicus Mundi Schweiz (MMS), CH Novartis Foundation, CH R. Geigy-Stiftung, CH Sight and Life Foundation, CH Stanley Thomas Johnson Foundation, CH Stiftung für Infektiologie beider Basel, CH Stiftung für wissenschaftliche Forschung (SWF), CH Stiftung pro REHAB Basel, CH UBS Optimus Foundation, CH Uniscientia Stiftung, LI Verein für Studentisches Wohnen (WoVe), CH Vontobel-Stiftung, CH Walter Fischli-Stiftung, CH Wolfermann-Nägeli-Stiftung, CH

Public and Public-private Clients International Agence nationale de sécurité sanitaire de l’alimentation, de l’environnement et du travail (ANSES), FR Deutsche Gesellschaft für Internationale Zusammenarbeit (GIZ), DE Drugs for Neglected Diseases initiative (DNDi), CH Foundation for Innovative New Diagnostics (FIND), CH Gavi, the Vaccine Alliance, CH Global Alliance for Livestock, UK Global Alliance for TB Drug Development (TB Alliance), US Global Fund to Fight AIDS, Tuberculosis and Malaria, CH International AIDS Society, CH International Committee of the Red Cross (ICRC), CH Kreditanstalt für Wiederaufbau (KfW), DE Medical Care Development International, US Medicines for Malaria Venture (MMV), CH Natural History Museum, UK PATH, US United Nations Children’s Fund (UNICEF), US United States Agency for International Development (USAID), US Science for Global Development (NWO-WOTRO), NL World Health Organization (WHO), CH World Bank, US

Private Clients

Academic Partners

Ares Trading S.A., CH

Bernhard Nocht Institut für Tropenmedizin (BNI), DE

Médecins Sans Frontières (MSF), CH

Biozentrum der Universität Basel, CH

Bacoba AG, CH

Centre de Support en Santé Internationale (CSSI), TD

BASF, DE

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

BEPHA, CM

Consortium pour la Recherche Economique et Sociale (CRES), SEN

CARE, CD

École polytechnique fédérale de Lausanne (EPFL), CH

GFA Consulting Group, DE

Eidgenössische Technische Hochschule Zürich (ETHZ), CH

GlaxoSmithKline (GSK), UK

Fundacio Privada Institut de Salut, ES

International Confederation of Midwives, NL

Ghent University, BE

Janssen Diagnostics, CH

Harvard T.H. Chan School of Public Health, US

Karger AG, CH

Ifakara Health Institute (IHI), TZ

Krebsliga, CH

Imperial College London, UK

Lungenliga beider Basel, CH

Insel Gruppe AG, CH

Lygature, NL

Institute for Research in Biomedicine, CH

Merck KGaA, DE

Institute of Nursing Science, University of Basel, CH

Novartis Institute for Tropical Diseases (NITD), US

L’Institut de Recherche en Elevage pour le Développement, TD

Novartis Institutes for BioMedical Research (NIBR), US

Johns Hopkins University, US

Novartis Pharma AG, CH

Liverpool School of Tropical Medicine, UK

Population Services International (PSI), US

Roll Back Malaria Partnership (RBM), CH

Rimas Insurance-Broker AG, CH

Sanaria Inc., US

Rotarians Against Malaria (RAM), AUS

Scuola universitaria professionale della Svizzera italiana (SUPSI), CH

Skat Consulting Ltd., CH

Swiss Biobanking Platform, CH

Straumann, CH

Swiss School of Public Health (SSPH+), CH

Swisscom AG, CH

University Children’s Hospital Basel (UKBB), CH

Syngenta Crop Protection, CH

University Hospital Basel, CH

Thrasher Research Fund, US

University of Bern, CH

Verfora SA, CH

University of Calabar Teaching Hospital, NG

Vital Strategies, US

University of Cambridge, UK

Wiley & Sons, US

University of Cape Town, SA University of Georgia, US University of Lucerne, CH University of Melbourne, AU University of Nebraska, US University of Oxford, UK University of Toronto, CAN University of Utrecht, NL University of Warwick, UK University of Washington, US University of Zurich, CH The list shows Swiss TPH third-party funding partners making contributions of CHF 20,000 or more.

Swiss Tropical and Public Health Institute

Socinstrasse 57, P.O. Box, 4002 Basel, Switzerland +41 (0)61 284 84 11 www.swisstph.ch

Imprint Texts and edits: Danielle Powell, Lukas Meier, Sabina Beatrice-Matter Additional contributions: Jürg Utzinger, Department Heads Proofreading: Doris Tranter Layout and design: rheinblau kommunikation ag, Basel Pictures: Olivier Brandenberg, Christian Flierl, gravitytank, HAP Albania, Christian Heuss, Sameer Kermalli, Joachim Pelikan, Roland Schmid, Thomas Schuppisser, Erik van Twillert, Hubert Vuagnat and Swiss TPH staff Cover picture: Joachim Pelikan Printing: Werner Druck & Medien AG

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Swiss Tropical and Public Health Institute