2025-26 Project (McCreesh & Clark & White)

Effect of heterogeneity in vaccine hesitancy on the impact of tuberculosis vaccines in South Africa

SUPERVISORY TEAM

Supervisor

Dr Nicky McCreesh at LSHTM
Email: nicky.mccreesh@lshtm.ac.uk

Co-Supervisor

Dr Rebecca Clark at LSHTM
Email: rebecca.clark@lshtm.ac.uk

Co-Supervisor

Prof Richard White at LSHTM
Email: richard.white@lshtm.ac.uk

PROJECT SUMMARY

Project Summary

Novel TB vaccines are in late-stage trials, and optimistically may be licenced and rolled out by 2030. Assuming 50% efficacy in preventing disease, a vaccine could potentially avert up to 1.2 million TB cases in South Africa by 2050. However, vaccine hesitancy may reduce the impact of novel TB vaccines on the TB burden, and hesitancy may be higher in some key risk groups.   

The student will use DHS data from South Africa to investigate risk factors for TB vaccine hesitancy, and clustering of vaccine hesitancy by household. They will develop a mathematical model of TB in South Africa, and use it to investigate how associations between TB risk factors and vaccine hesitancy may affect reductions in TB incidence achieved through vaccination, and how clustering of vaccine hesitancy by household may affect patterns of transmission and the impact of household screening.

Project Key Words

Tuberculosis, mathematical modelling, vaccine hesitancy, South Africa

MRC LID Themes

  1. Infectious Disease
  2. Global Health
  3. Health Data Science

Skills

MRC Core Skills

  1. Quantitative skills
  2. Interdisciplinary skills

Skills we expect a student to develop/acquire whilst pursuing this project

The student will develop or improve their skills in quantitative data analysis and mathematical modelling. They will also develop an understanding of TB epidemiology and vaccine hesitancy

Routes

Which route/s are available with this project?

  • 1+4 = Yes
  • +4 = Yes

Possible Master’s programme options identified by supervisory team for 1+4 applicants:

  • LSHTM – MSc Epidemiology
  • LSHTM – MSc Health Data Science
  • LSHTM – MSc Medical Statistics

Full-time/Part-time Study

Is this project available for full-time study? Yes
Is this project available for part-time study? Yes

Location & Travel

Students funded through MRC LID are expected to work on site at their primary institution, meeting – at the minimum – the institutional research degree regulations and expectations. Students may also be required to travel for conferences (up to 3 over the duration of the studentship), and for any required training (for research degree study). Other travel expectations and opportunities highlighted by the supervisory team are noted below.

Primary location for duration of this research degree: LSHTM, London

Travel requirements for this project: Travel for conferences and training courses only

Eligibility/Requirements

Particular prior educational requirements for a student undertaking this project

  • Minimum LSHTM institutional eligibility criteria for doctoral study.
  • We would normally expect applicants to have a Master’s in a quantitative field, e.g. epidemiology, statistics, maths, computing. Applicants with a Master’s in a public health related field and evidence of good quantitative skills will also be considered, as will applicants with a good BSc in a quantitative field. We may recommend that some applicants apply for a 1+4 studentship

Other useful information

  • Potential Industrial CASE (iCASE) conversion? = No

PROJECT IN MORE DETAIL

Scientific description of this research project

Tuberculosis is a leading cause of death in South Africa, killing an estimated 54K people in 2022. New TB vaccines are in trials, and could be introduced by 2030. Mathematical modelling estimated that a 50% efficacy vaccine preventing disease in Mtb-infected participants could avert 1.56m cases in South Africa by 2050.   

Vaccine hesitancy is thought to be an increasing problem in South Africa, potentially reducing the impact of vaccination programmes. Surveys of attitudes towards COVID vaccines have shown that vaccine acceptance was lower in men and higher in people with lower levels of education-groups at increased TB risk. It is unclear whether the same relationships will hold for novel TB vaccines, or what the impact of varying levels of hesitancy in different risk groups will be on reductions in TB.   

One way to improve TB detection is household case finding-screening household members of people diagnosed with TB. It can have a high yield, but limited impact on TB incidence, due to high community transmission. Introduction of TB vaccines may change transmission patterns, with clustering of hesitancy by household leading to an increased proportion of TB resulting from household transmission. This could increase the impact of household case finding, making it an important intervention to mitigate some effects of vaccine hesitancy.   

The aim of this project is to investigate the impact of heterogeneity in TB vaccine hesitancy on the potential impact of TB vaccination in South Africa. Applicants are encouraged to develop the project in line with their interests, however we propose three potential objectives.   

Project objectives:   

Objective 1: Investigate factors related to vaccine hesitancy and household clustering of hesitancy in the South Africa. The 2026 South African Demographic and Health surveillance survey will contain questions on TB vaccine acceptability, providing valuable data on hesitancy, including risk factors and household clustering. The student will analyse this data, investigating factors related to hesitancy and household clustering of hesitancy.   

Objective 2: Investigate the effect of vaccine hesitancy on the potential impact of TB vaccination in South Africa.  The student will develop an individual-based model of TB in South Africa. TB risk factors associated with hesitancy will be explicitly modelled. Vaccine roll-out will be simulated, with no vaccine hesitancy, with equivalent hesitancy levels in all groups, and with heterogeneity in hesitancy by risk group, and projected reductions in TB compared. The student will also investigate how the relative risk of TB in different risk groups may change following vaccine introduction.   

Objective 3: Investigate the impact of interactions between vaccination and household case finding on reductions in TB incidence achieved by each intervention approach  The student will adapt the model to explicitly simulate household and community transmission, and clustering of risk factors and hesitancy by household. Four scenarios will be simulated: no intervention, vaccination only, household case finding only, and both interventions. The impact of interventions individually and in combination will be estimated.   

Techniques to be used: Quantitative data analysis and mathematical modelling  Confirmed availability of any required databases or specialist materials: The study will use publicly available data only. 

Potential risks to the project and plans for their mitigation: DHS data not available in time. Use alternative sources

Further reading

Relevant preprints and/or open access articles:
(DOI = Digital Object Identifier)

Additional information from the supervisory team

The supervisory team has provided a recording for prospective applicants who are interested in their project. This recording should be watched before any discussions begin with the supervisory team.

McCreesh-Clark-White recording

MRC LID LINKS

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