Kōkiri Marae hosted an all-day hui to launch the SYMBIOTIC Programme, a five-year research programme that focuses on finding ways of reducing the burden of infectious diseases, long-term conditions, and poverty in Aotearoa New Zealand.
Professor Michael Baker is Director of this new Health Research Council-funded programme which is based at the University of Otago, Wellington. He says the programme aims to make the 2020s the “decade of elimination”.
“The successful elimination of COVID-19 transmission in Aotearoa New Zealand has shown us the value of aiming high. With good science and good leadership, tough challenges that previously were thought to be impossible are now within our reach,” Professor Baker says.
Deputy Director Dr Amanda Kvalsvig also emphasised lessons learned from COVID-19. “The programme was developed long before 2020, but COVID-19 is an outstanding example of a syndemic. Syndemics link infectious diseases, long-term conditions, and inequalities together to create a perfect storm. Trying to solve these issues one by one can never be fully effective,” Dr Kvalsvig says.
Instead, the team aims to break these destructive cycles by taking an integrated, whānau-centred approach. A senior Māori researcher in the group, Andrew Waa, says a key strength of the programme is the potential for innovative strengths-based solutions that combine syndemic approaches with Māori models of health.
“Grounding the research within Māori experiences will help identify solutions for how infectious diseases and long-term conditions can be better managed by and with Māori communities,” Mr Waa says.
Cheryl Davies, another senior Māori researcher in the group, and her colleagues are already beginning the conversations with community providers that will ensure that whānau ora approaches are enhanced, valued, and enabled throughout the programme. The values framework of the Tākiri Mai Te Ata Whānau Ora Collective – which includes both Kōkiri and Tu Kotahi – will provide a foundation for this work. “The whakatauki in the framework is especially relevant to our relationship: ‘Me mahi tahi tātau, ka ora ai te iwi. Working together as one’”, Ms Davies says.
About the research
Infectious and non-infectious health conditions are linked in multiple ways. Many infectious diseases cause non-infectious complications in later life; prevention or elimination of the infectious disease will also prevent these other complications. For example, infection with the bacteria Helicobacter pylori is the leading cause of stomach cancer; so elimination of H. pylori infection will not only treat the infection, it will also be cancer-preventing. One aim of the SYMBIOTIC Programme is to generate key evidence to guide effective screening and treatment of H.pylori infection in the populations most at risk, with particular benefit for Māori and Pasifika.
The cycle also works the other way. Having multiple long-term conditions is an important risk factor for infectious conditions, such as influenza. An integrated approach to those with multiple conditions can identify strategies to keep them well and protect them from the consequences of serious infections.
In addition to the above examples, there is a growing list of infections that can be eliminated in our populations, with potentially enormous benefits for health and wellbeing across the life course. Tuberculosis and Hepatitis C are two examples of serious infections that can be eliminated from Aotearoa in the next few years with suitable science-informed leadership and adequately-resourced public health programmes; there are many others.
“Understanding the connections between infectious diseases, long-term conditions, and disadvantage is just the start,” says Professor Baker.
“An important strength of the SYMBIOTIC Programme is that the research is linked to action both in the community and at a policy level.”
The programme supports multiple collaborations with other researchers and institutions, including Massey and Auckland Universities. There are also strong links with end-users and next-users of the research including the Ministry of Health, primary health organisations and communities.
Commitment to Māori health advancement is central to the programme. Examples of this commitment in action include: upholding Te Tiriti in the design and conduct of research, leadership by Māori researchers, supporting emerging Māori researchers, and working alongside communities and providers using strengths-based approaches.
More about the SYMBIOTIC Programme:
Five-year HRC programme, $5 million funding; based at the University of Otago Wellington.
Prof Michael Baker is the Director; Dr Amanda Kvalsvig is the Deputy Director.
Summary: SYMBIOTIC is a large programme of research with seven separate but related projects that will use a syndemic approach to identify and quantify the linked effects of infectious diseases, long-term conditions and structural inequalities. The programme has deliberately focused on preventable health issues that impose a high burden on Māori whānau. We will use New Zealand’s unique health data and indigenous knowledge to generate new evidence of national and international importance, and anticipate that the findings will be able to be applied to a broad range of syndemics, not only those studied in SYMBIOTIC.
SYMBIOTIC stands for “Syndemic Management of the Biology and Treatment of Infections and Chronic conditions”.
A syndemic is the aggregation of two or more diseases in a person or a population that interact and amplify disease outcomes. For example, we know that the relationship between infectious diseases (ID) and long-term conditions (LTC) works in both directions and is impacted by inequity, with profound consequences for whānau health. The COVID-19 pandemic has been described as a syndemic because the risks are patterned in exactly this way.
Rheumatic fever is a good example of a syndemic as it is caused by exposure to an infection (group A streptococcus bacteria infection of the throat or skin) and results in rheumatic heart disease, a long-term condition. Disease risk is also strongly associated with poverty and poor housing. The syndemic programme aims to link to work on rheumatic fever that is also being led by Prof Michael Baker at the University of Otago, Wellington.