Leanne J. Robinson

Long-standing global partnerships, critical for protecting the health of human beings and the planet we share, are under attack in 2025. Around the world, a pendulum swing towards nationalism and populism [1] has threatened to destroy international scientific collaborations that took decades to build. Globally, the rise of hard-right extremism jeopardizes fragile structures established to protect the health and human rights of people everywhere [2]. The chaos of haphazard disruption, devoid of accountability, normalizes a lack of perceived responsibility for our fellow human beings [3]. Reckless global socio-political shifts hurt all of us, as citizens of one world, sharing its limited resources and facing common threats of diseases that respect neither borders nor executive orders [4,5]. As scientists and global health advocates, we have dedicated our careers (and much of our lives) to developing and testing innovative solutions that anticipate, prevent, manage and eliminate serious threats to the health of our global community. Our new reality drives us to continue our work. We are accustomed to challenges and recognize their capacity to strengthen our vision for the future. We have learned important lessons, over decades of combined experience and we have joined forces, across the globe, to communicate these broadly [6]. We believe that long-term, trusting, resilient global partnerships have the potential to carry our global community through crises. If the global health community is to weather the current storm, we must rebuild, restore and reinforce our critically important bridges of collaboration, by tethering them to a set of solid, tested foundations [6], summarized here and illustrated in Fig 1.

Background: Immunization coverage varies across Papua New Guinea. In East New Britain (ENB) Province in 2022, only 65.5% and 50.2% of children under one year received their first dose of pentavalent (DTP1) and measles-rubella (MR1) vaccine, respectively. This study aimed to examine barriers and enablers to routine immunization in areas of un(der)-vaccination in ENB. Methods: A face-to-face survey was conducted with caregivers of children aged 12-23 months in ENB. We used Poisson regression to calculate incidence rate ratios (IRR) and 95% confidence intervals (95% CI) for factors associated with timely receipt of DTP1 or MR1 vaccines, defined as a child who was vaccinated between -2 and +30 days of the vaccine schedule. Delayed receipt is defined as a child who was vaccinated >30 days from the recommended due date. Results: Among 237 caregivers surveyed, 59.9% of children were vaccinated within the "timely" window for DTP1 and 34.1% for MR1. Timely DTP1 receipt was associated with a facility-based birth (IRR:1.93; 95% CI: 1.10-3.38) and trusting healthcare workers "very much", compared to "a little or moderately" (IRR:1.53; 95% CI: 1.17-1.99). For MR1, the caregiver having completed tertiary/vocational education (IRR:1.79; 95% CI: 1.15-2.78), reporting taking a child to be vaccinated is affordable (IRR:1.52; 95% CI: 1.04-2.22), and healthcare workers explaining immunization services and answering associated questions (IRR:1.68; 95% CI: 1.18-2.41) were associated with timely vaccination. Conclusions: Activities to improve timely vaccination in ENB could include strengthening healthcare worker interpersonal communication skills to optimize trust and incentivizing women to give birth in a health facility.

Cambodia is targeting malaria elimination by 2025, aligning with the WHO's Mekong Malaria Elimination program. While elimination of Plasmodium falciparum is nearly achieved, Plasmodium vivax elimination presents challenges inherent to this species due to the occurrence of dormant parasite stages, known as hypnozoites. A new approach has been proposed to serologically identify individuals likely carrying hypnozoites that should receive appropriate antimalarial treatment: P. vivax serological testing and treatment (PvSeroTAT). This study aims to determine the technical feasibility of a PvSeroTAT approach in malaria endemic communities with highly mobile populations in Eastern Cambodia. From October 24th 2021 to February 26th 2023, two successive rounds of PvSeroTAT were conducted in adult and adolescent males in three villages of Mondolkiri, Eastern Cambodia. At each round, capillary blood samples were collected from consenting participants to be used for P. vivax serology and G6PD activity determination. Seropositive participants, who were G6PD normal, were then recontacted to be provided an anti-hypnozoite primaquine regimen following Cambodian treatment guidelines (0.25 mg/kg for 14 days). Cross-sectional surveys to evaluate P. vivax prevalence were conducted before, during and after the PvSeroTAT interventions in the same three villages and in three additional neighboring control villages where interventions were not implemented. Participation was high, with 96% (456/477) of eligible individuals enrolled in at least one round of PvSeroTAT. However, only 63% of participants enrolled in the first PvSeroTAT round agreed to participate in the second round. In the first and second round of PvSeroTAT, 31% (101/327) and 30% (98/334) of enrolled participants, respectively, were seropositive and among those, 82% (163/199) were eligible for primaquine treatment. All 163 seropositive eligible individuals could be recontacted and offered a primaquine treatment, this occurred within 10 days for 96% of individuals (157/163). P. vivax prevalence decreased in all villages, including the control ones, after the first round of PvSeroTAT from 7.7% to 2.7% overall. The participation rates and overall technical feasibility of PvSeroTAT in highly mobile individuals living within communities in malaria endemic areas of Cambodia were very promising. PvSeroTAT with a lab-based assay is feasible in Cambodia even if it is logistically more challenging than using point-of-care assays. Further studies to understand community perspectives about test and treat approaches in the absence of clinical symptoms will be important for the development of tailored community education and awareness material to improve participation in multiple rounds of test and treat interventions. The PvSeroTAT interventions received funding from the Global Fund RAI3 initiative. Cross-sectional surveys were funded by the NIH International Centers of Excellence for Malaria Research (ICEMR) Asia-Pacific (U19AI129392).

International public health surveillance and timely response cannot exist without strengthened local surveillance and response systems. Supporting front-line healthcare workers to embed the use of innovative electronic health information systems into adaptable and sustainable processes within their contexts is essential for response to ongoing vector-borne diseases (VBDs) and emerging infectious diseases in resource-constrained settings such as Papua New Guinea (PNG). Baseline health service assessments were conducted at eight provinces to inform the implementation of the STRIVE-Tupaia platform. The STRIVE-Tupaia platform is an innovative electronic real-time data aggregation platform in PNG where healthcare workers are able to review, interpret and respond to febrile illness, molecular diagnostic and vector surveillance data to support evidence-based decision making. Baseline health service assessments involved semi-structured interviews and structured observations of facility procedures. Quantitative data were analyzed using Microsoft Excel, while the qualitative data were thematically coded in NVivo12 (QSR International Pty Ltd). A deductive analysis focussed on the health systems barriers and enablers using the WHO's seven component health systems framework. An inductive analysis explored these impacts for vector-borne disease services specifically. Results indicated barriers to VBD reporting, notification and response including limited training, infrastructure challenges, overstretched workforce and limited governance support. Key learnings from STRIVE's baseline health facility assessments have been used to inform the implementation of the STRIVE-Tupaia platform and improve health care workers routine reporting, notification and response to vector-borne diseases in Papua New Guinea.

Objective: Although the incidence of malaria is increased in women in endemic areas after delivery compared to non-pregnant women, no studies have assessed the benefit of presumptive antimalarial treatment given postpartum. Methods: A randomised controlled trial investigating the efficacy of antimalarial treatment in preventing postpartum malaria was performed in healthy Papua New Guinea mothers immediately following delivery. Participants were randomised 1:1 to no treatment (n = 90) or artemisinin combination therapy (ACT), with further 1:1 ACT randomisation to artemether-lumefantrine (AL; n = 45) or dihydroartemisinin-piperaquine (DP; n = 45). Standardised reviews were conducted monthly for 6 months, including clinical assessment, malaria screening and haemoglobin measurement. The primary endpoint was incidence of slide-positive malaria within 6 months of delivery. Results: Of 183 recruited participants, 151 completed study procedures and were included in per-protocol analyses (no treatment n = 71, AL n = 40, DP, n = 40). Those allocated to ACT were significantly less likely to develop slide-positive malaria during the 6-month follow-up period compared to those who were untreated (n = 17 (21%) vs n = 27 (38%); P = 0.016; hazard ratio 0.49 (95% confidence intervals 0.27-0.90). There was no significant difference in malaria incidence between the two ACT groups. Conclusions: A treatment course of ACT at time of delivery halved the incidence of malaria infection during the first 6-month postpartum.

Community Studies to Monitor the Impact of Triple Drug Therapy Relative to Double Drug Therapy on Lymphatic Filariasis Infection Indicators