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SYMBIOTIC: Integrated prevention of infectious diseases and long-term conditions

The SYMBIOTIC research programme addresses the need for a more effective response to the clustering of health problems in our populations.

About SYMBIOTIC

A 'syndemic' is the aggregation of two or more diseases in a person or a population that interact and amplify disease outcomes. For example the relationship between infectious diseases (IDs) and long-term conditions (LTCs) works in both directions and are impacted by inequity, with profound consequences for whānau health.

The Syndemic Management of the Biology and Treatment of Infections and Chronic conditions (SYMBIOTIC) programme addresses this key challenge for health and wellbeing.

SYMBIOTIC tohu (logo) and whakamarama (explanation)

Symbiotic research programme logo A logo has been developed for SYMBIOTIC by John Kingi, Kōkiri Marae Hauora, as part of their aspirations for this research project. The logo’s whakamarama (explanation) provided by John is:

The blue continuous kōwhaiwhai (scroll pattern) represents the multiple services working together to support the delivery of whānau-centred care (researchers, primary health, Māori health providers).

Whero (red) / toto (blood) represents whakapapa, improving the health of people. People are the driving force and focus of change. Services assist people to change, positively or negatively.

The brown border represents Ngāi Māori!

The niho (teeth) represent the continuation of whakapapa, resilience and that tikanga / kawa are our strength and at the heart of wellness. The niho also show the connection of the multiple health and wellness issues that Māori suffer from on a daily basis (the SYMBIOTIC kaupapa) thus the design appears shadowed and overlays the main design. It is a reality that our people know all too well.

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Our people

Professor Michael Baker (Principal Investigator) and Dr Amanda Kvalsvig (Lead Researcher) lead the SYMBIOTIC programme at the Department of Public Health, University of Otago, Wellington.

We are working in partnership with communities, practitioners, Māori health providers, and policymakers. Our longstanding research partnership with Kōkiri Marae is integral to the Programme.

Professor Michael Baker

Michael Baker image

Email michael.baker@otago.ac.nz

Dr Amanda Kvalsvig

Amanda Kvalsvig image

Email amanda.kvalsvig@otago.ac.nz

Dr Virginia Signal

Virginia Signal image

Email virginia.signal@otago.ac.nz

Julie Cooper

Julie Cooper image

Email julie.cooper@otago.ac.nz

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SYMBIOTIC research programme

SYMBIOTIC is a large programme of research that will use a syndemic approach to identify and quantify the linked effects of IDs, LTCs, 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 the SYMBIOTIC programme.

View Hon Dr Ayesha Verrall's message officially launching the SYMBIOTIC programme and more about the launch event at Kokiri marae.

Programme framework

The SYMBIOTIC programme hypothesises a range of interrelationships between IDs and LTCs, with three major areas of interest: 

  • Autoimmunity, inflammation, and carcinogenesis
  • Effects of antibiotic treatment
  • Immune suppression

The programme has four major components: 

  1. Whānau ora approach to syndemics (potential intervention points include prevention, vaccination, screening and treatment, antibiotic stewardship and management of LTCs)
  2. Quantifying the links between infectious diseases and long-term conditions
  3. Managing the infectious disease risk of multimorbidity
  4. Endgame strategies for infectious diseases causing long-term conditions

Programme approach

  • Codesign a community partnership approach to explore how syndemics research can be applied within a whānau ora framework and to identify policy and primary care solutions to syndemics that are culturally located, whānau-centred and equity-promoting.
  • Analyse linked data to identify and quantify syndemic pathways to both use and further develop NZ’s rich data environment. We will examine potential novel associations of early life exposures with LTCs (e.g. antibiotic prescribing using the IDI) and quantify the amplifying effect of inequities and clustered conditions.
  • Collect and synthesise evidence based on interviews and testing of clinical samples from members of the community to guide design of a national screening programme for H. pylori infection and other activities to reduce the burden of stomach cancer among whānau Māori.
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SYMBIOTIC aims and projects

Named researchers are from the University of Otago, Wellington, unless otherwise indicated.

Aim 1: To integrate syndemics research into a whānau ora framework

Reducing the effects of poverty and discrimination

To identify whānau-level factors that enable or block syndemics, and determine how a whānau-centred approach to syndemics of IDs and LTCs can reduce the effects of poverty and discrimination.

Co-lead: Cheryl Davies, (also Kōkiri Marae) and Anaru Waa
Team: Carmen Timu-Parata, Takari Mai Collective, and Te Awakairangi Health Network

Aligning primary care services with Whānau Ora

To identify how primary care services could be more strongly orientated towards Whānau Ora to reduce the syndemic effects of IDs and LTCs and improve access to care.

Co-lead: Cheryl Davies, (also Kōkiri Marae) and Anaru Waa
Team: Carmen Timu-Parata, Takari Mai Collective, and Te Awakairangi Health Network

Estimating impacts to aid prioritisation

To produce integrated estimates of the impact of IDs and associated LTCs on hospitalisations, mortality, health inequities, and health care costs in NZ, to guide prioritisation decisions.

Lead: Michael Baker

Aim 2: To quantify the links between IDs and LTCs with a high public health burden

Assessing associations between gastroenteritis and subsequent illness

To assess the association between acute gastroenteritis caused by a range of common pathogens and subsequent illness, notably Guillain-Barré syndrome (GBS), inflammatory bowel disease (IBD), hospitalisations, and mortality in the subsequent year.

Lead: Andrew Day
Team: Jonathan Kennedy , Sheree Gibb

Antibiotic use and childhood conditions

To assess the association between antibiotic use and subsequent development of three chronic childhood conditions: type 1 diabetes mellitus (T1D); IBD (inflammatory bowel disease); and attention deficit hyperactivity disorder (ADHD) and explore implications for clinical practice.

Lead: Jeroen Douwes (Massey University)
Team: Andrea ’t Mannetje (Massey University), Marine Corbin (Massey University), Peter McIntyre 

Aim 3: To quantify and manage the infectious disease risk of multi-morbidity

Quantifying public health benefits

To quantify the public health benefits of an integrated approach to management of multi-morbidity and serious IDs including influenza, using whānau ora principles

Lead: Amanda Kvalsvig
Team: James Stanley, Jason Gurney, William Leung, Jonathan Kennedy, Peter McIntyre 

Aim 4: To inform endgames to eliminate IDs that cause serious LTCs

National screening programme proposal

To measure current prevalence of and inform the ‘endgame’ for H. pylori - a proposed national screening programme - to eliminate this infection, and also to produce evidence to inform other interventions to reduce the impact of stomach cancer in NZ

Co-leads: James Stanley and Andrea Teng
Team: Virginia Signal, Kirsty Danielson, Stephen Inns, Jason Gurney

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University of Otago research partners

Takiri Mai Te Ata Whanau Ora Collective

Takiri Mai Te Ata logoCheryl Davies is a Māori researcher with extensive leadership experience in community health research and translation. She is the manager of Tu Kotahi Māori Asthma and Research Trust
Email cheryl@kokiri-hauora.org.nz
Web Takiri Mai Te Ata Whanau Ora Collective website

Centre for Public Health Research, Massey University

Centre for Public Health logoWe are working with Professor Jeroen Douwes, the Director of the Centre for Public Health Research at Massey University, Wellington. Professor Douwes is an epidemiologist with a strong track record in public health research, particularly involving chronic conditions in children including studies using IDI.
Email j.douwes@massey.ac.nz

Associate Professor ‘t Mannetje is an epidemiologist at the Centre for Public Health Research at Massey University, Wellington. She has considerable expertise in cohort, case-control and data linkage studies, including those conducted within the Stats NZ Integrated Data Infrastructure (IDI).
Email A.Mannetje@massey.ac.nz

Dr Marine Corbin is a biostatistician at the Massey University Centre for Public Health Research. She has considerable relevant experience using the IDI for public health research.
Email M.Corbin@massey.ac.nz
Web Centre for Public Health Research website

Telethon Kids Institute

Telethon Kids Institute logoDr Jeffrey Cannon is a Postdoctoral Research Fellow at the Harvard T.H. School of Public Health in the US and a Health Economist for the Telethon Kids Institute in Australia. His PhD studies resulted in the first estimates of both the health and economic burdens of all diseases due to group A Streptococcus (Strep A) in Australia and the cost-effectiveness of various prevention strategies.

Subsequently, his research is focused on the broader health, economic, and social value of public health interventions against diseases in general, with practical application to the public health value proposition of preventing Strep A infections by vaccination.
Email Jeffrey.Cannon@telethonkids.org.au or cjeffrey@hsph.harvard.edu
Web Telethon Kids Institute website

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Funding

The programme is funded by the Health Research Council (HRC 20/631 PI: Baker)

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SYMBIOTIC launch hui at Kokiri marae

Recording of Hon Dr Ayesha Verrall's message officially opening the SYMBIOTIC programme

Launch of new public health research programme led by Professor Michael Baker (media release)

Symbiotic launch team photo image
SYMBIOTIC Launch Hui with the team of researchers at Kokiri marae.

Cheryl Davies presenting at Symbiotic launch
SYMBIOTIC Launch Hui speaker Cheryl Davies.

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