KE-KRA-P051637065Q-VacAMR-NIHR156011 Health Research Operations Kenya Limited AMR-attributable deaths (~1.3 million/yr) are mostly due to respiratory infection (LRI). Annually there are >2 million lower respiratory infection (LRI) deaths globally, most commonly in sub- Saharan Africa (SSA). Streptococcus pneumoniae (Spn), then RSV & Hib are the leading causes of LRI deaths among under-5 children. AMR Klebsiella pneumoniae is a leading cause of pneumonia & sepsis in newborns & vulnerable adults. Influenza virus, RSV & Spn infections are major drivers of antimicrobial use & therefore AMR. Deaths due to AMR respiratory pathogens are vaccine preventable. We therefore propose to improve AMR control by focusing on preventing disease syndromes (e.g. fever & pneumonia), as part of a multimodal approach that includes vaccine and non-vaccine interventions. Building on previous NIHR-funded success, we will tackle AMR through new strategic South-South partnerships between KEMRI-Wellcome, Kenya, Malawi-Liverpool-Wellcome (Kamuzu University of Health Sciences), Navrongo Health Research Centre, Ghana Nigeria Centre for Disease Control, & Nigerian Institute of Medical Research Overall Aim: Africa-led transformation of the public health approach to controlling respiratory pathogens & AMR through vaccine & non-vaccine-based multimodal interventions. Identify multimodal interventions to reduce AMR, developing the evidence base, co-creating interventions, modelling impact & prioritising methodologies. ii) Accelerate implementation of diagnostic approaches to support AMR intervention evaluation. iii) Evaluate candidate immune markers of protection to support intervention & outcome evaluation. iv) Strengthen evidence-to-policy translation. v) Engage communities to evaluate AMR risk & identify behaviour change interventions. vi) Empower Africa-based leadership & innovation in AMR. University College London London School of Hygiene and Tropical Medicine Liverpool School of Tropical Medicine Malawi-Liverpool Wellcome Programme Navrongo Health Research Centre Nigeria Centre for Disease Control Centre Suisse de Recherches Scientifiques en Côte d'Ivoire Nigeria Institute of Medical Research Wellcome Connecting Science Kamuzu College of Health Sciences Collaborating organisation 3026376 760307.69