Launch of new public health research programme led by Professor Michael Baker

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.
The original funding announcement is here.
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.