For Public Health Research, Seed Funding Has Big Returns

Authored by:

Whenever $1,000 turns into $1.2 million, it's a reason to pay attention. And in public health research, that return on investment goes beyond the merely financial. More funding is often the most straightforward path to healthier populations.

Emily R. Smith and Jordan Kuiper of the George Washington University Milken Institute School of Public Health have seen this firsthand in their ongoing study of maternal multiple micronutrient supplementation for maternal anemia prevention (MMS-MAP). the study, led by Smith, tracks the potential health benefits of high-dose iron supplementation in over 6,000 pregnant women in Tanzania. And a $1,000 Milken Institute SPH Research Enhancement Award (REA) to Smith, alongside faculty start-up funds to Kuiper, was an essential step toward $1.2 million of additional funding obtained from the Bill & Melinda Gates Foundation.

And their success is the tip of the REA iceberg. The broader research program, administered by Milken Institute SPH's Office of Research Excellence (ORE), helps faculty test new hypotheses and build stronger data-informed foundations for subsequent grant proposals, including through REA and Research Innovation Awards (RIAs). Since its inception in 2014, RIA has supported about 49 projects with $1.9 million in awards-resulting in 148 publications and over $60 million in new external funding. That's about $32 in external funding for every dollar invested by the school.

"We see internal pilot funds as critical to faculty success and the exploration of new ideas," said Christopher Mores, who is Milken Institute SPH's interim senior associate dean for research and innovation as well as a professor of global health.

These relatively modest awards can help researchers confirm the feasibility of their approaches and generate concrete evidence as to the merit of their inquiries-the kind of evidence funders and review panels always love to see, Mores said, regardless of an applicant's level of experience. "This program is important for support of new faculty who are building their programs as well as established investigators embarking on a new line of research."

Following Smith's path from REA to Gates Foundation funding shows how small successes, even in different fields, can turn into interdisciplinary funding with a broader impact.

The MMS-MAP project, led by Smith, interim chair of the Department of Global Health, focuses on maternal nutrition. (MMS is another term for prenatal vitamins, which are well-established as improving birth outcomes.) Globally, especially in low- and middle-income countries, many women have access to a formulation called the United Nations International Multiple Micronutrient Antenatal Preparation (UNIMMAP) MMS, which contains 15 essential vitamins and minerals.

But though UNIMMAP standards dictate only 30 milligrams of iron, some meta-analyses suggest that increasing a pregnant person's iron dose may proportionally both reduce the recipient's chance of developing anemia and improve their child's birth weight. Smith said 60 milligrams of iron is the most common dose for prenatal vitamins globally.

The study, a randomized trial funded by the Gates Foundation since 2022, supplies pregnant women in Tanzania with a randomized 30-, 45- or 60-milligram daily iron supplement and tracks their health and that of their children before and after birth.

"We have worked closely with the World Health Organization (WHO) to design the study, and we think it can answer a lot of remaining policy questions" around iron dosage, Smith said.

Smith invited Kuiper to join the project last year, seeing an opportunity to expand the study and explore how MMS might bolster recipients against environmental and climate-related stressors like extreme heat. However, the new line of inquiry needed some initial data to point to.

Smith's REA funds could get that data into place. But measuring individual impact of heat on the body, and how MMS may lessen that harm, would require gathering highly personalized data.

"The microlevel, individual environment is so important, but it's hard to measure and study," Kuiper said.

While local satellite temperature measurements are crucial, Kuiper said, a researcher using only that data would have no way of knowing the actual heat levels experienced by different participants throughout their day. A woman living with a large family under a heat-absorbing tiled roof, for instance, will deal with considerably higher temperatures than one in a living space with fewer occupants or a metal roof painted white to reflect heat. Some pregnant people live in houses without adequate ventilation; others have windows and electric fans. None of this is reflected in generalized weather data.

The best approach, Kuiper said, is to incorporate personal temperature and humidity sensors, devices about the size of a watch battery that can be taken home and used by individual participants.

But how to make the devices as simple as possible to use-and as difficult as possible to lose? That's where Kuiper and doctoral student Erin Oakley thought REA funding, along with startup funds and the connections they'd made at GW, might help. With a few thousand dollars, they could not only purchase a number of sensors but also use the 3D printer at GW's Himmelfarb Health Sciences Library to create prototype cases.

The cases needed to be wearable, lightweight and easy to produce. The team considered and even created a number of potential designs, including bracelets and necklaces, before finally settling on a keychain.

First the team tested the devices in the U.S. Botanic Garden Conversatory, which has a tropics room where the heat and humidity more closely resemble the climate of Tanzania. Then Oakley spent time in Tanzania, working with study nurses to understand which designs worked well technically and were also acceptable to women in the study area. When they needed more samples than the library could provide, they turned to a colleague whose hobby was 3D printing.

Within a few days, they had enough keychain cases to provide a convenient wearable sensor to all 525 participants in the "environmental co-exposures" or "ECO" sub-study of the larger MMS-MAP trial, providing heat and humidity patterning in real time.

"That seed funding and my startup funding were instrumental in making individual level assessments of heat possible," Kuiper said.

When Smith and Kuiper applied for additional Gates Foundation funding related to environmental health, they were able to point to their provision of wearable temperature sensors as an indicator of the team's capability and innovation. "We were able to really scale up that component of the project in a meaningful way."

Additionally, they aim to investigate how MMS might help shield mothers and infants against lead exposure. During pregnancy and lactation, the body metabolizes bone to release extra calcium for the developing infant. Unfortunately, lead is also stored long-term in bone tissue, so the process may release it into the bloodstreams of mother and child.

"We're interested in looking at whether having adequate micronutrient supplementation during pregnancy affects blood lead levels, potentially through mitigating the offloading of this historical lead exposure from your bone tissue to the fetus, or mitigating the absorption of lead if you ingest it during pregnancy," Kuiper said.

While Kuiper and Smith both specialize in maternal and child health, Kuiper said their respective areas of focus-environmental health versus infectious disease and nutrition-can be siloed.

Being at the Milken Institute SPH, where interdisciplinary collaboration is a priority, has helped bring the two fields into conversation as well as funding their path forward, Kuiper said.

"It's really fun to bring these two worlds together," he said. "In environmental health in general, we tend to focus on things that are bad for you, but we often stop short of asking, 'Where can we intervene? What can we do to mitigate that?' Nutrition is one area where we can actually potentially move the needle on mitigating impacts…and because these two fields are generally siloed, we just haven't really explored it."