Without partnerships, much – potentially all – global health work would be fruitless. That is why we decided to catch up with one of our key partners who has been instrumental in the neglected tropical diseases (NTDs) research community. Joseph Kamgno, MD, PhD, runs the Center for Research on Filariasis and other Tropical Diseases (CRFilMT) in Cameroon where his team of 20 researchers, four Lab Technicians and numerous trainees support elimination and control efforts on NTDs for Cameroon, as well as other neighboring countries. Since 2003, he has partnered with The Task Force for Global Health on various efforts, bringing his wealth of disease and field-based knowledge to help our programs and the global NTD community to stop these devastating diseases.
Q: When did you start partnering with Task Force programs?
In Cameroon and the surrounding region in Africa there are co-endemic areas where communities are affected by both onchocerciasis – commonly called river blindness, a parasitic infection of the skin and eyes – and loiasis, another filarial disease, resulting in a major problem for the onchocerciasis elimination effort. Indeed, people who are heavily infected with Loa loa (the causative agent of loiasis) and treated for onchocerciasis with ivermectin can develop severe adverse events such as comas or even death.
To address this issue, I was appointed in 2003 by the Mectizan® Donation Program (MDP), the Technical Consultative Committee of the African Program for Onchocerciasis Control, and the Mectizan® Expert Committee to help the Ministry of Public Health organize the treatment of onchocerciasis in areas co-endemic for loiasis because in the late 90s and early 2000s there was an “epidemic” of these Severe Adverse Events (SAEs). I was given the task of conducting surveillance, training and assistance of the health personnel, managing these severe adverse events, and conducting research on pathophysiology, other risk factors, and prevention of these SAEs through alternative treatments. All these activities were supported by MDP.
In 2005, I set up the Center for Research on Filariasis and other Tropical Diseases (CRFilMT), initially supported by MDP for almost 15 years. We are really thankful for this important support from MDP as well as those from the Mectizan® Expert Committee who provided technical support because it helped us grow our research activities.
CRFilMT also works with The Task Force’s Neglected Tropical Diseases Support Center (NTD-SC) on the implementation of research projects funded through NTD-SC in Cameroon and other countries.
We’ve had a great experience working with MDP and NTD-SC, and there is a continued partnership with Task Force programs that is not just based on funding but on the development of new ideas to better understand and tackle certain NTDs like onchocerciasis and ultimately improve the lives of people.
Q: How did you get started in working on NTDs?
During medical school, I wrote a thesis on the prevalence and causes of blindness in forest areas under the supervision of a French research team which was my first introduction to onchocerciasis and NTDs. Once I graduated from medical school, I had about 8 months before my placement in the hospital, so I went back to the French research team and asked if they had any more research I could help conduct during this waiting period. I began with a literature review on schistosomiasis in Cameroon and then joined a new clinical trial project on onchocerciasis in Cameroon. My boss was also the principal investigator of another research project which investigated the incidence of severe adverse events post-ivermectin administration. In the early 2000s, I completed my masters and PhD degrees based on these research projects. This experience was my entry point to NTDs that ultimately led me to working with MDP.
Q: Why did you start the Center for Research on Filariasis and other Tropical Diseases?
When I started the surveillance and the training of medical personnel in Cameroon and neighboring countries with the support of MDP, I was part of a non-governmental organization (NGO) called Coalition for the Control of Onchocerciasis. With this collaboration, I saw a need for research expertise to support the efforts of this NGO and others in controlling onchocerciasis. At the same time, there were many scientific questions concerning the post-ivermectin SAEs, and I decided to build a lab that would provide more support based on research in the field.
The Lions Club International Foundation (LCIF), which was part of the Coalition for the Control of Onchocerciasis, was willing to host the lab, but they didn’t have sufficient space, so I worked with the LCIF, with the encouragement of the Cameroonian Ministry of Public Health and the support of MDP, to set up the lab. At the beginning of this adventure, the staff of the lab were made up of a driver, a lab technician and myself. Now, the CRFilMT team is constituted of more than 20 personnel (including researchers, lab technicians and administrative staff), carrying out research on a number of NTDs and supporting work in various African countries.
Thanks to support from MDP and the Islamic Development Bank for Science and Technology, we now operate out of a 2000 square meter building with offices, laboratories, meeting room and amphitheater.
Q: What are some of the main projects the Center is working on now?
We support the Cameroonian Ministry of Public Health on various NTDs including mapping prevalence of filariasis and assessing the impact of mass drug administrations (MDAs) on onchocerciasis and lymphatic filariasis – another parasitic disease caused by Wuchereria bancrofti, affecting the lymphatic system and causing elephantiasis and hydrocele. For the elimination of onchocerciasis in Central Africa, there is a plan to provide preventive chemotherapy in hypo-endemic areas. However, some of these hypo-endemic areas are co-endemic for loiasis and due to the risk of developing SAEs that outweigh the benefit of mass treatment in these areas, mass treatment with ivermectin cannot be implemented. We are currently working on developing a new strategy called “Test and not Treat” (TaNT) which aims to test the population for loiasis using a diagnostic called the LoaScope before treating them with ivermectin.
The CRFilMT also supports other countries’ efforts to eliminate onchocerciasis by analyzing their samples in the framework of the Onchocerciasis Elimination Mapping (OEM) project, in coordination with The Task Force. Through a partnership with Sightsavers, we are implementing an elimination strategy combining ground larvicide vector control, testing for onchocerciasis, and then treating with Doxycycline and bi-annual mass treatment with ivermectin.
We are also conducting clinical trials to identify best treatment regimens against filarial diseases, including onchocerciasis and loiasis as well as measuring the impact of MDAs on soil transmitted helminths (STH), a group of intestinal worm infections. Additionally, we work on developing new strategies for control of schistosomiasis. We are very busy and are trying to develop our lab and expand our team to meet the massive and growing need for these disease elimination programs.
Q: Did you always want you would be a researcher?
When I was young, I was really hoping to become a medical doctor, but in my last year of secondary school, I received a prize in biology, a book by a South American called “Recherche médicale carrière d’avenir”. This book was about how being a researcher is like playing the lottery every day because research relies on hypotheses that sometimes work and sometimes don’t. The book also explained the anxiety of data analysis a researcher can face to draw conclusions on his research. It really created a passion in me to become a researcher. So, when I finished medical school and started with these research teams, for me, it was a life and passion accomplishment. Now, I’ve been doing this for the last 25 years, and I really like doing it, particularly when you see the results that help improve the lives of people.
For example, when I started doing onchocerciasis research in the Bafia region, I saw people suffering from this debilitating disease, suffering deeply in their heart, with skin completely destroyed, with high prevalence of blindness, but when I return now, after all the treatments that have been distributed there, I do not see onchocerciasis anymore. Onchocerciasis is yet to be completely eliminated there, but people can now live without severe signs of this disease. I am very proud of having participated in something that has improved the lives of humankind.
For me particularly, it is such a passion that I don’t see what I would have done other than medical research, and I’m eager to share my passion for research with young people who are really engaging in medicine and searching for their career path.
Q: What are some of the challenges you think the NTD community face?
NTDs do not benefit from the same kind of scientific and financial support as other diseases. If we had more manpower to help implement treatments and interventions and develop more accurate diagnostics, we could accelerate the elimination of these diseases. For example, when it comes to the co-endemicity of onchocerciasis and loiasis in communities, a clear strategy is to test and treat, but we don’t have sufficient means to deploy this strategy in all hypo-endemic areas.
But thanks to the researchers, donors, and organizations that are working on NTDs now, especially The Task Force for Global Health, the Bill & Melinda Gates Foundation and governments, we are making progress, and so I’m feeling optimistic that we will eventually overcome these diseases.