At the recent “Uniting to Combat NTDs: Translating the London Declaration into Action,” we had a chance to catch up with Dr. Patrick Lammie. Dr. Lammie is the Senior Scientist at the Centers for Disease Control and Prevention (CDC) and served as Senior Technical Director for the Global Network. We had the opportunity to learn about his personal experience working in the field with lymphatic filariasis (LF) patients, as well as some of the CDC’s objectives in the efforts to control infectious diseases. Additionally, Dr. Lammie recently discussed a campaign to control and eliminate LF in Haiti in this article on NPR: http://www.npr.org/blogs/health/2013/06/13/191291172/haiti-moves-a-step-closer-toward-eradicating-elephantiasis.
Global Network: Why should we care about NTDs?
Dr. Patrick Lammie: That’s a great question. And I don’t know that there’s a simple answer. I would say, though, based on personal experience; it’s really the effect on lives[…] I don’t think you can really put into words the emotional impact of watching somebody walk down the street dragging their leg behind them that impairs their mobility and leads them to be ostracized in the community.
Global Network: What is the CDC doing to help reach the elimination targets in 2020?
PL: I think the CDC has historically had an interest in disease eradication, from the days of smallpox […] And so, it is a message that resonates within the institution. The idea that you can permanently free a community – the world – of a risk of a particular disease […] You have to understand the tools that are needed. So a lot of the work that we do at this point is focused on development of the tools […] the ultimate objective is to make sure that we get the tools needed to affect these changes into the hands of the people at the country level that really need them.
Global Network: Why do you do what you do?
PL: I don’t know if there was ever that single moment. The first time I worked in the field, I was still a graduate student, where I spent a lot of time in Haiti. I had done essentially no travel outside the United States before that. And I think I was stunned by the fact that an hour and half from the United States you had communities without electricity, without access to water, without schools – where there were very high rates of infant mortality. I think it was that recognition of that gap that really struck me. I’m not sure that that was the epiphany moment, though.
I think the epiphany moment maybe came later as [CDC] moved from some of the initial phases of drug testing. For filariasis that was at one time a 12-day course of treatment. The greatest number of patients that we could keep on treatment during that period, on one protocol, was 20. And as we received support from WHO and others to start looking at single-dose therapies, we were able to go from treating 20 at a time to treating 1,000 at a time.
And CDC then, essentially challenged us to ask the question: Can we take that program to the level where we would be able to do a mass drug administration for an entire district? […] And, really, for me, that was the epiphany moment, when I realized that we didn’t have to treat people 20 at a time. We could treat 100,000 at a time. If you could treat 100,000 at a time, you could treat a million at a time.
Global Network: What do you think we need to achieve better integration in NTD programs?
PL: That is a very, very tough question […] I think we have this tendency to focus so much on a single disease objective that we lose sight of the fact that we can be much more effective if we can develop ways to collaborate across programs […] The classic [example] is really lymphatic filariasis in Africa, transmitted in most parts of the continent by the same mosquitoes that transmit malaria. And yet, to date, there’s been very little interaction between the malaria and LF programs.
I want to see these diseases gone. But the only way that’s going to happen is if we, as a community, figure out how to be more effective in the way that we are delivering our interventions.