Carter Center Eye of the Eagle | Winter 2021

EYEof theEAGLE Uganda Resumes MDA, Follows COVID-19 Protocols After stopping in April 2020 because The Carter Center of the COVID-19 pandemic, The Carter Center-assisted mass drug administration (MDA) program for onchocerciasis in Uganda Volume 22, Number 1 restarted in August, making it one of the first such campaigns in the world to resume. Winter 2021 The campaign provided 1,338,717 Mectizan® (donated by Merck & Co., Inc., Kenilworth, N.J., USA) treatments to the two 2 foci of Uganda still under MDA, demonstrat- ing that MDA can safely be conducted when 30th IACO Notes Progress 3 paired with well-focused coronavirus preven- tion messages, adequate protective equipment, Uganda Shows Significant and diligent adherence to protocols. Progress Toward Elimination 4 The World Health Organization (WHO) In Uganda, a community drug distributor advised on April 1 that community-based follows COVID-19 protocols, including wearing Ethiopia Elimination Meeting neglected tropical disease (NTD) programs a mask and administering treatment outdoors. should halt activities to prevent the spread Ugandan children under age 6 are not Ambaye Areru Retires of the novel coronavirus. The Uganda required to wear masks. Ministry of Health (MOH) established a task 5 force to develop procedures for COVID-19 Trachoma Staffers Make Exam continues on page 2 Scopes From Scratch 7 Amhara Program Manager Melds Innovation With Collaboration 8 Findings May Help Speed Trachoma Control Program Adjusts to Pandemic Elimination in Amhara, Ethiopia 9 The Carter Center has always strived to in 2020 as the world faced the COVID-19 Center Experts Present be an adaptable organization, prepared to pandemic. The program has sought to adapt Research at Conferences respond to global changes and challenges activities to address short-term COVID-19 when implementing programs in some of the needs while working alongside in-country 10 world’s most remote and ever-changing envi- partners and ministries of health to develop ronments. Insecurity, flooding, government risk assessment and mitigation action tools. New CEO, Health Vice President 11 Carter Center Plays Key Role leadership changes, and food shortages are In preparation for the restart of SAFE in 2020 NNN Conference just some of the many issues that the Center’s implementation (SAFE stands for surgery, Trachoma Control Program has faced over antibiotics, facial cleanliness, and environ- Guinea Worm Disease Update the past 21 years. mental improvement), the program has 12 In Memoriam: Center Pays The ability to adapt was put to the test been developing strategies and new standard Tribute to Three NTD Heroes operating procedures to reduce the risk of Electronic To receive this newsletter via email only, please COVID-19 community transmission during Edition send a request to [email protected]. the implementation of interventions. The goal continues on page 6

River Blindness 30th IACO Notes Progress Despite COVID-19 Discussion at the 30th InterAmerican The 2020 OEPA report in the setbacks in elimination timelines. Conference on Onchocerciasis WHO Weekly Epidemiological Ecuador, which stopped MDA centered around the challenges the Record included an analysis of mass COVID-19 pandemic has presented drug administration (MDA) treat- in 2009, reported a 2018 OV16 sero- to the partners of the Onchocerciasis ment rounds with effective coverage logical study conducted in children Elimination Program for the Americas. (i.e., coverage of at least 85%) in the ages 5 through 9 living in previously Yanomami focus area. This analysis hyperendemic communities; all tested The IACO meeting was held concluded that over 70% of the negative, indicating continued absence virtually Dec. 1–2, 2020. Dr. Marcos administrative districts should be of onchocerciasis transmission. This Espinal from the Pan American classified as “suspected transmission study was published in the November Health Organization and Dr. Mauricio interruption” because they have 2020 issue of American Journal of Sauerbrey from The Carter Center received over 20 effective treatment Tropical Medicine and Hygiene. gave opening remarks, and 10 pre- rounds. Brazil and Venezuela reported sentations centered on the Americas’ IACO celebrated renewed support last remaining transmission zone, the Studies suggest that mature to OEPA from the U.S. Agency for Yanomami focus area, which straddles programs like Brazil and International Development. In addi- the shared border of Venezuela tion to its donation of Mectizan,® and Brazil, home to about 35,000 Venezuela can withstand a Merck & Co., Inc. (Kenilworth, N.J., Yanomami indigenous people. missed treatment or two. USA), provided a one-year monetary grant to OEPA. IACO also noted the Mandated COVID-19 mitigation on 2019–2020 entomology testing attendance of several longtime partners efforts resulted in reduced treatment and serology assessments in children from both Lions Clubs International coverages (especially in Venezuela), that supported OEPA’s conclusion; Foundation and local Lions Clubs of delayed assessments, and canceled further serology and entomology the endemic and formerly endemic training. Air transit to reach the most should help solidify these findings. countries. remote communities was limited in COVID-19 impact modeling studies both countries, while fuel shortages suggest that mature programs like also affected Venezuela’s river-based Brazil and Venezuela can withstand a activities. missed treatment or two without great However, there is optimism. Uganda Resumes MDA MDA approach, which avoids the The MDA had its challenges. large crowds associated with fixed-post Despite a robust public information Continued from page 1 MDA campaigns. Community drug effort, many rural residents perceived distributors (CDDs) dispense Mectizan COVID-19 as an urban disease. Many mitigation and a practical plan for within their kinship zones, limiting individuals who could no longer work restarting NTD programs. The MOH, the involvement of nonresidents and or afford to live in cities because of implementing partners, and donors reducing the risk of transmission. the national lockdown moved to rural collaboratively developed plans, fol- Third, thorough risk assessments were communities. The influx meant there lowing the WHO’s evolving guidance. conducted, and appropriate mitigation were drug shortages in some communi- The WHO issued provisional guide- measures were instituted. CDDs, super- ties, but mop-up operations ensured lines for resuming core NTD activities visors, and other health workers wore everyone was treated. MDA also in late July, and the MOH resumed masks, washed their hands frequently, extended past the planned two-week MDA for onchocerciasis in August. and administered Mectizan outdoors. period as some CDDs moved from Checklists helped ensure protocols their villages, necessitating a repeat of The restart decision hinged on were followed. household registration. several factors. First, Uganda had few (1,029) COVID-19 cases at the time MDA was planned. Second, Uganda employs a house-to-house 2

River Blindness Uganda Shows Significant Progress Toward Elimination The 13th Uganda Onchocerciasis Elimination Figure 1. Uganda’s Progress in the Elimination of River Blindness Expert Advisory Committee (UOEEAC) meeting focused on three topics: (1) two foci that have com- entomological activities in cross-border areas. The committee pleted post-treatment surveillance, (2) two foci where was pleased to hear that the three countries are drafting joint transmission is still ongoing, and (3) cross-border trans- multidisease health plans that include references to oncho- mission zones Uganda shares with South Sudan and the cerciasis elimination in cross-border areas. The UOEEAC Democratic Republic of the Congo. expressed its hope that these plans will be signed as soon as possible to enable effective coordination among the ministries The meeting took place Aug. 4–6, 2020. Due to the of health. COVID-19 pandemic, it was held virtually and with a condensed agenda to accommodate participants in dif- ferent time zones. River blindness was initially endemic in Uganda in 16 foci, comprising 40 districts and about 4.7 million people at risk, excluding the Victoria Nile focus, which eliminated the disease in the early 1970s. Since the launch of the elimination program in 2007, approximately 3.1 million people are no longer at risk of onchocerciasis; Uganda has achieved transmission elimination in seven foci and transmission interruption in another seven foci, which are under post-treatment surveillance. Two foci, Wadelai and West Nile, have now completed the three-year post-treatment surveillance period recommended by the World Health Organization (WHO). The UOEEAC recommended these foci conduct serological surveys and submit the results to the committee before the August 2021 UOEEAC meeting. If there is no evidence of transmission, the foci will be reclassified as “transmission eliminated.” The UOEEAC advised that programmatic activi- ties, including mass drug administration, resume as soon as possible following nationally prescribed COVID-19 precautions. (MDA took place soon after the meeting occurred.) For the Madi Mid North focus, the UOEEAC recommended the program investigate whether there is evidence of transmission in adjacent areas. Ivermectin treatments are provided semiannually within the focus boundary, which spans parts of 11 districts in northern Uganda. The splitting and creation of new administra- tive units over time means that certain subcounties outside the focus lack baseline data. The UOEEAC recommended the program determine transmission risk in such areas following current WHO guidelines. The UOEEAC also recommended that Uganda con- tinue to provide laboratory support to the South Sudan and DRC programs and continue promoting cooperative 3

River Blindness Ethiopia Elimination Meeting Focuses on Mapping Endemicity The seventh meeting of the Ethiopian Onchocerciasis endemicity using serology in the world, Ethiopia is well Elimination Expert Advisory Committee (EOEEAC) cele- positioned to share its experience with site selection, brated achievements in mapping and impact on transmission team management, and laboratory development. These despite limitations imposed by the coronavirus pandemic. data are also of global importance as the onchocerciasis community discusses new procedures and thresholds for The meeting, held virtually Oct. 27–29, 2020, focused decision making. on efforts to map the endemicity of onchocerciasis throughout the country, assessments of communities along Other discussions focused on adding nuance to the Ethiopia’s border with Sudan, and comprehensive evalu- categories used to track districts — the “oncho flag.” Based ations of areas with unusual or lingering transmission. on a color-coded ranking, the flag quickly shows how Although the first round of treatments was missed in 2020 the country is progressing at a high level. The EOEEAC because of the pandemic, the Ethiopian program desires to discussed ways to incorporate midterm assessments and restart soon. Ethiopia delivers treatments every six months mathematical modeling to add new colors to the flag. and has the largest such program in the world, with over 30 million treatments administered in 2019. Over 40 people attended the virtual meeting, including representatives from Federal Ministry of Health, Ethiopia A major goal of the program is to complete onchocer- Public Health Institute, Sudan, five regions, and Jimma and ciasis elimination mapping as soon as possible. Since the Addis Ababa universities. Key partners included The Carter sixth meeting, 35,900 samples were collected from adults, Center, RTI International, Light for the World, the END largely from northern and eastern Ethiopia. Just under half Fund, the Bill & Melinda Gates Foundation, Lions Clubs (15,300) of these were analyzed in time for the meeting. International Foundation, and representatives from the These samples were tested in the Lions-Carter Center- Onchocerciasis Technical Subgroup at the World Health assisted molecular laboratory based at the Ethiopian Public Organization. Hiwot Solomon, head of the Disease Control Health Institute. Two of 51 districts surveyed had ≥ 2% and Prevention Division of the Federal Ministry of Health, OV16 positivity and were recommended for mass drug opened the meeting, which was chaired by Professor Rory administration by the committee. Only 17 districts remain Post of Liverpool John Moores University. Fikre Seife, to be mapped in Ethiopia, a major achievement that has national NTD coordinator for the Federal Ministry of taken many years to reach. Health, and Dr. Zerihun Tadesse, country representative for The Carter Center, are co-secretaries. As perhaps the largest effort to map onchocerciasis Ambaye Areru, Ethiopian Project Officer, Retires Ambaye Areru is an admirable partnership with the materials. regional government, health sectors, Ambaye received a bachelor’s retiring after over a and other partners, for which he and The Carter Center were acknowledged degree in public health from the decade of service to by the regional Bureau of Finance and University of Gondar in 1974. Before Economic Cooperation (BoFEC) for joining The Carter Center, he served The Carter Center best performance in 2016. He made his country at governmental and non- significant contributions in organizing governmental organizations for more in Ethiopia. Ambaye malaria-onchocerciasis campaigns, than two decades. which are believed to have helped joined the Center reduce the diseases’ prevalence. He Ambaye demonstrated amazing made major contributions to the leadership in coaching teammates; facil- in 2007 as a malaria design, preparation, and development itating large meetings, workshops, and of behavioral change activities, train- trainings; and producing quality reports. and onchocerciasis Ambaye Areru ing modules, and health education After decades of dedicated service, he is project advisor for now retiring, and the program staff wish him a healthy and peaceful life. Bench Maji, Kaffa, and Sheka project areas. He later joined the country office as project officer for the onchocerciasis and lym- phatic filariasis elimination programs. During his tenure, he established 4

Trachoma Trachoma Staffers Make Exam Scopes From Scratch Ideally, trachoma grading in the Scholtens owns a field is conducted in person by a trained grader who examines the patient’s con- $500 3D printer she junctivae, the membranes that cover the inner eyelids, for signs of tracho- uses in her hobby cre- matous inflammation-follicular (TF). When an in-person exam is not possible ating figurines. While because of a lack of trained graders, remote examination of high-quality working from home magnified photos has been shown to be a possible alternative. in Atlanta during the A relatively simple magnifying COVID-19 pandemic, scope attachment system for a smart- phone makes taking grading-quality she realized she could photos of the conjunctivae easy. The 3D-printed smartphone case — devel- use it to print parts for oped by the University of California San Francisco, and further adapted by the trachoma grading the Carter Center’s Trachoma Control Program — houses a magnification lens, scopes. After making two LED lights for external illumina- tion, a rotating arm that contacts the some mechanical patient’s skin around the eye socket, and a battery to power the lights. adjustments to her The Trachoma Control Program’s printer, she was able research manager, Drew Deathe, and program associate, Vanessa Scholtens, to print all six parts plan to fabricate two dozen of the scopes in the coming months. for a scope in just a A trachoma grading scope is fabricated couple of days. on a 3D printer in Vanessa Scholtens’ home office in Atlanta. “It was a real delight to be able to repurpose one of my hobbies into some- thing that would help the program in such a meaningful way,” Scholtens said. Once the parts Drew Deathe solders electronic components for the are printed out of 3D-printed scope, which can be attached to a mobile a polymer called phone for use in assessing trachoma symptoms. acrylonitrile butadi- ene styrene (ABS), Scholtens sends them to Deathe’s The need for the devices is home. Deathe then solders the electri- expected to grow. cal components and assembles the full “As national programs progress Photos: Courtesy of Drew Deathe (top); Vanessa Scholtens (bottom) scope. toward and reach elimination goals, “While it was a bit overwhelming it will become more difficult to find at first, this has been a great oppor- active cases to reliably train trachoma tunity to get creative and hands-on graders,” said Kelly Callahan, director while working remotely last spring,” of the Trachoma Control Program. “We Deathe said. can use gradable photos taken by survey Over the next few months, teams both to diagnose patients from Scholtens and Deathe will manufacture centralized grading centers and to train and send scopes to be used in opera- graders wherever they may be. This is tional research projects in Ethiopia, an exciting innovation that we will be Niger, and South Sudan. They plan able to implement in multiple upcom- eventually to design versions tailored to ing projects.” fit a variety of mobile phone models. 5

Trachoma Trachoma Control Program Public Health Training Initiative have rolled out in select areas, and the been working together to disseminate program is already seeing success. Continued from page 1 COVID-related health education Additionally, the Trachoma Control messages and distribute supplies in col- Program is piloting an adapted MDA is to ensure the safety of the staff and laboration with the Sudanese Ministry protocol in Eastern Equatoria state communities served while continuing of Health. that aims to successfully implement to fight blindness. MDA while also mitigating the trans- In South Sudan, where The Carter mission of COVID-19 among both The response to COVID-19 has Center has continually adapted to program staff and the communities taken different forms in each country a changing environment for years, being treated. The pilot saw some where the Trachoma Control Program the Trachoma Control Program has challenges, especially related to social works. In Amhara, Ethiopia, The focused on adapting protocols so distancing; however, the MDA was Carter Center has provided a vehicle SAFE activities can resume as soon well-received. The program hopes and driver to support the regional as possible. The focus is on mass drug to continue trachoma activities with COVID-19 task force and distribute administration (MDA) and health added safety measures in the months supplies; it also has allocated labora- education. In collaboration with the to come. tory space and the use of an Abbott Guinea Worm Eradication Program m2000 RealTime System to process and using its information, education, Despite the new challenges that COVID-19 samples at the Amhara communication tools, the trachoma 2020 brought, the Trachoma Control Public Health Institute laboratory program has supported the Ministry Program has remained flexible and in Bahir Dar. The Carter Center of Health to develop and implement adapted to fight against trachoma. developed specific standard operating new communication materials and While the future is uncertain, the procedures for house-to-house mass adapted health messages. These activi- program will continue to move forward drug administration and surgical ser- ties will help integrate hygiene and and adjust as necessary toward elimi- vices; the Ethiopia Federal Ministry of other messages relevant to COVID-19 nating trachoma as a public health Health adopted these procedures as the prevention. The materials have been problem and reducing suffering. exemplar and shared them with imple- menting partners in other regions. A radio broadcaster in Niger disseminates trachoma health education and Photo: The Carter Center COVID-19 preventative messages with the support of federal and regional In Niger, thanks to the support ministries of health and The Carter Center. of the Conrad N. Hilton Foundation, The Carter Center quickly pivoted to assist the Ministry of Health and regional health administrations to adapt trachoma radio broadcasts to include COVID-19 preventative messages. For many years, community radio has been used to share informa- tion about trachoma and was easily adaptable to address both diseases. Also in Niger, The Carter Center has supported the Ministry of Health and regional directorates of Diffa, Maradi, and Zinder regions to purchase soap, personal protective equipment, and handwashing stations, all of which address both the pandemic and trachoma. The Carter Center-Sudan’s Trachoma Control Program and 6

Trachoma Amhara Program Manager Melds Innovation With Collaboration As the trachoma program manager that one of the most for The Carter Center in Amhara, Ethiopia, Eshetu Sata wears many challenging parts of his hats to ensure the program runs smoothly. Based in Addis Ababa, Sata job is advocating for manages a team of over 120 people working across the Amhara region. the program. He works alongside officials from the Federal Ministry of Health and the “Sometimes, tra- Amhara Regional Health Bureau to support national and regional choma activities may trachoma programming. The Carter Center has been supporting Amhara’s not be considered a trachoma activities since 2001 and supports the full implementation of the priority health service,” World Health Organization-endorsed SAFE strategy. he said. “Much work Sata joined The Carter Center- is needed within Ethiopia team in July 2011 as the monitoring and evaluation manager the health sector to and is now overseeing the full Trachoma Control Program there. enhance ownership of Since he joined the team, the program has grown and changed in many ways. the program.” Still, it continues moving forward with the same goal: eliminating trachoma 2020 was a chal- as a public health problem. As the program manager, Sata provides tech- lenging year for the nical assistance and guidance to the program, supervises and monitors its program. Several implementation, and provides techni- cal assistance and advice to regional adjustments across and subregional project managers. the Amhara region Sata has implemented innovative approaches in Amhara, including were made to address operational research and house-to- house case finding to identify people the COVID-19 pan- needing surgical services. Both are much needed in one of the most demic. Sata’s team trachoma-endemic regions in Ethiopia and the world. developed standard Sata also serves on the National operating procedures Trachoma Task Force, which brings together implementing partners and for implementing mass Eshetu Sata (left) manages the Carter Center’s government entities to collaborate on national program policies. Sata notes treatment, active case- trachoma projects in Amhara, Ethiopia. He is pictured finding of trachomatous with Mulat Zerihun, regional manager for the Carter trichiasis (TT) cases, Center’s trachoma and malaria control projects in the and population-based Amhara region of Ethiopia. surveys in the context of COVID-19. and monitoring interventions. The The procedures require precautionary Carter Center’s vehicles and drivers measures to implement activities and have been made available to regional guide health workers, program manag- officials as needed to implement ers, and community members to ensure COVID-19 activities. activities are safely implemented while Despite the challenging year, COVID-19 remains a threat. Sata, Sata remains committed to his work along with the Amhara Regional and is inspired by what he sees in the Health Bureau, led the way for the field. His favorite parts of his work national program, sharing the operat- are observing the implementation of ing procedures developed as templates activities in remote villages, whether for other programs looking to restart sight-saving TT surgery, mass drug activities. The Carter Center-Ethiopia administration, or the school trachoma has also supported national COVID- program, and witnessing the satisfac- Photo: Laurie Baxley 19 response efforts in several ways. tion of the people relieved of suffering. Health workers at all levels have “I am looking forward to intensify- been involved in spreading aware- ing program activities in the years ness of the pandemic, contact tracing ahead,” he said, “and seeing the con- tinued impact of the program.” 7

Trachoma Findings May Help Speed Elimination in Amhara, Ethiopia Historically, Ethiopia’s Amhara add to the TF indicator information. antimicrobial resistance is a concern region has the highest known burden Through a generous donation from that prompted a second study. Using of trachoma in the world. Since scaling Abbott, the Amhara Public Health a technique called whole genome up the SAFE strategy over the years, Institute can test ocular samples using sequencing, the Center and its substantial disease reductions have a chlamydial DNA test. In a study partners used a sample of 99 ocular been achieved. recently published in PLOS NTD, the swabs from across Amhara to more Center’s authors swabbed a sample of effectively characterize C. tracho- However, some areas are proving over 7,000 children. They determined matis circulation. This study, called slow to improve despite interventions. that after five years of SAFE strategy “Genomics of Ocular Chlamydia Children are given clinical exams to interventions, considerable infection trachomatis after five years of SAFE monitor for the presence of tracho- remained. Furthermore, the youngest interventions for trachoma in Amhara, matous inflammation-follicular (TF). children and those with clinical signs Ethiopia,” was published in the Journal While continuing this practice, The of trachoma had the most significant of Infectious Diseases. It demonstrated Carter Center and its research partners infection burden in this population. that the C. trachomatis circulating in have deployed alternative monitoring The study was titled “Ocular Chlamydia Amhara had genetic sequences that tools to allow deeper study of disease trachomatis infection and infectious were typical of ocular C. trachomatis transmission in an effort to understand load among pre-school aged children worldwide. Furthermore, the authors the epidemiology of trachoma in within trachoma hyperendemic found no evidence of macrolide Amhara and unlock the door to accel- districts receiving the SAFE strategy, resistance in this population, which erating progress. Amhara region, Ethiopia.” is excellent news for a program using antibiotics as a critical intervention. Since 2011, The Carter Center With many cumulative doses of has been collecting ocular swabs to test antibiotic having been distributed, Recently, the Center and its part- for Chlamydia trachomatis infection and ners also studied program participants’ blood for signs of lifetime trachoma In Amhara, Ethiopia, a line of women with advanced trachoma await eyelid exposure. Survey teams working in Photo: Daniel Getachew surgery. The Carter Center and its partners are researching why disease reduction Amhara collected dried blood spots is taking longer in some areas than others. from all individuals examined for trachoma. The spots were assayed in Atlanta by the U.S. Centers for Disease Control and Prevention for serological responses to trachoma. That study determined that serology can discriminate between districts with low levels of trachoma and those with high levels of both infection and clini- cal disease. This tool could be used for long-term surveillance in Amhara and other trachoma-endemic areas. The study, “Population-based prevalence of Chlamydia trachomatis infection and antibodies in four districts with varying levels of trachoma endemicity in Amhara, Ethiopia,” was published in the American Journal of Hygiene and Tropical Medicine. 8

Global Health News Carter Center Experts Present Research at Major Annual Conferences The Carter Center is recognized as of mental health a leader in neglected tropical disease (NTD) control, elimination, and erad- expertise under ication. One of the Carter Center’s many contributions to the public former First Lady health field has been its operational research efforts, advanced through Rosalynn Carter’s hundreds of published scientific studies throughout the years. These efforts leadership. Center have contributed significantly to the growth, innovation, and development experts shared of more effective and impactful NTD programs in more than 30 African and their work on Latin American countries. recognizing stigma Since 1982, the Center has been an active participant of the American associated with Society for Tropical Medicine and Hygiene (ASTMH), the largest lymphatic filariasis international scientific organization dedicated to reducing the worldwide (LF), the program’s burden of tropical infectious diseases and improving global health. The support to patient Carter Center also has been an active member organization for the Coalition groups, called Hope for Operational Research for Neglected Tropical Diseases (COR-NTD) since Clubs, in Haiti its launch in 2014. COR-NTD meets each year in conjunction with the and Nigeria, and annual ASTMH conference, with participation from the World Health innovative research Organization, country program managers, implementers, researchers, in Haiti to evalu- and donors. ate the impact of In 2020, Carter Center health program representatives presented 20 a chronic disease studies across both events, comprising 10 oral presentations, nine digital self-management posters, and one symposium. program on For the first time, The Carter Center shared innovative research LF patients’ findings on the intersection of mental health and NTDs. The Center is well-being. uniquely positioned to address the stigma and mental health impact of Representing NTDs, leveraging more than 30 years the Trachoma Control Program, Scott Nash pre- sented in both Groundbreaking operational research has been conducted at the meetings on Amhara Public Health Institute laboratory in Bahir Dar, Ethiopia. alternative anti- biotic treatment strategies, focusing on the operational in Nigeria, among others. research conducted in the Amhara Lastly, the Center’s Guinea region of Ethiopia. Other topics Worm Eradication Program chaired a brought forth by the Carter Center symposium at ATSMH titled “Of Dogs team included the whole genomic and Dragons: Understanding Parasite sequencing studies conducted in Transmission Ecology and Applying Amhara, the trachoma elimination It to the Global Guinea Worm study by focused antibiotics (TESFA), Eradication Program.” The event the interruption of onchocerciasis explored the increase in Guinea worm transmission in active endemic areas infections in domestic dogs, cats, and in the Americas, and the assessment baboons and how these infections have of serological responses to Wuchereria not followed classical epidemiological Photo: Scott Nash bancrofti and Onchocerca volvulus patterns resulting from water-borne during LF post-treatment surveillance transmission. 9

Global Health News New CEO, Health Vice President Begin Carter Center Tenures Paige Alexander joined global career, with over served in the role since 2016 and The Carter Center last two decades of experience retired last October. summer as its new CEO. spanning government and “We are thrilled to welcome Dr. She succeeds Ambassador nonprofit sectors. She has Ijaz to the team, as he is a respected (ret.) Mary Ann Peters, who held leadership positions scientist, an engaged and passionate retired. at two regional bureaus leader, and a manager who builds The CEO is charged of the United States collaboration and trust across diverse with leading the Center Paige Alexander Agency for International teams,” said Carter Center CEO Paige into its next era of building Development (USAID), Alexander. “Colleagues describe him peace, health, and hope for the world’s covering missions and development as visionary, inspiring, and motiva- poorest people. programs in 25 countries from Eurasia tional. I know his ambition will help “Paige Alexander will carry to the Middle East and Africa over 15 The Carter Center continue to make forward the vision and values of years (1993–2001, 2011–2017). an impact by further improving health the Carter Center’s founders, my She also has had over a decade of care for the world’s poorest people in grandparents, Jimmy and Rosalynn nonprofit leadership roles, including as the coming decade.” Carter,” said Jason Carter, chair of the SVP and European founder/president Ijaz has held successive leadership Carter Center Board of Trustees. “The of IREX (2001–2010), an international positions since joining the CDC in Center’s mission to alleviate suffering civil society, democracy, and education 2002, including deputy director for and advance human rights globally has nonprofit organization. Since 2017, science and programs in the Center never been more urgent.” she has served as executive director of for Global Health, and chief of the Said President Carter, “Rosalynn the European Cooperative for Rural Tuberculosis Field Services and and I are excited that Paige Alexander Development (EUCORD) in Brussels Evaluation Branch in the National will become CEO of The Carter and Amsterdam. EUCORD helps Center for HIV, STD and TB Center. Paige is exceptionally well marginalized farmers in Africa grow Prevention. He began his career as a qualified to lead the Center into its marketable crops that sustainably medical epidemiologist at the Arkansas next chapter, and she is fully aligned improve the livelihoods of families and Department of Health, where he with our vision for the Center. We are communities. worked with marginalized confident that many of the Center’s Kashef Ijaz, M.D., rural populations at the most significant accomplishments are yet to come.” M.P.H., was appointed vice state, local, and community “My life’s work has been to lift president for health pro- levels. He has worked exten- up human rights, justice and fairness, economic and social opportunity,” grams at The Carter Center sively in Asia, Africa, and said Alexander. “For years, I have observed and admired the work of The last October. across the developing world Carter Center on the ground and in global human rights, health and peace- As a medical epidemi- on malaria, tuberculosis, and keeping contexts. Joining the Center at this time of transition, when the ologist, Ijaz most recently Ebola. founders’ vision, legacy and mission are served as the principal needed more than ever, is the privilege Dr. Kashef Ijaz He is a physician of a lifetime.” trained in public health deputy director in the As CEO, Alexander will provide from the University of Oklahoma and vision and leadership for The Carter Division of Global Health Protection, holds certificates in public health lead- Center and will oversee all program Center for Global Health at the U.S. ership from the University of Alabama implementation and operations. Centers for Disease Control and and in national preparedness and Alexander has had a distinguished Prevention. At The Carter Center, he response leadership from the Kennedy will provide leadership for programs School of Government and Harvard working to prevent or eliminate six Photo (top): Caroline Joe T.H. Chan School of Public Health at tropical diseases in 18 nations, as well Harvard University. Ijaz has more than as efforts to improve mental health 100 presentations and publications in care in the United States and abroad. peer-reviewed journals. He succeeds Dr. Dean Sienko, who 10

Global Health News Carter Center Plays Key Role in 2020 NNN Conference The year 2020 marked a crucial from the beginning, The Carter Center to provide context for meeting par- anniversary for neglected tropical diseases (NTDs). The World Health was deeply involved in the September ticipants. The meeting also served Organization and key stakeholders in the global NTD community came 2020 conference as a sponsor and as an opportunity to celebrate and together to celebrate accomplishments and affirm commitment to a new NTD through staff participation. Carter recognize the Center’s long history as Road Map that aims to reduce the burden of NTDs significantly by 2030. Center staff presented in three work- a recognized leader in the global fight Now more than ever, as the COVID- 19 pandemic preys on the health and shops and rapid-fire sessions, touching against NTDs, focusing efforts in some well-being of all populations, partner- ships and innovation are needed to on two crucial and relevant topics in of the poorest and most isolated places chart a path forward to reach global NTD elimination targets by 2030. the NTD arena: mental health and on earth. In this context, the Neglected NTDs, and effective NTD work in Carter Center staff worldwide Tropical Disease Nongovernmental Organization Network (NNN) held its conflict and humanitarian emergen- appreciated the opportunity that the annual conference in September 2020, with the title “Accelerating to 2030: cies. Carter Center staff are active virtual NNN conference provided to Building Resilient NTD Programmes in a Changing World.” The NNN in almost every NNN working group better understand their focused NTD was founded in 2009 as a global forum for NGOs to contribute to the and disease-specific group and make work and the essential connections control, elimination, eradication, and management of consequences of significant contributions to NTD between the Center’s contributions NTDs as outlined in the WHO’s NTD Road Map. implementation and best practices. and those of other organizations and As an active member of the NNN Angelia Sanders, associate director coalitions. Also important was the of the Carter Center’s Trachoma opportunity to learn about other Control Program, is chair of the programs and new ideas or strategies to NNN’s Conflict and Humanitarian support individual work. Emergencies working group. As The Carter Center continues Because the 2020 NNN to fulfill its mission to fight disease Conference was a virtual event, The and build hope through eradicating Carter Center encouraged broad staff and eliminating NTDs, we remain participation worldwide. A record 84 committed to the fundamental value Carter Center staff, including notable of partnership and interconnectedness. NTD experts from many countries, We look forward to continued involve- attended. To promote greater under- ment and leadership in networks and standing and perspective, the Center coalitions that will allow us to achieve organized a pre-conference gathering more in partnership than in isolation. 0 5 10 15 20 25 30 35 40 45 50 Chad 48 Ethiopia 0 Guinea Worm Disease Update Angola 1 January–December 2019 Cameroon* 1 Number of Human Cases Mali 0 South Sudan 4 January–December 2020** Number of Human Cases 0 5 10 15 20 25 30 35 40 45 50 0 5 10 15 20 25 30 Chad 48 Chad 12 Ethiopia 0 Ethiopia 11 Angola 1 Angola 1 Cameroon* 1 Cameroon* 1 Mali 0 Mali 1 South Sudan 1 South Sudan 4 *Likely imported from Chad **Provisional 0 5 10 15 20 25 30 Chad 12 11 Ethiopia 11 Angola 1

The Carter Center One Copenhill 453 John Lewis Freedom Parkway NE Atlanta, GA 30307 This issue is made possible in part thanks to the Michael G. DeGroote Health Program Publications Fund. For more information about The Carter Center and its health and peace programs, visit our website at www.cartercenter.org. In Memoriam: Center Pays Tribute to Three NTD Heroes The Carter Center acknowledges, Dr. Lucas’ skills as an organist and was Organization, with great sadness, the passing of happy to count him as a friend. he conducted three giants in the neglected tropical numerous consul- diseases community. Dr. Julius tancy missions. Schachter, a Dr. Thompson Dr. Adetokunbo microbiologist at was known for “Ade” Lucas the University of his strong focus was the founding California, San on the collection of quality data to director of the Francisco, was a support country decisions as well as his World Health force in the global commitment to the development of Organization’s trachoma community. The study of in-country technical expertise. Special Program chlamydial diseases, along with their He recently served as director and for Research and Training in Tropical diagnosis and treatment, encompassed principal investigator of the Chókwè Diseases from 1976 to 1986. He his career. Health Research and Training Centre worked toward the eradication of Dr. Schachter pioneered the treat- in Mozambique and as a member of the malaria, the elimination of schistoso- ment of trachoma through mass drug International Task Force for Disease miasis, the improvement of maternal administration. Eradication. The Carter Center’s Dr. and child health, and further develop- He supported the Carter Center’s Donald Hopkins said Thompson’s ment of health systems in Africa. work and was an esteemed collabora- death was “a terrible loss for his family Dr. Lucas was a valued member of tor in its Trachoma Control Program, and for humankind.” the Carter Center’s International Task speaking at its annual program review. Force for Disease Eradication from Dr. Tebebe Yemane Berhan, a giant of 2001 to 2017. Former U.S. President Dr. Ricardo Thompson was a Ethiopia public health, passed away as this Jimmy Carter personally testified to renowned parasitologist and an issue was going to press. His tribute will epidemiologist. At the World Health appear in the next issue.