The DeWorm3 Programme is a large-scale, five-year, community cluster randomised trial in India, Malawi and Benin which seeks to determine the feasibility of interrupting the transmission of soil-transmitted helminth infections (STH). Managed from a central hub at the Natural History Museum since 2015, DeWorm3 is supported by a vast array of international partnerships with governments, research institutes and global disease experts. If DeWorm3 is successful, it could contribute towards the overarching global target of eliminating STH as a public health problem, as part of the WHO NTD road map 2021-2030. To date, all three DeWorm3 sites have successfully conducted their six rounds of MDA with consistently high coverage and compliance and a stalwart reputation with local communities. With over 283,000 samples collected, prepared and stored, and over 890,000 albendazole doses distributed, we wanted to share the success, meet the team and discuss the significance of World NTD Day.
Tim Littlewood
DeWorm3 Senior Responsible Officer on behalf of the grant holding institution, Natural History Museum
How Does your work align with World NTD Day?
In early 2020 the Natural History Museum (NHM) launched its new strategy with a vision of a future where people and planet thrive and a mission to create advocates for the planet. As Executive Director of Science I oversee the strategic direction of the Natural History Museum’s Science Plan. A key part of this focuses on human and planetary health addressing areas of science that provides solutions from nature and for nature; very much aligned to the UN’s Sustainable Development Goals. Building on our collections based science, NTD research has been a core focus for NHM scientists for well over a 100 years particularly in the fields of taxonomy, systematics, evolutionary and ecological perspectives on parasites and vectors. Our focus on ‘unlocking our collections’ digitally and genomically offers opportunities to wider scientific and public audiences to benefit from research undertaken in combatting NTDs, whether finding ways to control, eliminate or eradicate infections. My own research has focussed on molecular tools applied to develop accurate diagnostics and a better understanding of the interaction between NTDs, their hosts and the environment towards elimination. As SRO of DeWorm3 I’m proud to help facilitate many experts committed to combatting soil-transmitted helminths.
"NTD research has been a core focus for NHM scientists for well over a 100 years, particularly in the fields of taxonomy, systematics, evolutionary and ecological perspectives on parasites and vectors. Our focus on ‘unlocking our collections’ digitally and genomically offers opportunities to wider scientific and public audiences to benefit from research undertaken in combatting NTDs. As SRO of DeWorm3, I’m proud to help facilitate many experts committed to combatting soil transmitted helminths."
Describe your typical working day:
I’m afraid I’m currently swamped in meetings but I do make time to continue research and publishing my helminth research whenever possible. I’m particularly interested in genetic and genomic variation in helminths and how this can be leveraged towards improved diagnostics and phylogenetics.
What do you consider to be the most significant impact of your work?
Helping establish a neutral, institutional home for DeWorm3 in supporting globally distributed colleagues and partner teams in India, Benin and Malawi has been an enormous team effort. The investment is in excellent hands and has the opportunity to provide key scientific data in establishing whether drug delivery alone, following externally validated mathematic models, can be shown to eliminate soil transmitted helminths. My own research has provided multiple phylogenies for flatworms, including schistosomes, other trematodes and tapeworms which have helped understand the evolutionary radiation of some NTDs whilst providing new markers to identify and differentiate them.
What are your professional goals in the next five to ten years?
Establishing a Science, Collections and Digitisation Centre for the NHM, as part of the Harwell Science and Innovation Campus (Oxfordshire, UK) will enable the NHM to accelerate progress in making its reference material available digitally and genomically. I’m passionate about collecting relevant reference (baseline) material that future generations will need access to in order to address future questions. An NTD repository, or a virtually connected distributed collection of NTD materials would be ideal.
What do you hope will be accomplished in the field of NTDs over the next decade?
A truly integrated One Health approach to understanding and tackling NTDs as part of our understanding of human, animal and environment interactions. The world is connected and we simply cannot focus on only one part of this triangle at a time without risking drug resistance, irreversible biodiversity loss or environmental damage. There is a planetary emergency and NTDs have the capacity to bounce back and affect the least resilient of communities.
What would you like the general public to know about NTDs?
NTDs are diseases of poverty and therefore a signature of neglected people. Everyone deserves an equal chance but NTDs will ensure this is not the case for millions of people around the world. Ironically, many NTDs can be controlled and eliminated from populations, if we choose collectively to do so.
Adrian JF Luty
Research Director, French National Research Institute for Sustainable Development
Principal Investigator, DeWorm3 Benin
"The general public may have heard of some of the more common NTDs, but may lack awareness of the cumulated public health and economic challenges faced by poor, predominantly rural populations across sub-Saharan Africa. My work has impacts primarily on alleviating the public health challenges faced by LMIC, but also, via my teaching and supervisory responsibilities, on training future generations of scientists."
Describe your typical working day:
I tend to spend most of my working day in my office and/or conducting project-related meetings with colleagues either face-to-face, by phone or more often, nowadays especially, via teleconferencing on-line. I send and receive large amounts of project-related messages by e-mail. Parts of my workday are also dedicated to preparing project reports that can comprise, for example, periodic updates of either financial or research-related activity. Depending on the programme of field-based activities, I also periodically spend time in the field with the core- and field-teams, and meet with the local authorities in the field study site to keep them updated on progress. I also have post-graduate teaching commitments, as well as public engagements and participation on PhD thesis committees. I currently also have 1 PhD student who I am supervising, so I spend time also with her when necessary. Lastly, as I am editor for several scientific journals, and I also do quite some reviewing of scientific papers, of project proposals and of fellowship applications for European Institutions, part of my workday can involve those types of commitments as well.
How Does your work align with World NTD Day?
If the DeWorm3 approach proves successful and scale-up to national level is envisaged, the hope is that treating whole populations for a relatively short period of time will obviate the need for continued treatment of schoolchildren, with no end in sight and the spectre of the twin dangers of drug resistance and donor fatigue setting in.
What do you consider to be the most significant impact of your work?
My work has impacts primarily on alleviating the public health challenges faced by LMIC (Low and Middle Income Countries), but also, via my teaching and supervisory responsibilities, on training future generations of scientists, especially, but not exclusively, Africans.
What are your professional goals in the next five to ten years?
I am in my last 5 years of professional activity before retiring. I will see the DeWorm3 project through to completion in 2023, beyond which there will be a few years’ worth of my time dedicated mostly to writing up the work from what is a major research undertaking, the largest of my career.
What do you hope will be accomplished in the field of NTDs over the next decade?
I hope that 1 or more of the NTDs will be eliminated across large parts of the world. Human African trypanosomiasis is one for which the incidence has already been reduced dramatically, whilst lymphatic filariasis is another. Onchocerciasis has also been controlled very extensively and is now a distant memory for many communities formerly affected. Further roll-out of praziquantel for schistosomiasis should also diminish that disease as a public health problem in the next decade.
What would you like the general public to know about NTDs?
The general public may have heard of some of the more common NTDs, but lack of awareness of the cumulated public health and economic challenges faced by poor, predominantly rural populations across sub-Saharan Africa, for example, is an issue that will always need more attention. Keeping such issues in the public mind is inevitably more difficult in the current pandemic situation, but we cannot afford to drop our guard, and, most importantly, funding levels for research and implementation must, at the very least, be maintained if not expanded.
Moudachirou Ibikounlé
Professor of Parasitology at the University of Abomey-Calavi Associate researcher at Institut de Recherche Clinique du Benin
Principal Investigator, DeWorm3 Benin
Describe your typical working day:
My working day depends on my program and the place where I am: in the field, in my office at the research centre or at the University. In the field, I spend my day supervising the field-based activities; face-to-face follow-up meetings with the field teams, information or debriefing meetings with the local authorities on the progress of projects and teleconferencing on-line with the central team to discuss the various implementation and monitoring activities. In my office at the IRCB, I spend my day conducting project-related meetings with colleagues and I send and receive large amounts of project-related messages by e-mail. Parts of my workday are also used to preparing project reports including periodic updates and research-related activity. At the University, I spend a part of my time teaching (animal biology and parasitology focused on NTD biology, transmission, control and their elimination), supervising master and PhD students, and reviewing scientific papers and for project proposals.
"I spend my day supervising the field-based activities, meetings with the field teams, debriefing meetings with the local authorities on the progress of projects, teleconferencing with the central team for various implementation and monitoring activities. My work is focused on NTD control and elimination and I will dedicate my time to fighting NTDs. "
How Does your work align with World NTD Day?
The DeWorm3 project addresses the public health problem of STH (Ascaris, hookworm & Trichuris) simultaneously in three sites: Benin, India and Malawi. The aims are to demonstrate the feasibility of interrupting STH transmission through a community-wide approach to MDA with albendazole contrasting the current standard of care targeted treatment of school-age children.
What are your professional goals in the next five to ten years?
I will dedicate my time to fighting NTDs. The DeWorm3 project is currently being implemented and will compete successfully in 2023. I will focus my time on scaling up the elimination strategy.
What do you hope will be accomplished in the field of NTDs over the next decade?
I hope that at least one of the NTDs (lymphatic filariasis, onchocerciasis, trachoma, Human African trypanosomiasis, and hopefully soil transmitted helminths!) will be eliminated across large parts of the world.
What would you like the general public to know about NTDs?
I would like the general public to know how to avoid the more common NTDs in their area, how to treat endemic NTDs and give the general public more facilities for the treatment of common NTDs.
Leanne Doran
DeWorm3 Project Manager, Natural History Museum
"Behind every NTD programme is an army of project managers, financial managers, data managers, accountants, administrators, procurement and logistics personnel, junior researchers, field teams and local stakeholders- every one of them is essential for delivery of a successful programme. NHM advocates for increased capacity building as part of its collaborations with LMICs and DeWorm3 has demonstrated that there is no shortage of skills for solving challenges such as NTDs, but issues of resource equity still need to be addressed. With a focus on collaboration, capacity-building and communities, real progress can be made toward eliminating the threat of NTDs."
What do you consider to be the most significant impact of your work?
One of the most significant barriers to improvement is a lack of resources, and a dependency on cash can result in constant risks and limitations to research institutions in LMICs. Developing a dual-strand financing system which allowed for pre-financed tranches to be released to our in-country partners is one of the most significant impacts of our work at NHM. It provided the necessary cash flow and flexibility to allow uninterrupted work at the site level while assuring value-for-money and thorough and transparent reporting for our funders.
When the COVID-19 pandemic halted operations at the sites, we worked diligently with our funders, partners and Ministries of Health to ensure safe and efficient response. With flexibility granted from our funder, we were able to reprogramme project funds to secure sufficient protective equipment, resources and training for the sites to safely resume work. Not only were our partners able to deliver on their contributions to the DeWorm3 project itself, but the communities benefitted also. Our partners in Malawi were able to develop their own local capacity in molecular diagnostics, with the part DeWorm3 funded molecular laboratory facilities at the College of Medicine allowing for national testing of COVID-19 which benefits the entire nation. Additionally, the community wide infrastructure and sensitization frameworks already established as part of DeWorm3 facilitated a rapid community response to the COVID-19 threat, slowing the spread of the virus. Just as the DeWorm3 programme leveraged LF programmes before it, the COVID response was now benefitting from the established infrastructure of DeWorm3.
How Does your work align with World NTD Day?
If DeWorm3 is successful, it could contribute towards the overarching NTD global targets of reducing the amount of people requiring STH interventions, reducing the disability adjusted life years related to STH and contribute to the overall elimination of STH transmission. The NTD road map advocates integrated approaches, multisectoral coordination and country ownership- factors which are integral to the success of DeWorm3, which thrives because of its international partnerships, collaborations and focus on capacity-building.
Describe your typical working day:
I have worked on the DeWorm3 programme at NHM for over 4 years so I’m quite fortunate to have experienced nearly the entire project life-cycle of the 5 year investment. I began as a grants administrator, progressed to operations manager and now project manage the NHM grant, overseeing the budget, operations, communications and reporting. The DeWorm3 investment spans multiple countries, time-zones and cultures, and with three core sites and a plethora of interdependent support units- there is always something to keep you busy! NHM has functioned as a neutral body ensuring equity, oversight and good governance of the investment. It has been a rollercoaster ride with many challenges, but with all three sites now having successfully completed their 6 rounds of MDA with consistently high coverage and a stalwart reputation with local communities, we are proud to wrap up a job well done.
What do you hope will be accomplished in the field of NTDs over the next decade?
I hope there will be a more holistic approach to how we tackle issues like NTDs, which incorporate the social, economic and environmental considerations of affected communities. The NHM’s Vision and Strategy for 2031 was developed with the United Nations Sustainable Development Goals (SDGs) in mind, with DeWorm3 focusing primarily on SDG 3 (Good Health & Well-being). Almost all of the other 16 SDGs are related to health, or their achievement will contribute to health indirectly, so I hope tackling these challenges with an interdisciplinary approach will eliminate the burden of NTDs and vastly improve the lives of affected communities.
What would you like the general public to know about NTDs?
Behind every NTD programme is an army of project managers, data managers, financial managers, accountants, administrators, procurement and logistics personnel, junior researchers, field teams and local stakeholders- not everyone gets their name on the papers but every one of them is essential for delivery of a successful programme. NHM advocates for increased capacity building as part of its collaborations with LMICs and DeWorm3 has demonstrated that there is no shortage of skills for solving challenges such as NTDs, but issues of resource equity still need to be addressed. With a focus on collaboration, capacity-building and communities, real progress can be made toward eliminating the threat of NTDs.
Parfait Houngbegnon
Statistician – Public Health at Institut de Recherche Clinique du Bénin
Coordinator of Data Collection and Data Management, DeWorm3 Bénin
How Does your work align with World NTD Day?
I am working in the DeWorm3 project which addresses the public health problem of STH (Ascaris, hookworm & Trichuris), with the primary objective of demonstrating the feasibility of interrupting their transmission through a community-wide approach to MDA with albendazole rather than the current standard involving targeted treatment of school-age children alone. Producing quality data to meet this objective seems to me to be an important aspect that should be highlighted during the World NTD Day.
What do you consider to be the most significant impact of your work?
Developing digitalization in data collection, monitoring and data management has a big impact on the success of mass distribution campaigns.
"My working day is focused on training enumerators, supervising data collection, and ensuring that Standard Operating Procedures are followed by the data collectors. The development of digitalization in data collection, monitoring and data management has a big impact on the success of mass distribution campaigns."
Describe your typical working day:
My working day in the field is focused on the training of enumerators, supervising data collection and ensuring that the Standard Operating Procedure are followed by the data collectors. I am also working on e-monitoring to control the quality of data, and ensuring we have the participation of the whole community. At the office, my working day involves producing reports of activities, ensuring quality control of the data, preparing for the next trial activities and I also work on writing papers.
What are your professional goals in the next five to ten years?
Be in the best international NTD teams! And to develop and promote appropriate digitalization tools to better manage mass distribution campaigns.
What do you hope will be accomplished in the field of NTDs over the next decade?
I hope we’ll have more scientific knowledge to make better choices in mass distribution, to improve how we address issues such as migration in mass distribution campaigns.
What would you like the general public to know about NTDs?
The general public should know that despite all the financial resources allocated to NTDs, the populations themselves are the key to the success of the various programs against NTDs.
Alex Schaefer
DeWorm3 Data Manager, University of Washington
"The results of this trial have the potential to affect health policy all over the world, reducing suffering and harm afflicting millions of children and adults. I’m proud to be part of the collaboration with the trial sites and other research partners to support the creation of evidence that will inform effective public health strategies in the future."
How Does your work align with World NTD Day?
I process, reshape, merge, and assemble incoming datasets from the DeWorm3 trials in order to prepare them for analysis, with the ultimate goal of determining whether mass drug administration is able to interrupt the transmission of soil-transmitted helminths.
Describe your typical working day:
During the pandemic, I typically work from my living room. My time is split between calls with collaborators (in the US, UK, Malawi, India, and Benin), preparing lists of individuals to be treated by the field teams, downloading and preparing data from treatment activities and censuses, and developing automated data management systems to track stool samples and qPCR results.
What do you consider to be the most significant impact of your work?
The results of this trial have the potential to affect health policy all over the world, reducing suffering and harm afflicting millions of children and adults. I’m proud to be part of the collaboration with the trial sites and other research partners to support the creation of evidence that will inform effective public health strategies in the future.
What are your professional goals in the next five to ten years?
I would like to continue to develop technical skills that can be used for epidemiological surveillance, program evaluation, and geospatial and statistical analysis.
What do you hope will be accomplished in the field of NTDs over the next decade?
I hope that the wealth inequality and colonial context that allow NTDs to flourish in many regions are recognized and rectified alongside the scale-up of effective interventions.
What would you like the general public to know about NTDs?
Primarily that, while devastating, these diseases are preventable and treatable, and many can be eliminated if we generate the political will to redistribute resources toward this goal and toward ending poverty.
Euripide Avokpaho
Epidemiologist at Institut de Recherche Clinique du Bénin
Site Coordinator DeWorm3 Bénin
How Does your work align with World NTD Day?
I am part of the Benin team for Deworm3, a multicounty (Benin, India, Malawi) clinical trial which aims to assess the feasibility of interrupting the transmission of 3 species of STH (Ascaris, Hookworm and Trichuris).
Describe your typical working day:
My daily work consists of planning Deworm3 activities and ensuring that the needs of each team member to accomplish their duties is addressed. Before deployment of the teams in the field, I make sure that authorities and community sensitization is done properly. At the end of activities, I organize feedback to the community.
"I think that the recent increasing mobilization around NTDs will help reach elimination goal in several NTDs. Mathematical models already show that it is possible to interrupt STH transmission. The clinical trials will give us the answer in the real world."
What do you consider to be the most significant impact of your work?
There is a part of my work which consists of collecting data about how to best implement community MDA for a scaling up. I think that Implementation Science data is critical to succeed in STH elimination.
What are your professional goals in the next five to ten years?
Achieve elimination of STH with Deworm3, collaborate in writing high impact collaborative papers on NTDs, and implement other projects with the ultimate goal of NTDs elimination.
What do you hope will be accomplished in the field of NTDs over the next decade?
I think that the recent increasing mobilization around NTDs will help reach elimination goal in several NTDs. Mathematical models already show that it is possible to interrupt STH transmission. The clinical trials will give us the answer in the real world. Environmental studies (research of STH eggs in water and soil) could also help develop other diagnostic tools for MDA evaluation, as alternatives to stool collection.
What would you like the general public to know about NTDs?
The general public should know that simple behaviours can help prevent transmission of STH and NTDs in general. Hand washing after defecation and before eating, and avoiding open defecation are behavioural practices that can help fight NTDs.
Kristjana Ásbjörnsdóttir
Assistant Professor of Epidemiology, University of Iceland
"A lot of my work is focused on making sure that we maintain the original priorities and plans for the study; with five years of data collection, four hundred thousand participants, collaborating institutions across five continents, and a variety of unexpected events, it’s easy for focus to drift a little. I document decisions we make, write a lot of memos and planning documents, and occasionally do get a chance to analyse data or communicate our progress and results to the wider community, which is always exciting!"
How Does your work align with World NTD Day?
I have been working on DeWorm3 since 2015. Our overarching objective is to determine whether transmission of soil-transmitted helminths, an NTD affecting over a billion people worldwide, can be interrupted rather than merely controlled.
Describe your typical working day:
In theory, I mostly work on data analysis and science writing; but in reality a lot of my day is spent on Zoom and emails. I have a call with some part of the DeWorm3 team every day of the week where we share information and put out fires as they come up. A lot of my work is focused on making sure that we maintain the original priorities and plans for the study; with five years of data collection, four hundred thousand participants, collaborating institutions across five continents, and a variety of unexpected events, it’s easy for focus to drift a little. I document decisions we make, write a lot of memos and planning documents, and occasionally do get a chance to analyse data or communicate our progress and results to the wider community, which is always exciting!
What do you consider to be the most significant impact of your work?
With DeWorm3, we’re aiming to answer a crucial question for soil transmitted helminth control policy: can transmission be interrupted through mass drug administration alone? The landscape is shifting rapidly, there is interest in moving from controlling transmission to interrupting it, and this very large project is uniquely placed to address some of the outstanding questions.What are your professional goals in the next five to ten years?
What do you hope will be accomplished in the field of NTDs over the next decade?
I am hopeful that most NTDs will be eradicated as a public health problem.
What would you like the general public to know about NTDs?
NTDs affect an enormous number of people and most are preventable or treatable. They’re diseases of neglected communities, and there are real opportunities to do better.
