26 September 2022 · Global Partnership for Zero Leprosy
Q&A: Meet Jordan Tappero, GPZL Leadership Team Member
Your career in global health spans many regions and disease areas. What have been some of your main areas of focus?
I spent 25 years (1992-2017) as a medical epidemiologist in the United States Public Health Service (USPHS). I was assigned to the US Centers for Disease Control and Prevention (CDC). During these years, my focus was on the conduct of randomized clinical trials; the implementation of HIV/AIDS, tuberculosis, and NTD prevention, care, and treatment programs; the introduction of new childhood vaccines; developing surveillance systems and the validation of new diagnostic tools for infectious diseases; and serving as CDC Incident Manager for complex humanitarian emergencies (Haiti post-earthquake cholera and West African Ebola epidemics).
You served as CDC Country Director for 14 years in Botswana, Thailand, Uganda, and Haiti. Can you characterize the fight against NTDs from your position as a CDC Country Director?
CDC Country Offices are typically co-located with Ministries of Health (MoH) of the host government. Generally speaking, CDC Country Offices provide direct support to large national programs such as HIV, TB, Malaria, Childhood Immunization, Influenza, and Emerging Infectious Disease Programs. In addition, CDC Country Offices are often called upon by MoH officials to assist ad hoc with other public health challenges. While serving as Country Director, I supported programs addressing several NTDs, including Buruli ulcer, mycetoma, leishmaniasis, dengue fever, rabies, schistosomiasis, and lymphatic filariasis.
How did you first develop an interest in leprosy?
Following my residency training in internal medicine, I pursued follow-on fellowship training in dermatology because of an interest in better understanding Kaposi’s sarcoma, an early AIDS-defining condition presenting in the skin. Given my interest in infectious diseases, as part of my clinical training in dermatology, I spent every Friday on rotation with the USPHS’s Hansen’s Disease Program in San Francisco. The clinic cared for over 500 patients. The director of the clinic was also funded by the NIH to study new therapeutics and diagnostics. In 1987, I joined a research team for a month-long field evaluation of arabinogalactan-based serologic test for early infection in the Himalayan Mountain Kingdom of Bhutan. Lastly, I served as the Epidemiology Section Chief for CDC Meningitis and Special Pathogens Branch (MSPB) from 1998-2000, and MSPB had responsibility for Mycobacterium leprae infections.
Your current work focuses on Guinea worm, lymphatic filariasis, human African trypanosomiasis, and visceral leishmaniasis. Where do you see opportunities for the integration of leprosy with other disease-specific work?
The Gates Foundation has been supporting the elimination of visceral leishmaniasis (VL) as a public health problem (EPHP) in India since 2013. India is on track to achieve the validation of VL EPHP in the next few years. One threat to sustaining EPHP is post-kala-azar dermal leishmaniasis (PKDL). In India, it is estimated that about 10 – 20% of patients treated for VL will go on to develop PKDL one to three years after successful treatment for VL. Because patients with PKDL can transmit Leishmania donovani via the bite of a sandfly, the early diagnosis and treatment of PKDL are essential for sustaining VL EPHP. Moreover, because the morphology of skin lesions of PKDL can mimic that of leprosy skin lesions, the Foundation is investing in confirmatory rapid diagnostics for PKDL and leprosy, such that patients presenting with either cutaneous disease can be screened, correctly diagnosed, and referred for early treatment.
What do you hope to see the Global Partnership for Zero Leprosy accomplish in the near and long term?
Though great strides have been made in reducing the number of countries with new leprosy cases in recent years, achieving the WHO NTD Roadmap 2030 goal of the interruption of transmission of M. leprae in 120 countries (61% of all countries and territories) by the close of 2030 remains elusive. The development of new diagnostics to identify latent infections and the implementation of promising new targeted preventive chemotherapy could help accelerate the interruption of transmission.