Lorenzo Pezzoli is an infectious disease epidemiologist, currently based at WHO in Geneva within the Cholera Programme. There, he works to specifically support the activities related to the use of cholera vaccine, in integration with all other interventions, in line with the new global strategy for cholera control (Ending Cholera—A Global Roadmap to 2030) launched in October 2017.
He completed the European Programme for Intervention Epidemiology Training (EPIET) at the Health Protection Agency Centre for Infections in London in 2008, and has developed his career working for the last 10 years in low and middle income countries. You can find him on Twitter @pezzapezzi #EndCholera
Tell us about yourself and current research, and about how you came to be interested in this field?
My training is in infectious disease epidemiology. I have a degree in Veterinary Medicine and a PhD with a focus on epidemiology, but my breakthrough to field epidemiology was thanks to the European Programme for Intervention Epidemiology Training (EPIET), which I have completed at the Health Protection Agency (now Public Health England) Centre for Infections in London between 2006 and 2008.
As an EPIET fellow I got the chance to apply my scientific knowledge to public health, namely on outbreak investigation, surveillance and operational research. During the EPIET fellowship I was also fortunate to go on an international mission for a few weeks to Bolivia with the Pan American Health Organization to evaluate a national yellow fever vaccination campaign. We used a mix of Custer and Lot Quality Assurance (LQA) sampling methods to assess where the areas of low vaccination coverage where within the country. That experience opened the doors of international public health for me and after EPIET I worked as an independent consultant for some years evaluating public health programs ranging from vaccination campaigns, routine immunization, lymphatic filariasis elimination, and tuberculosis surveillance, in different countries across Africa, Latin America, and the South Pacific. This was a very exciting period of my life, not only because of the amazing places I was lucky to see and the wonderful people that I met, but also because of the great learning experiences. Each consultancy was different and with specific challenges, and finding a way to overcome as part of a team, is thrilling, and often exhausting. But there is nothing more rewarding than having a drink or some (local) food, after a long field day, with your team members. And the rewards did not stop there. Many of these experiences resulted in publications, which developed further our knowledge, and, I trust, transmitted it to others. Then, in 2014, after a few years as itinerant epidemiologist, I joined the cholera program at the World Health Organization (WHO) to handle the secretariat of the recently revitalized Global Task Force on Cholera Control (GTFCC). Again, this was a wonderful opportunity to translate years of field experience in infectious disease control in support of the global cholera control strategy of WHO and partners. As both the amount of work (unfortunately cholera is still a major public health problem in many areas of the world which lack basic access to safe water and sanitation) and, consequently, the team grew, I am focusing these days especially on the use of oral cholera vaccine integrated in the cholera control plans of affected countries. This is in line with the Global Roadmap to Eliminate Cholera by 2030, recently launched by the GTFCC, which advocates for a multisectoral approach for cholera elimination using all tools available.
What made you decide to join the editorial team at the PLOS Cholera Channel?
Although I am more of a public health practitioner than a researcher, it would be impossible for me to be effective in my work without maintaining a scientific approach. Science is fundamental to guide public health actions; and every time these actions are taken, there are learning opportunities to improve our approaches, which we can capitalize by conducting evaluations and operation research. Being an editor of the cholera channel is a great way to remain in touch with the research ongoing and disseminate research for public health purposes. Last but not least, it was impossible to refuse being part of the editorial team since the other members are among the colleagues I hold in the highest regard in the “cholera community”. They are also good friends, as it may have transpired already.
Where do you see your field of research heading in the next few years? What are the next big questions the field will address?
In terms of cholera control, really the game changer has been the availability of a safe and effective oral cholera vaccine (OCV). OCVs have been around since more than 20 years. However, in the current form they have been prequalified since 2012 and a global stockpile established in 2013, with funding from Gavi, the vaccine alliance. The stockpile created a new momentum in cholera control, with countries now having access to an additional effective tool, which generated a demand, and motivated manufacturers to increase supply. Although we still have more demand than supply unfortunately, we are really seeing virtuous cycle by which countries are motivated to request increasing amounts of doses and the production is following. In 2013, only about 200,000 doses from the 2-million-dose stockpile were shipped, but the stock has been more than doubling every year and last year, more than 12 million doses were shipped—and many more were requested by affected countries. As we increase the use of OCV as a cholera control tool, there is still a lot to learn from refining the current vaccination strategies, like dose spacing (the current vaccine is given in 2 doses two weeks apart, but increasing the dose spacing may make it even more effective), using a single dose for outbreak response, exploring the best ways to integrate its use with other measures, or administering it in controlled temperature chain or even in self-administration regimens; to develop new and even more effective vaccines, that are lighter to carry, do not require cold chain, require a single dose only, and are more effective than the current ones in children.
What is your favorite piece on the Channel to date? What do you think is a must-read on the Channel?
I liked the piece on the genomic history of the seventh pandemic. Understanding how cholera “moves” (where it originated from and where it is spreading) is not only fascinating but is also extremely important, since it guides our control measures. It is a complex matter since in certain areas by direct (human-to-human) transmission is the more important route, while in others it is the environmental transmission, and often it is a mix of both (e.g. when feces from a contaminated patient pollute the environment). This is really information for action, if we want to achieve cholera elimination by 2030.
What is the importance of open access and open data in your field?
When it comes to public health, I dare to say that the only way is open access. Research should be easily accessible to everyone who needs it across the world. Also having open databases of infectious disease data is essential for global control. Unfortunately this is not always possible because of country sensitivities. Cholera is a very political disease and not all countries affected are willing to even acknowledge that they have a “cholera problem”, resulting in no or under reporting of surveillance data.