Armand Van Deun - pioneering public health physician (1953-2023)

Armand Van Deun was born on 2 November 1953 in Brecht, Belgium. He obtained his medical degree in 1978 from one of Europe’s oldest universities, the Katholieke Universiteit Leuven, Belgium. After preparing himself for clinical work in Africa, he took a post as Regional Tuberculosis and Leprosy Coordinator in the Kigoma region of Tanzania from 1979 to 1985. Being among the first in the world, he applied the highly efficacious and effective multidrug therapy model for leprosy, and he spearheaded the implementation of what would later become known as the DOTS strategy for TB, pioneered by the Tanzanian government and the late Dr Karel Styblo from the International Union Against Tuberculosis and Lung Disease (The Union). From 1985 to 1990, he stayed in Belgium to obtain a specialty degree in clinical biology at his alma mater. Subsequently, he accepted a position in Rwanda as the Adjunct Programme Director for the Damien Foundation working with the newly created National Tuberculosis and Leprosy Programme. He also embarked there on what would be his lifetime scientific preoccupation with TB – operational research. He focused on two key areas in TB control: first, diagnosis, more specifically on quality assurance of sputum smear microscopy; and second, chemotherapy, particularly on standardized treatment of multidrug-resistant TB (MDRTB). His work was abruptly terminated by the events of 1994, which forced him and his family to leave Rwanda. After an interlude, with occasional working missions for the Damien Foundation, he was appointed Medical Director of the Damien Foundation in Bangladesh. During his 4 years in Bangladesh, in collaboration with the National exceptional efficiency had never previously been applied comprehensively on a large scale within peripheral microscopy laboratories for TB – most mycobacteriologists were not even aware of the method. This groundbreaking effort resulted in the adoption and publication of international guidelines for external quality assurance for sputum smear microscopy. In 1999, he joined the Mycobacteriology Unit of the Institute of Tropical Medicine (ITM) in Antwerp, Belgium. He was mainly responsible for the coordination and execution of research projects around the world, largely in collaboration with the Damien Foundation. Furthermore, he coordinated and analyzed the annual rounds of proficiency testing of Mycobacterium tuberculosis drug susceptibility testing (DST) for the global network of supranational TB reference laboratories, an initiative of the Global TB Drug Resistance Surveillance project of the WHO and The Union. He found that DST results may not be consistent between different testing methods and culture media, even among the most renowned mycobacteriology laboratories in the world. He and his colleagues observed that some rifampicin resistance due to specific mutations may be missed by the rapid liquid culture system but not the slower solid culture system, drawing global attention to the challenge of ‘borderline rifampicin resistance’. From 2001 onwards,


Armand worked most of his time for The Union, while being continuously employed by the ITM in Antwerp, with support from the Damien Foundation. One key contribution of Armand during this time was the initiation of the Tuberculosis Control Programme, the Foundation’s TB and leprosy program was expanded greatly, covering a population of 20 million and treating thousands of patients. One key research project he initiated in Bangladesh was to test and apply a ‘lot quality assurance system’ for sputum smear microscopy. This method known for its ‘International Course in Applied Mycobacteriology’, held for the first time in Dakar, Senegal, in 2004. It assisted national TB programs throughout the African region in building national laboratory networks. In 2008, Armand obtained his PhD as a Doctor in Medical Sciences from the Katholieke Universiteit of Leuven, with a thesis entitled ‘Optimization of smear microscopy for acid-fast bacilli in tuberculosis.

It remains perhaps the most comprehensive review and definitive work on the technique of the current century. The second pillar of his scientific endeavors, complementing the initial focus on microscopic diagnosis, involved optimizing treatment for rifampicin-resistant TB. He chose a sequentially adaptive design to pilot and evaluate treatment regimens of ever-improving treatment outcome results. Commencing in 1997 with the adoption of a WHO-recommended 21-month regimen proposed by a team led by Sir John Crofton in 1996, Armand and his collaborators advanced sequentially through six steps to a well-tolerated, inexpensive, and highly efficient sterilizing 9- to 11-month regimen in 2007. The regimen relied on a fourth-generation fluoroquinolone as the core drug to replace the lost rifampicin. He paid great attention to the wisdom of ‘not creating acquired resistance’ as the guiding principle of TB chemotherapy in all his endeavors in regimen design. At the same time, the effectiveness of the regimen had to be ensured in real world conditions of resource-limited settings where access to conventional DST may be limited. His goal was to establish a uniform treatment approach, with the aim of making it more affordable and accessible to all patients in need. Skepticism about the ‘Bangladesh regimen’ was initially widespread among specialists. Not even replicating the unprecedented treatment success with more than one thousand patients in nine African countries could appease all opinion leaders. The Union, together with globally renowned experts, conducted a randomized controlled trial that demonstrated non-inferiority of the so-called Bangladesh short MDR-TB regimen compared to the more than twice as long WHO-recommended regimen. Ultimately, the undeniable reality that effectively treating rifampicin-resistant TB (and even more complex resistance) with a standard regimen lasting less than one year has become accepted. The current new regimens rely, however, on the addition of powerful new drugs and carry substantially higher costs. Armand’s fight for the blatantly obvious has thus at last prevailed in a modified form. Due to the outstanding quality of his work, which has helped save the life of thousands of patients, Armand received the Kochon Prize in 2010. The prize, which consists of a medal and an amount of 65,000 USD, is awarded annually by the Stop TB Partnership to individuals or organizations that have made a significant contribution to combating TB. Armand decided to share the prize with the Damien Foundation for supporting its work in Bangladesh and to allocate the other half to fund collaborative work with his colleagues in Africa. Armand was also very much a family man, drawing incredible strength from the support of his wife and their delight in and devotion to their children. The family often had to endure hardship when his work took him to challenging places. Such was the case in the late 1970s in Tanzania, be it for finding the appropriate food for their small children or obtaining seemingly simple things such as matches. Since he was an adolescent, Armand’s hobby was breeding tropical fish species and he cultivated his hobby throughout his life into his retirement and even during times of deteriorating health. He kept several fish tanks in their home. The fish and their fry needed food like mosquitos and other delicacies, and his wife also became the carer for the hungry fish during his travels. Mycobacteriology found representation even in that context: once Mycobacterium marinum made it into a fish tank and a photograph documents a hunchbacked Sturisoma festivum which Armand clinically diagnosed as M. marinum spondylitis. Armand was known not only for his towering intellect and in-depth and comprehensive subject knowledge, but also for his integrity in all circumstances. He was a passionate and dedicated teacher mentoring countless students and colleagues with whom he shared his expertise, experience, and practical insights. He went out to wherever he was called and needed. Dr Nevin Wilson, a former Union student and colleague, now working with the UN in Jordan, recalls: ‘Armand started teaching me in the early 1990s, when he visited me in the forests of southern India where I worked with tribal communities. A great and good man who I was able to relate to as physician, teacher, mentor and friend.’ People who met and interacted with Armand appreciated his dedication to TB patients, particularly in low-income countries. His extensive experience in the field gave him a solid foundation in his search for a rational approach to technically appropriate problem solving. He will be remembered for his broad knowledge, his scientific rigor, his great humanity, and, above all, his humility. Armand leaves his wife Reinhilde, their children Thomas, Katrijn and Maarten, and four grandchildren.