Lives of the fellows

Brian Oliver Lyndhurst Duke

b.24 June 1926 d.3 June 2006
OBE(1961) CBE(1975) MB BChir Cantab(1951) DTM&H(1952) MD(1962) ScD(1969) FRCP(1975)

Through his research and original contributions, Brian Duke did more than any other single person to triumph over river blindness, one of the most terrifying scourges of tropical Africa. This surely must be the greatest achievement in tropical medicine in the last 30 years and the mectizan donation programme that followed blazed the way for public/private partnerships that are now so successfully being developed to combat HIV/AIDS and poverty.

Onchocerciasis or river blindness is a blinding parasitic infection carried from one person to another by a biting blackfly. The blackfly breeds in rivers and streams, and people who live nearby are bitten and infected. It occurs predominantly in Sub-Saharan Africa and some isolated areas in Latin America. In the worst-affected villages everyone is infected by the age of five and half the people will become blind before they die in their 30s. Altogether some 80 or so million people are at risk and 20 million are currently infected. When Brian Duke first went to the Cameroons in the 1950s there was no treatment for river blindness of ‘oncho’.

Brian was born in Kampala, Uganda, and was educated at Eastbourne College, Sussex, where he was head of school and captain of cricket. He gained an open minor scholarship to Gonville and Caius College, Cambridge. After completing his undergraduate training, he studied at Guy’s Hospital (the seventh of eight generations to study there) and received his MB BChir in 1951 and a diploma in tropical medicine in 1952. He ultimately obtained an MA, MD and a ScD, all from Cambridge.

From 1953 until 1975 he worked in the Cameroons, first for the Colonial Medical Service and later for the Medical Research Council. During this time he studied the migration of adult worms and microfilaria in the human body, their response to various new treatments, the role and dynamics of different blackfly vectors, and conducted a range of animal studies. With his attention for detail and precise methods and observations his work really defined the dynamics of the disease and established the methodology for all future clinical trials. He even found a new worm – onchocerca dukeii. In addition he undertook extensive studies into loa loa and schistosomiasis, two other common parasitic infections. With the coming of independence he was actively involved in establishing pathology and parasitology services in Nigeria, Ghana, Sierra Leone and the Gambia. The oncho literature is liberally littered with references to the pioneering work of B O L Duke. In all, he published 172 scientific papers.

In 1975 he went to the World Health Organization in Geneva as the chief of the filariasis infections unit. He was closely involved with the TDR programme (the Special Programme for Research and Training in Tropical Diseases) and particularly the development of ivermectin. His experience in the field, his knowledge of the disease and his understanding of what was required in clinical trials greatly facilitated the rapid assessment of this exciting new drug. It was his outrageous suggestion in an interview reported in the magazine South that Merck should give ivermectin away free, that may well have catalysed the subsequent mectizan donation programme. It certainly caused him a lot of difficulties within WHO and a reprimand from the director general after Merck had complained. Later Roy Vagalos, the CEO of Merck, recounted the story somewhat differently. However, in 1987 Merck went on and made the unprecedented commitment to provide this miracle drug free to anyone with onchocerciasis, anywhere in the world for as long as was needed. To date, over half a billion doses of the expensive drug have been distributed at no cost and 60 million people a year in 34 countries receive treatment.

After Brian reached mandatory retirement age at WHO in 1985 he worked at the Armed Forces Institute of Pathology in Bethesda, Maryland, and in 1991 he ‘retired’ with his new and growing family to Lancaster. He joined the board of the River Blindness Foundation and was their medical director until 1996. He worked tirelessly to expand the availability and improve the distribution of ivermectin and continued to travel widely to endemic areas. He continued to consult for various groups, including the Carter Center in Atlanta and WHO. His expertise was constantly sought out by researchers, especially to assess the effects of treatment on worms, and his last paper on the effect of ivermectin on the genes and fertility of female worms was published in January 2006.

He received an OBE in 1961 and a CBE in 1975. His magnificent contributions were also recognised by his colleagues. He received awards from the Royal College of Physicians, the British, German and American Societies of Tropical Medicine, the Mectizan Expert Committee and Rotary International. He is survived by his wife Diane and children Lottie and Molly and, from a previous marriage, Oliver, Annie and Lucy, and five grandchildren.

He was a wonderful husband and father. He had a wry smile and a wicked sense of humour. He had been ‘brought up proper’ and knew what was right, always did it himself and expected the same from others. His time in Africa gave him a wonderful range of stories and practical solutions to many problems. His intellect and memory made him a superb and practical scientist who quickly recognised the potential of new advances and rapidly applied them to further his and the world’s understanding. He was a great mentor to many and overall had an unwavering concern for humanity. Duke died suddenly while mowing his lawn, three weeks before his 80th birthday.

Hugh R Taylor

[The Lancet 2006 368 196]

(Volume XII, page web)

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