Can we rid Africa of a blinding neglected tropical disease?

By Simon Bush, Director of Neglected Tropical Diseases at Sightsavers

In 1947 when Sightsavers’ founder, Sir John Wilson, coined the phrase river blindness to describe the almost unpronounceable disease onchocerciasis, rife amongst Africa’s river-side communities, there was little choice for those living in areas where what we now call a neglected tropical disease (NTD) was endemic.  Fear of being infected by the bite of the simulim fly, which was breeding in the rivers’ fast flowing waters and then going blind meant that villages were abandoned and with them, the rich fertile lands and people’s livelihoods.

Today, although the World Health Organization estimates that 120 million people1 are at risk of river blindness, there is hope.

For the last 25 years, drug distribution programmes to treat river blindness have been established across most endemic countries, and community-based distribution systems are used to ensure people receive an annual dose of ‘Mectizan’® (ivermectin)*. The drugs are donated by global pharmaceutical company Merck & Co. Inc. (known as MSD in the UK), and organizations like Sightsavers support the distribution.

However the real hope comes through evidence from the African Programme for Onchocerciasis Control (APOC), our key partner in fighting river blindness. It has found that when taken once or twice a year for 15 to 17 years ‘Mectizan’® can help control this debilitating NTD. This, at last, puts the end in sight! 

Elimination of transmission is already a real possibility for some communities across Africa. Evidence shows that elimination of the disease as a public health threat by the end of 2012 in regions in Uganda, Nigeria and Mali should be feasible2. Moving forward, the new Roadmap for NTDs published this week by the World Health Organisation sets the goal for river blindness elimination in a number of African countries by 2020, and we would anticipate this being the case in Ghana, Guinea Bissau, Togo and Benin.

With the strong evidence that this disease can be beaten, Sightsavers has developed its own ten-year plan to fast-track the elimination of the disease in programmes where we know elimination of transmission of the disease is feasible. The plan, just-launched, is to fundraise and invest more than £27 million over the next decade: increasing annual treatments by approximately 30 per cent, to reach 30 million people a year and training 150,000 community directed distributors annually to support increases in ‘Mectizan’®  distribution. It costs just 5p for Sightsavers to protect someone against river blindness for a year. With such a cost-effective methodology available for combating this disease the focus becomes reaching more people and ensuring consistency in the delivery of treatment.

With elimination the rationale for our investment it was heartening to see the UK Government increasing its support for NTDs five-fold, including supporting treatments to prevent more than three million people from developing river blindness. Other high level commitments were made yesterday at the London Declaration, where the Bill and Melinda Gates Foundation, governments, NGOs, multilateral organisations and the private sector united to help consign the diseases to history. The event was co-hosted by the UK Coalition against NTDs of which Sightsavers are a member, and I participated in discussions about how we can harmonize efforts on NTDs to achieve control and elimination.

For Sightsavers’ part we are starting work this month in the Democratic Republic of the Congo (DRC) where the disease is endemic. Working with The United Front against Riverblindness (UFAR) in the DRC we aim to reach some of the 19.3 million people living in at-risk communities in that country3. Post-conflict conditions and logistical challenges mean that the DRC has received little support in the past, but efforts will be scaled-up with treatment distribution starting imminently. We also have plans to support Ivory Coast and Angola in combating this blinding disease.

When you witness how this disease needlessly devastates the lives of individuals, families and whole communities you have to believe that it could – and should – be consigned to medical history. Helping rid Africa of this parasitic disease would not just eliminate one of the NTDs but it would alleviate the impact of blindness in Africa by reducing those needlessly blinded by this disease, removing a serious obstacle to socio-economic development across the continent. Treating (and ultimately eliminating) such disease is a clear way to help alleviate poverty in some of the world’s poorest communities – so let’s make this our aim.

 

Notes:

*Mectizan is not licenced for use in the UK

1. Yaounde Declaration on Onchocerciasis Control in Africa. (2006); A Declaration of African Ministers of Health on the future of onchocerciasis in Africa and report of the meeting

2.  Charting the Lion’s Share: The story of river blindness mapping in Africa, APOC, WHO, 2010

Simon Bush is the Director of Neglected Tropical Diseases at Sightsavers, an international NGO helping people with visual impairments in developing countries.  Simon’s work includes travelling to monitor Sightsavers projects, advocating for changes to policy from top decision makers, and developing approaches to social inclusion and inclusive education for the blind and people with disabilities. He also has the important task of managing the relationships with Sightsavers’ public-private partnerships that concern Sightsavers work with potentially blinding neglected tropical diseases (NTDs), such as trachoma and onchoceriasis.

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