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FEATURE STORY

Forty Years Later: The Extraordinary River Blindness Partnership Sets its Sights on New Goals

July 3, 2014

STORY HIGHLIGHTS
  • A 40-year partnership between the WHO, the World Bank, African governments, pharmaceutical firms and over 30 development partners protects 100 million people a year from river blindness in 31 African countries.
  • The river blindness partnership owes its extraordinary success to sustained private-sector drug donations and a community-based approach to delivering preventative medication once or twice a year.
  • The partnership is now setting its sights on new goals—to completely eliminate the disease, and to adapt the river blindness approach to other preventable diseases that affect poor people.

WASHINGTON, June 23, 2014—River blindness is a terrible disease that causes severe discomfort and eventual blindness among infected people. Known in the medical world as onchocerciasis, the disease has been steadily beaten back in Africa thanks to 40 years of coordinated efforts to defeat it.  

The flies that spread river blindness breed in fast-flowing water. As a result, vast tracts of fertile land in Africa, fed by rivers such as the Volta, were unsafe for agriculture as recently as the 1960s. But today,

25 million hectares of land are free of river blindness, restoring livelihoods and boosting food security.

In fact, in 28 countries of the 31 African countries where river blindness is endemic, people no longer go blind from the disease. This victory against river blindness has been possible because of a wonder drug called ivermectin, which now reaches and protects 100 million people across a vast swathe of Africa.

1952: “The country of the blind”

Lady Jean Wilson, wife of Sir John Wilson, former director of the British organization Sightsavers, recalls a silent “country of the blind” during a visit to rural West Africa nearly 60 years ago. There, sightless men were guided by children, while blind women found their way to the community well using a rope.

In 1952, the year the Wilsons drove out from Accra, the capital of Ghana, towards the Volta River, river blindness was so tragically common that hundreds of villages were abandoned for fear of the dreaded infection. The impact was devastating for poor people who lived off the land.

Lady Wilson coined the term ‘river blindness’ to help raise awareness about the disease and how it spreads among vulnerable people. The new name was a step forward for both the advocacy and the painstaking coordination that would be needed to check its transmission in Africa.

1974: An “incredibly audacious” commitment

The World Bank’s first health project, initiated in 1974, was its support to the fight against river blindness, one of several debilitating ‘neglected tropical diseases’ (NTDs). This initiative signaled former World Bank president Robert McNamara’s recognition of the cruel nexus between poverty and disease, and the link between disease and development.

Mrs. Diana McNamara, who was among several speakers at a 40th anniversary celebration in Washington, said her late husband was happy to have made this contribution. Images of disease and of poverty had left a great impact on him after a visit to Upper Volta (present-day Burkina Faso), she said.

The Onchocerciasis Control Program (OCP) that was set up 40 years ago began by treating large areas in 11 countries with a larvicide.

Mr. Tim Evans, Director, Health, Nutrition and Population, World Bank Group said that the OCP’s aerial spraying using helicopters was not a fool’s errand, as some saw it, but an important first step, and that the river blindness partnership’s commitment had been “incredibly audacious” at the time.

1988: “A game-changing intervention”

While the larvicide spraying was effective, it was also expensive to keep up, and there were signs of emerging resistance. Clearly, a new and more sustainable solution was needed.

Trials of ivermectin (Mectizan) in the 1980s showed it could be used to prevent river blindness. In 1988, Mr. Roy Vagelos, former CEO of Merck & Co., and one of the team of scientists who developed the drug, promised to donate as much Mectizan to control river blindness in Africa as would ever be needed.

Looking back on 40 years of partnership, World Bank Group President Jim Yong Kim noted that back in the day when there were scant resources for global health, this decision to donate ivermectin for as long as was needed in Africa was a “game changing intervention” by Merck and all other partners.

Ms. Geralyn Ritter, Senior Vice President, Global Public Policy and Corporate Responsibility, Merck & Co. reaffirmed Vagelos’s 1988 commitment to donate Mectizan free of cost for as long as needed, as much as needed, and wherever needed.

“Twenty seven years later, we are doing just that,” Ms. Ritter said.

1995: APOC is set up, contributes to “peace dividend”

Today’s African Program for Onchocerciasis Control (APOC), set up in 1995, took Mectizan to 19 countries at first. The program has been implemented by the WHO, with fiscal management by the World Bank and critical support from African health ministries, the private sector, donors and NGOs.

Princess Alexandra, President of Sightsavers, spoke of the thousands of community volunteers across Africa who are working with Ministries of Health, APOC, and non-governmental organizations to distribute Mectizan, the drug donated by Merck, to their communities. 

Her Royal Highness highlighted that the involvement of the volunteers who have come together to defeat the disease is essential to the river blindness programs.

As President Kim observed, APOC’s river blindness control was often part of the peace dividend when long-running conflicts ended in many countries, such as Liberia and Sierra Leone. In fact, he said, the only countries in Africa where river blindness still causes loss of sight are those where conflict persists.

2014: APOC sets its sights on new goals

Dr. Luis Sambo, WHO Regional Director for Africa, noted that although APOC was first set up to control river blindness, it now aims for complete elimination of the disease in Africa. All 47 ministers of health in Sub-Saharan Africa have recently agreed to expand APOC’s mandate over the period 2016-2020, he said.

APOC’s community-based approach can be adapted to combat the other preventable NTDs—especially elephantiasis, but also bilharzia, trachoma, and intestinal worms. Pharmaceutical companies have agreed to donate preventative drugs to address all of these diseases.

Dr. Sambo cautioned however, that this was a complex undertaking which called for an investment case, a pledging conference to build a solid support mechanism, and commitment from African governments and the broader partnership to translate promises into effective delivery.

“I think that this undertaking is socially fair, technically feasible, financially affordable and politically commendable,” he concluded.

The World Bank Group’s commitment

With reference to APOC, and in his capacity as Dean of the World Bank Group’s Executive Board and Executive Director for Kuwait, Mr. Merza Hasan endorsed APOC’s successful river blindness model and called for sustained commitment to the NTDs. “Let’s finish the job,” he said, “We are not far away.”

Mr. Makhtar Diop, World Bank Vice President for Africa noted that, in addition to supporting APOC, the Bank is also helping African countries to address the NTDs, with commitments of nearly US $120 million this year.

“Our support, as you know, is because these diseases are closely linked to deep poverty and to losses of productivity,” Mr. Diop said, also mentioning the Bank’s intention to help tackle NTDs in the Sahel.

A recent study by Summers et al in the Lancet suggested that improvements in health outcomes from 2000-2011 in developing countries accounted for 24% of ‘full-income growth’ during that period.

Full-income growth adds the monetary value of changes in life expectancy to changes in GDP growth.

Referring to this study, President Kim said, “We now know that investing in health is not just the right thing to do morally, we know that it’s the smart thing to do in terms of spurring economic growth.”

“As we consider the way forward in fighting the neglected tropical diseases, we have to remember that these diseases are also diseases of neglected people,” he concluded.