The next steps to eliminate river blindness

In 1987, pharmaceutical giant Merck made a generous pledge: donate — for as long as needed — the drugs that would help control the spread of onchocerciasis or river blindness, the second most common cause of visual impairment due to infection after trachoma.

That promise, global health groups claim, has been instrumental in the fight against the disease for the past 40 years, and is now what is making it possible to move from the control to elimination phase. This transition, however, presents even bigger challenges and will therefore require a considerable scaling up of efforts. About 120 million people are still at risk of contracting the disease, 38 million of whom are already infected, according to the World Health Organization.

World Bank President Jim Kim, other senior officials from the bank, representatives of donor governments, health experts and members of the private sector are scheduled to gather on Friday in Washington, D.C., to discuss the next steps to eliminate this and other similar neglected tropical diseases.

Ahead of the meeting, we reached out to Simon Bush, director of NTDs at SightSavers, and Helen Hamilton, NTDs policy adviser at the U.K.-based NGO, who shared with us a few insights on what will be the biggest challenges in this shift to an elimination strategy, how they plan to overcome those obstacles and what their priorities should be for the coming years.

How do you plan to move from control to elimination of transmission of river blindness? Any new technique, strategy, approach or partnership we can expect?

Results from studies have provided empirical evidence that elimination is feasible in some endemic areas in Africa. In Uganda, after 13 years of treatment, there was a dramatic fall in the prevalence of carriers, from 71 percent to just 7 percent. The government has since started to implement an elimination strategy with twice yearly treatment. In Sightsavers-supported countries, we initiated a fast track initiative in 2011 with several objectives, such as maintaining full geographic and therapeutic coverages, helping countries verify elimination and promote the delivery of onchocerciasis control activities with other health interventions. To do this, we plan to train an extra 150,000 community drug distributors and support the training of 20,000 health workers annually to build their capacity in delivering interventions for this disease. We will reinforce health education and sensitization activities in 18-supported countries to reach all target districts. In addition, we plan to engage in more partnerships, including with universities and research institutes, to better inform our decision-making and program direction.

What challenges are you seeing in this shift from control to elimination of river blindness, and how do you plan to tackle them?

To ensure elimination we need to scale up programs and integrate with other health interventions. The challenges are engaging community leaders and communities to maintain high coverage rates, and ensuring good understanding within a community of why we are stopping treatments in some places wherein interventions may no longer be necessary, but in which we will continue post-intervention surveillance to ensure any form of disease re-introduction is detected and tackled early on. Linked to this is improving the community-directed distributors-to-population ratio, and ensuring continued support and resources for surveillance and monitoring, and that national health systems are equipped and supported to do this.

For the past years, you’ve gotten significant help from the private sector. What other roles are there for them as you transition to the elimination phase?

The program wouldn’t be where it is without the Merck partnership but the critical element is making sure the treatments reach the communities. First and last miles remain a challenge we're working with them on — that is getting treatments through customs procedures and then moving them all the way through levels of the health system so that they reach the rural communities.

What do you see should be the biggest focus in this next phase of combatting river blindness?

The biggest focus is building health system capacity for surveillance and ensuring that it is well-resourced enough. Scale up and coverage, coverage, coverage! We have to hit our targets on this and we can't afford to miss even one year, otherwise we put a project back a year elimination wise and won't sustain the gains we've made so far.

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