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WASHINGTON, December 5, 1995 - A new joint international program, launched today at a conference hosted by the World Bank, should save millions of Africans from a debilitating disease that causes unbearable itching, blindness, and disfigurement.
The African Programme for Onchocerciasis Control (APOC), a partnership between governments, non-governmental development organizations (NGDOs), bilateral donors, and international agencies, including the World Bank, will implement community-based drug-treatment programs in 16 African countries. The drug, called Mectizan©, is being donated by its discoverer, Merck & Co., Inc. The program is modeled on the highly successful Onchocerciasis Control Programme (OCP), which was established in 1974 to eliminate riverblindness in an 11-country sub-region of West Africa.
The goal is the elimination of onchocerciasis-commonly known as riverblindness-as a major public health problem and impediment to socioeconomic development throughout Africa. According to World Health Organization estimates, nearly 100 million people are at risk of the disease and 15 million are infected in the 16 countries to be covered by the new program.
"Over the next generation, APOC will add 10 million years of productive labor to the 16 African countries covered by the program. And, by way of OCP, we know that the tools exist and the international collaboration can be garnered to fully control the disease and achieve results," said World Bank President James D. Wolfensohn.
The program, supported by its statutory bodies, would:
- finance community-based drug treatment projects within countries and across borders;
- advise and provide guidelines to the treatment projects;
- ensure coordination;
- organize operational research and training;
- provide independent monitoring and evaluation of control; and
- ensure financial oversight.
The African Programme for Onchocerciasis Control
Donor nations, sponsoring international organizations, and a coalition of 11 NGDOs have mobilized to form the APOC to eliminate riverblindness from the remainder of the continent. This area is a broad swath containing parts of 16 countries and running from Cameroon in the west to Ethiopia in the east and then south to Angola and Malawi.
The program is modeled on the Onchocerciasis Control Programme (OCP), which is on the verge of eliminating riverblindness in an 11-country African sub-region containing 32 million people. The World Bank was instrumental in the creation of the OCP and continues to play a major role as a leading sponsor and its second-largest donor.
The OCP, in addition to controlling the carrier of the disease (the blackfly) with a method called "vector control," uses a drug called Mectizan© (generically known as ivermectin), donated by Merck and Co., Inc., to kill the immature worms in the human body. Mectizan© was found safe and effective in the treatment of riverblindness through extensive clinical trials conducted by Merck in collaboration with the World Health Organization (WHO). Merck announced in 1987 that it would give the drug free to approved riverblindness programs "for as long as needed to as many as need it." Currently some 13 million people are being treated with donated supplies of Mectizan©, a number which will vastly increase with the new program.
The international community realized that the availability of free Mectizan© presented a unique opportunity to control riverblindness as a public health problem in the non-OCP areas of Africa that are not technically suited to vector control.
The nonprofit Carter Center in Atlanta, Georgia, houses the Mectizan© Expert Committee, which approves supply of the drug for major programs. The Mectizan© Donation Program, which oversees the drug's distribution, is also located at The Carter Center. Former U.S. President Jimmy Carter personally supports and has been active in promoting the APOC. In particular, he and The Carter Center support the model of global partnership for disease control throughout Africa represented by this new program.
Experience from the OCP shows that Mectizan© treatment is very popular among endemic populations, and that communities can effectively take responsibility for their own treatments. It is possible, therefore, to control riverblindness at very low cost with community self-treatment and free Mectizan©.
Armed with this knowledge, and building on the success of the OCP, the APOC will control the disease by establishing community-based ivermectin distribution systems. The program will be based on a partnership between participating governments, NGDOs and other parties operational in the field, bilateral donors, and international agencies.
Like the OCP, the APOC will be co-sponsored by the United Nations Development Programme (UNDP), the Food and Agriculture Organization of the United Nations (FAO), the World Bank, and the World Health Organization (WHO). The executing agency will be WHO, and the World Bank will be responsible for all donor coordination and fund mobilization. The APOC will be headquartered in Africa.
The Ministries of Health and NGDOs will deliver Mectizan© on the basis of technical service agreements, and a liaison office will be maintained through the WHO office in Geneva to maintain working relations with the NGDOs and other partners associated with the program.
If we move expeditiously and begin sustained mass treatment programs now, there is a good possibility of eventually breaking the chain of transmission and eliminating the disease as a major public health problem throughout those major parts of Africa where the disease remains endemic," said Bruce Benton, Head of the World Bank's Onchocerciasis Unit.