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Partnership Celebrates Success in Eliminating River Blindness

Last week, a statue of a boy leading a blind man, symbolizing the international fight against river blindness, was unveiled at World Health Organization (WHO) headquarters in Geneva. The unveiling, attended by former US President Jimmy Carter, World Bank President James Wolfensohn, WHO Director Gro Harlem Brundtland, and Merck & Co., Inc., Chief Executive Officer Ray Gilmartin, celebrated the success of the public/private sector collaborations that have led to the virtual elimination in West Africa of river blindness, or onchocerciasis, once a devastating disease that maimed and disabled thousands of people a year. (See video.)

Last week, a statue of a boy leading a blind man, symbolizing the international fight against river blindness, was unveiled at World Health Organization (WHO) headquarters in Geneva. A copy of the statue is housed at World Bank´s headquarters

Onchocerciasis is caused by a parasite, which is transmitted by the bite of a blackfly and ultimately causes blindness in those infected

Nearly six million people in OCP countries are currently being treated with the drug ivermectin, which must be continued for 14 years

Replicas of the statue have also been placed at World Bank headquarters, Merck & Co. headquarters, and the Carter Center in Atlanta, Georgia.

This week, donor countries, convened by the World Bank, are meeting in Paris to address financing shortfalls for programs aimed at eliminating the disease throughout the African continent.

The West African Onchocerciasis Control Program (OCP), undertaken in 1974 by the World Bank, along with the United Nations Development Programme (UNDP), the Food and Agriculture Organization (FAO), and WHO, is considered one of the most successful multi-donor programs in the history of development assistance.

Covering eleven countries (Benin, Burkina Faso, Côte d’Ivoire, Ghana, Guinea, Guinea-Bissau, Mali, Niger, Senegal, Sierra Leone, and Togo), the program has virtually eliminated onchocerciasis in an area of 34 million people. It is estimated that 12 million children born within the OCP area have been spared any risk of contracting the disease.

When the program is completed in 2002, 600,000 cases of blindness will have been prevented, and a total of five million years of productive labor will have been added to the economies of the 11 countries comprising OCP. In addition, an estimated 25 million hectares of arable land have been freed up and are now experiencing spontaneous settlement since the disease has been largely cleared from the area.

Onchocerciasis is caused by a parasite, which is transmitted by the bite of a blackfly and ultimately causes blindness in those infected. The flight of people from infested areas has also left large tracts of farmland unused. The disease is controlled by the spraying of environmentally safe insecticides, screened by an independent ecological committee, and treated with the drug ivermectin. The treatment, to be effective, must be continued for 14 years, the length of time that the adult worm lives in the human body. Nearly six million people in OCP countries are currently being treated with the drug.

The remarkable success of OCP led to the establishment in 1995 of the African Programme for Onchocerciasis Control (APOC), which extends the area of control into the 19 remaining endemic countries on the continent. (The countries covered are Angola, Burundi, Cameroon, Central African Republic, Chad, Democratic Republic of the Congo, Republic of Congo, Equatorial Guinea, Ethiopia, Gabon, Kenya, Liberia, Malawi, Mozambique, Nigeria, Rwanda, Sudan, Tanzania, and Uganda.) APOC aims to treat 50 million people by 2002, prevent a million cases of blindness, and provide 7.5 million additional years of productive labor to affected economies.

The 57 projects underway will soon be treating 32 million people in 12 countries, representing 70 percent of the target coverage. Merck supplies the necessary drugs at no charge.

However, $7.5 million is needed to see the OCP project through, says Bruce Benton, manager of the World Bank’s Onchocerciasis Coordination Unit. The funding gap for APOC is another $8 million, a shortfall of about 13 percent of the program’s cost.

Funding shortfalls for successful programs as they near their conclusion are not unusual, says Benton, “because it is frequently assumed that victory has already been achieved. Some programs in the past that have been widely recognized as successes have received less funding than required for their conclusion.”

“In the case of OCP, we lack $7.5 million which is only 1.3 percent of the total financing required. We made some headway in this donors’ meeting in closing this gap and I am confident that we will completely close it and bring the program to its successful and lasting conclusion within its last three years.”

In addition to reducing the financing gap for river blindness programs, the Paris conference is expected to address the incorporation of the control of lymphatic filariasis (elephantiasis) into OCP and APOC. “Lymphatic filariasis is a highly disabling disease which affects 43 million Africans,” says Benton. “It can be controlled with the same drug (ivermectin) or Mectizan which is given free by Merck & Co. for onchocerciasis. We would hope that many of the donors will react positively to the possibility of integrating lymphatic filariasis control into OCP/APOC because this would be both cost-effective and feasible.”

In addition to co-sponsoring OCP and APOC with three agencies, the World Bank is the second largest donor and acts as the Secretariat for both programs. “OCP and APOC are major partnerships which consist of over 100 partners including donors, the African Governments, NGOs, the private sector and grass-roots communities that are actively involved in delivering the drug and thereby helping to eliminate the disease,” Benton adds.

Helpful links: For more information regarding river blindness, visit the following WHO website, http://www.who.int/ocp/.

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