14 December 2001

Africa: Elimination Of River Blindness 'Possible Within Ten Years'

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Washington, DC — The Global Partnership to Eliminate River blindness announced Friday that US$39m has been pledged by donors to wipe out Onchocerciasis, more commonly known as River Blindness, in Africa by 2010. The disease causes blindness, skin lesions, disfigurement and almost unbearable itching.

The news comes amid celebration that the first phase of the campaign has been so successful; World Heath Organisation officials say River Blindness has almost been eliminated in West Africa; some 1.5m people in the region who were once infected with the disease no longer have any trace of it.

The disease is caused by a parasitic worm, "onchocerca volvulus." This worm grows from a parasite that is introduced into humans by the bite of a blackfly. The adult worm, over its fourteen-year life span, produces millions of microscopic parasites - "microfilariae." These infant parasites spread throughout the body causing the disease.

The flies need fast, running water to breed and in 1972, two French scientists proposed attacking the blackfly when it seemed most vulnerable: during its larval stage, when it clung to sticks and rocks in the rivers. If blackflies could be controlled for at least 14 years, they reasoned - the time an adult worm lives in the human body - then theoretically the parasite colony in humans would die out.

In 1972, they convinced Robert McNamara, then President of the World Bank, that this would work. McNamara was traveling in West Africa, to see the effects of the severe drought that was battering the Sahel. Donald B. Easum, then U.S. Ambassador to Upper Volta (since renamed Burkina Faso) recalls that while McNamara was visiting the capital, Ouagadougou, he asked to visit Bobo Dioulasso in the southwest to talk with ORSTOM (Institut Français de Recherche Scientifique pour le Dèveloppement en Coopération), the French tropical medicine research organization.

"While there inspecting drought conditions," says Easum, "he was struck, as was his wife, by the tremendous number of people who were blind, especially farmers who in their villages were being led around the place on a stick by a child.They were very moved by that."

"Of course, he may have gone to Bobo Dioulasso with something of this already in his mind. After all why would he go to see these French technicians if it was solely the drought that he was interested in? He may have been told about blindness before he got there, but he certainly saw a lot of blindness there when they were going around the countryside."

Easum describes McNamara as "very much taken" with the research aimed at controlling the blackfly. "And when he got back to Washington he called a meeting in Paris to meet with possible interested organizations. In 1974, McNamara announced that the World Bank would embark on a major program to attack this disease by means of spraying river valleys where the fly was breeding."

In its first phase, the Onchocerciasis Control Program (APOC) targeted West Africa, using a two-pronged combination of spraying and treatment with the drug "Ivermectin" provided free by pharmaceutical company, Merck and administered once a year to the people living in the affected areas.

Today, "except for one or two pockets where the disease remains," said a World Bank spokesperson, it been has almost completely eliminated in 11 West African nations.

18m children born in the target area during the programme now "face no risk of the disease," according to a World Bank statement. Forty million people in the 11-nation area of operation are currently protected and 25 million hectares of arable land has been made safe for farming and settlement.

The partnership fighting River Blindness includes representatives from some 30 African nations, Merck which, between 1987 and the end of 1996, donated more than 65m doses of the drug, a dozen NGOs and agencies such as the World Bank, World Health Organization (WHO), United Nations Development Program (UNDP) and the Food and Agriculture Organization (FAO). They have been meeting all week at World Bank Headquarters.

The newly pledged US$39m is for the second phase of APOC and will be targeted at central, eastern and southern Africa. The Partnership believes it can replicate its success in West Africa throughout the sub-Saharan region, where the disease remains one of the major causes of blindness. Out of 120m people worldwide who are at risk of onchocerciasis, 96% are in Africa, the remainder in Yemen and some Latin American countries.

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