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Sustainable Development: a winning combination River Blindness eradicated in Tropical Africa
[mis à jour le 22 April 2004 à 09h17]
WHO’s program to fight against onchocerciasis in Western Africa (OCP) will soon end in Ouagadougou (Burkina Faso). This success has enabled 25 million hectares to be repopulated and re-seeded to feed 17 million inhabitants . The time when more than 50% of the population in these regions suffered from river blindness is over. There are no traces of a disease which WHO no longer considers to be a problem…
And this thanks to a unique collaboration among 4 United Nations Agencies, 13 non-governmental organisations and the governments of roughly 30 countries… Thanks also to a donation programme supported for 15 years by the manufacturer of the only drug effective against this plague. Since 1987, 250 million doses of this drug have been distributed. The result? As WHO’s Dr. Noma Mounkaila explains, "all of the children born after 1974 are no longer blind. The lands which these populations had fled have been re-colonised, agricultural paradises have been established. Not only is there agriculture, but also fish farming and electricity …"
Two years ago, onchocerciasis was still the 2nd leading infectious cause of blindness in the world. It is provoked by a worm carried from human to human through the bite from a small black fly, the simulium, which lives near rivers. Its larvae develop in waterfalls and rapids, hence the name river blindness… But the disease also causes skin lesions and dramatically affects life quality and expectancy. Endemic in 36 countries, 30 of which are in Sub-Saharan Africa and Yemen, the disease represents a direct threat to 120 million people!
The main strategy consists of interrupting the larva’s cycle by eliminating the simulium through insecticide dissemination or through active drugs against the larva in the human host. This parasite can live in humans for 14 years! If today, the disease reservoir has practically disappeared in the 7 countries where the OCP programme was launched, it is thanks to the combined actions of dissemination and population treatment. And, as WHO emphasises, thanks to the fact that in 1987 "the ivermectine’s manufacturer, Merck and C°, committed itself to providing without cost the necessary quantities of the drug for as long as needed to eliminate onchocerciasis as a public health problem."Discovered by a laboratory in the United States at the end of the 1980’s, ivermectine proved to be an oral drug which was very interesting with a long lasting action, to the point where treatment could be given just once a year. "It was almost a miracle and by definition, a drug adapted to mass treatment in developing countries where there are few medical structures," explains Dr Philippe Gaxotte, an actor from the outset. Registered for the first time in France under the name of Mectizan, this substance, whose price could never be paid by the concerned populations, is offered to WHO.
An independent group of experts - specialists in parasitology, tropical medicine and public health - was founded in February 1988 to pilot the programme. Donations began in October and 10 years later, the 100 millionth treatment was given in Uganda. Last month in Bombani, a small Tanzanian village, Merck’s president and Tanzania’s vice-president gave the 250 millionth dose …
Usually, things are not so formal… The villagers themselves are responsible for the distribution. In the area of mass prevention, it is essential to personally implicate individuals. Dr. Jeff Jacobs, manager of the donation programme, is in direct contact with the 109,000 distributors who assure that it works smoothly. "Each village determines its procedure. They choose two, three or four community distributors. They decide how they will do it: under a tree or three days of door-to-door. Its up to them."
But the programme’s group of experts assure that all of the distribution aspects are well under control! That the populations are registered, followed over time, that the operations are co-ordinated among the United Nations Agencies, non-governmental organisations, local authorities… And that each year, tens of millions of people receive one dose. Philippe Gaxotte "has never seen a tropical medicine programme work so well!" with a real enthusiasm from the population, who re-establish their traditional agricultural practices and re-conquer their nutritional autonomy.The Johannesburg Summit on Sustainable Development has just closed its session. In a joint declaration last September 10, Mary Robinson, the United Nations’ Head Commissioner for Human Rights and Dr. Peter Piot, Executive Director of UNAIDS, reaffirmed that the offensive against the HIV epidemic is based on human rights principles.
Within this context, the renewed commitment of Merck and C°’s president, Raymond V. Gilmartin, takes on a special significance. In his opinion, "because of this commitment in the area of health and taking into account that it is an essential factor of economic and social development, we feel obligated to go beyond our research efforts. Providing Mectizan has a strong impact in terms of economic development Here in the field, by discussing with authorities, we realise that we soothe suffering, but also that we free individuals and enable them to lead a more productive live."
The differences between behaviours from one continent to another are striking, according to whether a company is committed here or a government there. Aid to development, should it be the responsibility of governments alone? It is more comforting to see economic actors engage in co-operative actions, in direct relation with the on-site institutions and communities. "I heard several members of the Bush administration bring up HIV-AIDS infection as an obstacle to economic development", recognises Raymond Gilmartin. "I am convinced that the American government understands the relationship between the fight against HIV and aid to development. Indeed, I think that the differences between our countries are essentially oriented by their approach to the problem, not by their concern for it."
Furthermore, this type of action is coherent with the capitalistic ideal! Because "our actions with the Bill and Melinda Gates Foundation and the Republic of Botswana for an integrated prevention and management policy of HIV-AIDS has provoked no negative reactions from the public. Our company is respected for its efforts which aim to facilitate access to the drugs which it has discovered. In our opinion, it is even a special strength which we present as such to our shareholders."
As for Bjorn Thylefors, former Director of WHO’s Ophthalmology Prevention Programmes and currently engaged in this action, he affirms his conviction that "this kind of partnership is called to expand. Several groups have been created over the last few months: so we have Merck with the Mectizan programme, GlaxoSmithKline with the donation for the fight against lymphatic filariasis, Pfizer with the fight against trachoma, Novartis against leprosy, we will probably see Boehringer-Ingelheim join the fight against AIDS…"
In Africa, many observers would like to see in this co-operation a ’blueprint’ for other challenges. It should also be stated that between HIV-AIDS, polio and tuberculosis whose multi-resistant forms never cease to appear, the projects will not be lacking…
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