The Task Force for Global Health

Removing the Greatest Obstacle to the Elimination of River Blindness Highly Ranked

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Project Summary

Two hundred million people in 10 Central African countries are at risk of river blindness, a parasitic infection that causes eye and skin disease. Half of them have gone untreated by the “wonder drug” ivermectin – recognized with the 2015 Nobel Prize for its potential to eliminate river blindness – because of another parasite, Loa loa, which can cause serious or fatal side effects following treatment. A new mobile phone-based diagnostic technology, recently validated in Cameroon, presents an opportunity to remove this last major obstacle and permit safe treatment in areas with Loa loa. Our partnership will seize this opportunity, first, by expanding access to the technology; second, by resolving uncertainty about the extent of disease overlap through mapping; and third, by initiating data-driven disease elimination programs across all of the populations currently excluded from treatment. This work will clear a path towards WHO's goal of river blindness elimination.

Problem Statement

More than 100 million people in Central Africa – an entire generation – have gone without ivermectin treatment for river blindness for the past 30 years. River blindness is a parasitic infection transmitted via blackfly bites that leads to intolerable itching of the skin and, later on, loss of sight. While ivermectin has been distributed in parts of Africa and South America since 1987, leading to decreasing rates of infection, this neglected generation has not accessed the treatment due to a major obstacle: Loa loa. This problem was discovered in the early 1990s, when mass treatment in Cameroon and the Democratic Republic of Congo caused serious adverse events, including deaths. Investigations revealed that the tragic reactions occurred because of high levels of Loa loa, an unrelated parasite, in the blood. After this discovery, communities and donors alike became discouraged from conducting river blindness treatment programs in districts within 10 countries – with an estimated population of 100 million – where the two infections are co-endemic. Without treatment in these areas, these individuals are at risk of river blindness morbidity. Further, without treatment, these areas could act as reservoirs for the infection, putting neighboring areas at risk of re-introduction. This ongoing problem will cost millions in continued treatments and will mean a failure to meet the World Health Organization’s goal of eliminating river blindness (as well as elephantiasis, which is also prevented using ivermectin) for good.

Solution Overview

We aim to solve the Loa problem by leveraging technical and public health innovations. Our solution will enable the treatment of communities that have been excluded from river blindness treatment for 30 years. It will entail a series of measurable steps:1) Scaling Up Technology & Establishing Health Information Systems: Produce LoaScopes and software needed to support mapping (n=1,000) and treatment delivery (n=10,000)2) Precision Mapping: Define areas that require treatment in each of the 10 countries where river blindness and Loa co-exist, building off existing data from countries and WHO and collecting new data using the LoaScope3) Scaling Up Intervention: Scale up mass treatment with ivermectin safely, either via regular mass drug administration or using the "Test and Not Treat" strategy, as determined in the mapping phaseCritically, our work will provide clarity about the geographical distribution of the Loa problem, and we will orchestrate the scaling up of technically and ethically appropriate interventions to eliminate river blindness safely. Our solution, though focused primarily on river blindness, is based on technologies and mapping strategies that open the door to the introduction of additional community-based health interventions using mass treatment with ivermectin as a platform for service delivery. In solving the Loa problem, we will be providing an important building block for local health system development and improving access of millions of people to basic health care. This solution is based in evidence gathered via research supported by the Bill & Melinda Gates Foundation, USAID, and other donors.

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Project Funders

  • Bill & Melinda Gates Foundation (to The Task Force) 2018 - 2023
  • Bill & Melinda Gates Foundation (to U.C. Berkeley)

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