The
Onchocerciasis Control Program, 1974-2002
A
successful multilateral collaborative effort, dealing with longitudinal effects
in health, economics, and development
Specific
events and dates are included in the Timeline page!
Ivermectin
is dispensed by Community Distributors trained and hired by OCP. Courtesy
of WHO/TDR.
|
A patient
is weighed to determine his ivermectin dosage. Courtesy of WHO/TDR.
|
Program Details
- Provided over 25 years of continuous operations
- Covered 1,200,000 sq. km [i]
- Goal: To “improve their living conditions by integrating a
health program with socioeconomic uplift.” [a]
- At first, the program consisted exclusively of aerial larvicide spraying,
contracted to U.S. and Canadian companies. Pilots picked up and disseminated
larvicide from operational bases and storage dumps throughout the OCP region.
Over 100 hydrologic stations transmitted data by satellite to ground station
computers which predicted water flow, identified the appropriate larvicide
and dosage, and the most cost-effective spraying routes available. [h, i]
- In 1987, ivermectin (Mectizan®) replaced or supplemented larvicide
measures. It is a safe, effective drug suitable for mass administration. It
doesn’t kill adult worms, but kills the microfilariae and halt the progression
to blindness. OCP disseminated the drug along with training for local health
workers and administrators in heavily infected villages. [h, i]
- Spraying operations were expanded west and south in 1986 to prevent
re-invasion of treated areas by blackflies. [h]
Newsworthy Accomplishments
- One of the first programs to explicitly address both health and economics.
[f]
- Virtually halted transmission (brought the disease under control)
in all participating countries except Sierra Leone, where a decade-long civil
war interrupted operations. War and civil unrest did not appreciably affect
the program’s efficacy in other locations. [h, i, o]
- Eradicated the disease from Kenya. [o]
- Protected 30 million people in 11 countries: Dahomey (now Benin),
Ghaha, Côte d’Ivoire, Niger, Mali, Togo, Upper Volta (now Burkina
Faso); later Guinea, Guinea-Bissau, Senegal, Sierra Leone [a, h, i]
· 600,000 cases of blindness prevented [i]
- 18 million children have been born in now-controlled areas and face
no risk of infection. No infections have occurred in children born in the
original program area since 1974, except in re-invasion zones and those with
operational difficulties like Sierra Leone, where the infections were still
reduced to 10-20% of what would have been expected in the absence of larviciding.
[f, i]
- As early as 1978, the annual transmission potential (ATP, the theoretical
number of larvae received by a person stationed at an insect capture point
during one year) dropped from 800 to below the acceptable level of 100 in
two-thirds of the sprayed regions. [f]
- The ***donation*** of ivermectin (Mectizan®), originally $3 per
tablet, by Merck & Co., “for as long as needed to as many as need
it” free of charge, is one of the most far-reaching and impactful humanitarian
acts in history.
- The inclusion of an ecological unit, under leadership of Laurent
Yamego, which reports directly to the international ***Ecological Group***,
makes OCP unique among other public health programs. [h]
- No adverse impact of larvicides on fish or invertebrate populations.
[f]
- 25 million hectares (250,000 sq. km) were made safe for resettlement
and cultivation [i]
- Brought settlement back to riverside areas previously deserted out
of fear of infection. Implemented resettlement, cultivation, and economic
development. Constructed 100 new villages, strengthened 230 existing traditional
villages, created 8000 new farms, improved agricultural practices in over
5600 traditional farm holdings, constructed over 1000 km of country roads,
drilled almost 700 wells and bore-holes to supply 400 liters of water per
family per day, and constructed 41 schools and 22 outpatient clinics and 11
village stores. [f]
- Training conducted by OCP operatives consisted of fellowships granted
to several hundred African scholars from participating countries and in-service
training and refresher courses for 800 staff employed by OCP.
- Research: Nearly 50 papers prepared by staff members and consultants
published in scientific journals. Over 100 internal reports issued by the
OCP and collaborating institutions. [f]
- By 1993, the cost was $340 million. “Per capita, that’s
$0.54 USD [1984 exchange rate] per person, “not counting the returns
of increased productivity from preventing people fom becoming debilitated
and going blind, and the potential production from the 25 million hectares
of arable land which is being liberated from oncho infestation.” –
Bruce Benton, World Bank’s coordinator. [h]
