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.
- 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]
- 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]