Research Article: Growth, Challenges, and Solutions over 25 Years of Mectizan and the Impact on Onchocerciasis Control

Date Published: May 14, 2015

Publisher: Public Library of Science

Author(s): Joni Lawrence, Yao K. Sodahlon, Kisito T. Ogoussan, Adrian D. Hopkins, Maria Elena Bottazzi.

Abstract: None

Partial Text: The Mectizan Donation Program (MDP) was established in 1987 to oversee Merck’s donation of Mectizan (ivermectin, MSD) for the control of onchocerciasis (river blindness) worldwide [1]. This was accelerated and expanded when Merck made a groundbreaking announcement in 1987: it would donate ivermectin, completely free of charge, as much as needed and for as long as needed, for the elimination of river blindness as a public health problem in all endemic countries.

In addition to drug donations, MDP also provides technical and often additional financial resources to address specific problems encountered on the ground. The new CDTi strategy, distributing drugs at the community level, created some significant challenges (see Table 1). Mechanisms to determine where to treat evolved rapidly over a period of just a few years. Initially, cluster-based population studies were carried out using skin snips, an invasive technique not welcomed by communities. To address this issue, a non-invasive technique called “Rapid Epidemiologic Assessment” (REA) was developed. REA measured the disease burden by palpating onchocerca nodules in communities. The number of people in the community with nodules bore a fairly consistent relationship with skin snips to measure prevalence. TDR further developed the assessment tool and developed Rapid Epidemiological Mapping for Onchocerciasis (REMO), which was used in combination with REA studies in targeted communities based on the location of breeding sites of the black fly disease vector so that these two tools could be implemented to assess the disease burden based on ecology and geography [7]. Significant blindness was found only in hyper-endemic and meso-endemic areas. These areas were selected as priority areas for treatment to achieve the initial objective to control the disease.

By the end of 2012, the distribution of Mectizan had ceased in almost all endemic foci in the Americas. Colombia was the first country worldwide to receive verification of elimination of transmission by WHO [12]. The success in the Americas is due to the high geographic and therapeutic coverage achieved in limited and geographically isolated foci. This high coverage was achieved due to the political will in each country and the leadership demonstrated by OEPA.

There have been many lessons learned during more than 25 years of Mectizan donation. MDP initiated the use of mass drug administration as a major strategy to control and eliminate river blindness. Donations from Merck have made the elimination of onchocerciasis a realistic goal for low-income endemic countries. Since the inception of the program, river blindness has been virtually eliminated in the Americas. The commitment of Merck remains firmly in place, and by 2025, there is hope that the donation will have achieved much more than was ever expected 25 years ago.



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