Focus on River Blindness

Celestina Hiza is a 50-year-old farmer from the village of Bombani in northeastern Tanzania and her long days are spent tilling land, looking after her house and preparing food. However, last week, surrounded by cameras, journalists, high-ranking business executives and health officials, she stole the limelight as she received the 250 millionth treatment of Mectizan, provided by the Merck Mectizan Donation Programme (MDP). The treatment marked the 15th anniversary of Merck & Company's MDP, a campaign that has combated onchocerciasis, more commonly known as river blindness, through the free supply of the drug to any country that needed it. However, analysts say that it also points towards the potential success of well-managed public/private healthcare partnerships in the developing world. For Celestina, the treatment had arrived on time and the worst stages of onchocerciasis, a debilitating, disfiguring and often blinding disease, had not set in. She was only suffering from the swelling and thickening of her skin, known as lizard skin. However, according to the World Health Organisation (WHO), in Africa and some parts of South America, 18 million people are infected and an estimated one million are already visually impaired or blind as a result of the disease. IMPACT Onchocerciasis is a parasitic disease that is transmitted to humans through the bite of a blackfly that is found along the banks of rivers. Once in the human body, the adult parasite can live for as long as 15 years, producing offspring know as microfilariae that cause the skin rashes, itching, disfigurement and, in many cases, blindness. Apart from the health impact, experts say that the socio-economic impact of so many people becoming blind is crippling. "We are losing two productivity values," said World Bank expert Dr Frannie Leautier, referring to the all-too-familiar sight of a child using a stick to lead an elderly blind person. "One is that of the young boy who has to lead the old man, and the other the old man himself, so the worst effect of the disease is the loss of productivity of more than one person." Another impact of the disease has been the forced migration of communities from the areas where the flies breed, added Richard Porter, Chief Executive of the non-governmental organisation (NGO) Sight Savers International. "The fly breeds near fast flowing rivers, which is often the most fertile land, so the result is that people had to abandon the areas, resulting in the loss of productivity and these people becoming reliant on the meagre resources of others," Porter commented. BREAKTHROUGHS But analysts say that significant progress is being made to bring the disease under control. The World Bank-sponsored Onchocerciasis Control Programme (OCP) which was set up in West Africa in 1974 is due to end this year, and has been hailed as a success as the disease has been largely eradicated. The programme initially attacked the black flies in their larval stage by spraying larvicides along riverbanks, but lately, the use of Mectizan was introduced to treat those already affected. "With the large scale spraying completed, we now have to soak up the more dispersed, but very important cases of onchocerciasis. This is where the MDP has been playing an important role," a health specialist in Dar es Salaam told IRIN. "For 15 years we have been at this work - one dose, once a year," Merck Chairman Raymond Gilmartin told the villagers in Tanzania. "Today we will do this for the 250 millionth time and I renew my pledge today that Merck will keep donating Mectizan wherever it is needed, for as long as it remains needed." "During its history, the MDP has helped prevent more than 600,000 cases of blindness and has reduced infection rates from the black fly to almost zero. The programme has also helped people to live again on land once ravaged by the black fly - and to help them farm enough land to feed 17 million people," he added. Analysts tend to agree, as the impact of this programme - a partnership between Merck, the World Bank, WHO, NGOs, health officials in various countries and, most importantly, the local communities - is beginning to be seen. "It is still too early to make a long-term verdict, but we have been involved in the MDP and have seen that the impact is highly beneficial as the symptoms are beginning to disappear and people are realising that they can go back to their land," Porter said. "It is pretty sustainable as well," added Dr Leautier. "According to the NGOs I talk to, the costs of distribution are about US $0.20 a dose." MODEL FOR NEW PARTNERSHIPS The MDP is also being seen by many as an example for other such groups to explore the benefits of public/private partnerships in healthcare. "It is quite a complex arrangement to put together, but if you can - and you have to persevere because there are a lot of vested interests - what you find is a programme like this that can have a major impact on the community in Africa," Porter said. "I think, in many ways, that this is a model. If people study this, they can get some lessons as to how you can roll that out in other disease areas," he concluded.