Public Health Initiatives

The Onchocerciasis Control Program

The OCP was launched in 1974 by the World Health Organization (WHO) in collaboration with the World Bank, the United Nations Development Program (UNDP), and the Food and Agriculture Organization (FAO). The primary goal of the OCP was “the elimination of onchocerciasis as a public health problem and as an obstacle to socioeconomic development”(34) in the 11 participating West African countries. At the onset of activities, the only method available was vector control via aerial larvaciding of blackfly habitats. When Merk made Ivermectin available in 1987, the OCP incorporated mass treatment in most areas.

As a result of OCP success, over 600,000 cases of blindness were prevented and morbidity due to onchocerciasis was greatly reduced. These health improvements have been translated in national benefits such as increased productivity. At least 25 million hectares of land were made safe for agriculture that have potential to feed 17 million people per year with indigenous practices; such changes have changed many West African nations from aid receiving to food exporting. In 2002, the OCP was officially closed, having succeeded in virtually stopping transmission in all countries except Sierra Leon where ongoing civil war interrupted treatment. National programs are currently able to independantly oversee monitoring and remaining treatment needs.
(33, 34, 35)


African Program for Onchoceriasis Control

The APOC was founded in 1995 with the mission of eliminating Onchocericasis as a public health problem on the African Continent. It built upon the experiences of the OPC and many NGO partners who initially pioneered distribution efforts in the APOC region. The program pursued control through mass distribution of Ivermectin in hyper and mesoendemic areas that span 19 countries, primarily in Central and East Africa. It relies on many diverse partners including communities, Ministries of Health, NGOs, Merck & Co., several UN agencies and the World Bank.

In order to identify locations for APOC activities, new assessment methods were developed. Rapid Epidemiological Assessment (REA) relies on nodule counts to make rough community diagnosis. These results are used to produce a map of Onchocerciasis prevalence and activity, a method called Rapid Epidemiological Mapping of Onchocerciasis (REMO).

For implementation of treatment, the APOC pioneered a community based distribution strategy called Community-Directed Treatment with Ivermectin (CDTI). CDTI aims to empower communities and create sustainable programs by allowing communities to organize, run, and monitor their distribution programs. The intention was for community programs to be independent of APOC after about five years. In 2008, The APOC will begin the phasing out process which should resolve in 2010 with complete withdrawal from local programs. Thus far, APOC programs have greatly reduced morbidity due to Onchoceriasis. Evaluations are currently suggesting, however, that many CDTI programs may not be sufficiently prepared for cessation of APOC guidance by 2007.

(18, 36, 37)


Onchocerciasis Elimination Program for the Americas

The OEPA is a regional coalition in Central and South America that was formed in 1996. At that time Pan American Health Organization (PAHO), the Center for Disease Control (CDC), the Carter Center, the Lions Clubs International Foundations, and other NGDOs joined forces to take advantage of Merk & Co.’s provision of Ivermectin. National programs existed before formation of the coalition, but national budget constraints and the regional nature of infectious disease limited their impact. Since the inception of OPEA in 1996 access to treatment has skyrocketed and by 2003 all countries obtained the 85% coverage necessary for eventual elimination.

OPEA encourages and supports local ministries of health in organizing, administering and monitoring their distribution programs. It promotes bi-annual ivermectin treatment with an ultimate goal of 85% coverage in all populations. This strategy has shown good results and at the 2002 Conference on the Eradicability of Onchocerciasis professionals agreed that elimination can be achieved in the Americas. Following the conference, the Bill and Melinda Gates Foundation donated $10 million of the $15 million needed to complete elimination of Onchocerciasis in the Americas by the end of the decade and challenged OPEA to secure the final $5 million.
(39, 41, 42)