Onchocerciasis disease, or River Blindness, is a neglected tropical disease (NTD) plaguing Africa for years, thriving among poverty-ridden populations. The Gates Foundation, in partnership with other organizations, is combating this disease by making its medical treatment easily accessible. In 2023, Niger became the first African country to eliminate this disease, marking a significant achievement in public health. Niger eradicates river blindness, setting a precedent for other countries in the fight against NTDs.

River Blindness in Africa

River Blindness is a result of the bites of infected blackflies of the genus Simulium and its symptoms include visual impairment, intense itching, disfiguring skin conditions and permanent blindness. In 2018, onchocerciasis infection was most widespread in central and western Africa. The highest average infection rates at the national level were recorded in Ghana, with a prevalence of 12.2%. Furthermore, other countries with national infection rates exceeding 5% included Cameroon, the Central African Republic, the Democratic Republic of the Congo (DRC), Guinea-Bissau, Sierra Leone and South Sudan.

According to the Reaching the Last Mile Fund (RLMF), 240 million people are at risk of River Blindness and 99% of people infected with Onchocerciasis live in Africa. As stated earlier, Onchocerciasis is an NTD, which is a group of infectious diseases that primarily affect populations in tropical and subtropical regions, often characterized by limited health care access and insufficient attention from the global health community.

Moreover, as an NTD, River Blindness disproportionately affects the poorest populations, compounding the cycle of poverty by hindering access to preventive medicine and basic clinical care. The resulting blindness further limits economic opportunities for affected individuals, perpetuating the challenges faced by these communities. Addressing the complex interplay between health and socioeconomic factors is crucial to breaking this cycle and improving the overall well-being of those impacted by River Blindness.

Eliminating River Blindness in Niger

The primary approach for eradicating River Blindness involves population-based treatment using ivermectin, commonly referred to as mass drug administration (MDA). This strategy aims for a minimum therapeutic coverage of 80%. In regions with high and moderate endemicity (hyper and meso endemic areas), a sustained effort of 12-15 years of annual treatment is necessary to break the transmission cycle, aligning with the lifespan of the adult Onchocerca volvulus parasite.

Additionally, Merck generously donates the drug known as Mectizan®. Remarkably, the World Health Organization (WHO) has officially recognized four countries — Colombia in 2013, Ecuador in 2014, Mexico in 2015 and Guatemala in 2016 — as free from onchocerciasis after they successfully conducted elimination activities for several decades.

Globally, 1.8 million people now reside in areas where mass drug administration for onchocerciasis is no longer required. In 2023, Niger accomplished a significant milestone by becoming the initial African country to successfully halt the transmission of river blindness.

Looking Ahead

Senegal is on track to become the second African country to eliminate Onchocerciasis. Currently, the Gates Foundation collaborates with Reaching the Last Mile and other global partners to eliminate River Blindness and lymphatic filariasis in 39 countries across Africa and Yemen. In addition, this collaborative effort seeks to reduce the number of people needing treatment by 350 million. Niger eradicates river blindness, setting a significant precedent in the global health community’s fight against neglected tropical diseases.

– Lucciana Choueiry
Photo: Flickr