Bill & Melinda Gates Foundation

River Blindness Success in Colombia Blazes Trail for Others to Eliminate the Disease

September 12, 2013

Colombia is the first nation in the Americas to eliminate onchocerciasis, also known as river blindness disease. This milestone not only ensures people in the Colombian community of Naicioná no longer suffer its symptoms—unbearable itching, skin lesions, diminished vision and potential blindness—but also paves the way for other countries in Latin America to wipe out the parasitic disease. On the global stage, Colombia serves as a model for battling river blindness in Africa, where more than 100 million people risk contracting the disease.

The Carter Center—through its Onchocerciasis Elimination Program for the Americas (OEPA) has been working closely with ministries of health in all six affected Latin American countries since absorbing the River Blindness Foundation in 1996.  The Center also fights river blindness in parts of four African countries.


Credit: The Carter Center/H. Ruiz. Former U.S. President Jimmy Carter speaks with Colombia’s Minister of Health and Social Protection Alejandro Gaviria Uribe at an event to celebrate Colombia being verified as having eliminated river blindness. 


River blindness is caused by worms that form nests beneath the skin.  These worms produce thousands of microfilariae, or baby worms. The microfilariae cause severe inflammation of the skin, intense itching, and—if the microfilariae invade the eyes—blindness.   The cycle of transmission continues when a vector black fly picks up the microfilariae from an infected person when feeding. The fly then transmits the parasite to the next person it feeds from. Passing through the black fly is the only way the baby worms can grow to be reproductive adults.  The flies breed in rivers, and transmission of the infection is most intense near rivers, which is reflected in the disease’s (scientifically known as onchocerciasis) common name ‘river blindness.’

A safe and effective drug called ivermectin—the veterinary form of which is used to prevent heartworms in dogs and cats—kills the microfilariae in humans. An unprecedented turning point in the battle against river blindness occurred when the pharmaceutical company Merck pledged to donate ivermectin, packaged as Mectizan, for as long as necessary to fight the disease worldwide.

Colombia’s success was based on a strategy of delivering Mectizan to villagers every six months, together with health education and community engagement. For more than a decade, community workers devoted themselves to eliminating river blindness, working hand in hand with Ministry of Health staff who logged thousands of miles—often on foot through rough terrain—to assist in delivering health interventions in a remote area plagued by political insecurity and armed conflict.

Based on a program of careful monitoring of impact, supported by the Center’s OEPA and its generous donors, river blindness transmission was interrupted.  Mectizan treatments were stopped and for three years, ‘post-treatment surveillance’ was successfully conducted to confirm the parasite would not return.

Colombia requested verification of river blindness elimination from the World Health Organization (WHO).  A WHO team visited the country in late 2012, and in 2013 the Director General of WHO informed Colombia that elimination of river blindness was verified.

As the first country in the world to be granted verification of elimination by the WHO, Colombia is a role model for wiping out river blindness. It is hoped that Ecuador, which recently completed its post treatment surveillance period and has requested verification by WHO, will be next.  Now, only a few remaining areas in the Americas have active transmission of the disease; these are located along the Brazil-Venezuela border, deep in the Amazon.

Colombia’s success has also served as inspiration for a new Carter Center goal: to eliminate river blindness everywhere it assists the national programs, including in Africa. The Carter Center has already assisted Sudan and Uganda to interrupt river blindness transmission in key endemic areas, demonstrating that elimination in Africa is possible, despite previously held beliefs to the contrary.

River blindness elimination offers hope that the cycle of disease and poverty can be broken.  Our vision is for people in endemic communities who are freed from scratching day and night, and who have healthy vision and a healthy future; children are able to go to school and concentrate on their studies, and adults can once again contribute to their family’s livelihood and their country’s economy.  

If you are interested in learning more about how you can get involved to help end river blindness, visit The Carter Center’s website

 
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