Congratulations to Niger – the country has been verified by the World Health Organization (WHO) for eliminating transmission of onchocerciasis.
This is a historic milestone in the history of global health achievements of Africa. Niger is the first country in Africa to be declared free of onchocerciasis, a parasitic disease caused by the Onchocerca volvulus worm, transmitted through the bites of infected black flies.
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Niger has been significantly impacted by this disease, affecting communities primarily along riverbanks of fast-flowing rivers where these flies breed, hence the disease is also known as river blindness.
Robust commitment and a strong national elimination programme have enabled Niger to achieve this goal. Partners in the effort to wipe out river blindness included the Ministry of Health of Niger, the United States Agency for International Development (USAID), Helen Keller International, the End Fund’s Reaching the Last Mile Program (a Crown-Prince of Abu Dhabi legacy), WHO, thousands of community-based volunteers and many others.
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When onchocerciasis was widespread in West Africa, communities near rivers experienced higher rates of infection. Consequently, millions of people left these regions, often giving up farming on family land. Those who remained suffered severe symptoms such as blindness or incessant itching, which greatly limited their productivity.
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Professor Daniel Boakye, Entomologist and Senior Technical Advisor to the END Fund, explains the relevance of vector control interventions in Niger’s elimination strategy: “Between 1976 and 1989, Niger implemented vector control measures that nearly eliminated onchocerciasis. Black fly breeding sites were regularly treated with a rotation of larvicides, as overusing a single chemical can lead to larvae developing resistance. The Onchocerciasis Control Programme (1974–2002) utilized five different insecticides to target larvae in the rivers of Southwest Niger. The use of helicopter for larvicide treatments was costly but effective. By 2002, the prevalence of the disease had dropped to nearly zero, with only a handful of cases remaining in hard-to-reach areas.”
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Ongoing surveillance from 2002 to 2015 confirmed low disease rates. Ultimately, Niger has successfully been verified for elimination of onchocerciasis transmission mainly through effective vector control. Lastly, mass drug administration (MDA) with ivermectin and albendazole targeting lymphatic filariasis between 2008 and 2019 undoubtely benefited in eliminating any remaining pockets of transmission. Once the parasite was eliminated, people could return to the river basins and resume their economic activities.
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His Excellency Dr Garba Hakimi, Minister of Public Health, Population and Social Affairs of Niger, comments: “Through hard work and collaboration, we have managed to eliminate this terrible disease. Our health workforce, local leaders and international partners have made this possible, and we celebrate them and this achievement. We may be the first endemic country in Africa achieving verification of onchocerciasis elimination, but we will not to be the last one. Niger is a blueprint for more countries in the region to achieve elimination and ensure that generations can live without the fear of river blindness.”
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Dr Salissou Adamou Batchiri, Niger’s national coordinator for lymphatic filariasis and onchocerciasis, highlights: “After almost 50 years combating river blindness, Niger’s success is a testament to the power of long-term, sustained investments, country ownership of health goals and effective public–private partnerships.”
“Niger’s achievement is truly inspiring,” says Dr Yaobi Zhang, Helen Keller International’s Senior Scientific Advisor and onchocerciasis focal point: “The country has demonstrated remarkable leadership and resilience on its long and challenging journey to eliminate river blindness. This commitment has generated billions in economic benefits for Niger and will create significant momentum in the global NTD community. Investing in NTDs is regarded as a “best buy” in global health, as the cost per supported treatment is less than US$ 0.50 per person.”
WHO has set ambitious targets for the elimination of transmission of onchocerciasis. Elimination of onchocerciasis, while achievable, faces several challenges and requires continued efforts, including sustained MDA, enhanced surveillance and research into new tools and strategies, which will be crucial to reach this goal. Onchocerciasis is one of the three diseases targeted for elimination of transmission in the WHO NTD road map for neglected tropical diseases 2021–2030, the other being leprosy and the gambiense form of human African trypanosomiasis. The aim of the 2030 targets is to stop MDA with ivermectin in at least one focus area in 34 countries, in more than 50% of the population in at least 16 countries, and in the entire endemic population in at least 12 countries.
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Pictures // © WHO/TDR Andy Crump