Achievements in Lymphatic Filariasis Elimination

HDI’s Achievements in the area of LF Elimination, (through 2000)

The 1997 Magnetic Island Policy Retreat in Australia

A policy retreat initiated and co-sponsored by HDI to help decide how best to turn new scientific tools into an effective public health initiative to eliminate lymphatic filariasis, this gathering defined some of the major directions for the entire global LF elimination campaign.

The Policy Retreat specified types of partners that will be necessary for lymphatic filariasis elimination to succeed, and other key issues to be addressed. Participants included scientists, public health policy academicians, ministry of health personnel from Africa and Asia, and senior WHO staff, as well as representatives from non-pharmaceutical industry and non-governmental agencies.

Major issues identified at the Policy Retreat included the need for national programs to incorporate alleviation of the suffering caused by filariasis, as a key pillar alongside efforts to interrupt disease transmission. The LF Elimination program thus became the first ever disease eradication program to strive for alleviation of suffering for those already infected, from the very start. All previous public health programs to eradicate or eliminate a disease as a public health program have concentrated solely on interrupting transmission of the disease. Also highlighted was the need for more detailed socio-economic analysis of damage caused by filariasis, and benefits of its elimination. Concerns about advocacy and the challenges filariasis poses, were key to many of the Magnetic Island discussions.

An important follow-on step after Magnetic Island was the subsequent SmithKline Beecham-WHO Partners Forum, held in Geneva, October 28-30, 1998. HDI was represented by both our President, Dr. Jacquie L. Kay, and our Executive Director, Dr. Anders R. Seim. Similarly, the Centers for Disease Control and Prevention (CDC) held a meeting of epidemiologists in Atlanta in 1998, to discuss key issues relating to reliably measuring progress made by national programs.

Also subsequent to recommendations made at the Policy Retreat, came establishment of the “Economics of Lymphatic Filariasis Project” at Emory University in Atlanta, Georgia, USA. The Economics Project aims to quantify the costs of lymphatic filariasis to patients and the societies in which they live, as well as performing cost-benefit, cost-effectiveness and decision analyses for the Global Programme to Eliminate Lymphatic Filariasis.

The Annecy Drug Distribution Workshop

February 24-26 1999, HDI convened a workshop on “Effective and Efficient Drug Distribution for the Elimination of Lymphatic Filariasis”. Held at the conference center of Fondation Meriuex, a WHO Collaborating Center in Annecy, France, an hour south of Geneva, this was a logical follow-up to the Global Policy Retreat HDI co-sponsored on Magnetic Island in Australia during July of 1997.

The Annecy workshop’s 31 participants included the Deputy Minister of Health from Ghana, the former Minister of Health from the Philippines, the World Bank, WHO, The Carter Center, Centers for Disease Control and Prevention (CDC), Merck, SmithKline Beecham, several non-governmental organizations including Physicians Without Borders (MSF), and public health specialists and scientists from Brazil, Ghana, Nigeria, Tanzania, and Togo.

At theAnnecy conference, HDI and its partners got down to nuts and bolts regarding drug distribution. How do we distribute drugs, from two very different and sometimes competing manufacturers, to millions of people in remote rural and urban corners of developing countries? And how do we do it in ways that avoid pilferage or damage to supplies, and which make both drugs simultaneously available to each individual, reaching over 85% of the treated populations? How do we do this in intimate collaboration with the regular health care services (where such services exist)? How do we do it in areas where other health care services are very weak or essentially non-existent? How do we ensure complementarity and co-ordination with other major mass-treatment programs, such as those against river blindness and intestinal worms? Many of these questions were answered at Annecy. And still other issues are being resolved because of the workshop.

The annual distribution of drugs and symptom alleviation supplies (mainly soap, antimicrobial ointments and some bandaging materials), will be a major pillar of every national filariasis elimination program. Approaches hammered out in Annecy will help resolve issues which could have become contentious, and they should have a direct, very positive impact on the ability of national lymphatic elimination programs to succeed.

The Annecy workshop, which has already been characterized as one of the key events in lymphatic filariasis elimination, was a major undertaking for HDI.

HDI’s Lymphatic Filariasis Brochure

After a long gestation period, a penultimate version of our lymphatic filariasis brochure was printed in time for the Geneva Partners Forum in October 1998. Comments and refinements were incorporated, and a larger print run of 1,000 copies was ready for the above mentioned Annecy workshop.

The brochure has received rave reviews and was distributed by the World Bank to overseas staff during its week of internal meetings called Human Development Week, in March 1999.

WHO, which has lent its logo to the final version, has similarly used the brochure during international meetings, and printed a second edition in 2000 at their own expense, which we and WHO revised further in a joint effort.

Meeting of Endemic Countries in the Americas (& Africa)

In 2000, HDI initiated planning for the first ever gathering of endemic countries in the Americas. The Pan American Health Organization (PAHO) subsequently became engaged in this field and assigned a very active person to LF elimination. HDI acceded to PAHO’s strong desire to plan and organize this initial gathering, which we co-sponsored.

Similarly, HDI initiated planning for a meeting of African countries that are starting LF Elimination programs. Ghana has offered to host this meeting, which has not yet been held for a number of reasons.

Training Film on Treatment for Lymphatic Filariasis

HDI supported the production of a video training film, on treating patients whose lymphatic system has been damaged by lymphatic filariasis. The Centers for Disease Control and Prevention (CDC) in Atlanta made the film together with Dr. Gerusa Dreyer of Brazil. HDI’s contribution allowed Dr. Dreyer to visit Atlanta for crucial script preparations, at a time when no funding was available.

Collaboration with Glaxo SmithKline to support LF Elimination Training Center in Recife, Brazil

HDI collaborated with the pharmaceutical company SmithKline Beecham (which since became Glaxo SmithKline), by helping to facilitate their support for establishing a WHO LF-training center in Recife, Brazil.

LYMPHATIC FILARIASIS / ELEPHANTIASIS – AT THE COUNTRY LEVEL

Supporting Filariasis Elimination in Ghana and Togo

HDI’s support for LF Elimination activities appears to have been key in expeditiously recruiting additional funds for the Ghana and Togo programs from the UK government, and for approval of the initial Togolese application for a drug donation.

GHANA

Because Ghana was ready to provide mass-treatment to the population of a pilot area while the donation program for albendazole was not yet operational, HDI purchased albendazole from GlaxoSmithKline to allow Ghana’s program to move forward.

We and the government of Ghana felt it important to capitalize on the enthusiasm of the population which had already been mobilized and provide treatment to villagers who had already cooperated in scientific studies on this disease. In addition to medication, we provided test-kits to help evaluate the impact of program activities in this pilot area.

Ghana-LF Support In the Year 2000
In addition to purchasing medication for treating LF before the drug became available through the GlaxoSmithKline donation, as well as buying test kits for LF from Australia, HDI has supported the establishment of a LF Elimination secretariat in the Ghana program. HDI is providing salaries for an administrative manager, a technical officer and a driver, as well as having purchased a vehicle. This kick-started the program, making possible rapid initiation of mass-treatment drug distributions in pilot areas during the summer and autumn of this year. And HDI plans to support salaries in the Ghana LF Elimination secretariat for another year or two, after which it is our intention that its funding must be included in funding from larger donors.

In addition, Dr. John Gyapong of Ghana, a world-class LF epidemiologist, continues to be available to support other programs in Africa through HDI.

TOGO

HDI supported the initial national survey for lymphatic filariasis in Ghana’s next door neighbor, Togo, using a plan developed with the support of Ghana’s Dr. John Gyapong during a visit by Dr. Gyapong and HDI’s Executive Director. Dr. Gyapong is recognized as one of the world’s leading filariasis epidemiologists and regularly consulted by WHO and others.

Togo’s survey was completed during the final months of 1998, with HDI support for test materials, staff perdiems, fuel etc. They found lymphatic filariasis to be present in all but one of the regions searched.

Planning then got under way for beginning mass-treatment of populations in the affected areas of Togo, and for doing a more detailed search of the area where no cases were found, to be sure pockets of filariasis are not overlooked.

Togo’s first mass-treatments in five pilot areas got under way with HDI support. During the planning stage, Prof. Charles McKenzie of Michigan State University traveled to Togo for HDI, to help prepare the first round of drugs distribution and to consider how HDI support might most profitably be applied there. Prof. McKenzie knows the Togo program well and helped prepare the country’s successful application for drug donations for LF elimination. Since then, HDI has provided for the expert consultative services of Dr. Yankum Dadzie, former head for WHO of the entire river blindness (onchocerciasis) program, covering most of West Africa.

Togo became the first country in Africa to train physicians from all parts of the country in techniques to alleviate suffering from lymphoedema, and stop progression of the disease in those already on their way towards elephantiasis. Also, Togo has embarked on a rapidly expanding series of annual drug distributions to interrupt transmission of lymphatic filariasis.

DOMINICAN REPUBLIC

The Dominican Republic has a solid group of enthusiastic, dedicated professionals who are ready to begin LF elimination activities. They were stimulated by the recent gathering of LF endemic countries held in the Dominican. Yet, no funding has been available to start LF elimination in the Dominican Republic.

Because the start of a national program in one country should stimulate activities elsewhere in the region, HDI provided initial support for activities there by supporting the training of surgeons from the Dominican Republic, with participants also from neighboring Haiti to maximize the benefit this initiative could achieve. The workshop was led by Drs. Gerusa Dreyer and Joaquim Noroes from Recife Brazil.

The Dominican Republic is not a country that HDI plans to support nationally in the long term, but addressing this acute need, permitted this country to bring a LF elimination in all of the Americas major step forward.

As this was the first-ever training workshop for surgeons in the new techniques of alleviating the tremendous urogenital disabilities that lymphatic filariasis causes in men, providing support for this initiative was in keeping with HDI’s mode of operation.