HDI’s Achievements in Lymphatic Filariasis Elimination, (through 2017)
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 to incorporate alleviation of suffering from LF as a key pillar alongside efforts to interrupt disease transmission. The LF Elimination program thus became the first ever disease eradication program to include alleviation of suffering for those already infected as one of its aims from the very start. Previous programs to eradicate or eliminate a disease had 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 at that time, Dr. Jacquie L. Kay, and our Executive Director, Dr. Anders 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.
The “Economics of Lymphatic Filariasis Project” at Emory University in Atlanta, Georgia, USA was established subsequent to the Magnetic Island policy retreat. The Economics Project aims to quantify the costs of lymphatic filariasis to patients and societies, 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 Ghana’s Deputy Minister of Health, a former Minister of Health from the Philippines, World Bank, WHO, The Carter Center, Centers for Disease Control and Prevention (CDC), Merck, SmithKline Beecham, several non-governmental organizations including Doctors Without Borders (MSF), as well as public health specialists and scientists from Brazil, Ghana, Nigeria, Tanzania, and Togo.
At the Annecy conference, HDI and its partners dug into the nuts and bolts of 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, ways that 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 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.
With the annual distribution of drugs and symptom-alleviation supplies (mainly soap, antimicrobial ointments and some bandaging materials), as the two major pillars of national LF elimination programs, approaches hammered out in Annecy helped resolve issues that could have become contentious, and they have had a direct, very positive impact on the ability of national programs to succeed.
The Annecy workshop has since 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 Annecy workshop.
The brochure 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 lent its logo to the final version, used the brochure during international meetings and printed a second edition in 2000 at their own expense, an edition 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 were starting LF Elimination programs. Ghana offered to host the African meeting.
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 LF. 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. For a number of years at the outset, HDI was the receiving agency for millions of dollars of annually donated Mectizan (ivermectin), for Togo in particular.
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 agreed with the government of Ghana which felt it important to capitalize on the enthusiasm of the population which had already been mobilized, and especially to treat 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.
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 supported the establishment of a LF Elimination secretariat in the Ghana program, providing salaries for an administrative manager, a technical officer and a driver, as well as purchasing 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 2000. HDI continued supporting salaries in the Ghana LF Elimination secretariat for another year or two, after which support for their program began being funded by larger donors as the Ghana program grew rapidly.
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 one of the world’s leading filariasis epidemiologists and was a key LF researcher at that time.
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 mass-treatment of populations in Togo’s affected areas, and for doing a more detailed search of the area where no cases were found to be sure no pockets of filariasis were 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 travelled to Togo for HDI to help prepare the first round of drugs distribution and consider how HDI support might most profitably be applied there. Prof. McKenzie helped prepare the country’s successful application for drug donations for LF elimination. HDI then provided for the expert consultative services of Dr. Yankum Dadzie, former head of WHO’s entire river blindness 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. And Togo embarked on a rapidly expanding series of annual drug distributions to interrupt transmission of lymphatic filariasis with such high coverage that Mass Drug Administration was stopped in 2009. In 2017 Togo was validated by WHO as being the first country in Africa to have freed its population of LF, after intense disease surveillance during the intervening years.
The Dominican Republic has a solid group of enthusiastic, dedicated professionals who are ready to begin LF elimination activities. They were stimulated by a gathering of LF endemic countries held in their country. Yet, no funding was available to start LF elimination in the Dominican Republic.
Because the start of a national program in one country should stimulate activity 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.
HDI did not support the Dominican Republic over the long haul, but addressing this acute need permitted this country to bring LF elimination in all of the Americas big 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.
For more information about Lymphatic Filariasis check out Resources.