Dr. Daniel Boakye remembers witnessing the dire effects of onchocerciasis during a trip to Ghana in the 1970s as a student entomologist. He was studying black flies, which spread the skin and eye disease more commonly known as river blindness. At the time, the debilitating disease was ravaging West Africa. In some of the affected villages, more than half of all men aged 20 and above had gone blind or visually impaired.

In Ghana’s rural villages located near fast-flowing rivers and streams, the blackfly’s breeding ground, life was at a standstill. Without enough able-bodied people to tend the fields, families went hungry. Children dropped out of school to care for blind relatives. Where there was river blindness, there was poverty. Touched by what he saw, Daniel has spent the 50 years since then working to tackle the disease. “I’ve been chasing flies all my life,” he said.

Now the Senior Technical Advisor for elimination of onchocerciasis at the END Fund, a philanthropic fund focused on ending neglected tropical diseases (NTDs), Daniel is a leader in the effort to reduce the spread of river blindness in Africa. Working with the World Health Organization (WHO), global health organizations, and the government, his team helped Niger become the first country in Africa to declare the total elimination of onchocerciasis in 2021.

The path that led to that huge milestone now serves as a roadmap for other countries in the region to follow. “It was amazing to see the villages come back to life,” said Daniel. “People reoccupied fertile farmlands they had abandoned because of the disease. Adults could fend for their families and children went back to school.”

The Challenges of Donor Fatigue and Government Inaction

River blindness is caused by repeated bites from blackflies infected with the Onchocerca volvulus parasitic worm. Once introduced into the bloodstream, the worm can grow to almost 1 meter in length and produces millions of larvae that migrate to the skin and eyes. Symptoms include extreme itching and, in one third of cases, tunnel vision and eventually blindness.

The disease is one among a group of diverse conditions known as NTDs, which cause a range of health, social, and economic problems. Together, they are estimated to affect more than 1 billion people, but still rank very low in the priorities of policymakers around the world.

According to WHO, more than 99% of people infected with river blindness live in just 31 African countries. While a few of those countries, such as Niger, have managed to find the political will to tackle the disease, many are still struggling. In neighboring Nigeria, for example, river blindness affects 32 of the country’s 36 states.

Anita Gwom is Director of NTDs at Sightsavers, a nonprofit that provides disease treatment for rural communities. When she visits villages in Nigeria, she sees children having to skip school to lead their blind grandparents around. Income levels suffer, especially during the rainy season, when people avoid working outside for fear of being bitten by blackflies. “Fishermen know that when they go to the river, they will be bitten,” said Gwom. “When you talk to them, they will tell you they have been bitten by the fly multiple times.”

Gwom said it takes 10–15 years of focused interventions to break the transmission of river blindness in an endemic community. And climate change is making that harder as frequent flooding expands the blackfly breeding areas. Nonprofits are doing what they can. In the six Nigerian states in which Sightsavers works, it has already given out 100 billion treatments against river blindness. But it’s not nearly enough, said Gwom. “There is donor fatigue. Government support is usually very poor. Not prioritizing NTDs is an issue,” she said.

The Challenges of Donor Fatigue and Government Inaction

Government buy-in was crucial in Niger’s successful battle against river blindness. At first, Daniel and colleagues at the World Health Organization Onchocerciasis control Programme in West Africa were focused on vector control, using chemicals and other techniques to kill the black flies and their larvae.

Then, in 1987, researchers Merck and Co found that the veterinary drug ivermectin was extremely effective at killing the Onchocerca volvulus worm inside the human body. “It was a total game changer. Using the drug for mass treatment was cheaper and more effective than vector control,” Daniel said.

Through a collaboration with the WHO and the governments of Niger and other affected countries in Africa, pharmaceutical manufacturer Merck and Co. made ivermectin freely and widely available for as long as it was needed. Under the WHO’s African Programme for Onchocerciasis Control and the World Bank Group’s Onchocerciasis Control Program, the 31 African countries where river blindness is endemic committed to cross-border cooperation on their shared goal of eliminating the transmission of the disease using a combination of ivermectin treatment and vector control.

Various other global organizations played a part, such as the United States Agency for International Development (USAID) and the Task Force for Global Health. And vital funding also came from the Reaching the Last Mile Fund, which mobilized $100 million over 10 years to fight river blindness in seven countries, including Niger. “Many countries have put a lot of work into integrating treatment into their health systems, but funds like this help with the last mile of effort, such as mainstreaming surveillance of the disease and gathering the documentation to demonstrate elimination,” said Dr Maria Rebollo Polo, Lead of the Global Onchocerciasis Elimination Program at the WHO.

With all of these elements in place, river blindness rates in Niger fell from 70% in the 1970s to 0.02% by 2002 and continue to fall. Now Niger has become the first African country to have eliminated the disease. It joins an exclusive club – only Colombia, Ecuador, Mexico, and Guatemala have been verified as onchocerciasis-free by the WHO so far. But, Daniel said, they could soon have company, with Senegal, Mali, Benin, and Togo all close to achieving the same status.

After five decades of chasing flies, Daniel Boakye is celebrating these milestones, but has not slowed down his work. “It’s exciting, I didn’t always believe this was possible,” he said. “We’ve got to keep going, keep overcoming delays and obstacles on the road to total elimination of onchocerciasis transmission across the continent.”

This article was originally published by the WHO Foundation on February 12, 2025. Read the original article here.