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Our commitment on Lymphatic Filariasis

The global eradication of smallpox represents one of the greatest sustainable public health achievements in history. Yet despite the huge advances in our understanding of diseases and their mechanisms, international experts believe that there are still very few major diseases that can be deemed eradicable by existing technology.

The World Health Organization (WHO) is currently targeting seven diseases or disorders for elimination or eradication: Guinea worm (dracunculiasis), polio, leprosy, neonatal tetanus, Chagas disease, iodine deficiency disorders, and lymphatic filariasis.

LF is an ancient scourge that has disabled and disfigured people for thousands of years. Images and descriptions of the disease are depicted on the pharaonic murals of Egypt and in the ancient medical texts of China, India, Japan and Persia.

Elimination strategy
Global efforts to get rid of LF began in May 1997 when the World Health Assembly called on governments to support plans to eliminate the disease as a public health problem.

In December 1997, we formed a collaboration with the WHO to spearhead efforts to eliminate LF. We would donate albendazole, one of the three essential anti-parasitic drugs, for as long as necessary until the disease was eliminated - best estimates put the scale of this commitment at around six billion treatments. Since then, the programme has evolved into a major public-private partnership known as the Global Alliance to Eliminate Lymphatic Filariasis.

WHO recommends that LF infection can be prevented by treating entire endemic communities once a year with two co-administered antiparasitic drugs. In African countries the drugs are albendazole and ivermectin (Mectizan®, donated by Merck and Co., Inc.), and for the rest of the world, albendazole and diethylcarbamazine (DEC, a generic drug).

The community treatments must be repeated each year for four to six years until the parasite dies out. An alternative community-wide regime is the use of common cooking salt fortified with DEC in the endemic area for a period of one to three years. The goal for each strategy is to control the infectious larval parasites in the blood and thus break transmission of the disease to uninfected members of the community.

It should be stressed that community drug distribution is a disease prevention initiative -- it will not treat the symptoms in people already affected by the disease. For those with clinical symptoms of LF, there are separate WHO, Ministry of Health and NGO-driven programmes using rigorous skin hygiene for lymphoedema and surgery for male hydrocoele.

Our commitment
We became an active and involved partner with WHO, organisations in the private and public sectors, and academia. In addition to donating free albendazole tablets, we provide significant financial support for coalition-building, workshops and communications, and dedicated staff expertise.

Elimination of LF is a daunting task. With an at-risk population of more than one billion people, some living in the most inaccessible of places, there are many challenges to achieving success.

To interrupt transmission of LF, it is necessary to treat more than 80 per cent of the entire at risk populations. This means reaching even the most secluded rural communities or overcrowded urban shanty dwellings, and ensuring that people actually take the tablets. To achieve this, it is necessary for communities to understand the disease and its prevention. This will increase awareness and motivate participation: two of the most important factors for success.

The LF programme also helps build primary healthcare infrastructure at the country level. Early indications are that the programme can integrate well with some other disease control efforts such as malaria bednets, school de-worming, river blindness prevention and schistosomiasis treatment. It also seems to be helping build or enhance a local network of medical services, non-governmental organisations and community health leaders.

For centuries LF was a neglected disease because there was little hope for treatment or prevention. Fortunately there is new hope for both control of the disease and those afflicted with it.

As when smallpox was prevalent, LF is widespread and feared. But by the year 2020, the intention of the WHO is to have placed the name of lymphatic filariasis alongside that of smallpox as one of the diseases consigned to the past.