ABSTRACT
The prevention and cure of river blindness is one of the most remarkable stories in medical history. It depended upon scientific ingenuity, Pharmaco-Philanthropy, innovative public-private partnerships, good will and persistence. This is the story of how a successful coalition in global health forms a decisive moment in the history of understanding, preventing and curing a human disease. In the middle of the last century, it was estimated that about five million square miles of the earth’s surface, and some 20 million people, were infected with river blindness (onchocerciasis), a chronically disabling condition which affected the poor in many lower-income countries. The parasitic disease, caused by the filarial threadworm Onchocerca volvulus, is transmitted through the infected bite of blackflies of the genus Simulium, which inhabit fast-flowing streams and rivers. Blackflies are vectors for the parasites, which burrow into the skin and grow into mature worms, sometimes measuring more than 60 centimetres, or two feet, in length. Adult worms develop in subcutaneous nodules where the females produce larvae, which migrate as microfilariae into surrounding tissue and the eyes. During this migration, the human host experiences intense, unbearable itching, which can lead to devastating dermatological diseases, stigma, social isolation, reduced economic performance and irreversible blindness. An adult worm can live for up to 16 years in the human body, and the fear of impending blindness, combined with the blackflies’ unremitting biting intensity, led in some parts of the savannah areas of West Africa to the abandonment of human settlements on fecund lands near rivers. The physical suffering and economic desolation caused by this insidious disease was such that strategies evolved to help reduce the inexorable sequence of exposure, disability and penury.
