Circle Complete -- River Blindness Project Begins Final Stage

Next week, some of those scientists will return to the Sudan to "complete the circle," to finish a program many thought would never reach this point and to finish off a disease that claims millions of victims every year.

"We are now on the road to treatment and our ultimate goal of total disease control," said Charles Mackenzie, chairperson of Michigan State University's Department of Pathology, who was among those "young scientists" who started the eradication program nearly two decades ago.

On Sept. 2, dignitaries from around the world will gather in Khartoum for the APOC/NOTF Workshop, a conference that will officially begin the final drive to end the disease, which also is known by the name onchocerciasis.

(APOC is an acronym for African Program for Onchocerciasis Control; NOTF is the National Onchocerciasis Task Force.)

"This will mark the official commencement of the major treatment program and, of course, the conclusion of many months of planning and collaboration," Mackenzie said.

Among those participating in the conference will be Mackenzie; representatives from the Atlanta-based Carter Center, which has been involved in the eradication program; officials from APOC and NOTF, including task force chairperson Mamoun Homeida, a Sudanese physician and nationally recognized tropical medicine expert; and many others, including representatives of other nations ravaged by the disease and organizations that have donated millions of dollars to help battle the disease.

Onchocerciasis is a devastating disease in which parasites get beneath the skin, causing unbearable itching and discomfort. The parasites eventually make their way to the victim's eyes, causing blindness. The disease is called river blindness because it is spread by the black flies that breed in rivers.

It's estimated that as many as 20 million people throughout Africa, Latin America and the Middle East are infected with onchocerciasis. Of those, nearly a million suffer serious sight impairment and a quarter-million are blind.

One reason health officials are optimistic the disease is on the verge of eradication is the development of a drug called Ivermectin. Developed by the Merck Co., the drug has been incredibly effective in treating parasitic disease in animals and has now been deemed safe for human use.

If all goes according to plan, Mackenzie said onchocerciasis could be a memory within a decade.

One drawback of the medication: Onchocerciasis victims must take the drug for a number of years for it to work.

"We must treat everyone who is infected once a year for probably eight or nine years," Mackenzie said. "This means getting the pills to about 2 million people, virtually all of whom live in the furthest reaches of the Sudan."

No easy task, especially in a nation that has been ravaged by, among other things, a civil war that has dragged on for nearly 30 years.

"In addition, the area is compromised by the lack of communications, the absence of any road system of any significance, and the sheer size of the country -- it's the biggest in Africa," Mackenzie said. "All these factors make the challenges of getting the new treatment to those needing it great indeed."

It's estimated that about 2 million Sudanese are infected with onchocerciasis. About 11 million live in the east Africa nation.

MSU has long been involved in the river blindness battle. Mackenzie, who actually joined the fray when he was on faculty of the London School of Hygiene and Tropical Medicine, along with MSU professors Jeffrey Williams and James Bennett have long been a presence in the Sudan.

Risking war, land mines and even scorpion stings, Mackenzie and company have all become quite familiar with the Sudanese landscape, traveling to remote villages, teaching people how to take the medication and evaluating its effectiveness. They have also worked closely with Sudanese health care officials, helping them to distribute the much-needed medication.

"We've conducted much research in the characteristics of the disease, the search for new drugs and the development of an integrated delivery system in the primary health system of the Sudan," Mackenzie said. "Happily we now are able to complete the circle, return to the infected people and give them treatment with real hope of controlling the disease and alleviating their suffering."

Just last year, Mackenzie engaged in a bit of shuttle diplomacy, helping bring the country's warring factions together in an effort to battle onchocerciasis.

"We managed to help get the two sides to meet and we were all great friends," he said with a grin. "A cease fire was in place for a while, but, unfortunately, the hostilities have since started up again."