How Colombia Defeated River Blindness

Ed note. I am pleased to welcome Carolina Uribe to UN Dispatch. Carolina is an MPH graduate from Lund University in Sweden with a particular interest in global health and Latin America. 

This week, the World Health Organization announced that Colombia has eliminated river blindness, becoming the first of six endemic countries in the Americas to achieve this major milestone.

River Blindness, or onchocerciasis, is a parasitic disease and is one of the leading causes of preventable blindness in the world with some 18 million people infected in 37 countries. The parasite is transmitted by small black flies that breed along fast-flowing rivers and once infected can cause painful skin lesions, intense itching and eye disease that often leads to irreversible blindness in humans.

Although river blindness is not a direct cause of mortality, it can significantly reduce life expectancy and has an immensely negative socioeconomic impact on the afflicted population. Due to the debilitating effects and social stigma of the disease, river blindness affects people’s ability to work, go to school or take care of the home. Having populations with chronic infections affects opportunities for entire regions to grow economically, resulting in a perpetual circle of poverty.

Colombia’s success can be attributed to a combination of a sustained public-private partnership, mass drug administration and consistent access to health education. Collaborative efforts were led by the Carter Center through the Onchocerciasis Elimination Program of the Americas (OEPA) and Colombia’s National Institute of Health along with the support of Ministry of Health and Social Protection, PAHO/WHO and Merck.

The strategy was based on mass administration of ivermectin, an antiparisitic drug donated by Merck, twice a year for 12 consecutive years in the isolated and final endemic community of Naicioná in the Cauca region. Community treatment of the drug ended in 2008, once interruption of the transmission of the disease was achieved. Before receiving certified status, a post treatment surveillance period of several years took place to determine if the disease was still present in the community. Also key to the success was community involvement and health education to increase understanding of the need to continue to use the drug year after year.

Elimination of the river blindness in the Americas is now within reach, with Mexico, Guatemala and Ecuador expected to receive verification of elimination in the near future and only one isolated area between Brazil and Venezuela will remain endemic.

Although this is celebratory news for the Americas, 99% of all river blindness cases occur in Africa. A far bigger feat will be the ability to replicate the Colombia model in regions with less financial and political commitment, nonetheless the decade long effort provides hope where there was none.