(An excerpt from the Mectizan Donation Program Annual Highlights for 2021)
The COVID-19 pandemic continued to be a challenge for all of us in 2021. Despite obstacles, Merck & Co., Inc.* never interrupted operations to supply Mectizan® to partner countries. Those countries in turn demonstrated their determination, through thick and thin, to eliminate onchocerciasis (river blindness) and lymphatic filariasis (LF); and their strong commitment to making progress towards the goals and targets outlined in the WHO NTD Road Map 2021-2030, which was launched in January 2021.
Despite the ongoing difficulties, in 2021 the Mectizan Donation Program (MDP) persevered in getting Mectizan to 29 countries and territories for mass drug administration (MDA) to eliminate river blindness and lymphatic filariasis.
Mass treatments were interrupted at the beginning of the pandemic in 2020 from April to September, but by 2021 we were happy to see MDA had resumed with COVID-19 mitigation measures in place. This perseverance revealed the extraordinary resilience of endemic communities, community drug distributors, governments, donors, and NGO partners.
In 2021, a total of 364.4 million treatments was approved—a decrease from 2020 when 416.8 million treatments were approved. This drop was due to several factors, most of which are related to the cancellation of ten applications due to surplus inventory of Mectizan that remained after the 2020 lockdown and resulting interruptions and delays to MDA. Another factor was the temporary suspension of MDA in two countries where high customs clearance fees prevented shipments of donated Mectizan from reaching the national programs. We invite governments of countries where high clearance fees are assessed on donated medicines to take special measures to eliminate these import charges.
An unexpected challenge arose as misinformation about the use of ivermectin to treat COVID-19 patients circulated around the globe. This misrepresentation raised the risk of diversion of Mectizan for unauthorized uses. In a heartening display of resilience, country partners and supporting organizations, MDP, the Mectizan Expert Committee, and Merck & Co., Inc. took diligent measures to protect Mectizan for its intended use: treatment of river blindness and LF. We are particularly grateful to our colleagues from the Department of Control of Neglected Tropical Diseases at WHO headquarters and from WHO’s Expanded Special Program to Eliminate NTDs (ESPEN) for hosting two webinars to clarify the WHO position and sensitize countries on the appropriate use of Mectizan.
As of the end of 2021, cumulatively, nearly 4.8 billion Mectizan treatments have been approved by MDP since the program started in 1987, and nearly 11 billion tablets have been shipped to endemic countries. These numbers are staggering!
Even more staggering is the number of people who no longer need treatment with Mectizan as transmission of the diseases is suspected to have been interrupted. For river blindness, this number is 15.7 million and for LF the number is 191.8 million. It is remarkable to see these numbers increase each year as countries make substantial progress towards reaching their goals.
Five new countries and territories (Comoros, French Polynesia, Myanmar, Nepal, and New Caledonia) were approved to receive Mectizan for the implementation of IDA (co-administration of ivermectin, diethylcarbamazine, and albendazole) to accelerate elimination of LF, bringing the number of IDA-implementing countries and territories to 20.
With the goals of the WHO NTD Road Map 2021-2030 in mind, the Mectizan Donation Program held a virtual onchocerciasis stakeholders meeting in October 2021, bringing together organizations and individuals from multiple sectors. The onchocerciasis community will be working together to develop solutions to some of the most common challenges. In other promising developments for river blindness elimination, WHO published target product profiles for new diagnostics; cross-border collaboration between endemic countries is growing stronger; and national onchocerciasis elimination committees are supporting Ministries of Health to ensure progress is made toward the elimination of transmission.
Achieving high treatment coverage and expanding treatment to hypoendemic areas are critical to maintaining and accelerating elimination of river blindness. Training new entomologists and building laboratory capacity are also critical to the long-term success of river blindness elimination.
In 2021, it was encouraging to see Niger begin to compile its dossier for WHO to verify elimination of transmission of river blindness. If it is verified, we look forward to celebrating the first country in Africa to achieve this milestone and are optimistic that other countries will follow soon.
Lymphatic filariasis elimination, too, is well on track to meeting the goals established by the new NTD Road Map. Two new countries, Benin and Cameroon, stopped treatment with Mectizan and albendazole (donated by GSK) for LF in all endemic districts and have joined Mali and Uganda in undertaking the five-year post-treatment surveillance to demonstrate that elimination has been achieved. Based on trends toward scaling up and scaling down of MDA implementation, WHO estimates that 17 of the 20 countries implementing IDA will no longer require treatment by 2025.
In 2022, we remain committed to work with partners to continue the positive trajectory toward achieving the 2030 NTD Road Map goals for LF and river blindness—perhaps even surpassing them.
On behalf of the MDP team and the Mectizan Expert Committee, I am committed to ensuring that Mectizan is supplied in a timely manner and to supporting endemic countries and our partners as we work together to #StampOutOncho and #EliminateLF!
Dr. Yao Sodahlon, Director
Mectizan Donation Program