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MEETING OF THE INTERNATIONAL TASK FORCE FOR DISEASE ERADICATION, JANUARY 2014

Friday, 11th of April 2014

MEETING OF THE INTERNATIONAL TASK FORCE FOR DISEASE ERADICATION, JANUARY 2014

WEEKLY EPIDEMIOLOGICAL RECORD, 11 APRIL 2014,

Conclusions and recommendations below; full text, in French and English, is at
http://www.who.int/wer/2014/wer8915.pdf?ua=1

1.There has been significant progress in efforts to eliminate onchocerciasis and lymphatic filariasis (LF) in Africa since the ITFDE first discussed this topic (collaborative assault on these 2 diseases in Africa) nearly 3 years ago. There is increased evidence that both diseases are eradicable, the feasibility of onchocerciasis elimination in Africa has been embraced by APOC, at least 5 African governments have established national goals of onchocerciasis elimination, and coverage with MDA for both diseases and with LLINs has also improved.

2.Interventions against both diseases provide exceptional value for money, are relatively inexpensive (given the generous donations of drugs), are pro-poor and help to alleviate poverty directly, but both programmes are still inadequately funded, especially the efforts to eliminate LF.

3.In order to meet the current goals to eliminate LF by 2020 and onchocerciasis by 2025, mapping of LF and supplemental mapping of hypo-endemic onchocerciasis areas need to be completed by 2014 and 2015 respectively, while available funding and interventions for elimination of LF need to be scaled up much more rapidly.

4. The ITFDE believes that the logic for integration of onchocerciasis/LF/malaria programmes at local, national and continental levels in Africa is compelling, with mutual benefits such as the additional impact of MDA with ivermectin for LF or onchocerciasis on malaria, the impact of LLINs on transmission of LF and malaria, and the impact of MDA with ivermectin and albendazole for LF on oncho - cerciasis, in addition to the operational efficiencies expected from such coordination.

5.There is new evidence of safe interventions to stop transmission of LF in areas where Loa loais endemic, and potential strategies for doing so for onchocerciasis, but more research on the latter is needed urgently.

6.The ITFDE endorses support for interventions against the entire package of Preventable Chemotherapy for Neglected Tropical Diseases, but urges special attention to increased support for onchocerciasis and LF, which are being targeted for elimination of transmission. Within the campaign against LF and onchocerciasis in Africa, only 3 countries – DRC, Ethiopia and Nigeria – account for over one-third and over one-half of the burden of those 2 diseases in Africa respectively, and should thus be considered priorities for early assistance.

7. Given the complexity of associated technical issues, there is a need for authoritative, clear, sound, and timely advice to countries on technical aspects related to elimination of onchocerciasis and LF in Africa, such as: uptake of flexible new strategies or of interventions shown to have worked elsewhere; criteria for deciding when to stop MDA for either or both diseases; a harmonized implementation unit; and monitoring during post-treatment surveillance.

8.More useful diagnostic tools for assessing the prevalence of LF and onchocerciasis have been developed and are expected to be deployed more widely soon after more validation studies have been completed. The Bill & Melinda Gates Foundation is also investing heavily in supporting efforts to identify effective macrofilaricides for adult Onchocerca and Wuchereria parasites, including testing existing drugs, screening new compounds, and testing combinations of drugs, but an effective macrofilaricide is not expected to become available for practical use against either parasite in the near future.

9. The Task Force notes the ongoing development of cost projections for joint implementation of LF and onchocerciasis elimination programmes and urges these to be completed and made available as soon as possible to inform discussions with donors.

10. The Task Force commends Nigeria for its progress in combatting onchocerciasis, LF, and malaria, and congratulates the Federal Ministry of Health of Nigeria on its forthcoming Guidelines for Malaria-Lymphatic Filariasis Co-Implementation in Nigeria.