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LF Elimination Programme Treats Over Half Billion People And Protects Millions More From Debilitating Disease

June 26, 2017

A study published today confirms that in the ten years since its initiation, the international effort to eliminate lymphatic filariasis (LF) has made unprecedented strides towards ridding the world of one of its most debilitating diseases. The study found that the LF elimination programme has prevented 6.6 million children from acquiring LF and stopped another 9.5 million people already infected with the disease from progressing to more debilitating stages. All of this is the result of the most rapid scale-up of a drug administration programme in public health history, delivering what the study calls the "best buy in public health".

The paper, published this week in the open-access journal PLoS Neglected Tropical Diseases, assessed the impact of the World Health Organization sponsored Global Programme to Eliminate Lymphatic Filariasis, which has proven to be a model for international collaborations to end global health scourges because of its remarkable achievements.

"These data illustrate that with the right partnerships, it is possible to make an extraordinary impact on the health of hundreds of millions of people at minimal cost," said Dr. Mwele Malecela, PhD, Director of the Tanzania Lymphatic Filariasis Programme and Chair of the Global Alliance to Eliminate Lymphatic Filariasis. "We are on track to accomplish our goal of elimination by 2020. When we do, this programme will be a leading case study for how to scale-up disease elimination programmes globally."

Lymphatic filariasis, often called elephantiasis, is a parasitic infection spread by mosquitoes that causes grotesque, painful swelling of the limbs, breasts, and genitals. Considered a neglected tropical disease, LF almost exclusively affects the world's poorest people. Approximately one fifth of the world's population (1.3 billion people) is at risk of contracting LF and approximately 120 million people in 83 countries are currently infected.

The Global Programme to Eliminate LF has already become the most rapidly scaled-up drug administration programme in public health history, and is on track to becoming the largest such programme in history. The study found that since drug administrations began in 2000, the programme has administered more than 1.9 billion treatments to over 570 million people in 48 of the 83 countries with endemic LF.

The LF elimination treatment programme utilises a combination of two anti-parasitic drugs, administered once yearly to everyone in an at-risk area. When given for a minimum of five consecutive years, these drugs can effectively stop transmission of LF. The drugs used to eliminate LF are the same medications used to treat a number of intestinal worms and parasitic skin diseases, which infect hundreds of millions of people in developing countries and are major contributors to malnutrition, disability, delayed development, and problems during pregnancy.

"The benefits of this programme go far beyond simply preventing LF infections," said Dr. Eric A. Ottesen, MD, Director of the Atlanta Lymphatic Filariasis Support Center and lead author of the paper. "Because of the LF programme, at least 56.6 million children and 44.5 million women of childbearing age have been treated for intestinal worms, most multiple times. The drugs have also treated millions more in Africa for skin diseases."

These data help the PLoS paper confirm what some public health officials have long asserted: that the LF programme is the 'best buy' in public health, providing benefits that far outweigh its costs. The total cost per patient over the first eight years of the programme is estimated to be less than US $0.50. This low cost is made possible in part by the donation of albendazole and Mectizan® from the programme's two key pharmaceutical partners GlaxoSmithKline and Merck & Co., Inc.

The cost-efficiency combined with the programme's achievements have made the LF elimination effort a model for future large-scale international public health partnerships and has prompted officials to call for the development of a dedicated fund for the treatment and elimination of other neglected tropical diseases.

"Future public-private partnerships will look to the global LF elimination effort as a standout example of how groups can come together to solve a major public health issue," said Dr. Lorenzo Savioli, MD, MSc, Director of the Department Neglected Tropical Disease at the WHO. "We must take the lessons we have learned from the LF model and apply them toward the treatment and elimination of other neglected tropical diseases."

As the Global Programme continues towards its goal of eliminating LF by 2020, the coming years will see additional rapid growth and expansion.

About the LF Programme

The elimination programme is based on a simple two drug, once-yearly treatment of at-risk individuals using safe and effective medicines (albendazole plus either Mectizan® or diethylcarbamazine [DEC]). The World Health Organization (WHO) recommends a minimum of five rounds to reduce the level of disease below the threshold for sustaining transmission; then mass drug administration (MDA) can be stopped. MDA programmes are already underway in 48 of the 83 LF-endemic countries and a number of other countries are in the process of organising such programmes. Since the programme began, 66 million babies have been born into risk free areas, a number that is expected to increase sharply as even more countries begin LF elimination programmes.

The drugs used for LF elimination are also highly effective in treating intestinal worm infections. Consequently, LF treatments have a positive impact on the educational prospects of children through enhanced mental and physical development, and on reducing low birth weights and maternal anaemia.

About the partnership

WHO's Global Programme to Eliminate Lymphatic Filariasis began in 1997 when the World Health Assembly unanimously resolved to eliminate the disease globally as a public health problem. In 1998, two pharmaceutical companies GlaxoSmithKline (then SmithKline Beecham) and Merck & Co., Inc. partnered with WHO and pledged to donate two of the drugs necessary for LF elimination (albendazole and Mectizan®, respectively) to treat as many people as necessary for as long as required, an unprecedented donation to global public health. This partnership along with others from the public and private sector evolved into the Global Alliance to Eliminate LF. This Alliance is a free and unrestricted partnership of interested groups with the LF endemic countries at the core with the objective of advocating for LF elimination and working towards resource mobilisation.

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