Over a comparatively short period of time, the development and distribution of ivermectin (Mectizan(R)) has radically altered the consequences of infection with Onchocerca volvulus. To achieve this required the fostering of many partnerships and the development of new tools and methods. The long-term commitment of Merck, the World Bank and other sponsors, as well as governments and non-governmental organizations, has been crucial. Yet the enthusiasm with which communities have taken up the delivery of ivermectin among themselves is perhaps the greatest reason for the success of this programme. The present challenge is sustaining the methods that have brought success so far, and making them part of health services and disease control programmes in some of the world's most impoverished and unstable areas. A major part of this challenge is continuing the commitment to controlling onchocerciasis as memory of the disease is fading, and while the hope of elimination or eradication for most endemic countries remains distant.
