Lymphatic filariasis elimination: progress in global programme development

The Global Programme to Eliminate Lymphatic Filariasis (GPELF) is an innovative, public-private partnership for health improvement. The progress made since the programme was initiated, in 1998, is here reviewed. The programme is largely based on the regular mass administration of albendazole with either ivermectin (Mectizan(R)) or diethylcarbamazine. Both albendazole and ivermectin have been donated by their manufacturers, for as long as necessary. The first national campaigns based on these drugs commenced in late 1999. Since then, rapid progress has been made in confirming the safety of the drug combinations, establishing a regional approach, and recognizing that experiences, epidemiological settings, health systems, the best drug combinations and disease burdens all vary with the country involved. There is a continuing trend towards decentralization, and this should lead to greater regional and national ownership and more inter-country activities. The progress made in mapping the geographical distribution of lymphatic filariasis (LF), by designated implementation units and, ultimately, by country, is also summarized. Country-specific methods of social mobilization and drug distribution, that are compatible with health planning at central and district level, need to be developed. However, the assessment of coverage by mass drug administration (MDA) needs to be strengthened, to allow reliable national monitoring and inter-country or inter-region comparisons. Valuable contributions made by non-governmental development organizations (NGDO) and civil society organizations (CSO) are acknowledged, such organizations (and particularly local NGDO) should be encouraged to help more in implementing the various activities at district level. The GPELF has developed during an era of considerable change in international health policy. The programme can contribute to the relief of poverty, as LF is closely associated with low-income communities in the least developed countries and MDA is a pro-poor intervention. There are clear opportunities for linking the activities of the GPELF (which uses cheap or free drugs that bring considerable incidental health benefits, in addition to arresting the transmission of the parasites causing LF) with other health interventions. New evidence indicates that annual treatments with antifilarial drugs greatly reduce the clinical abnormalities of the disease. The programme has expanded rapidly, with the annual number of people treated rising from 2.9 million (in 12 countries) in the year 2000 to 25.89 million (in 22 countries) in 2001 and an estimated 80 million (in 34 countries) in 2002. At the recent meeting of the Global Alliance, held in New Delhi in May 2002, a significant but realistic challenge - of scaling-up the programme to cover up to 350 million of those at risk, by the end of 2005 - was set. The rate of growth necessary to meet this target presents considerable strategic and managerial challenges to all of the partners involved in the programme, from the development of synergies with other, large-scale, public-health interventions to the logistics of drug manufacture, shipping and local transportation and resolving the problems of social mobilization, reporting, evaluation and monitoring on such a scale. Such challenges are, however, easily outweighed by the potential benefits of success. If the international health community cannot provide the necessary support to complement the investments being made by the endemic countries (as they scale-up their LF-elimination campaigns and ensure yearly access to two free and efficacious drugs that bring major benefits to those treated), significant progress in the control of other infectious diseases becomes a very distant goal.