The World Health Organization (WHO) has officially recognized Niger as the first country in Africa to eliminate onchocerciasis, commonly known as river blindness. This milestone makes Niger the fifth country globally to achieve this status, marking a significant victory in the fight against neglected tropical diseases (NTDs). The announcement was met with praise from global health leaders, including WHO Director-General Dr. Tedros Adhanom Ghebreyesus, who commended Niger’s dedication to improving public health and alleviating human suffering.
Onchocerciasis is a parasitic disease caused by Onchocerca volvulus, transmitted to humans through repeated bites from infected blackflies (Simulium species). These flies breed in fast-flowing rivers and streams, which is why the disease is prevalent in rural, riverine areas. Onchocerciasis is the second leading infectious cause of blindness globally, following trachoma. In addition to blindness, the disease causes intense itching, skin lesions, and severe socio-economic challenges, particularly in impoverished regions.
The burden of onchocerciasis has been most pronounced in sub-Saharan Africa, along with smaller endemic areas in Latin America and Yemen. Its debilitating effects have historically forced people to abandon fertile lands near rivers, hampering agricultural productivity and economic development.
Niger’s efforts to eliminate onchocerciasis date back several decades. The country was part of the WHO Onchocerciasis Control Programme in West Africa (OCP), which ran from 1976 to 2002. The program focused on vector control by spraying insecticides to reduce blackfly populations. Although this strategy significantly decreased transmission levels, complete elimination required additional measures.
A major breakthrough came with the donation of ivermectin by Merck & Co. (MSD) through the Mectizan Donation Program. Ivermectin is highly effective in killing the parasite’s microfilariae (larval stage), preventing further transmission and reducing disease symptoms. From 2008 to 2019, Niger integrated ivermectin into its mass drug administration (MDA) campaigns, originally targeting lymphatic filariasis (LF), another neglected tropical disease. Because onchocerciasis and LF overlap in certain areas, the treatment campaign inadvertently tackled both diseases simultaneously.
In 2014, Niger began conducting preliminary assessments to evaluate whether onchocerciasis transmission had been interrupted. The assessments involved entomological and epidemiological surveys, which provided crucial data on parasite prevalence and blackfly infection rates.
Results showed a dramatic decline in onchocerciasis prevalence, from approximately 60% to just 0.02%. This demonstrated that sustained vector control, combined with ivermectin distribution, had successfully halted disease transmission. Based on this compelling evidence, WHO verified Niger’s elimination of onchocerciasis, paving the way for the official certification.
Niger’s achievement was made possible by a combination of government-led initiatives, international partnerships, and sustained public health interventions. Key factors included:
Strong Government Commitment – The Nigerien government prioritized the fight against onchocerciasis, ensuring long-term investment in vector control and drug distribution programs.
Collaboration with WHO and NGOs – Partnerships with WHO, non-governmental organizations, and donors such as Merck facilitated access to medicines, technical expertise, and funding.
Mass Drug Administration (MDA) – The strategic distribution of ivermectin in affected communities played a crucial role in reducing parasite transmission.
Vector Control Measures – Early interventions focused on controlling blackfly populations significantly reduced the risk of infection.
Surveillance and Monitoring – Ongoing epidemiological studies ensured that interventions remained effective and adapted to changing circumstances.
Niger’s success serves as an inspiration for other countries battling onchocerciasis and other NTDs. WHO Regional Director for Africa, Dr. Matshidiso Moeti, highlighted the broader implications of this achievement, emphasizing its impact on both public health and economic development. She noted that Niger had already demonstrated leadership in disease elimination by eradicating Guinea-worm disease in 2013.
Onchocerciasis elimination is not only a health victory but also a socio-economic one. By freeing communities from this disease, Niger has opened new opportunities for economic growth, particularly in agriculture and river-based livelihoods.
With Niger leading the way, other African nations can accelerate their efforts toward eliminating onchocerciasis. Several countries have made substantial progress, and Niger’s success provides a blueprint for achieving elimination through coordinated efforts in drug distribution, vector control, and continuous surveillance.
WHO continues to support endemic countries in their fight against onchocerciasis and other NTDs, reinforcing the global commitment to disease elimination. Niger’s historic accomplishment is a powerful reminder that with sustained dedication and international collaboration, eliminating neglected tropical diseases is within reach.
