Mectizan Studies Presented at Symposium (web article)

Students and faculty attend Mectizan symposium

The development of the drug Mectizan (ivermectin) by Merck and Co., Inc., and its distribution worldwide have radically altered the consequences of onchocerciasis, or river blindness, which once blinded millions in Africa, and Latin America. On May 14, 2004, researchers from the Johns Hopkins Bloomberg School of Public Health presented the findings of four new studies evaluating the Mectizan Donation Program during the symposium “Controlling River Blindness: Achievements of a 15-year Public-Private Partnership.”

Alfred Sommer, MD, MHS, dean of the Bloomberg School of Public Health, opened the discussion. He described the introduction of Mectizan for the treatment for river blindness as “One of those great public health triumphs, not yet entirely complete, but long on its way to being there.” Dr. Sommer also credited the Mectizan Donation Program as an example of a successful public-private partnership, which led to the development of other programs like the international trachoma initiative.

Brenda Colatrella, senior director of the Office of Contributions of Merck and Co., Inc., discussed the development of Mectizan and the formation of the Mectizan Donation Program. She said that one Merck’s priorities is to purse programs, partnerships and policies that help bring medicine and health care to people throughout the world. These priorities are met in part through monetary donations and donations of medications, such as Mectizan, which Merck agreed to donate for river blindness treatment for as long as is needed. In 1987, Merck formed the Mectizan Donation Program to oversee the donation of the drug to organizations and agencies who would deliver the medication directly to the people in need of treatment. The program continued to grow throughout the 1990s through a partnership involving the World Bank, WHO, Ministries of Health, local communities and non-governmental organizations. Colatrella noted that the Mectizan donation program has been a success, because of its strong partnerships and clear objectives and goals. She said Merck is applying the lessons learned from the Mectizan partnership to new initiatives for the treatment of HIV/AIDS.

Bjorn Thylefors, MD, director, Mectizan Donation Program, presented a progress report on the river blindness treatment effort. He said that the program continues to expand to reach people in parts of Africa river blindness is still a problem, but more work is needed to reach the goal of bringing onchocerciasis worldwide under total control. “It is true Merck has made a pledge, a very strong commitment to provide Mectizan as long as is needed, but obviously you have to see an end point in the treatment. This is where we hope that a major international research effort will be made in the next few years which will allow us to develop the ultimate strategies to reach that goal,” said Dr. Thylefors.

Dr. Gilbert Burnham

“The Mectizan Donation Program is really one of the great public health success stories. It is the benchmark for all other disease prevention efforts in the developing world,” said Gilbert Burnham, MD, an associate professor in the School’s Department of International Health. In his study, Dr. Burnham noted that the number of annual Mectizan treatments approved through community-based, mass treatment grew from 255,000 in 1988 to nearly 50 million by 2002. The program continues to grow, with a projected 90 million people still in need of treatment by 2010. “One of the real keys to the success the Mectizan Donation Program is the public-private-partnerships on the international, national and local levels. These partnerships created a great deal of interest and involvement at the community level so that the people who needed the medication were receiving it,” said Dr. Burnham.

Hugh Waters, PhD, assistant professor of International Health, discussed the economic benefits and effectiveness of the Mectizan Donation Program. “It has been economically a very successful intervention,” he said. Waters noted that treatment allowed communities to continue farming by reducing the number of people blinded by the disease.

Traci Phillips, MPH, Healthcare Finance and Special Projects Manager for the Maryland Hospital Association, presented findings of a study she co-authored by David Peters, MD, MPH, DrPH, assistant professor of International Health at the School of Public Health. They examined how these diverse partners worked together and if the public-private partnership could be a model for other programs. Phillips explained that the 25 partners of the Mectizan Donation Program believed that the perceived benefits of the partnership far outweigh the challenges, and that the direct costs to the organizations were minimal. The partnership also is rated highly on many aspects of governance and management, with relatively few problems identified.

James Tielsch, PhD, professor with the School’s Department of International Health, reported that Mectizan treatment had a substantial impact on reducing river blindness. He also noted it was likely that the treatment likely provided other benefits, such as preventing weight loss from parasitic infection. However, these benefits have not been fully studied, he added. Currently, Mectizan is not given to pregnant women or children under age 5, but Dr. Tielsch said he felt they could benefit from inclusion in this program.--Tim Parsons

“The Delivery of Ivermectin (Mectizan)” was written by Gilbert Burnham and T. Mebrahtu.

“Economic Evaluation of Mectizan Distribution” was written by Hugh Waters and Julia Ann Rehwinkel.

“Mectizan Donation Program: Evaluation of a Public-Private Partnership” was written by David Peters and Traci Phillips

“Impact of Ivermectin on Illness and Disability Associated with Onchocerciasis” was written by James Tielsch and Arlyn Beeche.

Photos by Will Kirk