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A new World Bank grant program could help 24 million people protect their eyesight by doubling the number being treated for river blindness (onchocerciasis). Established in part as a result of support from former President Jimmy Carter, the program aims to attract $120 million in financing from donors over 12 years to control the disease in 16 African countries.

President Carter and Roy Vagelos, M.D., former chairman of Merck & Co. Inc., announced the program in Chad, where they helped distribute Mectizan, a drug developed by Merck. One dose of Mectizan each year is all that is needed to prevent river blindness. They gave out the drug in Nia, a village of 500 where nearly everyone has river blindness.

"We wanted to come to Chad where river blindness is prevalent," said President Carter, who visited the West African country with his wife, Rosalynn, in September. "Almost all of the villagers have river blindness, and 5 percent of them are already permanently blind."

According to the World Health Organization (WHO), river blindness is the the leading cause of blindness in Africa and Latin America, robbing more than 1 million people of their sight. Eighteen million people are infected, and 126 million people are at risk of the disease. Twenty-seven African countries and six Latin American nations are endemic.

The parasitic disease is transmitted by black flies that breed near fast-flowing rivers. When the flies bite people, they deposit microscopic larvae that mature and produce thousands of microworms. These worms cause severe itching and skin lesions. Left untreated, the microworms eventually scar the eye and cause blindness.

Merck joined forces with The Carter Center in 1988 to facilitate drug distribution through the Mectizan Donation Program. The program is administered by The Task Force for Child Survival and Development (TFCSD), an independent partner of the Center. A committee of experts, chaired by TFCSD Executive Director William Foege, M.D., reviews and approves applications from governments and nongovernmental organizations that want to distribute the drug.

To date, Merck has donated 29 million tablets, worth more than $80 million. More than 11 million people in remote villages will be treated this year.

In 1993, 130,000 Chadians were treated with Mectizan; treatments began on a small scale in 1990. Before then, the black fly infestation was so bad that it forced farmers living south of Nia to abandon their land, some of the most fertile in Chad.

"River blindness is a socioeconomic disease," said Michael Heisler, M.D., director of the Mectizan Donation Program at TFCSD. "When you fix the medical problem, which is easy to do with Mectizan, these villages become repopulated, cash crops begin to grow again, and families can come back together."

Resources aimed at delivering Mectizan also have stimulated expansion of primary health care services for underserved populations in Africa. "You can't just pass out the product and consider the task accomplished. It takes a complete health system to deliver Mectizan in an appropriate and sustainable manner," said Africare's Gabriel Daniel. A nonprofit organization, Africare works with the local government to distribute Mectizan in Chad.

"The Mectizan donation story is a powerful reminder that it is possible to help people change their lives," President Carter said. "This partnership among private, public, and nonprofit organizations has significantly improved the health of millions of Africans who are at risk for river blindness."

Jimmy Carter, Rosalynn Carter, and Roy Vagelos (center) visit with villagers in Nia, Chad, where nearly all 500 residents are infected with river blindness. Gabriel Daniel (right) works with Africare, a nonprofit organization that works with local governments to distribute Mectizan. (Photo: Bill Van Der Decker)