In most places where The Carter Center works, community drug distributors, such as Stella Chibueze in southern Nigeria, now travel from house to house to provide treatments due to new COVID-19 procedures. In the past, gathering places such as schools and churches were often used as community distribution points.
The COVID-19 pandemic’s relentless spread across the world forced Carter Center health programs to make drastic changes. The World Health Organization recommended halting mass drug administration for all neglected tropical disease programs in April 2020, and The Carter Center complied.
Mass drug administration, in which entire communities receive drug treatment to halt disease transmission, was interrupted or delayed, but intense work went on behind the scenes to develop sets of COVID-safe procedures.
Programs aim to distribute more than 115 million treatments in 2021.
“We worked harder in the past 12 months than I could have ever imagined, because we had to ensure we were not completely stopped by the pandemic,” said Kelly Callahan, director of the Center’s Trachoma Control Program.
Program staff developed new methods of delivering treatments, tailored to each location. They reviewed the new procedures with health ministries and other partners, procured equipment such as masks and face shields, planned complicated logistics, and devised ways to incorporate COVID-19 messaging and mitigation into their activities.
“Costs for the various activities increased tremendously compared to previous years because of the elaborate precautions put in place to prevent COVID-19 transmission,” said Dr. Emmanuel Emukah, director of Carter Center health programs in Nigeria’s Edo and Delta states.
With authority from the World Health Organization, drug distribution for river blindness in Uganda began again last August, among the first in the world. One by one, other programs assisted by The Carter Center followed suit.
Pre-pandemic, community drug distribution often would take place at a community location, such as a health clinic or school. Now, most distribution takes place house to house, outdoors, in a slower and more labor-intensive process.
Household members are first screened for COVID symptoms. In Nigeria, the height-measuring pole, which determines dosage, is leaned against a wall and measurements read from 6 feet away; in other places, a masked worker takes the measurement up close. Tablets are dispensed with a spoon that only one person ever touches, and recipients use their own water and cups when possible.
“You take as many precautions as you can, but you still have to get close enough to give them the medicine,” said Angelia Sanders, associate director of the Trachoma Control Program.
On top of observing the universal protocols such as wearing face masks and maintaining social distance, programs encountered novel challenges. For example, in Uganda, no more than three people could travel together in one vehicle, so the River Blindness Elimination Program had to hire additional vehicles and drivers.
“Our frontline staff are just amazing, as are the volunteers, who gave extra time to do the work,” said Lindsay Rakers, associate director of the Center’s river blindness, lymphatic filariasis, and schistosomiasis programs.
Using the lessons learned from 2020, Carter Center-supported programs aim to distribute more than 115 million treatments in 2021.
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