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From Guatemala to Nigeria and beyond, Dr. Frank O. Richards Jr. has dedicated most of his adult life to freeing people from the miseries of river blindness. He has been director of the Carter Center’s River Blindness Elimination program since its inception in 1996.

“River blindness is a punishing disease,” said Richards, widely considered one of the world’s foremost authorities on river blindness elimination using mass administration of Mectizan® tablets (ivermectin, donated by Merck). “First of all, it causes terrible itching. People are scratching day and night, sometimes using a stick or a rock, to the point where they bleed. Left untreated, the infection causes vision impairment and eventually total blindness.”

The parasitic disease, whose scientific name is onchocerciasis, ruins people’s ability to make a living and renders them dependent on others.

“People who have the infection are less able to learn, less able to work, and as a result of having this preventable disease, they become poorer, keeping them and their families stuck in the cycle of poverty,” Richards observed.

Growing up in St. Louis as the son of a surgeon and a social worker, Richards excelled in photography and the humanities but chose to pursue a career in medicine and the science of global health. He focused on pediatrics because as a medical student he was struck by how many children died of preventable parasitic diseases. He wanted to be a part of emerging global efforts aimed at giving children in the developing world a better chance at healthier lives. 

“Being a parent myself, I now appreciate much better how my parents supported me in pursuing my passion,” Richards said. “My father wanted me to be a surgeon and join him in his practice. They had serious doubts about the career path I chose, but they found the strength to stand behind me and helped me to realize my ambitions. I’m trying to return the favor with my own kids.”

Richards’ crusade against river blindness began in the early 1980s, when he was assigned as onchocerciasis desk officer for the Centers for Disease Control and Prevention. In 1987, CDC assigned him to an onchocerciasis research project in Guatemala, where the disease was first identified in 1916. On a mountainside coffee farm all those years ago, the young doctor was working on designing a health education program for some of the first communitywide distribution programs of a new “miracle drug” called ivermectin.

He asked an old man, "What is the most important disease in this community?"

The answer left Richards thunderstruck.

"Can you imagine that the poverty here in this community simply cannot be escaped?" the man said.

The thought of poverty as a disease was a revelation.

"It was like an arrow to my brain — the idea that poverty and hopelessness promote diseases like onchocerciasis,” Richards said. “It's both a cause and a consequence, and a downward spiral."

From that day on, Richards devoted himself to pushing back against river blindness and other neglected tropical diseases, maladies that afflict the poor, hopeless and forgotten, those who live beyond the end of the road.  

"Our success against river blindness in Guatemala has been tremendously gratifying for me both personally and professionally, since that’s where I really started,” Richards said. “The World Health Organization verified the elimination of river blindness from Guatemala in 2015, 30 years after I spoke to that wise old man."

Richards chairs the program coordinating committee of the Onchocerciasis Elimination Program for the Americas (OEPA), a Carter Center initiative that supports government ministries of health and other nongovernmental organizations to provide Mectizan at least twice per year through mass drug administration programs. The strategy has wiped out the disease in Colombia, Ecuador, Mexico, and Guatemala, leaving the Western Hemisphere largely free of river blindness except for an isolated indigenous population in the Amazon Rainforest on the Brazil-Venezuela border.

“President Carter always wanted The Carter Center to take on issues that were challenging, tasks that could potentially fail, but also could potentially be a great success,” Richards said. “River blindness fits into that scope of work. In large part due to President Carter’s advocacy, I’m happy to say that river blindness is no longer a neglected disease.  And what’s happening in the Americas is important as a guiding light to what can be achieved globally against river blindness.”

More than 99 percent of river blindness cases occur in Africa, where over 120 million people remain at risk and hundreds of thousands have been blinded by the condition.

Uganda is poised to become one of the first endemic countries in Africa to wipe out the disease nationwide. A unique aspect of Uganda’s success, developed by Carter Center epidemiologist Dr. Moses Katabarwa, has been pioneering the use of extended family groups, known as kinship groups, to effectively distribute Mectizan. The Ugandan government announced in 2014 that transmission was known or suspected to have been interrupted in 15 of its 17 transmission zones. Over 1.7 million Mectizan treatments are no longer needed for onchocerciasis, the greatest number of Mectizan treatments stopped for onchocerciasis in the world. 

In neighboring Sudan, The Carter Center and the federal Ministry of Health in 2012 succeeded in eliminating transmission of river blindness in the isolated community of Abu Hamad, implementing the same kinship approach.

Uganda and Sudan’s determination to eliminate the disease, rather than merely control it, made all the difference, Richards said.

“Once elimination becomes the goal, it is no longer business as usual,” he said. “A program and its partners must ratchet up interventions, and that’s exactly what Sudan did in Abu Hamad and what Uganda did nationwide.”

In some areas, a key to that transition is shifting mass administration of Mectizan from a yearly schedule to two or more times per year.

This goal presents a huge and costly challenge in Nigeria, Africa’s most populous country and most endemic for river blindness. About 50 million people have or are at risk of the disease there. The Carter Center’s proposal to eliminate river blindness in Nigeria is one of eight projects vying for $100 million in the John D. and Catherine T. MacArthur Foundation’s 100&Change grant competition. 

“We know Mectizan can halt and even prevent river blindness,” Richards said, his eyes glinting with passion. “We know because we've done it in the Americas, in Sudan, and in Uganda, eliminating the risk of river blindness for millions of people.”

Applying the same methods and determination on a grander scale, Richards is confident of triumph over river blindness in Nigeria as well.

“It is a long journey to the end of the road,” Richards said. “I collect inspiring quotes, and one of my favorites is by Mahatma Gandhi: ‘You must be the change you wish to see in the world.’”