In JACMEL, Haiti — In a sunny courtyard of the Evelina Levy School for Girls, hundreds of girls in blue uniforms did their part to rid Haiti of an ancient and reviled disease.
They lined up in pairs to get three pills dropped into their mouths. They swallowed them down with a quarter-cup of water. They got a second medicine, a flavored tablet, to chew as they walked back to class.
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Two middle-aged women treated 12 girls every 21 / 2 minutes, one pouring the water and the other shaking out the pills. Another woman ticked the columns for age, sex and drug on a white form with a green pen.
“Mass drug administration” is easy if your target is elementary school students. It’s harder when you want to reach nearly everyone else in a country of 10 million people.
That is the goal Haiti set this year in its campaign against a parasitic infection called lymphatic filariasis that is present in 80 percent of the country. Spread by mosquitoes, in severe cases it leads to permanent swelling of an arm or leg. That condition, called “elephantiasis,” can be grotesque and life-changing. In men, the worms can cause a swelling of the scrotum that is even more stigmatizing.
Lymphatic filariasis is a “neglected tropical disease,” the name for a group of maladies that have disappeared from industrialized countries or never existed there. Others include onchocerciasis (“river blindness”), schistosomiasis (“snail fever”), soil-based intestinal worms, and the eye infection trachoma. For 1.9 billion people, most of them poor, they are still threats.
Eliminating the diseases has been an object of intense effort and research over the past decade. The work is largely unknown outside the global health community, overshadowed by higher-profile campaigns against AIDS, malaria and tuberculosis.
In 2010, 484 million people worldwide took drugs against filariasis — more than for any other neglected tropical disease but still only one-third of the people at risk for it.
“You could argue it’s the world’s largest public health program,” said Peter J. Hotez, dean of the National School of Tropical Medicine at Baylor College of Medicine in Houston.
Most of the neglected diseases can be cured in their early stages with drugs taken once or twice a year. Pharmaceutical companies are donating drugs for mass administration. A bonus is that some treat more than one infection.
Ivermectin, donated by Merck, cures river blindness and filariasis. Albendazole, donated by GlaxoSmithKline, gets filariasis and intestinal worms. Some subsidiary effects are only now being discovered. When ivermectin was distributed for river blindness in Senegal, it reduced malaria transmission. When azithromycin (provided by Pfizer) was distributed twice a year to Ethiopian villagers for trachoma, childhood mortality fell 50 percent.
“What’s that all about? That’s the $64,000 question,” Hotez said.
Congress began earmarking money for mass drug administrations in 2006, and in 2008 President George W. Bush announced a five-year program to fight neglected tropical diseases. This year, the United States will spend $89 million on them — roughly 10 percent of the Obama administration’s global health budget.
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