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Riverblindness in Africa

Taming the Lion's Stare

Riverblindness (onchocerciasis)—a pervasive neglected disease, transmitted by the blackfly, that causes horrific itching, disfigurement, and loss of vision—is also known as "lion's stare" in reference to the fixed, lifeless glare of the eyes blinded by the disease. The disease has destroyed countless lives for generations, particularly in Africa. Its effects are so devastating that the areas where it is most common (large expanses of land around rivers where the fly breeds) end up abandoned as villages move farther and farther away to more arid environments in order to escape the fly-biting, and hence the disease. The disease devastates communities from multiple angles: a large portion of each stricken community's population is disabled, often permanently blind in the prime of life, placing a burden on the rest, and communities' efforts to escape infection force them to move to areas where farming is less productive.

To defeat riverblindness would not only release these communities from the heavy toll of the disease, but would also open more fertile areas in Africa to be inhabited, thus alleviating extreme poverty. These were the goals of the World Bank, led by then-president Robert McNamara, when launching a partnership to combat riverblindness more than forty-five years ago. In this book, Bruce Benton tells the remarkable story of that partnership's success. An authoritative account of the launch and scale-up of the effort, the book covers the transformation of the fight from a top-down high-tech operation to a grassroots drug treatment program covering all of endemic Africa. How, Benton asks, did the effort become such a unique partnership of UN agencies, donors, NGOs, a major pharmaceutical company, universities, African governments, and the stricken communities themselves?

Highlighting the importance of disease control in alleviating absolute poverty and promoting development, Benton examines the key developments, individuals, and notable qualities of the partnership in realizing success. He also extracts lessons from this particular story for addressing future challenges through partnership. Drawing on Benton's twenty years of experience managing the riverblindness program for the World Bank, along with extensive research and interviews with 100+ players in the program, Riverblindness in Africa is the first and only book of its kind. The story of the battle has an epic scale, both in terms of geography and the vast number of people and organizations involved. It provides a template for a broad range of global health efforts and is an excellent example of evolving, increasingly effective approaches to disease control and elimination.

About the Authors

Bruce Benton (BETHESDA, MD) worked as the manager of the Onchocerciasis (Riverblindess) Coordination Unit at the World Bank for 20 years. During this time, Benton mobilized US$750 million from 27 donor countries and international agencies to enable riverblindness programs to cover 31 countries in Africa, protecting 150 million people at risk of the disease.

Endorsementss

"In this book, Benton combines a huge amount of research with his unique insight into the evolution of riverblindness programs during his career at the World Bank. For those interested in the complexities of managing disease control programs and the need for strong partnerships, this is a must-read."

- David H. Molyneux, Liverpool School of Tropical Medicine

"The authoritative record and historical account of one of the most ambitious and successful parasite control approaches from someone who has been a key part of onchocerciasis control from just about the beginning."

- Gilbert M. Burnham, MD, Johns Hopkins Bloomberg School of Public Health

"An inspiring and essential contribution to the literature on international development and public health."

- Jean-Louis Sarbib, former Senior Vice President, World Bank

"Comprehensive, detailed, inspiring! Highlights how championing trust in the affected communities and close collaboration among all interested parties are essential for success."

- Ralph H. Henderson, MD, MPH, former US Assistant Surgeon General / Assistant Director General, World Health Organization

"An excellent summary of an ambitious operation illustrating what only international cooperation can achieve against complex—and in this case, insidious—diseases."

- Jacques Hamon, MD, former Assistant Director-General, World Health Organization

"The astonishingly successful effort to control onchocerciasis in Africa has indelibly shaped the field of global health. Benton illustrates how the success of global health initiatives depends on courageous individual decisions, dedication to a common cause, serendipitous events, and the pursuit of programmatic and scientific excellence."

- David Addiss, MD, MPH, Director, Focus Area for Compassion and Ethics, The Task Force for Global Health

"A balanced masterpiece that captures the oncho story that no one else could, with important lessons for the entire range of development partners—international aid agencies, the WHO, the World Bank, NGDOs, and governments. A must-read."

- Uche Amazigo, former Director, African Program for Onchocerciasis Control

"A unique historical work by someone uniquely qualified to write it. Riverblindness in Africa is remarkably comprehensive, and is remarkable, too, in its masterful sorting out of the contributions made by numerous agencies and individuals. An inspiring story and an instructive account of how numerous organizations, public and private, can work together to control a major infectious disease and even banish it from a vast region of the earth."

- William C. Campbell, Nobel Laureate, Drew University
Johns Hopkins University Press
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