GONE to combat onchocerciasis
Authors: Sanjeet Bagcchi
Journal: The Lancet Microbe (2024)

The first meeting of the Global Onchocerciasis Network for Elimination (GONE) was held in Mbour, Senegal, on Nov 1–2, 2023. Over 150 partners attended the meeting, including coordinators from endemic countries, researchers, donors, and civil society organisations. Their aim was to strengthen their joint efforts for eliminating onchocerciasis, a neglected tropical disease (NTD) caused by the parasitic filarial worm Onchocerca volvulus, which is transmitted by blackfly bites. Onchocerciasis causes blindness, skin ailments, and has been reported to be associated with epilepsy. 31 sub-Saharan African countries bear most of the burden of the disease, but infections also occur in Brazil, Venezuela, and Yemen. Over the past decades, several programmes have contributed to the fight against onchocerciasis, such as the Onchocerciasis Control Programme (OCP) in west Africa (1974–2002), which initially distributed aerial larvicides for vector control and later implemented annual ivermectin mass drug administration (MDA); the African Programme for Onchocerciasis Control (APOC), which provided annual ivermectin MDA to endemic African countries in 1995–2015; and the Onchocerciasis Elimination Program for the Americas, which has conducted ivermectin MDA twice a year in endemic Latin American countries since 1993. Additionally, the Expanded Special Project for Elimination of Neglected Tropical Diseases (ESPEN) has supported the elimination and control of five NTDs, including onchocerciasis, since 2016. GONE is a WHO-supported, country-driven initiative launched on Jan 30, 2023. It promotes an integrated approach to eliminate onchocerciasis and aims to have an active advocacy role. By encouraging communication and partnerships, GONE supports countries to accelerate their progress towards WHO NTD roadmap targets for onchocerciasis, which include verification of interruption of disease transmission in 12 countries by 2030. Participants at the GONE meeting discussed the advances made in fighting onchocerciasis. Onchocerciasis has already been declared eliminated in Colombia, Ecuador, Guatemala, and Mexico. In 2023, Niger applied for WHO verification of onchocerciasis elimination—the first African country to do so. Senegal interrupted onchocerciasis treatment in 2022 and is currently in the 3-year surveillance period, after which it can apply for WHO verification of elimination. During the meeting, specific working groups—focusing on entomology and on cross-border collaboration, for example—were formed to identify challenges and solutions to promote onchocerciasis elimination. Maria Rebollo (Global Onchocerciasis Elimination Programme, WHO) highlighted the shortage of entomologists as a particularly important issue, and told The Lancet Microbe, “Training more health and field workers in entomology…remains a critical gap, as highlighted in the NTD roadmap 2030.” Despite the existence of several initiatives for the fight against onchocerciasis, according to Adrian Hopkins (Onchocerciasis Elimination Committee) “GONE was a much-needed organisation for coordinating onchocerciasis elimination, particularly in Africa. Since the closure of the previous programme (APOC), countries without strong [non-governmental organisational] support have been struggling to maintain MDA for onchocerciasis and there is still a serious lack of funding for coverage surveys, impact assessments, and potential pre-stopping studies. There is also a serious lack of laboratory capacity.” Indeed, according to a 2022 study on onchocerciasis diagnostics, in sub-Saharan African countries, “dedicated NTD laboratory facilities are still relatively uncommon, and frequently under-resourced where they do exist”. GONE meeting participants emphasised the need to strengthen public–private partnerships to mobilise funds for the implementation of elimination measures. “There are several public–private partnerships in the area of onchocerciasis,” said Rebollo, such as the one between DNDi and ESPEN, which focuses on research and development. Hopkins added: “One aspect of GONE (and ESPEN at WHO [African region]) is the role of national ownership. This [approach] works in richer countries but not in poorer ones where health funding in general and NTD funding in particular is very limited.” GONE does not serve as a funding agency but rather, according to Rebollo, “as a communication platform where countries and partners discuss challenges and approaches regarding various issues and areas.” The need for a coordinating organisation such as GONE is underscored by Robert Colebunders’s comment (Global Health Institute, University of Antwerp) to The Lancet Microbe, “Onchocerciasis elimination programmes need to be strengthened, particularly in areas where there is still a high burden of onchocerciasis-associated disease, which includes onchocerciasis-associated epilepsy.” The next GONE meeting’s schedule and topics will be announced later in 2024, but a particular focus is expected to be on reaching the 2030 NTD roadmap targets.