Egypt has become the first country in the Eastern Mediterranean Region of the World Health Organisation (WHO) and the latest in the world to eliminate lymphatic filariasis (LF) as a public health problem.

Egypt’s success, according to the WHO, comes after almost two decades of implementing sustained control and prevention measures (including mass treatment of populations) and surveillance in affected/at-risk localities.

The country joins 10 others already validated by WHO as achieving this criteria. After implementing WHO-recommended large-scale treatment campaigns, Egypt continued surveillance for at least four years until elimination was validated.

The 10 countries are: Cambodia, Cook Islands, Maldives, Marshall Islands, Niue, Sri Lanka, Thailand, Togo, Tonga, and Vanuatu.

““This is a landmark achievement that brings prospects of hope and improved health to future generations of Egyptians” said Dr Jaouad Mahjour, Regional Director, WHO Eastern Mediterranean Region. “Egypt will continue to improve disease management among people who are already infected as well as ensure that appropriate surveillance is maintained to ensure zero transmission.”

In 2000, Egypt was one of the first countries in the world to implement a national elimination programme based on mass-drug administration (MDA). It followed a World Health Assembly resolution (WHA 50.97) on LF in 1997 that called for its global elimination by 2020.

“The strategy depended on high-level commitment, engaging local communities,and the availability of free medicines donated through WHO. Such combined action provided the greatest of opportunities for the sustainability of the programme” said Dr John Jabbour, WHO Representative in Egypt.

This required planning, logistics, coordination and collaboration with other ministries as well as building the capacity of healthcare workers and community workers.

At the onset, Egypt had to contend with several challenges and these included financing a national programme; prioritisation of a disabling, disfiguring disease in a resource-limited setting; determining its cost of implementation while leveraging the cost of disability management programmes such as hydrocele surgery.

After WHA 50.97, WHO invited countries to accelerate efforts to eliminate LF as a public-health problem and launched its National LF Elimination Programme (NLFEP) which set itself to:

• interrupt LF transmission through mass drug administration of DEC and albendazole, and;
• alleviate the suffering of affected people through morbidity management and disability prevention.

Remarkable efforts led to the implementation of several rounds of MDA until 2013 when surveys validated that infection has been reduced below transmission thresholds.

Final assessments conducted between 2014 and 2017 focused on both transmission and management of morbidity in affected patients and confirmed that Egypt has met all criteria for achieving elimination as a public health problem.

“Our ultimate aim was to eliminate this disease by adopting pro-poor, cost-effective public-health interventions,” said Dr Ayat Haggag, Undersecretary for Endemic Diseases, Ministry of Health and Population, Egypt. “Our government is determined to defeat other NTDs such as schistosomiasis, trachoma, soil-transmitted helminthiasis, leprosy, leishmaniasis and dengue”.

LF in Egypt

Egypt’s struggle to overcome lymphatic filariasis (also known as elephantiasis) is perhaps one of the oldest in the history of public health, with field activities going back to the early 20th century. Its clinical manifestations are shown in pharaonic statues and works of art, and are described in early Arabic literature, although its causal agent, the parasite Wuchereria bancrofti, was first documented there in 1874.

The disease burden was fully appreciated in the 20th century through large-scale surveys, which revealed its endemicity in rural areas, especially in the eastern Nile Delta region, where clinical manifestations such as lymphoedema and hydrocele (swollen limbs and genitals) were commonly observed.

Earlier control attempts

Disease control activities in Egypt started in the early 1960s, initially relying on the control of the mosquito vector Culex pipiens and on selective treatment with diethylcarbamazine (also known by its acronym, DEC).

New treatment, brighter prospects

In November 2017, WHO recommended IDA1 (combination of ivermectin, DEC and albendazole) – an alternative three drug regimen to accelerate the global elimination of lymphatic filariasis.

The recommendation followed large randomised community studies conducted in four countries (Haiti, India, Indonesia and Papua New Guinea) which found that IDA is as safe as the two-drug regimens when used during MDA.

The disease

Lymphatic filariasis is caused by infection with parasitic worms living in the lymphatic system. The infection impairs the lymphatic system triggering abnormal enlargement of body parts, causing pain, severe disability and social stigma.

The larval stages of the parasite (microfilaria) circulate in the blood and are transmitted from person to person by mosquitoes.

Manifestation of the disease after infection takes time and can result in an altered lymphatic system, causing abnormal enlargement of body parts, and leading to severe disability and social stigmatisation of those affected.

Almost 856 million people in 52 countries worldwide remain threatened by LF and require preventive treatment to stop its spread. Regular MDA reduces the density of microfilariae in the bloodstream and prevents the spread of parasites to mosquitoes.

MDA can interrupt the transmission cycle when conducted annually for 4–6 years with effective coverage of the total population at risk.

Salt fortified with DEC has also been used in a few settings to interrupt the transmission cycle.

Parasites that cause LF are transmitted by four main types of mosquitoes: Culex, Mansonia, Anopheles and Aedes.

The Environmental Rights Action/Friends of the Earth Nigeria (ERA/FoEN) has thrown its weight behind global calls for the International Labour Organisation (ILO) to cut ties with Big Tobacco. The group insists that the ILO engagements with Eliminating Child Labour in Tobacco Growing Foundation, a non-profit funded by tobacco companies since 2002, reflects a conflict of interest in the United Nations (UN) system.

This call is coming as the governing body of the ILO meets this month to decide whether it would shutter one of the tobacco industry’s last-remaining avenues of interference in the UN, making it harder for it to weaken, delay and block live-saving public health and labour policies.

The vote comes two weeks after the Director-General, Michael Moller, issued a report calling on the ILO governing body to end its public-partnerships with Big Tobacco. The Director-General’s report comes on the heels of over 150 public health and labour leaders calling on the ILO to cut ties with the deadly industry and as the Secretariat of the World Health Organisation Framework Convention on Tobacco Control (WHO-FCTC) is demanding the ILO sever ties.

“ILO and Big Tobacco’s split is long past-due: The ILO must join other U.N. agencies in casting this deadly industry out for good,” said Akinbode Oluwafemi, deputy executive director of ERA/FoEN. “Big Tobacco has no place in any U.N. space. This month, the ILO has the opportunity to stand on the right side of history and show Big Tobacco the door.”

To date, the ILO has received more than $15 million from tobacco corporations for joint programs, including more than $10 million from Japan Tobacco International (JTI) for an effort to curb child labor in tobacco farming. The Director-General’s report finds, however, that the focused initiatives do little to curb child labor in tobacco fields because they do not shift the tobacco industry-driven cycle of poverty for tobacco farmers that forces children into the fields.

The tobacco industry commonly promotes programmes like these to boost its public image and maintain influence in policymaking spaces. In the same vein as JTI’s effort, Philip Morris International recently launched a Foundation for a Smoke-Free World, to which it will give nearly $1 billion over the next decade.

“The ILO is one of the last avenues of Big Tobacco’s influence into the U.N.,” said Jaime Arcila, Latin America organiser with Corporate Accountability’s tobacco campaign. “It’s high time the ILO recognise the harms Big Tobacco poses to public health, workers and the environment and end its partnerships with the industry.”

Despite Big Tobacco’s abusive labor practices and its membership violating a core tenet of the Global Tobacco Treaty, its influence still runs deep in the ILO: In November 2017, the Governing Body failed to come to a decision on whether or not to end its private-public partnerships with tobacco corporations.

In Nigeria, just as elsewhere, the tobacco industry has been identified with monopolistic practices that have made farmers go the extra mile to meet their demands, including forcing their kids as young as five years of age to work 24/7 on tobacco farms.

Also, British America Tobacco Nigeria (BATN) is yet to wriggle from anti-labour practices leveled against it by some ex-workers, some of whom now have debilitating illnesses due to poor factory conditions and exposure to tobacco dust.

Along with Ebola, Zika and other well-known notorious diseases, Disease “X” was recently enlisted by the World Health Organisation (WHO) as the killer that is potential to trigger deadly global epidemic in the near future.

After a meeting at its Geneva headquarters gathering in Switzerland of health experts across the world, the organisation released its 2018 Blueprint list of priority diseases, which include Ebola, Lassa fever, Severe Acute Respiratory Syndrome (SARS), Rift Valley fever (RVF) and Zika.

According to the WHO, the Blueprint is to improve global coordination, accelerate research and development on certain diseases, develop norms and standards on worldwide scope and promote response plan in some contexts.

Among eight diseases, last but not the least threat is Disease “X”.

“Disease X represents the knowledge that a serious international epidemic could be caused by a pathogen currently unknown to cause human disease,’’ the WHO said.

Report says it is the first time that the organisation puts an entry of unknown disease in its Blueprint to arouse global awareness of health experts and communities.

According to an analysis by the Telegraph, sources of Disease X could be experiments of bio-weapons, animal diseases that can be transmitted to humans, zoonotic diseases in general, and the potential evolution of existing diseases.

Actually, the above sources have been unveiled as the causes of some fatal diseases which are well-known now but were mysterious killers when they first appeared, such as Ebola, HIV and even the smallpox virus.

The WHO said all the named diseases “pose major public health risks and further research and development is needed, including surveillance and diagnostics.”

Outside the 2018 Blueprint, the WHO also mentioned dengue, yellow fever, HIV/AIDs, tuberculosis, malaria, influenza causing severe human disease and smallpox.

Other diseases are cholera, leishmaniasis, West Nile Virus and plague, saying further research and development is needed to tackle these diseases.