100&Change | The Carter Center Takes Aim at a Big Fish

Dr. Richards with a patient.

Story and Photo: The Carter Center

By Frank Richards
Dr. Frank Richards leads the Carter Center’s efforts to eliminate river blindness (also known as onchocerciasis), a parasitic disease transmitted by the bites of infected black flies.

There’s a famous line in the movie “Jaws” – after the stunned sheriff sees the monster shark for the first time, he says to the shark hunter: “You’re gonna need a bigger boat.”

As The Carter Center tackles the monstrous challenge of eliminating river blindness in Nigeria, we’re gonna need a bigger plan, a bigger program, a bigger posse of volunteers—in short, a bigger paradigm. Our proposal to the MacArthur Foundation lays out a plan to do this that is entirely achievable with sufficient support; in other words, with a bigger budget.

But everyone involved, especially the millions of people in thousands of affected communities, must understand that to eliminate this curse, we need all hands on deck, and everyone needs to take the medication in the correct doses at the prescribed times. A Mectizan distribution program of this size, in the most populous nation in Africa and the most endemic for this disease worldwide, will require an exponential level of effort and perseverance; it has never been attempted at this scale.

We know our method works; we’ve used it to eliminate river blindness in Ecuador, Colombia, Guatemala, and Mexico. But Nigeria’s at-risk population is 100 times that of all of those places combined, so we have to scale everything up. Tens of thousands of volunteers will need to bring health education to their villages, measure for proper dosage and administer ivermectin tablets—medicine which is proven to stop transmission of the condition—and keep better records that will provide better data needed to track our progress. We will need a lot more volunteers, and each will need to be thoroughly trained, equipped and motivated. We’ll also need a lot more medication, storage space for it, and vehicles and drivers to distribute it. Once we’ve gained the advantage over river blindness, once it is gone from people and the environment, we can scale down all these activities for good.

This is a huge shark we are going after. But at The Carter Center, we don’t shy away from challenges. We believe that when the opportunity arises to make a terrible disease go away forever, we are morally obligated to give it our best shot.