Riverblindness in Africa: Taming the Lion's Stare

by Bruce Benton, James D. Wolfensohn

Overview

The remarkable story of how a large public-private partnership worked to control and defeat riverblindness—a scourge which had devastated rural communities and impeded socioeconomic development throughout much of Sub-Saharan Africa for generations.

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.

Product Details

ISBN-13:	9781421439662
Publisher:	Johns Hopkins University Press
Publication date:	12/01/2020
Pages:	328
Product dimensions:	6.00(w) x 9.00(h) x 0.97(d)
Age Range:	18 Years

About the Author

Riverblindness in Africa is the culmination of Bruce Benton's forty-year career focused on development assistance for Africa. Much of that career involved leading a World Bank–sponsored partnership to eliminate the disease throughout Africa. His leadership on riverblindness was recognized by the World Bank president with a Special Presidential Award in 2000. Benton began his career as a Peace Corps volunteer in Guinea in the mid-1960s. Subsequently, he earned a master's degree in African studies from Johns Hopkins University and one in development economics from the University of Michigan. He was responsible for commodity negotiations and the international development banks in the Office of the Secretary of the US Treasury throughout the 1970s, and advised the US Congress on foreign assistance prior to joining the World Bank in 1982. In retirement, Bruce taught global health at Georgetown University. Bruce and his wife, Patricia, live in Bethesda, Maryland, where they have raised four children. Recently they have begun transitioning to a new home and life of hiking, kayaking, and writing on beautiful Orcas Island in the Pacific Northwest.

Table of Contents

Foreword, by James D. Wolfensohn
Preface
Acknowledgments
Chapter 1. The Challenge
Chapter 2. Launching and Scaling Up the Onchocerciasis Control Program
Chapter 3. Expansion and Rescue
Chapter 4. The Game Changer—Ivermectin
Chapter 5. Getting Mectizan to Africa, Concluding the OCP
Chapter 6. A Closer Look at Socioeconomic Development
Chapter 7. Widening the Effort to All of Africa
Chapter 8. Deepening and Widening the Objective
Chapter 9. Learning from the Past, Looking to the Future
People Interviewed
Acronyms and Abbreviations
Notes
Bibliography
Index

What People are Saying About This

David H. Molyneux

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.

Katherine Marshall

Without determination, persistence, and guts, the onchocerciasis program could have folded again and again. Bruce Benton, who was stubbornly committed to the program has told a gripping tale that has countless, timely lessons. This book inspires us to believe that the partnerships vitally needed in today's interconnected world are indeed possible.

Gilbert M. Burnham

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.

Tore Godal

Riverblindness in Africa describes one of the great successes in the history of medicine. Guided by research and surveillance, the riverblindness program continuously changed and adapted its strategy to defeat riverblindness, a disease among poor people in poor countries. The book should be mandatory reading for students of global health.

William C. Campbell

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.

Jean-Louis Sarbib

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

Jacques Hamon

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

Uche Amazigo

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.

Peter J. Hotez

The story of riverblindness control is one of the most important in all global public health. Bruce Benton was there from the beginning, and his insights provide important and timeless lessons for conquering illness and health disparities.

Birger Fredriksen

Benton provides an excellent analysis of the parameters of a successful comprehensive partnership to address a grave regional health challenge. The Covid-19 pandemic is a stark reminder of the need for such effective international cooperation to deliver vital global public goods needed to address challenges that no country can solve alone.

David A. Ross

Bruce Benton's telling of the groundbreaking story of oncho from control to elimination is a must read. The partnership of UN organizations, World Bank, NGOs, Merck, African governments, donor agencies, and academic researchers has made this a better world. Benton provides an epic tale of epic achievement.

From the Publisher

Riverblindness in Africa describes one of the great successes in the history of medicine. Guided by research and surveillance, the riverblindness program continuously changed and adapted its strategy to defeat riverblindness, a disease among poor people in poor countries. The book should be mandatory reading for students of global health.
—Tore Godal, former Director, UNDP / World Bank / WHO Tropical Disease Research Program

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

The story of riverblindness control is one of the most important in all global public health. Bruce Benton was there from the beginning, and his insights provide important and timeless lessons for conquering illness and health disparities.
—Peter J. Hotez, MD, PhD, National School of Tropical Medicine, Baylor College of Medicine

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David Addiss

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.

Ellen Agler

In evocative prose that draws on research, data, and first-hand accounts, Bruce Benton takes us inside the history of one of the greatest international collaborations. A fascinating and essential book.

Ralph H. Henderson

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