On January 30, 2025, as we celebrate World NTD Day, I reflect on how we could effectively integrating innovative approaches for the last mile of onchocerciasis elimination efforts.

What is required to accelerate progress toward onchocerciasis elimination, and how can we collectively contribute to achieving this goal?

According to the Neglected Tropical Disease (NTD) Roadmap 2021–2030 [1], we are now halfway to the 2030 target goals. This marks a critical moment where we must synergize our efforts to ensure that all stakeholders make meaningful contributions to the last mile of elimination.

The last mile of disease elimination is both the most anticipated and the most challenging phase. It requires significant financial investment and tailored strategies to ensure that effective technologies and tools reach the communities that need them most. These tools and technologies must align with community needs and be deployed in ways that create meaningful impact. Communities play a pivotal role in elimination efforts and must be fully engaged as partners in these efforts.

To address these priorities, the Global Institute for Disease Elimination (GLIDE) hosted two stakeholder engagement roundtables on the sidelines of the American Society of Tropical Medicine and Hygiene (ASTMH) 73rd Annual Meeting in New Orleans in November 2024. These sessions explored two key topics: the potential of moxidectin as an additional tool for onchocerciasis elimination and the importance of community-centered delivery approaches. Together, these discussions highlight the complexity and promise of achieving onchocerciasis elimination. The detailed reports from these roundtables are available [here].

Reflections on key discussions from the roundtables

Moxidectin: a complementary tool in onchocerciasis elimination

The first roundtable explored the role of moxidectin, a promising complementary approach to ivermectin. This discussion built upon prior discussions on the rationale for using moxidectin based on data, including modeling studies that demonstrated moxidectin’s superiority over ivermectin in reducing program duration. The roundtable aimed to advance these conversations by identifying the necessary conditions for adoption of moxidectin, exploring barriers to implementation, and formulating actionable recommendations.

What made this roundtable unique was its inclusivity. Stakeholders representing diverse backgrounds—including implementers, funders, country representatives, modelers, academics, and policymakers—came together to share insights and align on next steps. This convening reflects GLIDE’s ongoing commitment to fostering collaboration, addressing critical gaps, and driving alignment toward shared goals.

Discussions highlighted the scenarios for which moxidectin would be the most impactful, including high-transmission hotspots, ivermectin-naïve populations, and marginalized groups. However, barriers such as financial constraints, data gaps, and procurement challenges were also emphasized. Transitioning from donated ivermectin to a procurement-based model for moxidectin raises concerns about affordability and sustainability, further complicated by limited visibility on demand.

Stakeholders stressed the importance of generating critical evidence through pilot programs, such as those planned in Angola [2] and the first programmatic rollout that is currently ongoing in Ghana [3], to demonstrate operational feasibility, and programmatic outcomes. Robust monitoring systems are also essential to assess moxidectin’s impact on transmission and elimination progress. Addressing procurement challenges by developing models that ensure affordability and sustainability was another key recommendation.

The consensus was clear: while moxidectin is not a standalone solution, it offers a promising opportunity to accelerate elimination efforts if integrated strategically and thoughtfully. Scribble-04

Community-centered delivery approaches: a cornerstone for success

The second roundtable focused on community-centered delivery approaches, a theme that underscores the importance of empowering communities to drive efforts in onchocerciasis elimination.

Community-directed treatment with ivermectin (CDTi) is a cornerstone strategy for mass drug administration (MDA) in African countries endemic for onchocerciasis. The success of MDA that directly contributes to advancing elimination goals is deeply rooted in community participation. However, this is influenced by the perception of the drug, the programme, and those delivering it. Thus, challenges such as misinformation, community fatigue, and lack of trust have impeded progress in some areas.

Participants highlighted the critical role of empowering communities to take ownership of elimination efforts. Two studies conducted in Cameroon and Mali exemplified the importance of conducting community-based studies to deepen knowledge of their communities, address barriers, and enhance participation. Discussions also underscored the importance of placing communities at the center, ensuring they lead on the selection of community drug distributors (CDDs), and are deeply involved in co-designing interventions and policies. Even though the CDTi model by definition and principle is community-led, in reality, aspects such as MDA schedules are dictated by donors and don’t always align with cultural and seasonal calendars. These strategies not only foster trust but also ensure that interventions are both relevant and impactful.

Another key insight was the value of integrating lessons from other disease programs. For example, the role of women in trachoma elimination efforts and the success of community health councils in malaria programs provide valuable models for enhancing onchocerciasis strategies. By leveraging these insights, stakeholders can optimize resources and amplify the impact of their efforts.

Conclusion

As I reflect on the discussions and insights shared during the roundtables, it is clear that achieving onchocerciasis elimination will require collective action, innovative solutions, and steady commitment. A tool like moxidectin offers great promise, but its success depends on addressing financial, logistical, and programmatic challenges. Equally important is the role of community-centered delivery approaches, which ensure that interventions are not only effective but also resonate with the people they are designed to serve.

World NTD Day is a reminder of how far we have come in advancing NTD control and elimination efforts and how much more remains to be done. By fostering collaboration across stakeholders, investing in evidence-based strategies, and empowering communities, we can overcome the final barriers and make significant progress in this critical last mile of elimination.

[1] Ending the neglect to attain the Sustainable Development Goals: A road map for neglected tropical diseases 2021–2030
[2] A randomized controlled trial in Angola
[3] Community pilot treatment implementation program

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Dr. Aïssatou Diawara

Dr. Aïssatou Diawara is a public health specialist with a keen interest in operational research for the control and elimination of neglected tropical diseases (NTDs). She holds a Ph.D. in parasitology from McGill University and a Master of Public Health from the London School of Hygiene and Tropical Medicine. With over 10 years of experience in NTDs and malaria research in developing countries, including Haiti and Burkina Faso, she gained extensive knowledge in research implementation, conducting epidemiological studies, and capacity building.

Aïssatou’s previous experiences also include working as a consultant in the team of Special Programme on Tropical Diseases Research (TDR) of the World Health Organization (WHO). Prior to joining GLIDE, Aïssatou was a researcher at New York University Abu Dhabi working on malaria.