We're The Carter Center, and we're competing in 100&Change, the MacArthur Foundation's $100 million competition to fund a single proposal aimed at solving a critical problem. Our proposal is to end "river blindness". AUA!

In the proposal, you have mentioned that "similar Carter Center projects have eliminated river blindness from four countries in the Americas and from parts of Uganda and Sudan", how is this project different from those ones and what challenges do you anticipate with Nigeria?

Great minds think alike! We just answered the first part of this question from another user (pittgrad09).

This project is the same in the sense that we must complete all of the WHO requirements needed to declare elimination of transmission in Nigeria just as we completed them in these other places. It's different because Nigeria is so much larger (most affected country in the world).

We think that five of the 37 states have done this already in Nigeria and many others are close. The population spared of river blindness in those five states alone dwarfs everything that I mentioned above in the Americas, Uganda, and Sudan. (F. Richards)

I think TCC really deserves this. It is the most impressive finalist imo.

Which component of the programs is the most important? For example: education, antibiotics, etc.

Which will receive the most of this $100 million?

Thank you! You are so kind! All components of the initiative are very important and complementary. We won't be successful without all of the components operating at their full capacity. That said, I can share with you my favorite component, which I think I've mentioned already, which is that of the community leadership in the process. It really goes beyond just health education. It's about people volunteering their own time to provide their friends, families, and neighbors with a safe medicine that has immediate and noticeable benefits. Imagine the terrible nonstop itching and skin disease that's quickly alleviated with a dose of a few donated tablets. And in the end, I hope that even after the disease is gone, once and for all there will be empowered people who will be asking what they can do next in partnership with their government to improve their health. When I traveled to Nigeria last month and visited some villages, I was thrilled by the dedication of the people to this program. (Frank Richards)

What are the plans for working in conflict affected areas of Nigeria and how will they mitigate against this risk? 

We kind of answered this question already (to profcece), but it is important to note that one of our partners, Helen Keller International, has been successfully working in northeast Nigeria to deliver Ivermectin in and around the areas threatened by Boko Haram. The Carter Center has active programs in the Niger Delta that have also been run effectively despite the insurgency there. We do weekly monitoring of the situation all across the country and the miracles of cellphone technology have allowed quicker responses when emergencies arise. (F. Richards)

What would you do with the $100 million from the MacArthur Foundation that you are not already doing?

$100 million will be used to super-size the program and enhance the flexibility to respond to the local epidemiology of the disease. For example, those areas we think are ready to stop mass treatment with Ivermectin will need a full WHO type evaluation that requires molecular laboratory support. That will be costly. In those areas where transmission is ongoing, we will need to add additional interventions like twice per year treatment with Ivermectin. That will be expensive too. Lastly, there are many areas in Nigeria that we have to reassess to determine if they are ready to stop or if they need twice per year treatment. That will be costly. The point is that we urgently need to do all of these things as soon as possible.

It can't be business as usual!!! (The Carter Center, Frank Richards)

1) What inspired this idea of yours? Why Nigeria?

2) Did you apply for any other challenges?

3) What do you think your chances are of actually winning?

1) Nigeria is the country most affected by river blindness in the world. 40% of the global population at risk is in Nigeria.

2) No, not for this proposal opportunity.

3) 12.5% because there are eight semi-finalists.

(Frank Richards)

Will $100 million be sufficient to implement the programme? If not, how will TCC fund the gap?

Great question!

Probably, and if not, $100 million is still very close to what we need.

A big issue is what the value of the Nigerian currency (Naira) is against the U.S. dollar. In other words, $100 million can be worth a lot more or a lot less depending on global exchange rates. And recently the Naira has been falling against the U.S. dollar. If it is not enough, The Carter Center has always had strong partnerships and generous donors. The infusion of these funds will surely draw other donors to the cause! (Frank Richards).

What do you think makes this project stand out against the other semi-finalists?

We admire all of the semifinalists and believe all proposals are worthy to be funded. If only there were enough money to do massive good!

That said, our proposal will eliminate a disease once and for all that will benefit generation after generation of Nigerians and serve as a beacon for other countries to follow suit. We believe in a world free of river blindness. (F. Richards)

Has TCC successfully assisted with the elimination of the transmission of river blindness in other countries?

The Carter Center has worked in the Americas as a partner to eliminate river blindness from four countries using Ivermectin: Colombia, Ecuador, Mexico, and last and most recently, Guatemala.

We've also had great success in Africa in Sudan and Uganda. Although those countries have not completed elimination within their borders like those countries mentioned above. (Frank Richards)

Do you really think this can be accomplished in 5 years?

Good question. The big issue is in areas where transmission is ongoing. We absolutely have to treat twice per year there, with good treatment coverage as soon as possible if we are to stop mass treatment throughout Nigeria by the year 2022. (Frank Richards).

Hi. Given that you have experience in eradication programme (Guinea Worm, OEPA) and Uganda, how do you plan to implement this when you get the funding?

It is important to recognize that The Carter Center is making this application on behalf of the Nigerian partnership dedicated to eliminating river blindness from the country. That includes the Ministry of Health, a number of other NGOs, and the communities afflicted by river blindness. We will implement the program through providing sub-grants to our partners who have been working in different states in the country to fight river blindness for many years. We all believe we can do this!!!! (Frank Richards)

Why community volunteers rather than paid employees?

It would be impossibly expensive and well over $100 million to pay distributors to treat over 50 million people. Just think, this is two dollars per person to treat over a period of up to five years. That's less than 50 cents per person per year.

So, we have to rely on volunteerism and it has worked up until now. Remember, Nigeria already has the largest Ivermectin distribution program in the world based on volunteer delivery.

In a way, we should also look at this as community empowerment and how people themselves can change their OWN lives. (Frank Richards)

how will the national program handle areas previously determined to be hypo-endemic but currently being treated with IVM through LF programme?  Will all hypo-endemic areas be remapped?

This is a great but very technical question. I hope to figure out a way to communicate with you to answer. The National Onchocerciasis Elimination Committee in Nigeria (a link to their deliberations will soon be on our website) addresses some of these issues, but others will need to be solved through a very active operations research element of the MacArthur proposal.

What are the risks associated with implementation? What could go wrong?

Insecurity like Boko Haram, and/or kidnapping and other insecurity is a big risk for everyone involved in this - Nigerians and foreigners. This keeps me up at night. But the people working on this are heroes! They are willing to take the risks and be on the front lines to treat the most neglected people in the hopes in solving at least one of their many problems. (F. Richards).

Hi! I'm a big fan of the Carter Center and the work that you all do! What led you to your current position and program? What is the most unexpected or exciting you've learned or discovered while working with river blindness?

Thank you so much! We are a big fan of our fans!

I've been in love with parasitic diseases since I was a medical student at Cornell. You can read my profile on cartercenter.org. The Atlanta Journal Constitution did a whole story on me to answer all of your questions and this is on our website also. (F. Richards)

how will you assess areas that where previously classified as not requiring treatment?

The Nigeria Onchocerciasis Elimination Committee (NOEC) has developed standard operating procedures for assessing these areas. In a nutshell, we go to villages located close to rivers where there are rapids and test children for antibodies that show they have been exposed or infected to river blindness. The test is a blood test (finger stick) for OV16 antibodies. If greater than one percent of kids are infected, the area is considered to be at risk. (F. Richards)

Hi Dr. Richards. Your work in the Americas and with river blindness around the world is very impressive.

What are the program differences between "elimination" and "control"? Is one easier than the other?

Thanks for doing this! I'm a big fan of TCC

Thanks MagnumPeeEye! Great name. A control program is one that goes on forever, whereas a true elimination program is one that comes to a safe ending. Elimination programs are much more difficult than control programs because they have to reach everyone, they have strict guidelines (high burden of proof), and an accelerated window to success. That means they are more costly, but in the long run they are infinitely more cost-effective. One more thing - not every disease can be eliminated. There is no dishonor in a good control program, but at The Carter Center we believe that when a disease CAN be eliminated, we should go for it! Because the rich and the poor all benefit equally form an elimination program, we believe there is an ethical imperative. This fits completely with President Carter's belief system of equity. (F. Richards).