Expanding the Reaching the Last Mile Fund: a game-changer for river blindness and lymphatic filariasis

Phil Downs, December 2023

On 3 December, the global community came together at the Reaching the Last Mile (RLM) Forum in Dubai to pledge US$777 million towards eliminating neglected tropical diseases.

This bold philanthropy – announced during COP28 Health Day – could protect more than one billion people from the devastating financial, physical and mental impact of these diseases.

I was particularly excited about the expansion of the RLM Fund, of which Sightsavers is a partner. This fund targets river blindness and lymphatic filariasis (LF) elimination, and the new resources pledged at the Forum are a huge step towards tackling these diseases.

Sightsavers’ own $60m pledge will help eliminate five neglected tropical diseases (NTDs): trachoma, river blindness, lymphatic filariasis, schistosomiasis and intestinal worms.

An eye health worker wearing a mask and visor checks a man's eyes for signs of trachoma.

Our work on neglected tropical diseases

We help to treat and prevent five debilitating diseases that affect more than a billion people.

Learn about NTDs

The current state of play

River blindness and LF are both debilitating diseases that can leave people unable to work, study or provide for their families, leading to poverty and stigma.

As of 2022, 288 million people were at risk of LF, a disease that makes body parts swell and causes intermittent fevers and secondary infections. Meanwhile, at least 246 million people are at risk of river blindness, which causes agonising itching and disfiguring skin conditions, and can lead to permanent blindness.

But there has been progress. Concerted global efforts to track these diseases, and decades spent persistently following the recommended World Health Organization (WHO) strategies, mean 19 countries have already eliminated LF as a public health problem and four have stopped the transmission of river blindness. In the Americas, river blindness has been eliminated in Colombia (2013), Ecuador (2014), Mexico (2015) and Guatemala (2016). We’re learning and applying knowledge gathered from these success stories.

Many people and organisations have supported this progress: from pharmaceutical firms Merck & Co and GlaxoSmithKline, who have donated millions of doses of medication, to the health workers and volunteers on the ground who distribute the drugs in the local communities they serve.

To date, Sightsavers has supported more than 640 million treatments for river blindness and 587 million treatments for LF. As of 2022, we estimate that more than 18.9 million people are no longer at risk of river blindness and LF due to Sightsavers-supported treatments. The expansion of the RLM Fund means that many more people will be protected from these diseases.

A health worker wearing a surgical mask takes a blood sample from a patient.
A health worker collects a blood sample to check if treatment campaigns for river blindness can stop in a community in Mali.

Why should the global community care about river blindness and lymphatic filariasis?

The WHO recommends that interventions to treat NTDs are among the ‘best buys’ in global public health. For every US$1 invested in treatments, the estimated net benefit to affected individuals is about US$25.

Eliminating these diseases increases productivity, reduces health care costs and improves quality of life. A 2017 study found that eliminating the disease in sub-Saharan Africa would generate between US$5.9 billion and US$6.4 billion in productivity gains.

Elimination is achievable, cost-effective and within reach for many countries. But these extraordinary achievements could be reversed if we don’t finish the job. Until river blindness and LF are eliminated everywhere, there remains a risk that these diseases could return to places where they’ve already been wiped out. This would mean having to start mass drug treatment campaigns again.

The spectre of climate change means we must act now

NTDs impact some of the most vulnerable people around the world. These are the same people who are finding it hardest to adapt in the face of climate change.

There is growing evidence to show that changes to the climate are changing the behaviour, range and intensity of the vectors – such as mosquitos and blackflies – that spread diseases such as LF, river blindness, dengue and malaria. If we delay now, we could allow transmission to intensify.

Sightsavers and the Walker Institute at the University of Reading have teamed up to understand how climate change could affect the way these diseases spread. Our first step will be working with the government of Malawi to explore how a range of climate scenarios could affect the country’s efforts to curb NTDs.

Without understanding the links between climate change and global health, the world’s poorest and most marginalised communities will remain at risk.

A boy wearing a bright blue shirt washes his face using water from a tap.

Sightsavers and the Walker Institute

The research project will work with the Malawian government to explore the impact of climate change on NTDs.

Read the news story

More support will be needed

Sightsavers and partners are working to remove the remaining obstacles that are stopping us from eliminating river blindness and LF. This means putting the resources in place to help countries reach their elimination targets by achieving high treatment coverage, carrying out surveys and building capacity in local health care services.

Although I’m glad to see partners coming together to increase the size of the Reaching the Last Mile Fund, I know that this will not be enough. The global community will need to make more commitments to eliminate these diseases.

To reach the finish line we will need funding to trial novel diagnostic techniques, support the roll-out of new treatment strategies, build a network of partner laboratories and enhance vector monitoring and control strategies.

Eliminating river blindness and lymphatic filariasis lies at the very heart of Sightsavers’ mission and ethos. When we have eliminated these diseases we will be closer to a world where no one is blind from avoidable causes, and where people with visual impairments and other disabilities can participate equally in society.


Phil Downs is Sightsavers’ technical director for neglected tropical diseases.


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