Joint Programme Committee first session, Yamoussoukro, Ivory Cost 25-27 November 1980: report

JOINT PROGRAM},IE COMMITTEE ONCHOCERCIASIS CONTROL PROGRAM},IE IN TI{E VOLTA RTVER BASIN AREA First session, Yamoussoukro, Ivory Coast 25-27 November 1980 REPORT CONTENTS 1. INTRODUCTION AND OPENING OF T1IE SESS]ON 2. ELECTION OF OFFICERS 3. ADOPTION OF TTM AGENDA 4. PROGRESS REPORT OF THE WORID HEALIH ORGANIZATION FOR 1980 5. REPORT OF THE EXPERT ADVISORY COMMITTEE 6. DISCUSSION ON THE PROGRESS RNPORT OF THE WORLD HEALTH ORGANIZATION FOR 1980 AND TIIE REPORT OF T}IE EXPERT ADVISORY COMMITTEE 7. SOCIOECONOMIC DEVELOPMENT 8. PI,AN OF ACTION AND BUDGET OF THE PROGRAMME FOR 1981 9. FINANCING OF TI{E ONCHOCERCIASIS CONTROL PROGRAI"IME 10. INTERII4 REPORT OF TTIE INDEPENDENT COWISSION ON T}M LONG-TERM PROSPECTS OF T}M PROGRAMME 11. INTERIM REPORT ON TI{E FEASIBILITY STUDY OF AN ONCHOCERCIASIS CONTROL CAMPAIGN IN T1IE SENEGAL RIVER BASIN AREA 12, FIELD VISIT 13. OT}IER MATTERS 14. DATE AND PI-ACE OF SECOND SESSION OF JPC 15. CLOSURE OF T}IE SESSION ANNEX I - AGENDA ANNEX II - LIST OF PARTICIPANTS ANNEX I]I - ONCHOCERCIASIS FIJND, INCEPTION TO 30 SEPTEMBER 1980 ANNEX IV - MOTION OF APPRECIATION FOR THN WORK OF T}IE PROGRAMME DIRECTOR rPcf L Page 2 3 3 ) 5 6 10 L2 L4 15 18 20 20 2l 2l 22 23 31 32 a rPcfL Page 2 1. INTRODUCTION AND OPENING 0F THE SESSION: Agenda item I 1.1 The first session of the Joint Progranrne Conunittee (JPC) of the Onchocerciasis Control Progranrne in the Volta River Basin area (OCP) was held at Yamoussoukro, Ivory Coast, from 25 to 27 November 1980. The Joint Progranrre Comnittee succeeded the Joint Coordinating Cormnittee (JCC), which held six sessions from 1975 to 1979. The session was attended by the representatives of Belgium, Benin, Canada, France, Federal Republic of Germany, Ghana, Ivory Coast, Japan, Kuwait, Ma1i, Netherlands, Niger, Togo, United Kingdom of Great Britain and Northern Ireland, United States of America, Upper Vo1ta, the United Nations Development Progranrne (UNDP), the Food and Agriculture Organization of the United Nations (FAO), the World Bank (IBRD), and the World Health Organization (WHO). Observers from Guinea, Senegal, the Cormnission of the European Conrnunities (CEC), the Organisation de Coordination et de CooP6ration Pour la Lutte contre les Grandes End6mies (OCCGE) and the Office de 1a Recherche scientifique et technique Outre-Mer (ORSTOM) \^7ere present. The session was also attended by the Chairman of the Expert Advisory Conrnittee (EAC) and the Chairman of the Independent Commission on the Long-term Prospects of the Progranrne. A list of participants is included as Annex II. L.2 In the absence of H.E. Dr Mockey, Interim Chairman appointed by the JCC, the session was opened by H.E. President Auguste Denise, Minister of State of Ivory Coast, who welcomed the Cosmittee on behalf of the Head of State, President Houphou'dt-Boigny, the Government and people of Ivory Coast. He noted that on the previous day rhe participants had been able to observe some of the Prograrrne's work in Ivory Coast and see for themselves the disastrous effects of onchocerciasis on the rural population. He expressed appreciation of the work of the Progranrne: as a result of the perseverance and determination of its staff, benefits were already becoming aPparent in the north of his country, where economic developmentprojects were getting under way and encouraging people to return to the fertile va1leys. As the President of Ivory Coast had told the JCC at its first session in Abidjan five years earlier, the ultimate purpose of the Prograrmne was to create the conditions for the economic advancement of the regi-on so that the people of rural Africa could lead a fuller and moreproductive life. 1.3 The Progranune Director, Mr Marc Ls. Bazin, also welcomed the participants on behalf of the Director-General and the WHO Regional Director for Africa. Reviewing the progress made since the Operational Agreement was signed by the seven Participating States in 1973, he stated that the Prograrmne's objective of reducing onchocerciasis transmission to a 1evel where the disease no longer constituted a major public health problem or an obstacle to economic development had practically been achieved. The vector was under control in 80% of the initial Prograunne area. The remaining 20% consisted of pockets of reinvasion, which were gradually being reduced. Onchocerciasis prevalence had fallen by IO-20% in all the villages situated in areas where transmission has been interrupted. The disease had become rare in children under 10 years of age, and new cases of blindness caused by it were almos t zero. Translated into economic terms, the excellent results of vector control meant that 276 OOO l<rn2 of land would be available for development, That would ease population pressure in other areas andincrease food production as a result of the considerable investment by the seven participating Governments. L-4 A number of countries and international agencies had ensured a reliable and adequate supply of funds, but that \^7as not the only reason for the Progranrne's success: other factors I^/ere the pioneering spirit and dedication of the technical experts associated with the Progranune, the spirit of genuine international cooperation within the JpC and among theAfrican countries concerned, and the unfailing helpfulness of the host country of Upper Vo1ta. 1.5 Consideration of the future of oCP had begun in 1978 with the technical and economic evaluation of the first four years of the Prograrmne and with the subsequent setting-up of the Commission on its long-term prospects. It seemed likely that after 1985 the predominantfeatures of the Prograrmne would be extensions southward and westward, the progressive responsibility for the Prograrmne by the Participating States themselves, intensified economic development activities, and the integration of health activities as a whole into the development activities . I t 33 4 rPcf L Page 3 2. ELECTION OF OFFICERS: Agenda item 2 2.L H.E. President Auguste Denise, Minister of State of Ivory Coast, was elecied Chairman of the session by acclamation. Mr D. Lindores of Canada was elected Vice-Chairman. 2.2 The Chairman pointed out that, with the launching of the second phase in 198O, a large part of the area covered by the Progranrne was entering an era of consolidation when Participating States could begin to assume greater responsibilities. Reinvasion had been a problem, particularly in the west, but its impact had been reduced so that the annual f1y density and transmission rates in the greater part of the Prografltrne area were now 1ow enough to justify resettlement. Accordingly, while the Progranrme continued its onchocerciasis control operati-ons to maintain and improve on this encouraging situation, it was henceforth up to the Participating States to reap the benefit of what was being achieved and develop economic activities. Indeed, the determination they showed in promoting the constructive use of the onchocerciasi-s-controlled areas would greatly influence the donor countries in deciding whether to finance the southward extension of the present Progranrne and the proposed new Progranune in the Senegal River Basin. The progress attained each year in developing the area should be reflected in the reports prepared by each of the Participating Countries for the JPC. However, it was important to ensure that resettled populations were provided with the necessary health facilities in accordance with the global objective of health for all by the year 2OOO. ADOPTION OF TIIE AGENDA: Agenda item 3 1 The provisional agenda was adopted (see Annex I) PROGRESS REP0RT OF THE WORLD I{EALTH ORGA.NIZATION FOR 1980: Agenda item 4 4.1 I^IHO's progress report for 1980 (document JPCI.2) was presented by the PrograrEne Director 4.2 198O had seen several structural changes, in particular the establishment of the Expert Advisory Conmittee (EAC) and the Ecological Group, both of which had held their first meetings during the year. Ttre EAC was described by the Director-General as an assembly of wise men whose role would be to advise both the Progranrne Director and the JPC on the major technical and political developments the OCP would have to face in the years to come. The Ecological Group on the other hand would observe the impact on the environment of the insecticides used by the Progranrne. 4.3 Epidemiological surveillance enabled the globa1 effect of six years' vector cont.rol to be evaluated. To date a total of about 132 5OO persons in 450 villages had been covered and results continued to confirm that the level of vector control attained was effectively interrupting onchocerciasis transmission. In 198O some villages had been surveyed for the second and some for the third time. In eastern Upper Vo1ta, northern Togo and Niger, the disease had regressed by 2O% when compared with the initial surveys. In western Upper Volta incidence was zero in all age groups and all who were negative in 1978 remained negative. On the border between Upper Volta and Ivory Coast no child under four years oId was infected. 4.4 As far as medical research was concerned, in the chemotherapy trial in the area in 1979, suramin had proved totally effective in a consi-derably reduced dosage of 60 ^g/Xg. Also,examination of excised nodules at Gaoua, Upper Vo1ta, by a team from the Bernhard-Nocht Institute, Hamburg, had shown that 38% of the female worms were already dead. Such a change in the parasite population where vector control was effective could lead to an earlier disappearance of onchocerciasis infection that originally anticipated when the Prografitrne v/as launched. 4.5 Resistance to Abate (or temephos) first app eared in the S. damnosum c omplex in March on the lower reaches of the Bandama, downstream from Lake Kossou, then on the middle !1arahou6 and the Kan. This resistance \^ras found to be restricted to a forest species cf the complex S. sanctipauli The increase in tolerance rates observed ranged from between 2.4 to 38.7 rPcf t page 4 times' various possible reasons for this increase in tolerance r47ere being considered:for example, defective treatment, underdosage, modification of the insecticide formulation, cross-resistance with agricultural pesticides used in the area or even physiological stress resulting from water 1eve1 fluctuations caused by interrupted turbine operation. Whateverthe cause the phenomenon had been detected quickly and a replacement larvicide, chlorphoxim,had been applied with success. 4.6 Top priority would continue to be given to research on and evaluation of new insecticideformulations, and in this respect oCP had worked out a detailed t\ro-year plan in consultation with the Division of Vector Biolory and control at wHo headquarters. The plan involved tests on over 20 formulations and a series of visits to four major insecticide manufacturers.Consequently, t\,7o comPanies, Sandoz and Abbott, had already speeded up their research onBacillus thuringiensis serotype H.14. OCP had conducted a field trial with this new product, and shovm that in the rainy season it was successful in destroying the vector over a distance of 20 lqn downstream from the point of application. A second Abate formulation produced by American Cyanamid had also been tested and results confirmed its effect to be similar to that of the Procida formulation and suitable for the control operations. 4.7 The reinvasion studies had continued in 1980 and confirmed that the extension of spraying operations in Ivory Coast in 1979 had almost brought to an end the reinvasion of the Phase I area. Research had established that, where reinvasion persisted in Mali (phase IIIWest), the zone of dangerous transmj.ssion diminished significantly at distances exceeding I lsn from the river. The studies in Togo and Benin had resulted in better knowledge of theinfluence of meteorological factors on f1y movement. on the other hand, the six weeks of trial treatments of suspected source rivers had shown only partial success in reducing the reinvasion in northern Togo and northern Benin, and the trial would have to be repeated in 1981 on a larger scale. 4.8 Studies on the southward extension of the oCP zone had continued during the year and the final report would be presented to the JPC in 1981. The feasibility study on an onchocerciasis control progranrne in the Senegal River Basin was the object of a special interim report to the present meeting (document JPC1.7). 4.9 Research into the socioeconomic aspects of the Progrannne had received increased attention in 198O. A study on the association between onchocerciasis and farming techniques was beginning to show that the most serious form of the disease was associated with extensive farming, whereas intensive farming reduced the man-vector contact. Iour other studies on economic aspects had been undertaken: (a) on the material resources available to settlers in the zones covered by the Volta Valleys Development Authority (AVV); (b) on the economic role and social situation of blind people; (c) on health problems and policies in the Participating countries of OCP; and (d) on the effect of onchocerciasis on the productivity of the work force. Ttre first two studies had been completed and that on health policies had been the subject of a seminar at the University of Clermont-Ferrand, France, attended by 12 senior civil servants from the participating countries of OCP. So far 24 applications had been received for long-term fellowships in health economics. 4.10 At the meeting of National Onchocerciasis CormrLittees (NOCs) held in Ouagadougou in June 198O the Prograrmne had presented a document outlining the types of support, financial, technical and human, that OCP could provide for the countries' overall health efforts in the onchocerciasis zone. 4.Ll i,Iith regard to aquatic monitoring, OCP was continuing to cooperate closely with ORSTOM(Bouak6), the Institute of Aquatic Biolory (Achimota) and Salford University. The national monitoring teams due to take over \rere being formed and by mid-1981 they would be operating in Benin and Togo. Those in Ghana and Upper Volta were already operational and in Ivory Coast nationals were taking over the monitoring at seven sites. 4.L2 The Prograrmne had been honoured during the year by a two-day visit from the President of the Republic of Upper Vo1ta, during which he had been shown all aspects of the Programme's oPerations . 55 t 9 rPcf t Page 5 4.13 The Progranrne's total expenditure for l98O \^7as expected to amount to about $ 16 408 50O, approximately 6% above the estimate of $ 15 432 5OO. The additional expenditure was accounted for mainly by increases in fuel prices, increased aerial operati-ons and lower actual exchange rates than budgeted for. REPORT OF THE EXPERT ADVISORY COMMITTEE: Agenda item 5 .1 The Chairman of the Expert Advisory Comnittee (EAC), Professor M. G. Camus, introduced .he report of the Conmittee's first meeting (document JPC1.3), held in Geneva from t to 12 September 198o. 5.2 The bulk of the Cormnittee's report was devoted to a review of OCP activities. It noted the considerable progress made in investigating the phenomenon of reinvasion, which was bound to influence policy in relation to extension of the OCP operational area. Ihe knowledge acquired so far had enabled the Vector Control Unit to organize the surveillance and control acEivities in such a way as to minimize the effect of the reinvasion. 5.3 The EAC had set up a working group to consider in depth the recently detected resistance to Abate. For some years STAC had anticipated the appearance of resistance, first in the Phase 1 operational area where the blackfly population had been exposed to Abate for six years. Instead, it had appeared on the southern fringe of the Phase IV area in a forest sPec ies, S. sanctipauli. The EAC had stressed that there was sti1l no evidence of resistance in the two principal savanna vectors, S. damnosum and S. sirbanum Nevertheless, it was essential to provide OCP with the resources to carry out a research prograflme with two major objectives: (a) to monitor the possible developme nt of resistance in the S. damnosum c omplex throughout the operational area, and (b) to speed up the test prograrmne for ecologically acceptable alternative control agents, including B. thuringiensis H.14. 5.4 The EAC had been unable to review the economic development aspects in detail due to limited information. However, it had suggested that it might be helpful if some of its members could attend the annual meeting of the NOCs. 5.5 The Ecological Group had met on 8 and 9 September 1980. It had noted the considerable progress made in analy2ing the aquatic moni-toring data, which had shovm Abate to have only a marginal effect on non-target organisms. It seemed unlikely that the concentrations of Abate in fish could reach levels dangerous to human consumers. The Ecological Group had also stressed the importance of the appointment of the OCP hydrobiologist and had urged closer coordination of aquatic monitoring activities between Ghana and Ivory Coast in association with the University of Salford. 5.6 The EAC had also considered the interim report of the Independent Conrnission on the Long-term Prospects of the Onchocerciasis Control Prograrmne, presented by the Cormnission's Chairman, Dr C. E. Gordon Smith. The clear and conci-se report brought out a number of important factors, such as the enormous differences between one Participating Country and another and the need for their long-term commitment to technical and financial support. The EAC had reconrnended that in the final report, to be presented in 1981, the Independent Conrnission should pay greater attention to the question of alternative control technologies, to the control of other vector-borne diseases within the OCP area, to the extension of the OCP area, and to the broad financial implications under those headings. 5.7 The EAC had been unable to consider the interim report on the Feasibility Study of an Onchocerciasis Control Campaign in the Senegal River Basin area, since the report had not been finalized until the end of October. It was hoped that the final report would become available before the EAC's next meeting in 1981. rPcft page 6 6 DISCUSSION ON THE PROGRESS REPORT OF THE WORLD HEALTI] ORGAN]ZATION FOR 1980 AND THE REPORT OF THE EXPERT ADV]SORY COMMITTEE 6.1 The appearance of resistance to temephos in a species of the S. damnosum complex, the role of chlorphoxim in controlling that species and the need to irrf"r=Jfy the search for alternative insecticides were cormnented on at length. Further clarification was requested on the possible causes of resistance, the likelihood of it spreading and the risk of sub- 1etha1 doses reaching other species dovrnstream from the control area. More details were sought on the use of chlorphoxim, its overall effectiveness against the target organism,its effect on the environment generally and whether it had been approved by the Ecological Group and, finally, if its use may be considered time limited. Satisfaction was expressedgenerally at the Progress made in the development and testing of Bacillus thuringiensis H.14 and details were requested of its cost, availability and methods of treatment. A rePresentative asked what advantages accrued through obtaining Abate from a second source, American Cyanamid. The Conmittee, noting the intention to associate the Ecological Group with drawing uP Protocols for testing insecticides, emphasized that the Group should be closely involved in all matters related to insecticides, whether already in use or to beintroduced in the Progranrne. 6.2 oCP explained that several causes could be cited to explain the appearance of resistance 1n sanct auli for example, prolonged exposure to sub-1etha1 dosages downstream from the control oPerations, the relative isolation of the populations, the large-scale use of agricultural insecticides, etc. To meet the first difficulty, it intended in future totreat rivers along their whole length with Abate and not merely the upper or middle reaches Resistance for the moment is limited to the Bandama basin in the south of Ivory Coast. Chlorphoxim has been shown to be very effective against all the species of the S. damnosum complex at half the Abate dose, but its use will be limited to stretches of river where resj.stance to temephos has been confirmed, because it is considerably more toxic for other aquatic invertebrates than Abate. The Progranrne is fu1ly a\47are of this characteristic andis ensuring the aquatic monitoring of the rivers treated with chlorphoxim in consultation \"/iththe Ecological Group. It is the intention of OCP to try to reintroduce Abate in those areas previously treated with chlorphoxim. 6-3 In the resistance studies, in the related susceptibility tests in different parts of the Progranrne area and in the screening of new insecticides and formulations close collaborationhas continued with the OCCGE lnstitute of Onchocerciasis Research (IRO) in Bouak6. 6.4 Regarding the second equally efficient formulation of Abate now available, the Progranune explained that having an alternative supplier provided added security to the operations and a basis for price negotiation. 6.5 A member of EAC described the frui.tful cooperation between the htlo Special prograrmnefor Research and Training in Tropical Diseases (TDR) and OCp in field trials ofBacillus thuringiensis. Originally developed for agricultural pest control and widelytested in that field, it had so far proved to be relatively specific against the target pest and environmentally very safe. rt was likely to be inexpensive to produce, and developing countries in Africa might eventually make their own strains as attcottage industry", asChina had done. The serotype H.14 was specifically effective against the larvae of diptera, which meant that it could also be used to combat malaria and arbovirus vectors, rn view ofthe promise shown in its recent application in insect vector control, TDR's Scientific andTechnical Advisory committee had decided to provide more funds to promote further research. TDR was involved in the development of 23 compounds, including entomopathogens, some of which might prove useful in vector control. oCP reported thar, following early research on the use of serotyPe H.14 against Simulium by IRo, the first large-sca1e Erials were carried outby the Progrannne in october 198o. Preliminary results indicated total efficacy ofB. thuringiensis H.14 over a 2O km stretch of river in the Ivory Coast using a formula containing only 1% of the active substance. Other non-target fauna of the river were un4ffected. The product \47as not yet operational, because until new formulations with greater coilcentrations of the active ingredient and more readily visible with water were developed, the quantities required precluded aerial application in the OCP area I JPC/ L page 7 B. thuringiensis was certainly of particular interest as an alternative cornpound to Abate and chlorphoxim, and offered a further possible means of solving the problem of Abate resistance. 6.6 WHO explained that standards governing the physiochemical or biological properties and t oxic i ty of B. thuringiensis were currently being determined, and there would be a meeting on that subject in Geneva in March 1981 following collaborative tests in different parts of the wor1d. 6.7 While acknowledging the evident success of the Progranrne in controlling the vector' there was fresh apprehension at the continuing appearance of flies in some parts of the area, especially in Ma1i, northern Togo and northern Benin. The increased number of flies at Madina Diassa in Mali in 1980 as compared with 1979 caused some anxiety and it was felt that, should this continue, the Progranrne's achievements might be jeopardized. The Conrnittee urged that greater attention be given to the matter, especially in the western and in the eastern zones of the area. Representatives expressed the view that if extension of activities into the Senegal River Basin area and also into southern Ghana, Togo and Benin \rere approved and implemented, the problem would be greatly alleviated. Clarification was requested on the measures taken in reinvaded areas to minimize the effect of the seasonal influx of flies and to prevent them from becoming established. 6.8 Replying first on the situation in Mali, OCP said that although the level of invasion had resulted in 1980 in densities at one site five times greater than in L979, probably caused by more favourable climatic and hydrological conditions, that had not made any real difference to the transmi-ssion rate. It had, however, afforded an opportunity for research to be carried out into the epidemiological impact of the reinvading flies along the ri-ver banks. Their activity appeared to be restricted in that biting and onchocerciasis transmission rates fell dramatically in the first few hundred metres from the ri-ver and were as 1ow as LO% at distances over I krn. Ihat finding, though not providing all the answers to the invasion problem, was valuable for planning resettlement. Investigations in Togo had shovm that invasion there was caused by three species, the two savanna species together with Simulium squamosum, normal Iy associated with mountainous areas, and which it had been thought \,ras penetrating the control area up to no more than 1OO krn. Experimental insecticide treatment for six weeks of a band 100 km wide south of the control area had failed to reduce f1y densities along the M6 valley and Kara River as much as had been hoped. The report, due in December from the reinvasion study team, would determine the programrne to be followed in 1981, when a larger area would need to be treated experimentally. To meet the threat of reinvasion each year required a doubling of the Progranrne's vigilance and increasing effort to the extent necessary to find a solution. 6.9 Noting the benefits accruing to the countries by as much as 80% of the area the established criteria for Annual Transmission Potential (ATP) and Annual Biting Rate (ABR) were being met - and as a result, increasing numbers of children remained free of onchocerciasis, the disease was regressing and eye involvement stabilizing - a representative requested that in future more details of the actual numbers of individuals thus affected by the Progranrne be indicated. 6.10 A representative asked whether the encouraging statements in the Progress Report of WHO and in the EAC report about drug development research and, in particular, the efficacy of the low dosage chemotherapeutic trial with suramin meant that this drug could be considered for mass administration in OCP. 6.11 In response, OCP confirmed that diethylcarbamazine and suramin \rere still the only two drugs available. These drugs were not safe for widespread use. While it was now evident that Iow dose treatment schedules involving half the normal 1OO to LzO ng/kg dose of suramin did not interfere with the drug's efficacy, it was not certain that reducing the dose made it safer. It was pointed out that while drug treatment might come to have a more important place in the Progranune's stratery in the longer tem, a team assigned to trer-ting patients with suramin, if its use could ever be approved, would not be able to treat more than ]OOOpatients per year. rPcf t page 8 6'LZ EAC suggested that there were two separate areas of responsibility; oCp should supptyinformation and advice on treatment and, if possible, lay dor,m criteria; the participatingCountries should train personnel and use the infrastructure of their major Endemic DiseasesServices to put treatment measures into effect. He emphasized that the therapeutic aspect must not be lost sight of simply because the means for vector control involved the lesser risk' There might be room for a more active treatment prograilme using suramin on specific cases, especially those at risk of going blind. 6.13 oCP pointed out that suramin was suspected of being toxic to the optic nerve and several cases had been reported where blindness had occurred after treatment with suramin. The Progrannne ophthalmologists had found recently that the interruption of transmission led to the stabilization of ocular lesions. Accordingly, the condition of those already infected whenthe Progranrne's operations sEarted had not worsened, and almost none had become blind. The risk group - those needing treatment - was, therefore, practically non-existent. 6-14 A representative, referring to the Progress Report, felt that the results on drug research attributed to WHO/TDR might be a 1itt1e oprimistic. EAC supported this, saying that it was one thing for the pharmaceutical industry to develop an active substance against tropical diseases and quite another to determine its specific action. Companies which depended on profits were not prepared to finance up to five years' research when they knew that interested countries could not afford the final product. Accordingly, WHO/fOn naa taken over resPonsibility for the testing of prornising drugs. OCp would field-test thosedrugs cleared by TDR. However, with an aging parasite load in the population as a result of effective vector control, the OCP area was quickly becoming an atypical region for trials of drugs. 6.15 It was noted that research on other drugs for treatment of onchocerciasis was not at an advanced stage. Certain products were being screened in cattle in Australia suffering from a form of the disease which produced similar symptoms to those of human onchocerciasis. Carefully controlled human trials were carried out subsequently at the Chemotherapeutic Research Centre in Tamale, Ghana. 6.L6 During the field visit, one representative had observed the difference in duration of simple and detailed evaluations in a village like Krokokro, which had a population of 25O, and felt that greater use might be made of the teams doing the simple examinations. For example, they might be used to carry out the fu1ler clinical investigations that were sometimes necessary, or to collect information about other diseases. OCP explained that the teams were not under-utilized and, while the ophthalmological teams r^7ere examining a vi11age, the teams doing the simple evaluation would be collecting data from neighbouring vi11ages. These teams had also, on occasion, extended their surveys to obtai.n relevant data on the incidence of other di-seases in the area. 6.17 The Progranrne Director reported that at the last joint meeting of National Onchocerciasis Conrnittees (NOCs) in Ouagadougou, the matter of coordinated national activities against different diseases had been discussed. The Progranrne had no intention of interfering with national activities or extending its function without specific invitation from countries concerned. It \,ras up to the governments to decide on priorities for their national services, with which OCP could then cooperate as required within the limits of its mandate and the expertise available. 6.18 Representatives of the Participating Goverrunents stressed the desirability of closer liaison betvreen the Progranune and the national health services where the logistical potential of OCP could be used in the screening of other diseases to complement national acti,on. When some specific activities were identified, an approach would be made to OCP for cooperation, and it was hoped this would have the approval of the JPC. Other representatives, stressing the primary health care approach and especially the use of village health workers, encouraged early association of the OCP activities with the national health authorities, so that when the attack phase gave way to consolidation, the national servi-ces might be prepared to take over parts of the operations and combine them with the fight against other diseases. It was requested that progress towards defining a role for village health workers in maintaining onchocerciasis control be described in the Progress Report to the second session of the JPC. rPcfL Page 9 6.L9 The Progranrne Director recalled that at the meeting of NOCs it had been implied that specific disease problems in the area covered by OCP were not insurmountable. There were general problems requiring general solutions and calling for coordinated efforts. OCP might, on request, assist the Participating Countries to draw up a list of regional health problems and prepare plans for their solution by integrated health services. 6.2O Tribute was paid to the important part played by OCCGE, ORSTOM and other collaborating institutions in the work of OCP. It vras recognized that the facilities already existing for epidemiological and entornological surveillance within IRO - and for hydrobiological monitoring in certain national units - saved OCP time, effort and expense, and should be reinforced in preference to the establishment of new structures. 6.21 A representative noted that in 1980 the Annual Biting Rate (ABR) and Annual Transmission Potential (ATP) in northern Togo and northern Benin remained at the same high 1evel recorded in 1979, which indicated that resettlement of people in the area would have to be delayed. This would obviously adversely influence the implementation of plans for the socioeconomic development of that area, and he was accordingly inclined to favour the extension of the Prograrmne southward. However, recognizing that considerable hydrological and hydrobiological PreParations were sti1l required before control couLd be started, he asked whether OCP was prepared to help those countries with equipment, vehicles and associated costs to enable this work to be done. 6.22 The Programe Director explained that OCP was willing to enter into contractual agreements with hydrobiological units already operational in the area, in the same way as had been done in Ghana. Under these agreements, the necessary vehicles and equipment would be provided, together with appropriate financial support, within the budgetary limitations of OCP, to enable the collection of aquaEic monitoring data. Agreement had, in fact, already been reached in principle on cooperation with the national hydrobiological units and OCP had trained a number of personnel. Regarding the hydrological network, a draft tripartlte agreement with Benin and ORSTOM was in preparation, which conrnitted each party to assume certain responsibilities . 6.23 In reply to a question about the composition of EAC and its role and wider terms of reference, it was stated that the Conrrittee included specialists from many fields, but that, if necessary, additional expertise would be ca1led upon. The extent to which Participating Countries wished to make use of the Conunittee, and the information and resources they made available to it, would largely determine the scope of its activities, but its terms of reference outlined specific relationships to the other Progranrne bodies, with which there would be close consultation. Several representatives stressed the importance of EAC as an independent review body, and expressed the hope that it would not only review the technical and socioeconomic aspects of OCP, but would consult with the NOCs on matters of joint interest. It was agreed that the national reports on economic development should be made available to the EAC. The JPC again emphasized the importance it attached to the coments of the EAC on the final reports of the Independent Conrnission on the long-term prospects of the OCP and of the Feasibility Study on the Senegal River Basin area. 6.24 The JPC also wished the independence of the Ecological Group of the EAC to be carefully guarded, and its role in monitoring the impact of insecticide use in the PrograrEne to be assured. 6.25 The fact that all contributions from Participating Countries for 1979 had been received was a source of general satisfaction, and the hope vTas expressed Ehat the same level of support would continue throughout the Prograrmne's second phase. OCP reported further that most of the Participating Countries had already paid their contributions for 1980, and one even for two years in advance. 6.26 Some representatives noted that the total expenditure in 1979 had been some $ 800 OOO higher than forecast, whereas costs in earlier years had tended to be some 10% lower than forecast. There was an increase of some 6% fotecast for 1980, and the question was asked as to whether this was part of a trend. OCP replied that the administration had reduced rPcf t Page 10 the estimates for the 1979 and 1980 budgets after their approval. Experience had shor,m that to be an over-optimistic move, In late 1978, it was decided to carry out the extension studies in L979 without any extra provision for cost. A new feature was that income from sources other than the onchocerciasis Fund, namely contributions from Participating Countries and Miscellaneous Income, was now shown separately. Such income had previously been credited against expenditure, which had the effect of decreasing the total amount of expenditure shovm. 6.27 The OCP budget differed from those of United Nations agencies in two important ways. Firstly, OCP's operations were heavily dependent on natural phenomena: a long rainy season meant more spraying, vector resistance to insecticlde ca11ed for expenditure on alternative insecticides. The Progranrne had to go on, as interruption of vector control or monitoring would cause setbacks. Secondly, like many other United Nations agencies, OCP suffered from the disadvantages of a budget expressed in dollars, at an exchange rate prevailing at the time the budget is established. However, 60% of OCP's expenditure was in currencies other than the US dollar, and for the last two years, the exchange rate actually obtained had been unfavourable. Some benefit may be derived from the recent strengthening of the US dollar in terms of most of the other major currencies. 6.28 While the Prograrune had a policy of advance purchases of insecticides to forestall Price increases, the additional purchase of chlorphoxim to combat resistance by the vector had been an unforeseen expense in 1980. 6.29 Many sections of the budget were directly affected by prices of petroleum products. The Prograrmne had to fuel some 250 cars in the field, as well as the fixed-wing aircraft and helicopters for spraying. Fuel prices had increased by about 6O%. Airline fares had i-ncreased by about 4O%, affecting costs of duty travel. These increases, together with the $ :0O OOO due to fluctuations in the exchange rate, were largely responsible for the additional expenditure. Regarding the revised budget for 1980, as presented in document OCP/79.1, the Cormnittee noted that it will be exceeded by about $ 98O OOO. 7. SOCIOECON0MIC DEVELOPMENT: Agenda item 6 7.L lhe representative of Benin introduced his Government's report (document JPC1.4, Part 1), which outlined the national development p1an. Priority was given to agriculture as the basis for development, and industrialization was being planned on the basis of agricultural production. The document gave a complete list of economic development projects in progress in 1980 and planned projects for the country as a whole, but only the projects in the far north were in the Onchocerciasis Control Prograunne area. Even those areas \^7ere not yet entirely controlled. The disease remained endemic throughout almost the whole country, and it was therefore essential for socioeconomic development that the Programme area be extended further to the south. 7.2 The representative of Ghana, introducing his Government's report (document JPC1.4, Part 2), drew attention to the planning methodologr agreed between Ghana, UNDP, FAO and IBRD Ln 1974, which amounted to a three-pronged approach to the socioeconomic development of the onchocerciasis-freed areas: the Landsat project, funded by USAID, which used satetlite images to identify 1and, water and mineral resources with development potential, the agricultural survey and planning project for integrated rural development in the Northern Region, financed by CIDA, and the UNDP/FAO project for the integrated rural development planning in onchocerciasis-controlled areas of northern Ghana. The first two projects were making Progress, but the UNDP/FAO project had run into serious difficulties and its funds had al-most been used up without any worthwhile results having been achieved. 7.3 The representative of Ivory Coast, introducing his Government's report (document JPC1.4, Part 3), referred to the projects for the cultivation of sugar, rice, soya, fruit, cassava, cotton, and market garden crops being developed in the northern and central parts of the country ft was particularly important to develop stock-raising in the savanna regions, because Ivory Coast had a serious problem of animal protein supply; many large-sca1e projects were in Progress, but efforts v/ere hampered by the presence of the tsetse f1y. There were extensive plans to develop inland fishery was being greatly strengthened, supplies. rPcf L page 11 resources. ltre health structure in the OCP operational area and a major effort was under way to improve rural water of 7.4 Ttre representatives of MaIi, introducing their Government's report (document JPC1.4, Part 4), explained that a specific planning unit for onchocerciasis-control-1ed areas had been set up for two reasons: firstly because the onchocerciasis zone was virtually identical to that part of Mali where all the rdatercourses and most of the mineral resources r^/ere located; and secondly because the Government Tras endeavouring Eo PerPetuate onchocerciasis control by selecting development projects that would generate national resources for such control. In developing econornic activities, it was important to bear in mind the social and economic rehabilitation of onchocerciasis victims, including blind people. It was stressed that the fundamental objective riras to increase the production of crops and livestock. In addition to the activities listed in the report, attention was drawn to a number of projects that urgently needed funding. 7.5 The representatives of Niger introduced their Government's report (document JPC1.4, Part 5) and pointed out that onchocerciasis was endemic in their country only in the Say arrondissement which was, of course, covered by the Progranrne. Since 1974, the Government had been endeavouring to set up structures for the development of that region, which had tremendous economic potential because of the fertile land available, good rainfal1, and considerable mining resources. A number of studies had been funded by LJNDP and USAID, and a number of specific projects had already been started up with bilateral cooperation. In general, lack of finance was stil1 the main obstacle to economic development. 7.6 The representative of Togo, i-ntroducing his Government's report (document JPC1.4, Part 6), joined with the representative of Benin in calling for extension of onchocerciasis control to the whole of his country. The cornerstone of socioeconomic development in Togo was the t'green revolutiont', which placed special emphasis on the production of crops and livestock. lhe objective of the development projects described in Ehe rePort was to reclaim abandoned lands near to the rivers. Cooperative farming was being introduced. 7.7 Ttre representative of Upper Vo1ta, introducing his Government's report (document JPCL.4, Part 7), noted that although the onchocerciasis zone covered 84% of the national territory, the development activities were concentrating on the most fertile lands, namely, the valleys of the Volta rivers and their tributaries. The Volta Valley Development Authority (AVV) was engaged in a wide variety of projects: building of roads and dams, reafforestation, \^rater supply, and agricultural projects. It had resettled over 2OOO families on sma11 farms of their own, and was paying considerable attention to the training and education of the rural cormrunities. Primary health posts and health and social welfare centres had been set up, and the villagers were encouraged to take part in running the health and educational services. 7.8 In the discussion that fol1owed, representatives congratulated the Participating States on the presentation of their reports on socioeconomic development. The reports were particularly useful and informative, because they had been prepared by the people actually affected. 7.9 Representatives of the Contributing Parties pointed out that future support for the Progranrne by their Governments was likely to depend on the results achieved, not only in terms of improved human health, but also in terms of economic development, increased food production, and work for people. The information contained in some of the reports on the numbers of new settlers, the areas of land being brought under cuLtivation, and the types of crops being grown would prove extremely useful in justifying the Progranrne to decision-making bodies in the donor countries. 7.IO It was suggested that future country reports should provide some indications of the health infrastructure being created in the onchocerciasis-controlled areas, cn the lines the section included in the report by Ivory Coast. Farmers would not be able to produce food efficiently if they r.Iere not in good health, so there was a need for health services would continue disease surveillance and control. that rPcf L Page L2 7 .ll one representative urged that the reports should provide an indication of the status ofprojects listed - study stage, implementation stage, etc. - so as to make it easier for the Conrnittee to fo11ow progress from year to year. 7 .12 The World Bank suggested that future reports might place the activities in the onchocerciasis-controlled areas within the context of each country's broader economic development strategies. 7.L3 Some representatives expressed misgivings about the reference in Mali's report to widespread enthusiasm for the use of solar enerry. Solar enerry facilities were very expensive to install and maintain and required high technolory. It seemed more advisable to concentrate on the generation of biogas from vegetable and animal trash. Biogas production \rras a far cheaper solution to the enerry problem, which could use locally available resources and technologies. Moreover, the by-products could be used as high protein animal feed or as fertilizers. A joint approach to the development of biogas by the OCP countries seemed advisable. FAO and the Governments of the Netherlands and Great Britain intended to do a great deal more to assist developing countries in harnessing and utilizing rural enerry. 7.14 T"he representative of the Conunission of the European Conrnunities stated that the EEC rdas interested in developing solar enerry and new forms of enerry in l^Iest Africa, and was closely associated with the feasibility study on the use of solar enerry in Bamako. 8. PIAI{ OF ACTION A-ND BUDGET OF THE PROGRA}O,IE FOR 1981: Agenda irem 7 8.1 Introducing the Plan of Action and Budget for 1981 (document JPC1.5), the Progrartrne Director informed the Cormnittee that the estimated 1981 expenditure of $ L6 L23 600 was based on actual average costs determined in May 1980, increased by 11.5% for professional and general service staff salaries and by 8% for all other items. Estimated average costs for 1981 included $ 62 5OO per professional post, $ 4800 per general service post, $ 461 per flying hour including fue1, $ 52OO per consultant month and $ 12 84O per road vehicle. Exchange rates adopted included 4.46 French francs and 223 CFA francs per US dollar. Ttrose tr"ro currencies accounted for 55% of the Prografitrne's expenditure. 8.2 As usual, the lion's share of the budget went !o vector control wi-th 67.3%. Logistic activities were allocated, L2.4%, research and environmental monitoring 10.5%, epidemiological evaluation and economic development 6.8%, and other activities 3.2%. Operating costs accounEed for $ 15 236 OOO, and capital expenditure for $ 887 600. 8.3 It I4Ias hoped that $ 15 733 600 could be financed from the Onchocerciasis Fund, $ 240 OOO by the Participating States, and the remainder from Miscellaneous Income. 8.4 The budget included an amount of $ 437 2OO to finance the continuation and cornpletion of the extension studies. 8.5 A representative asked why the plan of action provided for a 6% reduction in helicopter hours and a 22% reduction in fixed-wing flying time, but there was no corresponding reduction in the insecticide requirements. Moreover, after several years of vector control, he felt greater reductions should have been possible, He asked for details of the success of OCP's experiment in discontinuing the treatment of some areas where vector control had been practised for some years, and what future cost reductions might be expected as a result. He was informed that the interruption of treatments produced very 1ittle saving of insecticide, because it was done in the dry season when the dosages applied were 1ow. The reduction in flying hours was not more substantial because the aircraft would stil1 have to overfly the untreated rivers to reach other rivers stiI1 being treated. It had been decided to discontinue treatments on certain rivers until the biting rate rose above 1O per *^nfduy o, nulliparous females were detected. On this basis, it had proved necessary to resume treatments after periods varying frorn four to eight weeks. The origin of the flies stil1 present hras not known, but reinvasion seemed most unlikely; it was suspected that in the dry rPcf L Page 13 season, when watercourses often split into many small channels, a few flies managed to survive and breed. From these sites there was then a redistribution of adults to neighbouring sites, a natural phenomenon amongst insects. They did not constitute a danger in themselves, but unless detected and dealt with, they might repopulate breeding sites. The policy on interrupting treatments was being reviewed, and less stringent criteria might produce greater savings without endangering the success of the Prograrmne. OCP hoped to interrupt treatments again in 1981, if possible on a larger scale, but not of course in areas sti11 subject to reinvasion. 8.6 In reply to a further question, the Conrnittee vTas informed that the budget contained no specific provision for the proposed larviciding of the fu1I length of rivers where Abate resistance was thought likely to occur, as the decision had only recently been taken. Only tlso rivers in lvory Coast were concerned, and the additional cost might be offset against the savings on insecticide in other parts of the Prograrmne area. 8.7 In reply to another question, the Cornnittee was told that the location of the bases for aerial operations was stil1 under review in relation to providing the most efficient logistical and operational support. 8.8 With regard to prospects for reducing the entomological evaluation activities, OCP said that one of the first tasks of the recently recruited statistician would be to evaluate the data accumulated so far, so as to determine whether it would be possible to reduce the frequency or intensity of surveillance. 8.9 A representative asked what OCP could do to develop or test simple and inexpensive methods for identifying individuals with living adult worms. It was most important to identify and treat such people, as they formed the reservoir from which onchocerciasis would spread if S. damnosum should reinvade OCP replied that a major priority in 1981 would be to develop an inrnunological or serological method for the early diagnosis of onchocerciasis, so as to detect any failure of entomological control in good time. In a few years, it would be necessary to devise a quite different stratery covering extensive areas, so as to determine the proportion of the population sti1l harbouring the parasite. As yet, it was too early to include such a programme in the plan of action. 8.10 A representative who asked about data processing facilities was informed that all entomological and epidemiological data were processed at WHO headquarters in Geneva, where the Programe statistician was located, and the capabilities were entirely satisfactoly. There was no intention of transferring those operations elsewhere. The aquatic monitoring data were processed at Salford University because of their highly specialized nature; there too, all the necessary facilities were available. 8.11 Another point raised concerned the plans to develop a mathematical model of onchocerciasis transmission. OCP stated that a mathematician at Ttibingen University was working on the model under contract to WHO/TDR and was expected to report shortly on his initial efforts. 8.12 One representative cormnented Ehat the iour research contracts carried out in 1980 for the Economic Development Unit did not appear to be directly related to the three major thrusts for the Unit outlined in the plan of action. The Progranrne Director agreed that such activities ought to be in line with OCP's objectives. 8.13 A number of representatives asked questions about the training prograflnne. Replying, the Progranrne Director said $ ZOO 0OO had been allocated for fellowships, and at least half of another $ ZOO OOO earmarked for health economics research would also be spent on training. The real problem in regard to training v/as not shortage of funds, but shortage of candidates. However, there had recently been an improvement in the number of candidates for training, and he hoped that trend would continue. rPcft Page 14 8.14 The Progranrne Director informed another representative that a Large proportion of the training provided by OCP so far was for its own staff. Hovrever, training was always available for suitably qualified nationals of the Participating Countries. He expected the Independent Cormnission to suggest in its final report what types of training the Progranrne ought to provide in preparation for the day when the Participating Countries would take over. 8.15 A representative expressed concern that the 1981 budget was based on estimates of 1980 expenditure that r^rere at least six months o1d, and he felt the 8% increase for costs other than staff salaries might prove unrealistic in view of inflation. OCP pointed out that the hourly cost of aerial operations was fixed by contract, and the factor of 8% had been applied to less than half the total budget. There were some encouraging signs that inflation was being brought under control, and it was hoped that the 8% estimate would not prove too optimis tic . 8.16 Replying to another question, OCP confirmed that there were problems in recruiting suitable professional staff. Some of the posts required very specialized qualifications possessed by only a handful of people around the world, and such specialists r^rere often not available when needed or not prepared to move to West Africa. 8.L7 Some concern was voiced about the cost of vehicles. Their average cost seemed to be relatively high, yet they appeared to have a rather limited life expectancy of only five years. Moreover, it might soon be appropriate to reconsider the size of the fleet. OCP stated that the size and the cost of the vehicle fleet was continuously under review. Accordingly, a cheaper type of vehicle hTas currently being tested to determine its utility and maintenance costs. Progranure vehicles had to operate over extremely rough terrain, and I"rere normally replaced after 1OO 0OO lsn or three years. The figures before the Conrnittee concerning the total number of Progranrne vehicles were slightly inflated, as they covered all the vehicles on the Progranune's inventory, including some that were worn out and about to be sold. 9. FINANCING OF TI{E ONCHOCERCIASIS CONTROL PROGRAI'{ME: Agenda item 8 9.1 For the discussion of this item, the Conrnittee had before it a table surnmarizing the state of receipt of contributions to the Onchocerciasis Fund at the end of the third quarter of 198O, and including in the footnotes information on those received since then (Annex lII). 9.2 The representative of the Lr/or1d Bank confirmed that the Fund was in a healthy position for the second phase of the Progranrne. 9.3 The representatives of Contributing Parties pledged contributions in the following amounts in 1981, dependent in most cases on parliamentary approval: Canada, Can $ 9OO OOO(US$ 760 OOO), of the total Can$ 6million announced for the second phase of the Prograrmne; France, FF 5 million (US$ 1.2 million) of the total FF 30 miIIion, pledged for the second phase; Federal Republic of Germany, DM 4 million (US$ 2.3 million); Japan, the equivalent of US$ 1.8 million; Kuwait, US$ 1 million of the total US$ 6 million for the second phase; Netherlands, 6.5 million guilders (US$ 3.3 million); United Kingdom, E3OO OOO (US$ 7OO OOO); United States of America, US$ 2 mil1ion. 9.4 Belgium had not indicated the exact leve1 of its contribution, but expected to rnaintain at least the same Ievel as in the past. 9.5 The representative of the Federal Republic of Germany said that his Government would conmrit itself only to a tto-year period in the second phase, and that further comitment would depend on the findings in the report of the Independent Conrnission. 9.6 The representative of Japan said that his Government had the intention to continue to increase its contributions to the extent that the national budgetary situation allowed. rPcf t Page 15 9.7 Ihe representative of the Netherlands said that his Government would contribute a further 7 million guilders later in 1981, by r.irich time 74% of its total contribution to the second phase would have been paid. 9.8 The representative of the United States of America said that its continued support to the Prograrmne would be subject to annual availability of funds and to the policy of the administration of USAID under the new Government; a project paper was in preparation, covering the six-year period of the second phase, and it was hoped that it would be possible to increase contributions so as to offset inflation. 9.9 ILre representative of the World Bank said that Contributing Parties not represented at the meeting would contribute in 1981 as follows: African Development Bank, about US$ 400 OOO; Norway, abour US$ 5Oo oOo; oPEC Fund for International Development, US$ 500 ooo; A1 Sabah Foundation, US$ 20 OOO; Switzerland, US$ 1.8 rnillion (already received); UNDP, US$ 7Oo ooo; and the World Bank itself, US$ 2 mi11ion. 9.10 Saudi Arabia had pledged its continued interest in the Progranrme and undertaken to maintain contacts with a view to possible further contributions. 9.11 A balance of some US$ 10 million would be carried forward into 1981, as well as an additional contribution of US$ 1 million sti11 expected in respect of 1980. It would be recalled that it had been agreed at the last JCC meeting that the Reserve for the first phase would be carried over as the Reserve for the second phase. I,Iith the pledges now received, the total should be more than sufficient to cover the needs of OCP in 1981. 9.L2 It further appeared that, taking i.nto account the pledges of contributions so far announced for the second phase as a rihole, together with a reasonable estimate of contributions to be expected from other donors, the Fund would sti1l need another US$ 10-15 million to meet the overall costs of that phase. Contacts were being maintained with donors with a vi.ew to closing that gap. The Participating Countries had shown their commitment to the Progranrne by increasing their contributions, having completed their payments for the first phase, and the fact that donors were making advanced contributions boded well for the future of the Programme's finances. 10 INTERIM RNPORT OF THE INDEPENDENT COMMISSION ON TTIE LONG-TERM PROSPECTS OF THE PR0GRAI"II,IE: Agenda item 9 10.1 Ttre Chairman of the Conrnission said that since completion of the interim report(document JPCl.6) submitted to WHO at the end of July, further information of interest had come from OCP, from technical- meetings held under the auspices of the Conxnission, and through visits to Participating Countries. The views he expressed on developments since July, which was also the date of the Cormnission's last meeting, would be his own; those developments, and particularly the information on maintenance zones and insecticide resistance, togeEher with the findings of the Conunission's technical working groups since July 1980 and the resuLts of the current discussion in JPC, would be covered by the Conunission's final report, which will be completed at the end of July 1981. lO.2 lhe reconrnendations of the working group on vector control to the Conrnission, based on the stated objective of the Prograrmne, addressed two courses of action, according to whether new activities were to be undertaken in zones bordering on the Prograrmne area or not. 10.3 If they hlere not, the working group considered that by 1985, transmission would have been inLerrupEed in 80% of the area - that is, all except reinvaded zones - for periods of 10 years or less. Ttre prevalence of infection would continue to fall, with few or no new infections and progressive mortality of adult worms. It would not yet be safe to relax conErol measures; some reduction might be possible, though recent experiments with withdrawal of vector control had been disappointing. Vector surveillance would thus have to be continued. The working group had suggested that consideration be given to using automatic insecticide dispensers in remote areas, to increased ground control at accessible sites, rPcf L Page 16 and to river bed modification at sites otherwise difficult or expensive to control, especially near large population centres. However, as long as large areas had to be regularly treated, aerial spraying would remain the method of choice, and the alternatives seemed likely to be cost effective only at a limited number of sites. Major cost reductions could thus not be expected by 1985. 10.4 After 1985 - stil1 assuming no extensi-on of the Progranune - the working group foresaw a progressive change: in areas wirere prevalence fel1 to a 1evel (yet to be determined by the working group on monitoring and surveillance and validated in further research) at which it would be safe to a1low limited f1y breeding, insecticide treatment might be withdrawn, except at sites of persistent intense breeding, wtrich might be dealt with by one of the alternative methods enumerated. Surveillance of vector and human infection would continue throughout the area ln a way to be determined by the competent working group. Resurgences of transmission detected by the most rapid possible means would be dealt with, probably by aerial vector control. Aerial control would also continue in the reinvaded areas, where a ner47 stratery wouLd have to be evolved - starting in 1981-1985 - because in the absence of extension operations, thelr populations would be at permanent risk. Ihe Conunission r^/as considering recomnending for these relatively l-imited areas pilot studies of chemotherapy combined with intensive ground control - possibly together rnrith controlled resettlement in accordance with the reported confinement of risk to narrov/ belts along rivers. Costs were expected to fal1 after 1985 as aerial control measures were restricted. 10.5 If the Prograrmne \4lere extended westwards in 1981-1985, the current activities in the western zone of reinvasion would be displaced, making the whole OCP area, except perhaps its eastern limits, susceptible to the stratery outlined for the first hypothesis. Costs would fall accordingly, offset for sorne years by the demands of extension. The working group on vector control saw advantages in extension, which woul-d retain the services of experienced Progranrne staff, the established mechanisms for coordination, and means for emergency aerial control operations. 10.6 To the east, reinvasion seemed to be less of a problem, unless assessment of the Simulium migration from Nigeria proved it to be substantial. However, until the disease could be eradicated from Africa - unlikely to be feasible in the foreseeable future - any freed area might be reinfected by movement of human or blackfly populations. Therefore the capabilities of Participating Countries for surveillance and the control of outbreaks must be developed. 10.7 Ttre working group had also considered what should be done if the Prograrmne were prematurely terminated as a result of political or other crisi-s in the area. It would reconrnend concentrating on long-term ground control and chemotherapy in priority areas. Even that would require reinforcement of national- scientific capabilities and the operative and supervising structures with, in many cases, financial support. Reinforcement \^ras, in any case, desirable in the interests of each country's self-reliance in disease surveillance and control surveillance and the integrated development of preventive and cormnunity medicine 1O.8 The Chairman drew the attention of the JPC to the absence of references in these recomendations of the working grouP on vector control to barrier zones and cordons sanitaires on which views had changed since preparation of the interim report in July 1980 10.9 Detailed costing of various strategies was not yet feasible beyond tdrat had already been intimated; a meeting on costing was Planned early in 1981. 10.10 The one factor which clearly would alter OCP stratery radically would be the availability for whole populations of a safe drug to kill the adult worm, and the highest priority should go to its discovery. Pharmaceutical companies needed special incentives to conrnit the necessary funds, even for development of a drug showing great potential, when only sma11 profits could be expected. Sponsors and donors might consider bearing the develoPment costs and costs of clinical testing for safety and efficacy. rPcfL Page 17 10.11 On the low-dose suramin treatment, the Chairman of the Independent Corrnission supported the view that it was very important to distinguish between its use for treatment of sick individuals and mass administration for interruption of transmission. 10.12 The Conunission's working group on vector control had considered involvement of OCP in control of vectors of other diseases, which it recormnended should be limited to aerial spraying to control outbreaks of human ye1low fever and trypanosomiasis, for example. Additional activities would mean higher costs. Development of capabilities for general disease control and surveillance called for the cooperation of many other bodies and progranmes. Training of national teams, transfer of technolory and consultative assistance were worthwhile means to that end. 10.13 Turning to the organLzation of future activities, the Chairman of the Independent Conrnission said that recent discussions with Participating Countries had centred on four options: (f) irmnediate termination; (2) maintenance of OCP in its present form until at least 1995; (3) progressive devolution of responsibilities for onchocerciasis control to national governments; and (4) gradual evolution to a regional prograrmne governed, staffed and frrnded jointly by the Participating Countries. they had focused on (3) and (4), with the emphasis differing, according to the particular features of the country's participation. A11 had seen the need for sorne combination of these options (a11 four would be set out in detail in the Cormnission's final report), each requiring some regional element, and the development of strong national capabilities to implement and rnonitor the control of onchocerciasis, together with other endemic diseases seriously hindering development. The ability to produce a viable, if sma11, national cadre of experts and effective infrastructure for peripheral control and surveillance operaLions would be critical. 10.14 In arguing the opEions, the Cormnission would weigh the achievements and expenditure thus far, the wishes of Participating Countries, current and foreseeable economic effects, and - most important - confidence that OCP's benefits could be maintained after transfer of responsibilities. 10.15 Reactions to the proposals in the interim report for progressive devolution of control and surveillance were positivel subject to OCP's cooperation in the transfer and to financial assistance with supplies of certain materials, Participating Countries expected to be able to assume responsibility for epidemiological surveillance in certain villages within the next few years, which could be important as a means of technolory transfer and equipping of national teams for a wider role in disease surveillance and progranrne evaluation generally. Current vector control and surveillance operations were considered beyond national competence and better operated centrally, but participation in pilot trials of vector surveillance and some ground control measures was seen as an opportunity to prepare for the organization of withdrawal of the regular vector control activities. The Goverrunent of Mali had suggested more extensive trials of ground control methods in the reinvasion zone. 10.16 In conclusion, the Chairman of the Conrnission said that the Wt{O Regional Director for Africa and his staff had appeared satisfied with the findings of the Conrnission thus far. 10.17 The Chairman of the EAC welcomed the change in policy on cordons sanitaires since the issue of the interim report, and expressed interest in the alternative strategies postulated by the Independent Conrnission's working group on vector control for the continuation of activities. Extreme caution must be exercised in attaching dates and times to such forecas ts . 10.18 In a discussion on alternative methods of onchocerciasis control or survei-1lance, it \^/as reported that the dearth of information on the resting sites of adult flies and the need for frequent applications of adulticides because of their lack of residual effect, were obstacles to considering this as an alternative means of control. Trapping, which had been used with some success for tsetse fly surveillance and control, was also doubtful as a valid alternative, especially with the methods currently available, because of the difference in the reproduction rate of the two kinds of f1-y. Likewise, the combination of trapping with biological control using pheromones to'rattract" flies was sti11 a highly conjectural branch of research. rPCft Page 18 10.19 Representatives of Participating Countries expressed appreciation of the close consultation with the Commission afforded by its Chairman's frequent visits, and of the foresight shown by the Progranrne Director and IRO in preparing national staff for decentralization and devolution through training activities. They confirmed their Governments'rejection of option (1), termination of the Progranrne, and their preference for regionalization and devolution, with a major role for OCP staff in the transfer of responsibilities and international support in the development of national resources and supply of equipment. lO.2O The representative of Ivory Coast stressed the need for consultation among countries to determine a uniform regional policy, and pledged his Government's support in the continuation of OCP, offering in particul-ar further opportunities for the training of entomologists at the Bouak6 Institute. l}.2l The representative of l{ali argued for extension of OCP in the interest of the elimination of residual infection, for the definition of maintenance zones and related criteria, for a 3-5 year pilot study of coordinated withdrawal stratery in Mali, and for the testing of appropriate technolory to prepare populations for reduced activities at the cormnunity leve1. LO.22 The representative of the United States of America said that the Independent Conrnission should, in its final report, list the arguments against option (1), termination of OCP. He urged that the Conrnission provide firmer directives for option (3), devolution, preparations for which should start in 1982-1985. Specific reconrnendations should be included on development of national infrastructure-related training, and technolory, and terms of reference should be elaborated for a pilot study, which was to be encouraged as a means of ensuring reduced costs in the long term. Countries should first, however, give serious consideration to the merits of option (2), continuation of oCP in its present form over (3) and (4), devolution and regionalization. It would be a pity to dismantle a mechanism that worked only in order to establish one that might not. Ttre Cormnission should also provide the JPC with as much help as possible in judging the merits of extending control to the Senegal River Basin area. LO.23 The Chairman of the Independent Commission said that the comments had been noted and would be taken into account in the final report, which would, of course, provide more detailed reconrnendations. With regard to extension in the Senegal River Basin, the Commission would examine this question in relation to its terms of reference and would be as helpful as possible. However, it was conscious that another body had been set up to carry out a feasibility study. 1O.24 On conrmunity participation, he said it must be recognized that onchocerciasis control was one of the hardest tasks to reconcile with such methods, but the Conrrission was considering what roles local populations might play. 11. INTERIM REPORT ON TI{E FEASIBILITY STUDY OF AN ONCHOCERCIASIS CONTROL CAMPA]GN IN T}iE SENEGAL RIVER BASIN AREA: Agenda item 1O 11.1 Presenting the interim report, the representative of Ehe WHO Regional Office for Africa apologized for having been unable to make the report available to EAC at its meeting in September. He recalled that the launching of the project had already been a year behind schedule at the last meeting of the JCC in December L979, after which a detailed plan had been drar,rn up to make it possible to accomplish the objectives of the project by the original target date. The final report v/as expected to be ready on time for EAC's next meeting. Ll.2 Much of the work had been done by the national teams involved, and had benefited from the contributions of OCCGE and ORSTOM consultants. 11.3 In addition to the financial conEributions (US$ 250 ooo), the United SE.ates of America (US$ been a recent pledge of US$ 1OO OOO from Kuwait. the Onchocerciasi-s Fund. JPCf L page 19 of Belgium (nearly US$ 107 oOO), Netherlands 600 ooo) and UNDP (us$ 2oo ooo), there had There were also US$ 89 OOO set aside in I1.4 Although the interim report was based on ocP experience and methodolory, it was expected that studies that are yet to be carried out would provide information on modifications that should be introduced to suit the leve1 of technological develoPment and resources of the participating Countries. For example, Ehe socioeconomic studies were exPected to give indications about road plans and conrmunity participation in disease control. fhe reconrnendations of OCP's Independent Conrnission on alternative methods of vector control would also be taken into account. 11.5 Ihe WIIO Regional Qffice \ras proposing measures to identify extrabudgetary resources for a study of integrated vect.or-borne disease control in the context of primary health care' 11.6 The leader of the feasibility study team said that the aim of the project was to Plan a campaign to control the savanna form of onchocerciasis in the Senegal River Basin area, where it affected parts of Guinea, Guinea-Bissau, Mali and Senegal, and to estimate costs' The report reviewed current findings and outlined stratery. ll.7 Entomological and epidemiological findings had been sufficient to provide the basis for the campaign in Mali and Senegal and in the upper Niger Basin area in Guinea, and to determine its western limits. Elsewhere, no systematic evaluation of breeding sites had been made, and the study had therefore concentrated on Gui.nea and Guinea-Bissau, relying on IRO consultants who trained national teams, one of whom had made an aerial assessment of larval sites of S. damnos um in the dry season in April-I1ay 1980. A similar assessment of the uPPer reaches had just been completed in Guinea and Sierra Leone. Participants been able to study the resulting maps at IRO, Bouak6, and these indicated in the JPC had the distribution of the savanna vector species, and thus enabled determination of the souEhern limit of the project area. The northern limit was already fixed by the range of the vector, while to the east, the area was contiguous with OCP. 11.8 Hydrometric srudies by an ORSTOI,I consultant had provided sufficient data for the assessment of insecEicide quantities for the campalgn in Mali and Senegal, but the hydrometric network would have to be strengthened before a control scheme could be implemented. Roads in the project area \rere inadequate, making conrmunications extremely difficult in the rainy season. The riverine fauna had been studied in March and April 1980 by ORSTOM hydrobiological teams, which had proposed an aquatic monitoring protocol. 11.9 Other data collected for the planning stage concerned roads, aerial conrnunications and the health infrastructure. ORSTOM was to study socioeconomic asPects of onchocerciasis control and would report in February 1981. By that time, the dry season entomological evaluation would have been completed in Sierra Leone, which, together with the rainy season finding s on S. damnosum breed ing sites in Guinea-Bissau and the firsE aerial assessment in Guinea and Guinea-Bissau in December 1980 would determine the precise limits o area. Epidemiological evaluation was also being completed in central Guinea. f the project 11.10 1,he stratery, which at present is the same as that of OCP, relies on insecticide, the quantities of which have yet to be calculated for Guinea and Guinea-Bissau. Subsequently, the aerial operations and their ground support, the necessary road cornmunications, the hydrometric network and radio links have to be planned, and the needs determined for entomological, epidemiological and hydrobiological surveillance and monitoring, economic evaluation, and training. 11.11 Whether the campaign r{as considered as an extension of OCP or as a separate operation, it was expected that it would be able to rely on the collaboration of the same technical, advisory, supervisory and coordinating bodies. The WHO Regional Office for Africa, which had to coordinate measures for the control of many diseases, was interested in conrnunity participation. rPc/r Page 20 ll.12 The representative of Niger warned against raising hopes prematurely with regard to new products, and agreed that Participating States and Contributing parties should combinetheir efforts to Persuade companies to continue their research for the development of other chemical agents. 11.13 EAC expressed considerable concern about the late appearance of the interim report andthe absence of clear indications permitting decisions to be taken by EAC, the EcologicalGroup and sponsoring agencies. It was absolutely essential that a thorough analysis be made of the advantages and disadvantages of an additional prograntrne compared with extension, and that technical staff of OCP be given the opportunity for detailed conunent. It was suggested that the Independent Cormnission's terms of reference might be broadened to includeguidance on the important points at issue before the final report on the feasibility study was completed. f1.14 Assurance was sought that adequate funds would be available for the completion of the feasibility study, which should not be confused with the preparation of a plan of acti-on; the statement of accounts in section 5 of the report had been established as at 31 July 19g0. The representative of the United States of America indicated that some additional information would be requested from trrIHO prior to the payment of his Government's second instalment of US$ 3o0 oOO; it was hoped that any additional resources necessary would be forthcoming from trrIHO for the achievement of the study's objectives. 11.15 The representative of Ma1i, on behalf of the countries concerned, outlined the difficulties and delays that had hampered the work of the national teams following the start of the feasibility study in November 1979, ten months 1ate. The necessary data had been collected from Mali and Senegal with the collaboration of OCCGE; that for Guinea would rapidly be completed; only the situation in Guinea-Bissau continued Eo pose problems. National authorities r^/ere politically conrnitted to the implementation of the programme, as had been shown at the meeting in Conakry, and wished to be associated in all stages of development; training of nationals was proceeding accordingly. It was hoped that the final rePort would take those factors into account, and would emphasize the socioeconomic arguments and primary health care aspects. The countries concerned were optimistic that the study would not remain a dead letter. 12. FIELD VISIT 12.l On the day before the meeting opened, the participants made a field visit, organizedjointly by OCP and the Government of Ivory Coast, to a number of the Progranrne's operations. They watched the spraying of insecticide by helicopter on the River Kan and by fixed-wing aircraft on the River N'Zi. The aquatic monitoring procedures rdere also demonstrated. At the village of Krokokro, the participants observed the activities of the epidemiological evaluation team: clinical examination, measurement of visual acuity, parasitological and ophthalmological exami-nations. Later on, they visited the OCCGE Onchocerciasis Research Institute (1RO) in Bouak6, where an extensive display of the InsEitute's activities, as well as those of the OCP sector and of the ORSTOM Hydrobiolory Laboratory was on view and activities were explained by the staff of the three organizations. 13. OTHER MATTERS: Agenda item 11 13.1 Several representatives took the floor to pay tribute to the Progranune Director, Mr Marc Ls. Bazin, who was departing after heading OCP for four years. During that period, he had displayed the utmost total dedication to his work and outstanding qualities as a manager, as an administrator and as a diplomat. The Conrnittee adopted a motion of appreciation to Mr Bazin, proposed by the representative of Benin (see Annex IV). The Cormnittee also paid tribute to the competence and efficiency of the Progranrne er, Miss Rosemary Villars, who was returning to WHO headquarters. a Ei" 13 of 13. Gatn 3 A warm welcome was extended to the Prograurne Director designate, Dr E. M. Samba of Lbia. rPcf L page 2l 14. DATE AND PLACE OF SECOND SESSION OF JPC l4.l As consultation on the date and place of the second session of the JpC had not beenfinalized, the Conrnittee was informed that details would be submitted to them at the time ofdistribution of the draft report of the first session. 15. CLOSURE OF THE SESSION: Agenda item 12 15.1 Participants exPressed their appreciation to the President and Government of Ivory Coastfor their kind hospitality, and thanked the Chairman for his efficient conduct of the meeting. 15.2 In his closing address, the chairman said the first session of the conEnittee had proved extremely constructive, with animated discussions and stimulating exchanges of views. Hehad been impressed by the spirit of collaboration that existed between OCp, the collaborating agencies, and the Contributing and Participating Countries. Over the years, the various Parties had grown into a close-knit OCP family, with the connnon objective of improving the well-being of millions of people. DespiEe the undoubted achievements, much remained to bedone. Reinvasion and the appearance of insecticide resistance were serious problems, andimPortant decisions would soon have to be taken concerning the extension of onchocerciasis control to other areas and the long-term policies of the prograrmne. 15.3 The Chairman declared closed the first session of the Joint programme Cormnittee of the onchocerciasis control Progranure in the volta River Basin area. rPcf L PaEe 22 ANNEX I 1 AGENDA Opening of the session Election of Officers 3 4 Adoption of the agenda Progress report of the World Health Organization for 1980 5 Report of the Expert Advisory Committee 6 7 8 Socioeconomic development Plan of Action and Budget of the Progranrne for 1981 Financing of the Onchocerciasis Control Progranrne Interim report of the Independent Conrnission on the long-term prospects of the Progranrne 10 Interim report of the Feasibility Study of an onchocerciasis control campaign in the Senegal River Basin area 11. Other matters l2 Closure of the first session 2 9 JPC/ 1 PaSe 23 ANNEX 1I LIST OF PARTICIPANTS PARTIC IPATING GOVERNMENTS Pe lefs ublic of Benin Son Excellence Monsieur Paul Ministre de la Sant6 publique Kpoffon Mr. Alphonse Fonteclounon Secr6taire administratif Comit6 national de Lutte contre lrOnchocercose Ivory Coast Son Excellence le Pr6sident Auguste Denise (Chairman, JPC) Ministre dtEtat Dr C.L. Coulibaty Directeur du Cabinet du Ministre dtEtat, MinistEre de la Sant6 publique et de la Population Mr Vidal Directeur du Cabinet du Pr6sident Denise Mrs Tenaille Secr6tariat du Pr6sidenE Denise Dr Ibrahim Kon6 Directeur des Relations r6gionales et internationales MinistEre de la Sant6 publique et de 1a Population Dr F. Serie Inspecteur g6n6ra1 de la Sant6 MinistEre de la Sant6 publique et de 1a population Dr K. NIDa Directeur de 1a Sant6 publique et de la Population Mr L. K6hin Directeur BSIE Ministdre des Einances Dr J.M. Rive MinistEre de 1a Sant6 publique et de Ia population Dr A. Rolland ophtalmologiste du Progranrne national de Lutte contre ltonchocercose Ghana Alhaj i Mohannned Abdullahi Deputy Minister of Health Ministry of Health JPC/I PaEe 24 Annex I1 Dr J.B.B. Asafu-Adjaye Executive Director National Onchocerciasis Secretariat Ministry of Finance and Economic planning Dr Y. Aboagye-Atta Deputy Director of Medical Services Ministry of Health Dr N.S. Belo-Giwa Secretary National Onchocerciasis Conrnittee Ministry of Finance and Economic Planning Upper Volta Son Excellence Le Docteur Tinga Douamba Ministre de la Sant6 publique Dr Jean-Marie Ky61em Directeur g6n6ra1 de 1a Sant6 publique M. Sim6on Sorgho Directeur g6n6ra1 Autorit6 des Am6nagements des Va116es des Volta Mali Son Excellence 1e Docteur N'Golo Traor6 Ministre de 1a Sant6 publique et des Affaires sociales Dr A. Dia11o Directeur g6n6ra1 de la Sant6 publique Dr Sidi Adama Konar6 M6decin-Chef Division de la M6decine socio-pr6ventive M. Bandiougou Gakou Chef, Ce11ule Oncho MinistEre du Plan Niger Son Excellence le Chef de Bataillon Amadou Seyni Maiga Ministre de la Sant6 publique et des Affaires sociales Dr Ibrahim Alfa Ciss6 Directeur de lrHygiEne et de la M6decine mobile MinistEre de la Sant6 pub1ique et des Affaires sociales Mr Abdou Aboubakar Responsable du Projet SAY MinistEre du Plan JPCII Page 25 Annex II Togo Son Excellence Monsieur Hodabalo Bodjona Ministre de la Sant6 publique Dr TognidE Houenassou-Houangbe Directeur g6n6ra1 de la Sant6 publique CONTRIBUTING PARTIES Saudi Arabia African Develo t Bank (ADB) Belgium Professor P.G. Janssens Member of Expert Advisory Corrnittee Canada Mr D. Lindores (Vice-Chairman, JPC) Vice-Pres ident Multilateral Prograrmnes Branch Canadian International Development Agency Miss Anne Sutherland Head, United Nations Prograrrres Section Canadian International Development Agency Mr Yves Contamine Second Secretary (Development) Embassy of Canada Abidj an United States of America Mr E. Dennis Conroy Director, Office of Regional Affairs Bureau for Africa Agency for International Development Dr Joe L. Stockard Tropical Medicine Specialist Office of Health Bureau for Technical Assistance Agency for International Development JPC/L Page 26 Annex II France Dr B. Durand Charg6 de Mission i la Sous-Direction de la Sant6 publique et de 1'Action sociale MinistEre de 1a Coop6ration Japan Mr Naotsugu Nakano Third Secretary Embassy of Japan in Tvory Coast Kuwait Dr Rashed Abdul Aziz A1-Owaish Director, Port Health Section Ministry of Public Health Dr Abdul-Karim Sadik Economic Adviser Kuwait Fund for Arab Economic Development The Netherlands Mr J. Berteling Special Programmes Division Directorate-General for International Cooperation Ministry of Foreign Affairs Miss J.M. van Vliet Third Secretary of Embassy in Ivory Coast Federal Republic of Ge rmany Dr W.-D. Ernert Ministerial Counsellor Federal Ministry for Economic Cooperation His Excellency Dr K. Schrameyer Ambassador, Federal Republic of Germany in Upper Volta United Kingdom Mr W. Hobman Head of Eastern and Western Africa Department Overseas Development Administration Dr P.T. Haskell Director Centre for Overseas Pest Research Ovqrseas Development Administration JPC|I PaEe 27 Annex 1I SPONSORING AGENCIES Food and Asricul ture Organization of the United Nations (reo; Mr M.S. Nicholas Director, Agricultural Services Division Mr Cyril G. Groom Senior Officer (Programre and Planning) Agricultural Services Division World Bank (IBRD) Mr Bi1sel Alisbah Director, Progranmes I, Western Africa Region Mr Stephen Denning Division Chief, Progr"nrmes I, Western Africa Region United Nations Development programne (UNDP) Mr Salif N'Diaye Chief, Division for Regional Projects Regional Bureau for Africa World ttealth Organization (wHo) Mr Marc Ls. Bazin Director, 0nchocerciasis Control progranme WHO Secretariat Mr A. Groenendijk Director, Division of Budget and Finance, WI10/HQ Dr C.-H. Vignes Director, Legal Division, WHO/HQ Dr E. Samba consultant, Director-Designate, Onchocerciasis control progranune Mr K.P. Supthut Chief , Administration and Management, Onchocerciasis Control prograrmne Dr H. Agoua Entomologist, Chief Tamale Sector, Onchocerciasis Control prograrmne Dr 0. Ba Parasitologist, Epidemiological Evaluation Unit Onchocerciasis Control Prograurne Mr B. Cliff chief, Aerial operations, Onchocerciasis control progranrne JPC/ 1 Page 28 Annex II Dr Y. Dadzie 0phthalmologist, Epidemiological Evaluation Unit Onchocerciasis Control Progratmue Dr J.B. Davies Chief, Entomological Evaluation, Vector Control Unit Onchocerciasis Control Prograrune MIle M. Desbois Information Officer, Onchocerciasis Control Prograrme Dr C. Gboho Entomologist, Vector Control Unit, Onchocerciasis Control Prograrroe Dr F.G. Glokpor Epidemiologist, Intercountry Project, Bnmako Dr F.C. Grant Regional 0fficer, Regional Office for Africa Onchocerciasis Control Programte Dr M. Karam Parasitologist, Onchocerciasis Control Prograrmte Mr S. Ladjouan Technical Officer, Onchocerciasis Control Prograrme Mr J.D.M.Marr onchocerciasis Control Programme Liaison Officer, WHO/HQ Dr P. Masumbuko Economic Development Unit, Onchocerciasis Control Prograrnme Dr K. Mu11en Statistician, onchocerciasis Control Progranrne, WHO/HQ Dr B. Philippon Chief, Vector Control Unit, Onchocerciasis Control Programne Dr A. Prost Parasitologist, Epidemiological Evaluation Unit Onchocerciasis Control Progranrne Dr G. Qu6lennec Biochemist, Pesticides Development and Safe Use Division of Vector Biology and Control, WHO/HQ Mr R.C. Sawadogo Sociologist, Onchocerciasis Control Programme ffi A. Seketeli Ehtomologist, Chief , Bouak6 Sector, Onchocerciasis Control Prograrmre Miss R. Villars Prograrmne Officer, Onchocerciasis Control Prograrrne Mr G. Zerbo Entomologist, Vector Control Unit 0nchocerciasis Control Prograrrne rPcfr PaEe 29 Annex II EX OFFICIO PARTICIPANTS .E"per! 4drli4ty !g!*i!!ee Professor G. Camus Chairman Dr 0.T. Grande Member !rylep enden t lqglEni s s i on Dr C.E. Gordon Smith Chairman Miss Barbara M. Secretary S tocking OBSERVERS Guinea Dr Mamadou Kaba Bah Directeur g6n6ra1 de 1a Sant6 MinistEre de la Sant6 Dr G. Sultan Directeur g6n6ra1 des Services de Pr6vention MinistEre de la Sant6 Mr Y. Kassa Chef du Service de Lutte contre lronchocercose en Guin6e Senegal Son Excellence Monsieur Mamadou Diop Ministre de 1a Sant6 publique Dr Babacar Samb Attach6 de Cabinet du Ministre de Ia Sant6 publique Dr Alassane MtBaye Conseiller technique MinistEre de 1a Sant6 publique Inter-State Permanent Committee for Dro t Control in the Sahel (CILSS) Cormnission of European Conununities (CEC) Mr A. Lesina De legate Mr J.C. Rossey Economic Adviser f JPC/I Page 30 Annex I1 anization for Coordination and eration in the Control of or Endemic Diseases (OCCGE Dr Cheick Sow Secretary General Office for Scientific and Technical Research overseas (oRSToM) Dr D. Qui116v6r6 Director, Onchocerciasis Research Institute rPcfL Page 3 1 q.NI\FX III ONCHOCERCIASIS FUND INCEPTrON T0 SEPTEIIBER 30, 1980 (expressed in millions of US dollars) a r R-ECEIPTS PHASE I PHASE II TOTAL: INCEPTION TO SEPTEMBER 30, 19 80 Contributions African Development Bank Belgium Canada France Germany, Federal Republic of Iraq Ivory Coast Japan Kuwai t Netherlands Norway OPEC Fund for International Development A1 Sabah Foundation Saudi Arabia Switzerland United Kingdom of Great Britain and Northern Ireland UNDP United States of America World Bank Sub-tota1 Income from investment Total DISBURSEMENTS Advances to hlHO Balance carried forward I ;1, 3.3 5.8 5.2 ,'.o01 5.O 6.0 6.5 1.1 4 1.5 2.4 4.0 7.O 5.2 -.7 ,-Z 05 ,:u 3.3 .5 2.4 6.6 6.0 9.8 1.6 5 o2 7 7 q .12 5.0 3.7 I 13.3 I J 5.6 .5 7.7 6.0 .4 .7J rls 6.0 t.2 7.7 7.5 6t.9 1.6 t6.2 7 8.2 9 2.5 63.5 L7 .t 80. 7 t 56 .2', 7.3 13. O 11.5 5 69 2 511 1 2 3 4 5 A portion of this amount was received in 1980 US $f.l million received after September 30, 1980 US $2 million received after September 30, 1980 Includes US $4 million for first quarter of 1980 Does not include first advance for 1981 WORLD BANK November 26, L98O rPcf L page 32 ANNEX IV MOTION OF APPRECIATION FOR TIIE WORK OF IHE PROGRAMME DIRECTOR PROPOSED BY THE REPRESENTATIVE OF BENIN The first session of the Joint Progranrne Conrnittee of the Onchocerciasis Control Programme in the Volta River Basin area, meeting in Yamoussoukro, Republic of Ivory Coast, ftom 24 to 27 November 1980, notes with satisfaction the outstanding results achieved by the Progranrne since its inception in 1975. It pays tribute to the efforts of the Donor Countries and Participating Countries, all of whom are firmly committed to the success of their joing undertaking. IE stressed that while the highly encouraging results are attributable ro theparticipation of aI1 concerned and particularly the Executing Agency, the World Health organization, they are also due in large measure to the unfailing conrnitment of the programme management and especially its Director, Mr Marc Bazin. Ihe Conrnittee takes this opportunity to draw attention to the special contribution made by the present Director, Mr Marc Louis Bazin, who has completely fuIfilIed the Conrnittee's expectations in implementing the programme with sustained drive. The Conrnittee therefore offers IvIr Bazin its sincere congratulations and exPresses its Sratitude to him for the scope he has given to his mission. Besides ensuring the coordinated and efficient implementation of the Programne aE the technical level he has given it an extremely human dimension at the level of internaEional collaboration. ,In noting his forthcoming departure from the Progranrne, the Committee welcomes Ehe choice of his successor who will be able to derive inspiration from Mr Bazin's example. The Committee wishes Dr E. M. Samba of the Republic of Gambia every success. t""** Yamoussoukro, 27 November 1980 Joint Programme Committee, Onchocerciasis Control Progranrne in the Volta River Basin area a ! /