An implementation research study supported by the UNDP-led Access and Delivery Partnership (ADP) project, and jointly conducted by TDR, The Bruyere Health Research Institute, Medicines Development for Global Health, Ghana Health Services and the University of Health and Allied Sciences, is assessing the feasibility and acceptability of replacing ivermectin with moxidectin in mass drug administration campaigns, with the goal of finally eliminating river blindness. The feature story below, prepared by ADP, details these efforts to introduce moxidectin in the Twifo-Atti Morkwa District of Ghana’s Central Region.
In many rural parts of Ghana, the waters that nourish crops and sustain livelihoods also bring a hidden danger. Black flies, breeding along fast-flowing rivers and streams, carry the parasite that causes river blindness – a disease that has robbed countless people of their sight, their ability to work and their independence.
River blindness, or onchocerciasis, leads to relentless itching, disfiguring skin conditions and progressive vision loss that can end in permanent blindness. The impact can be devastating, driving cycles of poverty and lost opportunity. In 2023, nearly 250 million people required preventive treatment against river blindness, with the vast majority residing in Africa and Yemen.
Ghana has made significant progress against the disease, particularly through aggressive vector control and annual mass drug administration (MDA) campaigns – a strategy that involves treating entire communities, regardless of their infection status. Even though these efforts have dramatically reduced the number of cases across much of the country, 142 districts remain endemic and 5.8 million people continue to be at risk.
The drug ivermectin has been the backbone of this river blindness control strategy for decades. While it effectively kills the parasite’s larval stage – the microfilariae – and halts their release by adult worms for several months, it does not kill the adult worms themselves. As a result, repopulation occurs, and annual MDA campaigns must be repeated indefinitely. This limitation has made it difficult to fully eliminate the disease in areas where transmission persists.
Now, a promising new drug is offering hope for elimination: moxidectin.
In the Twifo-Atti Morkwa District of Ghana’s Central Region, the lush, green waterways of are a prime breeding ground for black flies, particularly during the rainy season months of April to October. Communities have long lived under the burden of river blindness. But that may be changing. Moxidectin, recently approved for use in Ghana for individuals aged four and above, provides longer-lasting suppression of microfilariae. By keeping microfilarial levels significantly lower for up to 12 months after treatment, it is expected to enhance the impact of MDA campaigns and could accelerate progress towards disease elimination.
An implementation research study supported by the UNDP-led Access and Delivery Partnership project, and jointly conducted by the Special Programme for Research and Training in Tropical Diseases (TDR), The Bruyere Health Research Institute, Medicines Development for Global Health, Ghana Health Services and the University of Health and Allied Sciences, is assessing the feasibility and acceptability of replacing ivermectin with moxidectin in MDA campaigns, with the goal of finally eliminating the disease. The Access and Delivery Partnership project is supported by the Government of Japan.
As part of the study, MDAs were carried out in Twifo-Atti Morkwa – using ivermectin in July 2024 and moxidectin in January 2025. Following each MDA, the research team conducted Community Knowledge, Attitudes, and Practices (KAP) surveys and in-depth interviews with local community members, along with focus group discussions with community drug distributors and Ghana Health Services District Directors. In early April 2025, these activities were conducted in relation to the moxidectin MDA.
Mustapha Immurana, a senior research fellow at the University of Health and Allied Sciences, explains why the potential transition to moxidectin matters. “Moxidectin has proven to be effective in suppressing microfilariae for a prolonged period. Therefore, it has an advantage in dealing with the disease in an endemic setting. I see moxidectin as having great potential for elimination of river blindness in Ghana and other countries where it will be implemented.”
Assemblyman and community health committee member George Frimpong Sem takes part in a community engagement session to raise awareness of the importance of public participation in river blindness control activities. Credit: UNDP/Adenike Ademuyiwa.
For Emmanuel Sam, a health worker in Wamaso, one key lesson has been the importance of strong community engagement. “Many people don’t fully understand what river blindness is, so it can be difficult for them to accept the treatment. During community engagement sessions, people asked about side effects and we addressed their concerns. Overall, people seem willing to accept the new drug.”
The research team is now preparing for the next phase of the study. A second MDA with moxidectin is scheduled for July 2025, after which an additional round of assessment will measure changes in community perceptions and acceptability, as well as drug efficacy. In totality, the study will provide critical data to inform broader deployment across the country.
Investing in health, investing in futures
Ultimately, the introduction of moxidectin is about more than just a new pill – it is about expanding access to innovation, accelerating elimination of devestating neglected tropical diseases and improving lives.
“We call on policy makers, governments and all stakeholders to invest in the response to neglected tropical diseases,” Mustapha says. “It’s worth investing in.”
Thanks to the coordinated efforts of the UNDP-led Access and Delivery Partnership project, TDR, The Bruyere Health Research Institute, Medicines Development for Global Health, Ghana Health Services, the University of Health and Allied Sciences and local communities, that future feels closer than ever.
Read the full story here.
For more information, please contact Dr Corinne Merle