Mectizan as a stimulus for development of novel partnerships: the international organization's perspective.

Following the free donation of Mectizan (ivermectin, MSD) by Merck & Co. in 1987, early efforts to mass distribute the drug came from non-governmental development organizations (NGDO), which had already established projects in Africa and Latin America by 1989. In the beginning, these projects were NGDO-specific and fairly independent from one another. Subsequently, the need to co-ordinate all attempts at Mectizan distribution led to the creation of the Onchocerciasis Eradication Programme of the Americas (OEPA), in 1991, and the NGDO Co-ordination Group for Ivermectin Distribution, in 1992. The latter was to become the 'prime mover' in Mectizan-distribution programmes, particularly in areas of Africa not monitored by the Onchocerciasis Control Programme in West Africa (OCP), until the advent of the African Programme for Onchocerciasis Control (APOC) in 1995. Once the co-ordination group had been established and its co-ordinator appointed, the Mectizan-distribution programme expanded rapidly, reaching 7 million people by 1995. However, the limited resources of the co-ordination group and the need to achieve a better co-ordinated and more comprehensive control of onchocerciasis ultimately led to the creation of the APOC in 1995. The international co-operation behind the APOC has inaugurated a unique type of global partnership, in which the success of the programme lies not with a single player, but with close working relationships and collaboration between many partners: donors; governments of endemic countries; NGDO; international organizations; and private institutions. This is a complex process, the success of which cannot be guaranteed. However, if it can be made to succeed, it will serve as a model to be used to address other serious and intractable development or health problems.