Since 2013, for around two weeks each year, Sulaiman Tarawallie has pulled on his community drug distributor (CDD) uniform and gone from household to household in his remote farming community to hand out medication to fight river blindness and lymphatic filariasis. Once he has completed the rounds of his village, he heads further out to take the drugs to even more remote homes – keeping the diseases that had plagued generations at bay with a handful of pills.
But this year, Tarawallie, who works as a community health worker and primary school teacher in Sierra Leone’s northern Bombali district, will not be making his annual trip.
He is one of 30,000 CDDs in the country out of a job after the cancellation of USAID’s work on neglected tropical diseases (NTDs). It represented a tiny fraction of USAID’s budget, but had a huge impact, aid workers say.
The World Health Organization recognises about 20 NTDs, debilitating conditions typically found among poor communities in tropical areas. USAID work focused on five of the most common: lymphatic filariasis, trachoma, onchocerciasis (also known as river blindness), schistosomiasis and intestinal worms. They can be brought under control – and in time eliminated – via mass drug distribution in communities. Everyone takes the pills, whether they show symptoms or not.
The programme worked with the private sector, with every $1 of US government funding leveraging $26 in donated medicines for mass treatment campaigns.
A fact sheet prepared by USAID’s NTD team shortly before it was dismantled sets out the programme’s achievements: treatments have been delivered to 1.7 billion people across 31 countries. In almost half of those countries, at least one NTD has been eliminated as a public health problem, meaning millions of people no longer require treatment for diseases including lymphatic filariasis, trachoma and river blindness.
The programme was on track to repeat its success – 15 countries were expected to eliminate at least one NTD within five years, and 14 countries were in the middle of developing sustainability plans that would integrate NTDs into the wider health system.
Tarawallie credits the US government for providing the drugs to defeat onchocerciasis and lymphatic filariasis, commonly called elephantiasis. Now people in his community in Makeh, on the outskirts of Makeni city, are free of them.
“Before, [these diseases] were wreaking havoc on people,” Tarawallie says. In onchocerciasis, a parasitic worm causes severe itching, bumps under the skin and blindness. In lymphatic filariasis, parasites damage the lymphatic system leading to the abnormal enlargement of body parts, causing pain and disability.
Four of his relatives were affected. “They felt shame and stigma, and didn’t want to mingle with [other] members of the community,” he says.
Tarawallie also took part in a US-funded programme that hands out bed nets and sprays mosquito breeding grounds with insecticide to cut malaria cases. That too has been halted, he says.
Dr Angela Weaver, vice-president of the NTD portfolio at Helen Keller Intl, was the USAID team’s first employee in 2006 when it launched. She remains proud of “the greatest thing you’ve never heard of”. The spending of about $112m (£87m) a year was almost “a rounding error” compared with USAID’s bigger programmes tackling diseases like HIV and malaria, she says.
“For such a little amount, we’ve been able to reach so many people and we could finally get rid of some of these diseases that have been around since for ever. I mean, some of them were referenced in the Bible,” she says. “To have that all put at risk is really devastating. Just in our programme alone, there’s over 100 million people that are now going to be at risk.”
Helen Keller Intl implements the USAID programme in six countries in west Africa, including Sierra Leone. Its work is currently suspended.
“These six countries are ones that have been in the programme the longest, so that we’re starting to see the real impact of what happens when you actually invest continuously over time in these diseases,” she says.
In Mali, “the entire population was at risk for developing irreversible blindness because of trachoma, and two years ago, we were able to celebrate its elimination”. In January, Niger became the first country in Africa to eliminate onchocerciasis.
For 2025, according to calculations by NGOs, the pharmaceutical companies that donate drugs had committed $975m worth of medication. “Some of them had already begun to ship those drugs, and some were planned for shipment, and now everything’s on hold,” says Weaver.
Some drugs and diagnostic tests “will end up expiring if not used”, she adds. Some pharmaceutical companies were hesitating to ship supplies because they feared they would go to waste, others had suggested they might need to close down drug production lines “if we stay in this state”.
There are pockets of Africa that have yet to receive any mass drug administration, Weaver says. And even in the countries that have successfully suppressed the diseases “they can still come back – we haven’t changed the basic factors that make them possible”. That would amount, she says, to a waste of previously spent US taxpayer money.
With organisations across global health reeling from widespread cuts, Weaver says she fears that NTDs will “suffer from what we’ve always suffered from: that it’s diseases that people don’t know about, they don’t understand, they’re hard to pronounce, and they’ve just not been the priority when pitted against other diseases that kill people”.
Tarawallie pleaded for a reversal of the decision. “Thanks to this programme, you can never find someone who has these diseases in my community. But my worry now, if this programme is stopped, is the worst might happen.”
