Public needs to make an informed choice when taking these filaricides

Dear Editor,

Please allow me to respond to the Stabroek News editorial of 21st October, titled `Filariasis questions’.

First and foremost, I should highlight the fact that Mass Drug Administration (MDA) was tried before by the WHO and was a complete failure.

Editor, reports of attempts to control malaria through mass treatment with antimalarial drugs date back to at least 1932. In the 1950s, the WHO included MDA of antimalarial drugs as a tool for malaria eradication, in exceptional conditions when conventional control techniques had failed. In 1971, the WHO expert committee on malaria still recommended MDA in special circumstances. Subsequently, MDA was linked to the emergence of drug resistance and its overall benefit was questioned. Concomitantly, the goal of malaria eradication was replaced by one of prevention of malaria morbidity and mortality through the provision of effective treatment. The fact is that there is short lasting benefit of mass drug administration. It’s not long term as seen with MDA malaria. Malaria remains endemic and deadly worldwide and for our efforts we have to contend with drug resistant malaria parasites. We are still using the same methodology for MDA filaria as what we did for malaria. In essence we are doing the same thing but expect different results. Does that make sense? Also the world has become much more global compared to 1930. Eradicating filaria in one country would only be for a short time since any given population is not static. As a result, MDA for filariasis, in my opinion will fail.

Editor, I’ve been made privy to the Ministry of Public Health parents’ information booklet. I will quote verbatim.

“We hereby inform you that the deworming tablets would be provided at school during the MDA campaign in October. DEC and albendazole are safe and will help your child to grow healthier and perform better at school. The tablets administered during the MDA campaign are effective against intestinal worms”.

That’s absolute garbage. No tablet is without side effects. Side effects may not affect everyone but the fact is doctors do not know who it may affect hence they have to inform everyone. The public needs to make an informed choice when taking these filaricides . Secondly, are these filaricides multivitamins? How the hell can they make a child grow healthier and perform better at school? In my opinion, having comfortable chairs, well ventilated rooms, adequate nutrition among other things can improve a child’s performance at schools. Not filaricides. Stop misleading parents. Let them know the truth and make a decision based on facts. Not play on their fears of intestinal worms. This is more of a patients’ misinformation booklet.

Fourteen out of 81 countries have been able to eradicate filariasis after eighteen years. 2020 is fourteen months away. Within that time filaria will return to those fourteen countries and we will be back to square one. For me this is a complete failure.

In my opinion dealing with the mosquito problem is much more sensible. It may not eradicate filaria but it will provide better comfort to Guyanese. Also eradicating the mosquitoes would eliminate the main vector for filaria among other mosquito borne diseases. In my humble opinion that’s a better solution. Not MDA.

Yours faithfully, Dr. Mark Devonish MBBS MSc MRCP(UK) FRCP(Edin) Consultant Acute Medicine Nottingham University Hospital UK