Human African trypanosomiasis, commonly known as sleeping sickness, has been a persistent and dangerous illness in sub-Saharan Africa. The disease is caused by the protozoan parasite Trypanosoma brucei, which is transmitted to humans through the bite of the tsetse fly. Once the infection takes hold, it progresses in two stages, starting with flu-like symptoms such as fever, headaches, and joint pains, and eventually leading to neurological complications, including confusion, personality changes, and in extreme cases, coma or death. Sleeping sickness has long been considered one of the most debilitating diseases in Africa, with far-reaching consequences for the affected populations.
The World Health Organization (WHO) has set an ambitious goal to eradicate sleeping sickness by 2030. This target was outlined in 2021 as part of a global initiative to eliminate the disease as a public health problem. This declaration has raised hopes for millions of people living in endemic regions. However, while there have been significant advances in the battle against sleeping sickness, many challenges remain. As the world moves toward the 2030 deadline, the question arises: is the world truly getting rid of sleeping sickness, or will it resurge and continue to threaten vulnerable populations?
The Path Toward Eradication
The global effort to eradicate sleeping sickness began in earnest in the late 1990s and early 2000s when the disease was identified as a significant threat to public health. The WHO, in collaboration with health ministries, local governments, and international organizations, launched several initiatives to combat the disease. By 2021, these efforts had yielded remarkable results, with reported cases of sleeping sickness declining by a staggering 97.5% since 2000. The number of cases fell from nearly 40,000 in 1998 to fewer than 1,000 annually in recent years.
Seven African countries—Gabon, Guinea, Ivory Coast, Malawi, Niger, Senegal, and Sudan—have successfully reduced the incidence of the disease to below one case per 10,000 population, a significant milestone in the fight against sleeping sickness. Other countries, including Cameroon, the Central African Republic, and the Democratic Republic of the Congo (DRC), are making steady progress toward achieving similar results.
Despite this progress, WHO officials, health experts, and stakeholders acknowledge that declaring victory over sleeping sickness at this stage would be premature. One of the main reasons for caution is that the trypanosome parasites responsible for the disease have evolved mechanisms that allow them to evade the immune system. These parasites can change the proteins on their surface, which makes it difficult for the human immune system to mount an effective defense against the infection.
Additionally, the tsetse fly, the primary vector of the disease, continues to be widespread in many regions of sub-Saharan Africa. While efforts to control and reduce the tsetse fly population have been effective in certain areas, its persistence remains a significant hurdle in eliminating sleeping sickness entirely. As a result, experts like Gerardo Priotto, a medical officer at the WHO, warn that without continued vigilance and sustained efforts, sleeping sickness could easily return, potentially affecting millions of people.
Breakthroughs in Treatment
One of the most significant advancements in the fight against sleeping sickness has been the development of new treatment options. For many years, the primary treatment for sleeping sickness was melarsoprol, an arsenic-based drug that had severe side effects and required intravenous administration in a hospital setting. The drug was difficult to administer, especially in remote areas, and its toxic side effects were often debilitating for patients.
In 2020, a new oral drug called fexinidazole was introduced to replace melarsoprol. Fexinidazole represents a major improvement in the treatment of sleeping sickness. It can be administered as an oral medication, eliminating the need for hospitalization and painful injections. The drug has been a game-changer, accounting for approximately 70% of the treatments for sleeping sickness in recent years.
However, while fexinidazole is a significant advancement, it is not a perfect solution. The drug is less effective in the advanced stages of the disease, and side effects such as nausea and vomiting have caused some patients to abandon treatment before it is completed. As a result, there are still concerns about the ability to treat all cases effectively, particularly those that are diagnosed at a later stage when the disease has already caused neurological damage.
Another challenge is convincing people to seek treatment in the first place. In many rural areas, access to healthcare facilities is limited, and the cost of treatment can be prohibitive. Additionally, patients may be reluctant to seek medical care due to fears of stigma or misinformation about the disease. Researchers have found that it can sometimes take up to a year to convince individuals to begin treatment, and during this time, they may inadvertently transmit the disease to others.
Persistent Obstacles: War, Politics, and Donor Fatigue
Despite the progress made in recent years, several persistent obstacles remain in the fight against sleeping sickness. One of the most significant challenges is the ongoing civil unrest in key endemic regions, such as the Central African Republic, the Democratic Republic of the Congo (DRC), and southwestern Cameroon. In these areas, rebel factions and armed groups often target medical personnel and health workers, making it difficult for them to carry out active surveillance, diagnosis, and treatment campaigns.
In addition to political instability, there is growing concern about “donor fatigue.” As the number of reported cases of sleeping sickness decreases, the cost and effort required to detect and treat each new case increase. The WHO and other organizations are facing difficulties in securing funding for these efforts, as donors become less willing to contribute to an increasingly rare disease. “It’s difficult to convince people that we need as much money to detect one case as we used to need to detect 10–20 cases,” says Jean-Mathieu Bart, an investigator with the French National Research Institute for Sustainable Development.
This challenge is compounded by the fact that many African countries that are most affected by sleeping sickness have limited healthcare infrastructure and resources. The global health community must continue to invest in strengthening local health systems, providing training for medical personnel, and ensuring that there are adequate resources for surveillance, diagnosis, and treatment.
The Mystery of the Parasite’s Reservoir
In addition to the logistical and financial challenges, there are still scientific unknowns that complicate efforts to eradicate sleeping sickness. Researchers have yet to determine whether the trypanosome parasite has an undetected animal reservoir, which could allow the disease to persist in nature even if human cases were eliminated. If such a reservoir exists, it would pose a significant challenge to the eradication efforts, as the parasite could continue to circulate in animal populations and occasionally spill over into humans.
Furthermore, some individuals may harbor the parasite without ever developing symptoms of the disease, making it difficult to identify and treat all infected individuals. These asymptomatic carriers can unknowingly transmit the disease to others, potentially complicating eradication efforts.
WHO’s Commitment to 2030
Despite the many hurdles that remain, the World Health Organization remains committed to its goal of eliminating sleeping sickness as a public health problem by 2030. The organization continues to work closely with African governments, local health authorities, and international partners to strengthen disease surveillance, improve access to treatment, and control the spread of the tsetse fly.
While the road to eradicating sleeping sickness is long and challenging, there is hope that continued efforts, coupled with scientific breakthroughs and improved treatment options, will ultimately lead to the complete elimination of the disease. The world has made significant progress toward this goal, but the fight is far from over. The next decade will be crucial in determining whether sleeping sickness can be eradicated once and for all.
In conclusion, the WHO’s 2030 deadline to eradicate sleeping sickness is an ambitious but achievable goal. While the world has made significant strides in the battle against this deadly disease, challenges such as the persistence of the tsetse fly, the evolving nature of the parasite, political instability in endemic regions, and donor fatigue continue to pose significant obstacles. Nonetheless, with sustained commitment, funding, and cooperation from the global health community, sleeping sickness can be eliminated as a public health problem, bringing hope to millions of people living in affected regions.