RIVERBLINDNESS IN AFRICA: Taming the Lion’s Stare — Bruce Benton (Guinea)


Reviews of Riverblindness in Africa:
Taming the Lion’s Stare
by Bruce Benton


Reviews on Johns Hopkins University Press Website

“In this book, Benton combines a huge amount of research with his unique insight into the evolution of riverblindness programs during his career at the World Bank. For those interested in the complexities of managing disease control programs and the need for strong partnerships, this is a must-read.” — David H. Molyneux, Liverpool School of Tropical Medicine


“An inspiring and essential contribution to the literature on international development and public health.” — Jean-Louis Sarbib, former Senior Vice President, World Bank


“The authoritative record and historical account of one of the most ambitious and successful parasite control approaches from someone who has been a key part of onchocerciasis control from just about the beginning.” — Gilbert M. Burnham, MD, Johns Hopkins Bloomberg School of Public Health


“Comprehensive, detailed, inspiring! Highlights how championing trust in the affected communities and close collaboration among all interested parties are essential for success.” — Ralph H. Henderson, MD, MPH, former US Assistant Surgeon General / Assistant Director General, World Health Organization


“An excellent summary of an ambitious operation illustrating what only international cooperation can achieve against complex—and in this case, insidious—diseases.” — Jacques Hamon, MD, former Assistant Director-General, World Health Organization


“The astonishingly successful effort to control onchocerciasis in Africa has indelibly shaped the field of global health. Benton illustrates how the success of global health initiatives depends on courageous individual decisions, dedication to a common cause, serendipitous events, and the pursuit of programmatic and scientific excellence.” — David Addiss, MD, MPH, Director, Focus Area for Compassion and Ethics, The Task Force for Global Health


“A balanced masterpiece that captures the oncho story that no one else could, with important lessons for the entire range of development partners—international aid agencies, the WHO, the World Bank, NGDOs, and governments. A must-read.”— Uche Amazigo, former Director, African Program for Onchocerciasis Control


“A unique historical work by someone uniquely qualified to write it. Riverblindness in Africa is remarkably comprehensive, and is remarkable, too, in its masterful sorting out of the contributions made by numerous agencies and individuals. An inspiring story and an instructive account of how numerous organizations, public and private, can work together to control a major infectious disease and even banish it from a vast region of the earth.” — William C. Campbell, Nobel Laureate, Drew University


“The story of riverblindness control is one of the most important in all global public health. Bruce Benton was there from the beginning, and his insights provide important and timeless lessons for conquering illness and health disparities.” — Peter J. Hotez, MD, PhD, National School of Tropical Medicine, Baylor College of Medicine


“Without determination, persistence, and guts, the onchocerciasis program could have folded again and again. Bruce Benton, who was stubbornly committed to the program has told a gripping tale that has countless, timely lessons. This book inspires us to believe that the partnerships vitally needed in today’s interconnected world are indeed possible.” — Katherine Marshall, Former World Bank Director, Sahel Region


“In evocative prose that draws on research, data, and first-hand accounts, Bruce Benton takes us inside the history of one of the greatest international collaborations. A fascinating and essential book.” — Ellen Agler, CEO, The END Fund / Co-Chair, World Economic Forum on Africa


“Benton provides an excellent analysis of the parameters of a successful comprehensive partnership to address a grave regional health challenge. The Covid-19 pandemic is a stark reminder of the need for such effective international cooperation to deliver vital global public goods needed to address challenges that no country can solve alone.” — Birger Fredriksen, former World Bank Director of Human Development for Africa


“Bruce Benton’s telling of the groundbreaking story of oncho from control to elimination is a must read. The partnership of UN organizations, World Bank, NGOs, Merck, African governments, donor agencies, and academic researchers has made this a better world. Benton provides an epic tale of epic achievement.” — David A. Ross, ScD, CEO / President, The Task Force for Global Health


Riverblindness in Africa describes one of the great successes in the history of medicine. Guided by research and surveillance, the riverblindness program continuously changed and adapted its strategy to defeat riverblindness, a disease among poor people in poor countries. The book should be mandatory reading for students of global health.” — Tore Godal, former Director, UNDP / World Bank / WHO Tropical Disease Research Program


Review in the Journal, Foreign Affairs

River blindness, or onchocerciasis, is caused by a parasitic worm that is spread by the bites of a small black fly that is common around rivers in much of Africa. The disease still afflicts some 15 million to 20 million Africans, of whom around a million have suffered vision loss. Benton, who ran the World Bank’s river blindness project for over 20 years, has written a very useful history of the efforts by African governments and a consortium of donors to control and eventually eradicate the disease. He ably documents the policy process, the bureaucratic politics, and the individual actions that such a complex effort required. No vaccine is available yet, and so policymakers have no alternative but to support the slow and laborious work of trying to eradicate the disease-carrying fly with insecticides. Also, since 1981, the drug ivermectin has been found to be effective in killing the larvae of the worms inside the human body. Campaigns to provide two injections of the drug a year to affected populations have played a key role in controlling the disease. — Nicolas van de Walle Journal, Foreign Affairs


Reviews on Amazon

Daniel Promislow — 5.0 out of 5 stars Inspiring story of a global health success story. Reviewed in the United States on January 14, 2021

This is a fantastic first-hand account of the tremendous effort to eliminate riverblindness (onchocerciasis) from Africa. The author played a central role in bringing so many players to the table–many different developed nations, the World Bank, the WHO, pharmaceutical companies, and many, many dedicated individuals–to create an extraordinary collaboration. The disease affected tens of millions of people, and eliminating it has had a huge positive impact.

As much as this is an incredible story of the Herculean efforts to fight this disease, it is also an enormously thought-provoking story about key challenges to overcome when we set out to achieve any massive goal. The entire book illustrates the importance of focusing on successful collaboration, communication, and compassion, on ensuring that all participants feel like stakeholders. It is clear that the author deserves a huge amount of credit for building this community of stakeholders, but impressively, he is humble and quiet about his own accomplishments.

Most importantly for global health, the book underscores in such a powerful way the importance of *trust*, making sure that the ultimate responsibility is given to those who stand to benefit. In this case, the entire onchocerciasis elimination program kicked into overdrive when the communities themselves were given responsibility for dispensing and tracking the drugs used to treat the disease. (8 people found this helpful.)


Amazon Customer L. Wallen  5.0 out of 5 stars How global health partnerships can make a difference to ordinary people. Reviewed in the United States on February 22, 2021

This is the compelling history of the effort to control and eventually eliminate a horrific tropical disease that blinds millions of the absolute poorest people in the poorest parts of the world, notably Africa. Worse, it condemns them to a life of constant, unbearable itching that causes enormous suffering and renders a normal productive life impossible.

The first stage of the program, which proved to be highly successful in West Africa, was to prevent the blackfly from reproducing and transmitting the disease throughout an 11- country area. Then, a scientist at Merck discovered a drug that killed the microscopic worms in the body to stop the itching and the blindness (he won the Nobel Prize in 2015 for the discovery). And Merck made the unprecedented decision to donate the drug for as many who needed it as long as it was needed. This enabled expansion of the effort to all of Africa. But then came the seemingly insurmountable problem of how to get that little pill to the remotest areas of Africa.

Led by the World Bank and the World Health Organization, over 100 international partner organizations collaborated for more than 40 years on one of the largest development programs in history.

The ins and outs, the ups and downs of the massive program are chronicled by Bruce Benton who ran the Riverblindness program at the World Bank for 20 years. He concludes by offering a blueprint for multinational cooperation to tackle other diseases, an invaluable guide for the future of global health. Caution: if you are squeamish, skip the pages detailing how the disease is transmitted. (6 people found this helpful.)

Amazon Customer 5.0 out of 5 stars A must read for every public health student interested in Global Health. Reviewed in the United States on February 6, 2021

Riverblindness devastated vast areas in Africa but mostly affected poor and forgotten rural people. This neglected tropical disease in now almost eliminated.

Bruce Benton’s book narrates the journey of the control efforts and the role a partnership of passionate visionaries and communities played to assure that this scourge was tamed. It took many discoveries and innovations, but most of all persistence and commitment to tame the Lion’s Stare and the stigmatizing skin disease called onchocerciasis or Riverblindness.

In global health quick wins, low hanging fruit or bottle necks and short-term pilot projects are all too often the modus operandi. The book reminds us that we need long term commitments to make a real difference. (7 people found this helpful.)

Birger F. 5.0 out of 5 stars The crucial need for effective partnerships to address shared global challenges. Reviewed in the United States on February 8, 2021

Bruce Benton’s book provides an excellent, authoritative analysis of what it took to establish and maintain for decades the complex multi-sectoral partnership needed to combat Riverblindness, a pervasive neglected disease particularly prevalent in sub-Saharan Africa. It provides numerous valuable lessons for what it takes for UN agencies, donors, NGOs, pharmaceuticals, universities, governments and local communities to work together to achieve shared regional and global goals.

The Covid-19 pandemic is a stark reminder of the need for effective partnerships to deliver the type of vital regional and global public good functions needed to address challenges that no country can address alone. And the need for such partnerships — as well as the challenge of maintaining them — are growing in today’s globalized and multi-polar world, where nationalism is on the rise and the value of multilateralism is questioned.

The book should be required reading for people working on regional and global challenges where success depends on effective international cooperation. (6 people found this helpful.)


Margaret Carlson 5.0 out of 5 stars Art Matters . . .. Reviewed in the United States on February 22, 2021

One of the interesting parts of this book is the story of how an Alaska artist sculpted a bronze statue of a blind man being led by a child (a common scene in Africa where riverblindness is prevalent).

Six casts of this larger-than-life sculpture, appropriate for this largest intercountry health program in the world at the time, were placed around the U.S. and Europe at the headquarters of key partners in the disease elimination effort. The cool thing is that a work of art can serve as a better vehicle for a message to more people and for a much longer time than any press release or article. People will be looking at this “scene from the past” a hundred years from now.

I especially liked the photos of the sculptor working on it in his Juneau studio, and World Bank President Robert McNamara standing in front of the statue in the Bank’s atrium in Washington DC. (6 people found this helpful.)

Riverblindness in Africa: Taming the Lion’s Stare
Bruce  Benton (Guinea 1964–66)
Johns Hopkins University Press
December 2020
312 pages
$49.95 (hardcover), $37.49 (Kindle)



Leave a comment
  • Thank you so much, Bruce Benson, for writing this important research book. Thank you so much, Marian, for posting this with all the information and reviews. It should be required reading for all Peace Corps Staff, including staff in host countries.

  • Bruce,

    An extremely well done research on perhaps one of the most significance public health interventions in what is often called ‘the developing world’. Before Merck produced ‘ivermectin’, a tablet no larger than a baby aspirin, administered once yearly in most cases, millions of people were blinded every, most critically in Africa. Entire riverine villages had to be abandoned, accompanied by loss of agriculture and subsequent food products. When the World Bank did its initial evaluation of the outcome from ‘ivermectin’, millions of hectares of land had been returned to agriculture production.

    Great thanks for all the work you put in to this research project.

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