In June 2022, the government, in partnership with the World Scabies Program, launched an ambitious initiative to roll out the anti-parasitic drug ivermectin to the entire country – just over 700,000 people across hundreds of islands and atolls. Now the Solomons are in the throes of the second round of mass treatment.
These programs, known in global health jargon as 'mass drug administration' (MDA), are not uncommon; the approach has been used to tackle conditions ranging from elephantiasis to trachoma, also known as the 'thorn disease'.
But the Solomon Islands were the first to start a nationwide MDA against scabies, building on the success of smaller studies in the Pacific, where the disease is very common.
“We conducted a survey in 2021 and found that scabies is so widespread that it is endemic,” Oliver Sokana, member of the tropical diseases department of the Solomon Islands Ministry of Health and Medical Services, told the Telegraph. “MDA is the first phase in controlling the spread of the infection.”
He added that the disease is linked to poverty and overcrowded living conditions, plus poor hygiene and sanitation – problems that have persisted for generations.
“I remember often suffering from scabies as a boy,” says Mr Sokana. “It is now a priority for the government to address this.”
A notorious 'pandemic' drug
In the first round, it took six months and hundreds of health workers to deliver two tablets, one week apart, to people in all ten provinces. In some places, health workers brought close-knit communities together in one room to distribute the medicines, in others they went door to door.
A second MDA round was launched in March to maximize coverage; the goal is to reduce the prevalence of scabies to less than five percent.
“The goal is to get to a manageable level so that if someone gets scabies, they can get treated and stay treated,” said Dr. Lake. She added that the mite – which spreads through prolonged skin contact – thrives in crowded classrooms and playgrounds.
“Right now, if you are a child in a remote village and your parents make the effort to take you to the nearest clinic… you can get treatment, come home, go back to school. The next day they could easily get scabies again from their classmates.
“That's why we want to treat everyone at the same time, to eliminate it completely,” said Dr. Lake.
The program uses ivermectin – a drug that became infamous after it was proposed as an alternative treatment against the coronavirus during the pandemic.
But while it is not at all effective against Covid-19, it is extremely good at killing parasites; after two tablets the mites and their eggs are destroyed. The tiny creatures cannot survive without a human host, meaning the program effectively wipes out the reservoir of disease.
“The initial dose kills the mites,” said Dr. Lake. “But it doesn't penetrate the eggs so we give a second treatment seven days later, once the eggs hatch, to make sure none are left.”