# National control programs for scabies: Experiences from Fiji and Solomon Islands

## TL;DR

This paper documents the first national scabies control programs in Fiji and Solomon Islands using ivermectin, highlighting lessons learned and challenges faced during implementation.

## Contribution

The paper provides novel insights from the first real-world national scabies mass drug administration programs in Fiji and Solomon Islands.

## Key findings

- National scabies control programs using ivermectin can be implemented in endemic areas.
- Challenges include local misconceptions, the impact of the COVID-19 pandemic, and reaching urban populations.
- Integration with other health programs improves affordability and acceptability of scabies control efforts.

## Abstract

The most recent World Health Organization roadmap for neglected tropical diseases sets a target for countries to control scabies through several interventions, including mass drug administration in endemic areas where prevalence is 10% or greater using oral ivermectin and topical scabicides. This report documents the experiences and lessons learned from the first two countries in the world, Fiji and Solomon Islands, to implement national ivermectin-based mass drug administration for scabies. By identifying key challenges, this article aims to inform the global community as efforts are established to reach these targets.

The World Scabies Program was established by the Murdoch Children’s Research Institute in 2019, with the Kirby Institute at the University of New South Wales and the Ministries of Health in Fiji and Solomon Islands as key partners. The Program aims to translate research findings from studies of ivermectin-based mass drug administration into national scabies control programs in Fiji and Solomon Islands.

The Program adapted to meet several challenges. The COVID-19 pandemic restricted travel by Program staff, necessitating greater local autonomy. Addressing local misconceptions of scabies improves uptake and health worker motivation. Integrating with other neglected tropical diseases and health programs improved affordability and acceptability of the Program. New strategies are required to reach urban populations, and pragmatic dosing options across all ages would increase feasibility.

The implementation of scabies mass drug administration in highly endemic areas has the potential to lead to substantial improvements in health outcomes if large populations are reached. The impact of the mass drug administration campaigns in Fiji and Solomon Islands remains to be fully evaluated, but we have already learnt critical lessons to inform future efforts towards scabies control.

Human scabies is a highly prevalent skin disease, with an estimated global prevalence of over 200 million people, with an increased burden in tropical regions, particularly in children and young adults, and in areas with poor socioeconomic conditions. Persistently high scabies prevalence has long-term health and social consequences for individuals and their communities, and financial consequences to health systems in managing the complications of scabies. The most recent WHO roadmap for NTDs sets a target for countries to control scabies through a number of interventions including mass drug administration (MDA, also called preventive chemotherapy) in endemic areas, where prevalence is 10% or greater, using oral ivermectin and topical scabicides. This report aims to contribute to the overall evidence for public health control of scabies by documenting the experiences and lessons learned from the first two countries in the world, Fiji and Solomon Islands, to implement national ivermectin-based MDA for scabies in a non-research setting.