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

INTRODUCTION: 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. PROGRAM DESCRIPTION: 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. LESSONS LEARNED: 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. CONCLUSIONS: 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.