While much has been achieved in the treatment and progress toward elimination of onchocerciasis, a number of additional challenges remain that Merck and our partners are actively addressing.

To ensure continued supply of MECTIZAN^® (ivermectin) to support the activities of other program partners, Merck commits to continue to donate as much MECTIZAN as necessary for the elimination of river blindness globally and the elimination of lymphatic filariasis (LF) in African countries where the diseases coexist.

We also recognize the need to strengthen national capacity in all endemic countries to allow for integration of community-directed treatment with ivermectin (CDTI) into a country's healthcare system and co-implementation of other health interventions. Increasing competition between health programs for limited resources creates further pressure. Our ongoing support of African river blindness programs via the World Bank's trust fund will help support CDTI activities.

Beyond river blindness and LF, the MECTIZAN Donation Program is a key component of the growing trend towards integrated programs to address Neglected Tropical Diseases (NTDs.) In fact, the integration of onchocerciasis and lymphatic filariasis efforts via the MECTIZAN Donation Program, which began in 1998, set the foundation for many of these efforts, and Merck will remain engaged with key stakeholders to help with integration programs, where feasible.

As a result of these activities by Merck and the collaboration and contributions of the wide range of committed partners, we expect to achieve the following milestones in the years ahead:

• By 2012, transmission of river blindness in the Americas is expected to be halted, allowing treatment with MECTIZAN to be stopped in the Western Hemisphere.
• By 2015, program partners plan to achieve 100 percent geographic coverage of treatment with MECTIZAN in all river blindness-affected areas.
• We expect elimination of lymphatic filariasis as a public health problem by the year 2020.