Advanced schistosomiasis medication shows impact of African input

The development of Arpraziquantel to treat children of all ages for schistosomiasis which is endemic in many parts of Africa is a clear demonstration that to eliminate neglected tropical diseases, collaboration between African and international experts is essential.

In many parts of Africa, a child can go to school, drink clean water at home, follow public health advice and still be exposed to a disease that quietly shapes their health for years.

I have seen this at first-hand while working with communities where everyday activities like playing, washing, or collecting water carry hidden health risks that families cannot reasonably avoid or detect.

Schistosomiasis, a parasitic disease transmitted through contaminated freshwater, affects millions of African children. It undermines health, learning, and long-term development –yet it is entirely preventable and treatable.

Across Africa, progress against schistosomiasis and other neglected tropical diseases has never come from a single actor or a single breakthrough. It has been built through sustained partnership between governments, communities, researchers, donors, and pharmaceutical companies working steadily against diseases that affect millions of people yet too often remain out of sight.

For decades, large-scale medical aid programs have formed the backbone of national schistosomiasis control efforts. Through the sustained free distribution of Praziquantel (used to treat infections caused by Schistosoma worms, which enter the body through skin that has come into contact with contaminated water) led by the American pharmaceutical company Merck Group in partnership with governments and the World Health Organisation, more than 800m people have been treated, and over 2bn tablets have been provided since 2007.

These programs have delivered more than medicine. They have strengthened delivery systems, trained health workers, and embedded neglected tropical disease control into national public health infrastructure.

Custom built solutions

But, as these programs expanded, they revealed both their success and their limits. While school-aged children could be reached at scale, preschool-aged children were largely left behind, not because they were less vulnerable, but because the available medicine was not designed for them.

Standard Praziquantel tablets are large, bitter, and difficult for young children to swallow, and dosing them safely for very small bodies is challenging in community settings. As a result, some of the children most at risk of long-term harm were excluded from treatment simply because no appropriate option existed.

That gap was a signal.  It showed that if Africa were to move from controlling schistosomiasis to eliminating it, solutions would have to be designed for all children, from the very start of life. Addressing that challenge required a shift—from adapting existing tools to deliberately creating new ones.

After more than a decade of collaboration through the Pediatric Praziquantel Consortium, a child-friendly formulation—Arpraziquantel—was developed specifically for children aged three months to six years.

From the outset, it was conceived not as a commercial product, but as a public health tool. The decision to offer it at cost was deliberate: to support national programs, not private markets, and to ensure that price would not become another barrier between innovation and access.

African engagement has been central throughout the process. The medicine was designed with endemic-country realities in mind, developed through international collaboration, and prepared for production by African manufacturers. It meets the highest international standards, having received a positive scientific opinion from the European Medicines Agency and WHO prequalification.

This achievement matters beyond schistosomiasis. It demonstrates that Africa can help define problems, co-create solutions, and deliver medicines that meet global expectations rather than waiting for innovation to arrive from elsewhere.

How Arpraziquantel is being made available is as important as how it was developed. By offering the paediatric formulation at cost, the aim is to accelerate uptake within national programs and reinforce its role as a public health tool rather than a commercial product.

Combined with donated Praziquantel for school-aged children, countries now have the means to protect children earlier and for longer—supporting a life-course approach to schistosomiasis control and bringing elimination within reach.

But medicines alone do not eliminate disease. Whether this next phase succeeds depends on how effectively new tools are integrated into national systems.

Uneven access

Arpraziquantel has been submitted for registration in several African countries so that children on the continent can benefit first from an innovation developed for them. Yet regulatory timelines and requirements vary widely, creating uneven access even when safe, effective, and affordable medicines are available.

This challenge is not unique to schistosomiasis. Across neglected tropical diseases, aid programs—supported by multiple pharmaceutical companies working alongside governments and partners—have shown their value not only in reducing disease burden, but in strengthening health systems and building delivery platforms that serve broader public health goals.

The results are real. In recent years, several neglected tropical diseases have been eliminated in multiple countries, and the number of people requiring treatment continues to fall. These gains show what sustained partnership can achieve when commitment is maintained through the hardest stages of elimination.

History, however, offers a caution. Progress has too often stalled when attention faded just short of the finish line, allowing diseases to rebound even when effective tools were available. Schistosomiasis now stands at such an inflection point.

To move decisively from control to elimination, political and health leaders must act with urgency, harmonising regulatory processes, integrating paediatric Praziquantel into national NTD master plans and essential medicines lists, and investing in regional regulatory and supply-chain capacity so African manufacturing can reliably serve African needs.

Arpraziquantel is more than a new medicine. It is the result of a long-term partnership, a response to an unmet need, and a test of whether systems can keep pace with innovation.

Africa is no longer only at the centre of the schistosomiasis burden; it is increasingly at the centre of the solution. The task now is to ensure that this momentum is sustained, and that no child is left unprotected from a disease we already know how to prevent and treat.

Dr. Karim Bendhaou is an Algerian-Tunisian physician and pharmaceutical executive who serves as Head of the Africa Bureau and Head of Africa Affairs at Merck Group