In a significant public health achievement, Guinea has eliminated sleeping sickness — human African trypanosomiasis — as a public health concern, marking the country’s first victory over a neglected tropical disease. The journey to this milestone was marked by both innovative medical advances and considerable challenges.
The disease, transmitted by tsetse flies, had resurged along Guinea’s coast in the 1990s due to increased human activity in mangrove areas. Early treatment options were grim. Doctors relied on melarsoprol, an arsenic-based drug that killed one in twenty patients. The situation improved in 2009 with the introduction of NECT (nifurtimox-eflornithine combination therapy), a safer but cumbersome treatment requiring extended hospitalization.
Progress was temporarily halted during the Ebola outbreak (2013-2015) and later by COVID-19, but Guinea’s health authorities adapted by implementing door-to-door screening and deploying innovative tsetse fly traps.
DNDi, the Drugs for Neglected Diseases initiative, played a crucial role in transforming treatment options. With support from UK International Aid, which contributed over £53 million from 2019, DNDi worked alongside Guinea’s National Control Program and WHO to develop and implement new treatments. Their breakthrough came with the rediscovery of fexinidazole in their drug library, which they developed into an effective oral treatment that could be taken at home.
The country’s success relied on three key strategies: widespread testing campaigns, deployment of 15,000 blue “flag” traps annually to control tsetse flies, and the introduction of more effective, safer medications. By 2024, cases had dropped to approximately 12 per year, well below WHO’s threshold for elimination as a public health problem.
“Just thinking of melarsoprol gave us shivers. The injections were painful,” Dr. Wilfried Mutombo told Metro, reflecting on the earlier days of treatment. He is now the head of clinical operations for DNDi in the Democratic Republic of the Congo. “Unfortunately I lost two patients this way when I worked in the village.”
Looking ahead, researchers are developing acoziborole, a single-dose oral treatment that could be available by 2026, bringing hope for complete elimination of disease transmission by 2030.
Read more about this triumph in this article by Luke Alsford in the Metro: How a country wiped out sleeping sickness – the ‘frightening’ disease that requires a deadly drug to treat
… and this press release from the WHO: Guinea eliminates human African trypanosomiasis as a public health problem
Watch this video from DNDi to learn more:
In January 2025 Guinea announced that it had eliminated sleeping sickness as a public health problem. This is the first disease that the country can claim to have eliminated and a major milestone in the Africa-wide campaign to eliminate sleeping sickness.
The National Sleeping Sickness Programme in Guinea and its international partners – among them the French National Research Institute for Sustainable Development (IRD), the Drugs for Neglected Diseases initiative (DNDi), and the Institute Pasteur – have used all the tools at their disposal to achieve this milestone: small ‘tiny traps’ that dot the mangrove coasts of Guinea, rapid diagnostic tests, and revolutionary new medicines that are changing how doctors treat their patients.
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