The ancient Greek myth of Sisyphus, condemned by Zeus to endlessly push a boulder uphill only for it to roll back down, has become a powerful metaphor for modern global health challenges, particularly the fight against neglected tropical diseases (NTDs). Researchers studying NTDs say the story reflects the persistent struggle to eliminate infections that disproportionately affect poor populations in low-income countries. Though less deadly than diseases like HIV, malaria and tuberculosis, NTDs cause chronic pain, disability, disfigurement and social stigma, often leading to severe economic hardship.
For more than five decades, global health experts have worked to eradicate diseases such as onchocerciasis (river blindness) and lymphatic filariasis (elephantiasis). Efforts have focused on controlling insect vectors like black flies and mosquitoes, alongside mass drug administration campaigns in affected communities.
However, recent funding cuts have raised alarm. The Trump administration’s decision to defund the U.S. Agency for International Development (USAID) in 2025 has disrupted ongoing interventions, leaving disease elimination efforts at risk. Researchers warn that halting treatment midway is akin to abandoning the boulder before reaching the summit.
“Inevitably, the boulder will roll backward, undoing decades and billions of dollars of work,” the researchers noted, warning of a resurgence in infections if treatment programmes are not sustained.
Lymphatic filariasis and onchocerciasis are ancient diseases, with evidence of the former dating back to 2000 B.C., as suggested by an Egyptian statue of Pharaoh Mentuhotep II. Both are caused by parasitic worms that can live for years in the human body, causing severe complications.
In lymphatic filariasis, worms inhabit the lymphatic system, leading to extreme swelling of limbs or the scrotum. Onchocerciasis, by contrast, involves worms that form nodules under the skin, with larvae capable of migrating to the eyes and causing inflammation that can result in blindness.
Global elimination campaigns, coordinated by the World Health Organization since 1974 for onchocerciasis and 2000 for lymphatic filariasis, have relied heavily on pharmaceutical donations. Drugs such as ivermectin, provided free by Merck, as well as albendazole and diethylcarbamazine citrate donated by GlaxoSmithKline and Eisai, have been central to these efforts.
These initiatives have achieved significant progress. By 2024, approximately 871 million people no longer required preventive treatment for lymphatic filariasis, with 21 countries eliminating the disease. Five countries have also succeeded in eliminating onchocerciasis.
Despite these gains, experts caution that the job remains incomplete. The suspension of over 40 drug distribution campaigns in 2025, affecting more than 140 million people, alongside reduced global funding threatens to reverse hard-won progress. Researchers stress that without sustained commitment, “millions of people will be hurt by the boulder rolling back down.”
