Mass ivermectin program drastically reduces scabies in Pacific Islands

A world’s first scabies control program has drastically reduced cases of the highly contagious parasitic skin disease in the Solomon Islands and Fiji, according to a new study.

The research, led by the World Scabies Program (WSP) at Murdoch Children’s Research Institute (MCRI) and published in Nature Health, found that the first national mass drug administration (MDA) program of its kind led to substantial and sustained decreases in scabies and associated skin infections across the Pacific nations.

The MDA involved ivermectin, a safe and widely used antiparasitic treatment for neglected tropical diseases.

MCRI Dr. Susanna Lake said the results showed that scabies could be controlled through coordinated national action. “Our findings demonstrate for the first time that scabies, a disease that causes enormous suffering for children and families, can be significantly reduced when effective treatment is delivered at scale,” she said.

The MDA was implemented by the Ministries of Health and Medical Services in Solomon Islands and Fiji with support from the WSP, an initiative of MCRI that includes researchers from the Kirby Institute at UNSW Sydney. WSP was established in 2019 to translate research evidence into public health action for scabies control.

Sharp declines across both countries

The study found that after two annual rounds of MDA were delivered to the entire population of Solomon Islands, scabies prevalence fell from 23.2% to 3.9%. Rates of impetigo, a skin infection, declined from 9.2% to 1.6% during the same period.

In Fiji, where one round of MDA was rolled out nationwide, scabies prevalence almost halved from 6.2% to 3.4%, while impetigo rates dropped from 4.3% to 1.2% within 12 months of treatment.

More than 2.5 million doses of ivermectin were provided under the MDA program. Scabies and impetigo decreased across all age groups in both countries, including young children, who experience the highest burden of disease. The prevalence of moderate-to-severe scabies also declined substantially.

A neglected disease with lasting harm

Scabies, an endemic disease in Pacific Island countries, causes intense itching and skin damage. It can lead to secondary skin infections caused by Strep A bacteria and is linked to serious long-term complications, including kidney and potentially rheumatic heart disease.

Causing more than 600 million cases globally each year, scabies was recognized by the World Health Organization (WHO) as a neglected tropical disease in 2017, prompting increased global focus on effective control strategies.

MCRI Professor Andrew Steer said the findings were particularly important for countries with high scabies rates and limited health system resources.

“Scabies has long been neglected, despite its links to serious infections and long-term disease,” he said. “Our research provides critical evidence to inform national and international policy and supports the broader integration of scabies control into public health and neglected tropical disease programs.”

Coverage gaps remain in young children

Professor Steer said achieving high coverage in urban areas required multiple strategies to improve access, including delivering MDA through workplaces, schools and community gatherings.

He said further measures were needed to address the ongoing burden of scabies in young children, with prevalence still above 10% among those younger than 5 despite MDA treatment.

The results come as a scabies control guide produced by the WHO, which includes contributions from Lake, Steer and Dr. Daniel Engelman, has been published.

The guide outlines how to implement scabies control programs, including how to estimate disease burden, deliver control measures and establish effective monitoring and evaluation systems.

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