Historical perspective: Revisiting the St. Lucia Project, a multi-year comparison trial of schistosomiasis control strategies

In 1965, the government of St. Lucia and the Rockefeller Foundation undertook what became a sixteen-year project to determine the optimal strategy for controlling locally-endemic schistosomiasis mansoni. Many of the world’s leading researchers on schistosomiasis control participated in the project, including experts in epidemiology, snail ecology, water and sanitation, social mobilization, clinical trials, immunology, and health economics. In the process, they brought infection levels in the new island nation to an impressive and steady low. Now fifty years later, the island has maintained its control of the parasite and may be on the cusp of achieving national Schistosoma mansoni elimination status. There are many other countries still fighting endemic schistosomiasis, and for them, achieving elimination might seem an elusive goal. However, the research evidence from the St. Lucia project, as documented in its nearly 140 research publications and as summarized in book form by Peter Jordan in 1985 [1], provides many lessons that can be applied to countries battling Schistosoma transmission today (Box 1). For readers interested in the details of study design and the full results of the trials, we have included supplemental S1 and S2 Files at the end of this review to provide searchable listings of the many scientific reports published by the Project.