1. South Korea successfully implemented a sustained, nation-wide deworming campaign that was jump-started in 1969 with a three-year massive assistance program from the Overseas Technical Cooperation Agency (OTCA) of Japan, culminating in the 1997 WHO declaration that the country is essentially worm-free. This report presents objectives and achievements of this successful national deworming campaign; backgrounds and needs for the campaign; strategy and system employed; details of implementation; and assessment of impacts of the deworming campaign, from both epidemiological and economic perspectives.

2. Up until the 1960s before launching of the campaign, intestinal worm infection was endemic to all area of Korea, and most individuals in the population carried several different kinds of intestinal worms. Roundworms, whipworms, hookworms, and tapeworms were the most prevalent parasite species. In addition, many people suffered from clonorchiasis and infection by other types of worms. The Korean parasitologists and government officials were acutely aware of the health consequences of the intestinal worm infection, and of the likely negative impacts on educational and economic outcomes for those infected.

3. Leading parasitologists established the Korea Association for Parasite Eradication in 1964 with the goal of reducing the incidence of intestinal worm infection to zero within 10 years. In retrospect, their initial goal was overly ambitious, and it took the Association five years to lay down the necessary groundwork, and to sustain a sensible strategy for comprehensive school-based examinations and treatments for the next two and a half decades. The combined efforts by the Association and the government dramatically reduced the worm infection rates until it was decided that the comprehensive examination and treatment regimen might be safely ceased in 1995. Population dynamics of intestinal worms imply the existence of a “break point”. If a deworming campaign is prematurely ceased before the infection rate reaches the break point, the infection rate is bound to shoot back up to its former level of prevalence. If the infection rate is brought below the point, however, then the worm population should remain under check. That the national worm infection rates have remained at negligible levels for close to two decades since the halt of the massive intervention in 1995, suggests that the national deworming campaign indeed succeeded in overreaching this break point. Results from epidemiological assessments are indeed in line with this view.

4. This remarkable feat was achieved at modest costs to the public purse. Perhaps this had to do with the fact that the leading agency in charge of the national deworming campaign, KAPE, was a voluntary association of accomplished professionals dedicated to the mission of national deworming. The overhead at the Association was less than one third of the outlay, even including costs for construction of testing facilities. The Association was nimble and entrepreneurial. The Korean deworming campaign was the world’s first mass deworming campaign to adopt the newly developed, much cheaper, Kato?s stool examination method. The parasitologists at KAPE also worked closely with a local pharmaceutical company to develop and test effective treatments.
This collaboration resulted in effective medications optimized for the mixture of worms usually found in the host in the country available for the deworming campaignat a fraction of the financial burden it might have cost otherwise. These innovations undoubtedly saved taxpayers’ money, and helped sustain the national campaign for as long as it was needed.

5. To study long-term impacts of this sustained deworming campaign on educational attainment and productivity gains on the part of beneficiaries, we match individual workers from the 2000 Korean Census with the prevailing worm infection rate in the region where the worker attended middle school. The empirical strategy is inspired by the series of investigations by Hoyt Bleakley in his study of the long-term impacts of deworming in the American South. The results from our empirical analysis suggest substantial gains in years of schooling and other indicators of educational attainment,and also gains in earnings (and hence presumed gains in productivity).

6. Perhaps the three most important lessons that we may draw from this study of the Korean national deworming campaign are (a) that sustained, national deworming is a highly sensible public investment with the potential of huge returns, (b) that comprehensive school-based examination and treatment is a sound strategy, and (c) that to maximize the return for the public investment it is crucial that such a campaign be sustained long enough, until the campaign breaches the “break point”.

7. Sustaining a huge, national operation over a long period that a national campaign may require, is not an easy task in any society. It is particularly more difficult and challenging to developing countries that are struggling with poor government finance,inadequate institutions, and lack of quality human capital in critical mass among other things. The fact that Korea was able to pull this off should be an encouragement to them. For those considering design and implementation of a similar comprehensive national deworming strategy, we offer the following practical observations based on the Korean experiences: (a) an integrated legal foundation is essential for coordination among multiple stakeholders including various government ministries and local government authorities, as well as to sustain the momentum, (b) an independent body,like the KAPE, formed by accomplished and dedicated practitioners, should bring vitality and necessary agility, saving costs and helping sustain the momentum, (c) it is important that the examination and treatment regime be accompanied by rigorous,scientific efforts to monitor the progress of the campaign, so that the results might be deployed for on-going assessment and public awareness campaigns, and (d) efforts should be made to maximize leverage from opportunities to collaborate with donors and technical cooperation, in the form of policy consultation and manpower training, may prove to be as important, if not more, as in-kind aid or financing.

Summary


Chapter 1
Objectives and Achievements


Chapter 2
Backgrounds and Needs


Chapter 3
Strategy and System


Chapter 4
1. Details in the Implementation of the National Strategy
2. Educational Campaigns for the Students and the Public
3. Sanitation Improvement
4. Legal Foundation for the Government-KAPE Cooperation for Deworming


Chapter 5

Epidemiological Assessment


Chapter 6

Assessment of Long-term Socio-economic Impacts
1. Overview of the Assessment
2. Identifying Success Factors
3. Estimating Long-term Impacts of the Deworming Campaign on Education and Earning
Outcomes


Chapter 7
Implications for Developing Countries


References·