The international commitment to eliminate trachoma

Global debates about public health interventions to deal with infectious diseases use several key terms: control, elimination and eradication. The agreed definitions are:

• Control is the reduction in disease incidence, prevalence, intensity, morbidity or mortality (or a combination of these) to a locally acceptable level. Activities to maintain the reduction are required, for example, as used for diarrhoeal disease.
• Elimination of infection (interruption of transmission) implies that disease incidence has been reduced to zero or below the acceptable threshold, in a defined geographical area as a result of deliberate efforts. Continued measures to prevent re-establishment of transmission is required. Examples are measles, poliomyelitis.
• ‘Elimination as a public health problem’ is used only upon achievement of measurable targets for control set by countries. Trachoma’s target is elimination as a public health problem.
• Eradication is the permanent reduction to zero of the worldwide incidence of infection and further continued action is not required: for example, smallpox.

Which type of target is chosen depends on the effectiveness of available interventions, the availability of resources and the strength of overall commitment from society and government.

To eliminate trachoma as a public health problem, interventions have to contain both biological (disease) and operational (process) dimensions.

Global trachoma elimination

With this in mind, the strategy to eliminate trachoma as a public health problem has specific targets to attain. The plan is built on a framework of:

• Urgency to reduce the suffering of people affected by trachoma.
• Accountable ownership – countries lead their own elimination efforts and solicit coordination from donors and partners.
• Integration of trachoma activities at a local level with those for neglected tropical disease (NTDs), universal eye health, national health service development and/or water and sanitation programmes.
• Efficient, coordinated partnerships to scale up intervention and increase coverage within a country and globally across all affected countries.
• Tailoring of implementation to local data and knowledge.

As you listen to the conversation with Anthony Solomon, consider the local political factors and commitments, at both national and district levels, that are needed to take forward interventions for the elimination of trachoma as a public health problem. What are the possible challenges that need to be overcome?