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The international commitment to eliminate trachoma

Dr Anthony Solomon from the WHO discusses how the GET2020 alliance works collaboratively to guide international efforts to end blinding trachoma.
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Dr Patel: Hello and welcome to this session. Today, we’re joined by Dr. Anthony Solomon, who is the medical officer for trachoma elimination programme at the World Health Organization. Welcome, Dr. Solomon. Perhaps we can start by understanding why was there a need for an international commitment?
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Dr Solomon: I think we know what to do for trachoma. There are four things. Surgery, antibiotics, facial cleanliness, and environmental improvement. But an international commitment allows WHO to help give technical advice to member states on how those things should be implemented and to coordinate partners across the global stage. Some of those things, as you know, require cooperation between countries and between a number of different actors. Having that international commitment is important to allow that coordination to proceed.
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Dr Patel: What is the global elimination programme for trachoma and what do we mean by elimination?
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Dr Solomon: For trachoma, the agreed international goal is elimination as a public health problem by 2020. That means that our target is to ensure that by the end of December 2020, we’ve reduced the prevalence of trachoma to a point at which it’s no longer an important cause of new blindness or visual impairment in adults and that it’s no longer creating a risk for the current generation of children to go blind later in life in any population. It’s important to remember that elimination of trachoma as a public health problem doesn’t require a complete interruption of transmission of the infection that causes trachoma.
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Even though we know that interruption of transmission is possible in certain circumstances, and in fact, it’s been achieved in many rich countries like the UK and the US that used to have big trachoma problems.
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Dr Patel: Clearly, we’re going to have quite a number of players within this trachoma programme. Who are the key stakeholders and what are their roles?
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Dr Solomon: The stakeholders, as a group, form together as the WHO alliance for the global elimination of trachoma by 2020 or the GET 2020 alliance. It’s the group of organizations fighting to achieve trachoma elimination. The alliance includes endemic member states, non-governmental organizations, donors, and academics. It meets annually as a group to review and discuss progress, but the alliance is also incredibly active in a very collaborative way in between those meetings. Ministries of health of member states lead and implement their respective national elimination programmes. Academics help to generate and evaluate evidence for best practice. Donors donate. WHO forms the secretariat and provides global leadership, coordination, and monitoring. NGOs, I think, can do all of those things.
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They can implement, they can generate evidence, they can provide and channel resources, coordinate, monitor, give input on policy, and so on. I think the best NGOs try and fill the gaps that they find in a very flexible way, gluing local efforts together. We’re fortunate to have a number of those excellent NGO partners in trachoma. And the combined effort of all of those actors is helping to drive the global programme forward, now, in a very dynamic way.
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Dr Patel: Thank you very much and thank you for joining us in this session.
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?
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Eliminating Trachoma

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