Blinding trachoma, one of the oldest known infectious eye diseases, may be facing its end game. The world’s leading cause of preventable blindness, trachoma brings extraordinary human suffering and economic devastation to tens of millions of people, mostly women and children in poorer countries. Yet as a result of development and targeted interventions it is now limited to an estimated 59 countries, often affecting the poorest populations in Africa and Asia.
A new global strategic plan— 2020 INSight—created by an international coalition of partners lays out specific actions to take and milestones to meet that could lead to elimination of blinding trachoma by the year 2020. With World Sight Day set for Oct. 13 this year, there is no better time to focus on what is needed to reach this ambitious goal: country leadership, international coordination, logistical and planning support, and adequate funding.
An estimated 320 million people live in areas where they can be exposed to trachoma, a Neglected Tropical Disease. Repeated trachoma infections of the upper eyelid lead to scarring and inturned eyelashes, which rub on the cornea, and can eventually cause blindness. Trachoma blinds one person every 15 minutes and makes one person experience severe sight loss every four minutes. Over 8 million are in the final, painful stages of this eye disease and require surgery to prevent them from going blind.
The goal to eliminate blinding trachoma in less than nine years is, indeed, ambitious, but it is also achievable. The primary reason for hope is the World Health Organization -endorsed SAFE strategy. SAFE brings Surgery, Antibiotics, Facial cleanliness and Environmental improvement to the poorest communities where trachoma is most likely to be found. To implement SAFE, national governments and non-governmental organizations around the world are uniting like never before.
Over the last year, the International Trachoma Initiative worked with fellow partners in the International Coalition of Trachoma Control to create the global strategic plan 2020 INSight. The plan takes a hard look at where we are now, where we want to go over the next nine years, how we get there, and the cost and impact of finally eliminating blinding trachoma.
Mapping and assessing the magnitude of the disease is critical to defining areas that are priority for implementation of trachoma control efforts. About 1,115 districts in endemic countries have been surveyed in the last 12 years, but data must be gathered in at least 1,293 more districts to complete the picture.
We do know that nearly 110 million people live in areas where trachoma is confirmed to be endemic, and another 210 million live in districts where trachoma is suspected but no data are available to guide public health interventions.
The good news is that nine countries with trachoma have already reported achieving elimination targets. More than 80 percent of the burden of active trachoma is now concentrated in 14 countries, where immediate action is needed. Scaling up public health interventions described in the SAFE strategy, including antibiotic treatment with Zithromax, which is donated by Pfizer Inc., and improved access to water and sanitation, are the most crucial elements in the fight to stem transmission. Trachoma control programs must be under way by 2015 in affected countries to be sure that there is enough time to eliminate the disease by 2020.
2020 INSight lays out five guiding principles that provide a framework for making progress on the path to elimination: urgency for action and scale-up; accountable ownership by countries so they can integrate actions into the national health services; Integration so that trachoma focused efforts are aligned with activities for other NTDs, eye care and development strategies; efficient, coordinated partnerships with all stakeholders; and tailored interventions to meet local needs and context.
Delayed action will be costly. There is the human cost that occurs when vision loss or worse, blindness, leads to loss of social status, stigmatization and reclusion from society. There is the economic burden of trachoma on the lives of individuals, families, and communities that is enormous. Even conservative estimates suggest an annual loss of productivity due to trachoma between $3 billion and $6 billion. Eliminating blinding trachoma will clearly bring benefits at the human and economic level.
What will it cost to achieve that elimination goal? 2020 INSight calculates that an estimated $748 million in funding is needed to fully implement the SAFE strategy to prevent and treat blinding trachoma. Eliminating the disease in Africa alone would boost the continent’s GDP 20-30 percentage points based on conservative annual productivity loss estimates. A dollar spent on trachoma control is not only well spent but yields personal and economic benefits to individuals, communities, and countries. As 2020 INSight states, “The total cost is relatively small, the potential for impact enormous.”
Those of us involved in the fight against trachoma are hopeful. Trachoma was named as one of five priority diseases for the VISION 2020 “The Right to Sight” global initiative for the elimination of avoidable blindness launched by WHO and the International Agency for the Prevention of Blindness back in 1999. As we recognize World Sight Day 2011, there has been much great news to report over the past 12 years. If the global community uses our new strategic plan to focus time, attention and funding, trachoma doesn’t stand a chance.
• Haddad is the director of the International Trachoma Initiative