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• W2279136613 abstract "The words eradication, elimination and control have been regularly defined in attempts to avoid inappropriate use of terminology while addressing the realities and challenges of public health programmes. Whitty has recently outlined the dangers of raising expectations in the face of political, financial, biological and logistical efforts of eradication or elimination programmes, emphasising these risks in search of a holy grail. Bockarie et al. noted five categories that defined the elimination or endgame challenges—biological, sociogeographic, logistic, strategic and technical—providing examples from current programmes. These have created significant strategic and resource impediments to progress in implementation, requiring changes in approach often with significant financial implications. A variety of strategies are used to reduce incidence and prevalence of infectious diseases: vaccination (smallpox, polio, measles), chemotherapy (onchocerciasis, lymphatic filariasis, schistosomiasis), vector control, (onchocerciasis, malaria, schistosomiasis) and provision of improved clean water and sanitation (trachoma, guinea worm, soil transmitted helminths, schistosomiasis). Such strategies are more effective when combined, for example, chemotherapy, vector control and behaviour change, thereby achieving proportionately greater and more rapid impact on transmission. Eradication as a concept is specifically defined as a reduction to zero global incidence of a specific pathogen, not a disease, which results from such an infection. This represents a crucial distinction—the words disease and infection are often used interchangeably but incorrectly. Even WHO reporting recently on the yaws programme in India entitled their publication ‘Eradication of yaws in India.’ Thus, even WHO are unable to consistently use correct terminology. Another example is the call for the eradication of malaria. However, eradication is defined as the removal from the planet of a specific infection; raising the question, which of the five human species of Plasmodium is to be targeted? This is yet to be specified. If an organism, such as the smallpox virus, is maintained in the laboratory then the infection is considered eradicated but it is not extinct. In the case of smallpox, the virus was maintained in the USA and the Soviet Union (Russia). A global certification process is required for those organisms targeted for eradication and a Declaration of Global Eradication is required from WHO. For Dracunculiasis (guineawormdisease), an independent body, the International Commission for the Certification of Dracunculiasis Eradication,was established to oversee the process to conformwith WHO’s legal obligations through World Health Assembly resolutions. Members are appointed by the Director General of WHO to assess the validity of the evidence that transmission of Dracunculus medinensis has been achieved in previously endemic countries. Countries with no evidence of infection are required to submit a statement that transmission does not take place. Countries that have been certified following scrutiny of the evidence presented require a visit to validate the information provided toWHO by an independent certification team. If certified, countries are required to maintain vigilance that they remain transmission free through continued surveillance and maintenance of a rumour register. Any rumour should be investigated within 24 hours of being reported and the national reward system to do this should be continued. The responsibility for ‘proving a negative’ is a significant one if the target is global eradication or country or regional elimination. Evidence must be robust with regular assessments and surveillance for at least 3 years after the interventions have stopped. The smallpox programme in its final stages introduced a global reward of US$1000 to report any suspected case. Such a system will need to be established for guinea worm when all countries have been certified free of transmission. To date, some 194 countries and territories have been certified free of transmission. There remain four Guinea worm endemic countries: Chad, Ethiopia, Mali and South Sudan. The challenges of the endgame and the costs of driving transmission to zero country incidence are exemplified in high unit costs per case detected, in remote settings where" @default.
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• W2279136613 date "2015-08-26" @default.
• W2279136613 modified "2023-09-23" @default.
• W2279136613 title "Eradication and elimination: facing the challenges, tempering expectations" @default.
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• W2279136613 doi "https://doi.org/10.1093/inthealth/ihv050" @default.
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