Leadership from experience: America takes a front seat to tackle ancient disease

05 Dec 2017 
by Tim Jesudason
Tim Jesudason, International Coalition for Trachoma Control

Many people in the United States have never heard of trachoma, an ancient eye disease that can lead to irreversible blindness if not treated. It is a disease that thrives in areas where water, sanitation and hygiene are poor and disproportionately affects the world's most marginalized and impoverished communities. For most Americans, it is a disease that they will not come into contact with or ever meet anybody affected by it. But this has not always been the case. In fact, in 1897 trachoma became “the first disease to be classified as a loathsome or dangerous contagious disease by the U.S. government”.

Trachoma infection often starts in childhood or infancy. Repeated infection causes the upper eyelid to turn inwards, so that the eyelashes rub on the eyeball, resulting in intense pain and leading to irreversible blindness. There was so much anxiety about the disease that in 1905 the United States mandated all immigrants wishing to enter must undergo a trachoma examination at entry points, such as Ellis Island. Those who were found with trachoma infection were then deported back to the country they arrived from. 

Former US President Jimmy Carter has not forgotten the days when trachoma threatened his community in Georgia. At an event in 2013, he reminisced about being taught the importance of facial cleanliness to prevent being infected. Little did he know that this simple message of facial hygiene that his mother taught him would later become a pillar in a global strategy to eliminate the disease by 2020.

Much has changed since President Carter was washing his face to prevent trachoma. Improved sanitation and environmental conditions contributed to the disease being eliminated in the United States in the 1970s. Despite this, both President Carter and the United States have remained strong leaders in the fight to eliminate trachoma globally by the year 2020.

Joint funding from the United States and United Kingdom allowed 53 organizations, including 30 ministries of health, to conduct the world's largest infectious disease survey ever, the Global Trachoma Mapping Project. This helped to identify exactly where the world's trachoma endemic areas are and is now informing efforts to treat trachoma at an unprecedented scale.   

Photo: RTI ENVISION ProjectThe trachoma elimination strategy, known as the SAFE Strategy, has four components; (1) provide surgery to treat trichiasis, the late blinding stage of trachoma; (2) distribute antibiotics to communities that are endemic; (3) educate communities about facial cleanliness; and (4) make environmental improvements so that people have access to clean water and basic sanitation.

This strategy was adopted by the World Health Organization in 1996, and is being implemented by trachoma endemic countries with support from the International Coalition for Trachoma Control, a multi-stakeholder coalition of non-governmental organizations, donors and academic organizations working to support national programs. 

Investment and leadership from USAID and US based non-governmental organizations has contributed to a record-breaking 260,000 surgeries being conducted in 2016, 85 million people receiving antibiotics to treat infection as well as new programs to ensure communities have access to clean water and understand the relationship between good hygiene and good health.

This is already having a significant impact. Global efforts have resulted in five countries (Oman, Mexico, Morocco, Cambodia and the Lao People's Democratic Republic) successfully eliminating the disease, and the number of people at risk from the disease has dropped from 325 million in 2011 to 182 million today. 

Although trachoma has been relegated to the US history books, it is still a very real challenge facing many families in remote communities around the world today. Eliminating trachoma will have an enormous and immediate benefit for the people it affects, and it will significantly contribute to the achievement of the Sustainable Development Goals.

We have the strategy to beat trachoma and the time to do it is now!