International Coalition for Trachoma Control

Fiji has been validated by the World Health Organization (WHO) as having eliminated trachoma as a public health problem. It is the 26th country globally and the seventh in the WHO Western Pacific Region to achieve this milestone.

Trachoma was reported in Fiji as early as the 1930s through medical records of several physicians, and was found to be prevalent in at least part of the country through a community-based survey of eye diseases conducted in 1955. However, hospital data in the following decades suggested that trachoma was rare.

To better understand whether trachoma was a public health problem, Fiji conducted trachoma rapid assessments in 2007, which indicated that trachoma could still be a public health problem in the Western Division. This prompted formal population-based surveys in 2012, which found that the prevalence of signs of active trachoma in children, and of trachomatous trichiasis (TT, the late, blinding stage of the disease) in adults, both exceeded WHO’s elimination thresholds across multiple evaluation units. 

However, subsequent investigations in 2013 and 2015 applied alternative methods to estimate trachoma transmission intensity, including testing for conjunctival Chlamydia trachomatis infection using polymerase chain reaction and serological testing via dried blood spots. The results showed that interventions against ocular C. trachomatis infection were not needed, with no demonstrable association between TF and C. trachomatis status. Additionally, no TT cases were identified.

Research conducted in 2015 revealed that a common local practice of eyelash self-epilation likely explained the high TT prevalence reported in 2012, with many such individuals having been misclassified as suffering from TT in the 2012 surveys. A concurrent seroprevalence study did not provide support for  ongoing community transmission of conjunctival C. trachomatis infection.

Considered together, this collection of evidence prompted reconsideration of previously planned antibiotic mass drug administration campaigns for trachoma, and following an expert consultation in 2018, the consensus view was that baseline prevalence surveys should be repeated across all evaluation units using the highest international standards, whilst simultaneously strengthening activities related to facial cleanliness and environmental improvement—the “F” and “E” components of the WHO-endorsed SAFE strategy—to curb any residual transmission of trachoma. By 2019, Fiji had secured funding and implemented a comprehensive trachoma program to act on these evidence-based recommendations and work toward elimination.

“The elimination of trachoma as a public health problem in Fiji highlights the importance of using complementary or alternative indicators for trachoma, including infection and serological testing”, said Michaela Kelly, Chair, International Coalition for Trachoma Control (ICTC). “Fiji’s Ministry of Health and Medical Services displayed extraordinary commitment to understanding the epidemiological situation for trachoma so that it could be confident in its public health strategy and ensure that  trachoma was eliminated as a public health problem. ICTC heartily congratulates the Government of Fiji and all partners involved”. 

Since 2017, facial cleanliness has been promoted through Fiji’s “Wash, Brush and Splash” campaign, which encourages handwashing, tooth-brushing, and face-washing in primary schools as part of broader school health and wellness efforts. Activities include child-friendly education on trachoma prevention, demonstrations of face and hand washing, and distribution of hygiene kits containing soap, towels, and nail clippers. Teachers are trained to identify trachoma, and children showing symptoms are referred to public health nurses while following compulsory face-washing routines at school. Between 2023 and 2025, over 100 schools participated in the program.

Trachoma is targeted for global elimination as a public health problem under the road map for neglected tropical diseases 2021–2030, endorsed by WHO Member States at the World Health Assembly in November 2020. Since 2002, the number of people at risk of trachoma has fallen by 93%—from 1.5 billion to 103 million in 2025. Following a trachoma funding gap analysis completed in 2025, the ICTC estimated that between US$268 million and US$334 million is required to close existing funding gaps and meet the 2030 target.

Countries previously validated by WHO as having eliminated trachoma as a public health problem are: Benin, Burundi, Cambodia, China, the Gambia, Ghana, India, the Islamic Republic of Iran, Iraq, the Lao People’s Democratic Republic, Malawi, Mali, Mauritania, Mexico, Morocco, Myanmar, Nepal, Oman, Pakistan, Papua New Guinea, Saudi Arabia, Senegal, Togo, Vanuatu, and Viet Nam.

The elimination of trachoma as a public health problem in Fiji was supported by several ICTC members and observers, including The Fred Hollows Foundation, the International Agency for the Prevention of Blindness, London School of Hygiene & Tropical Medicine, The Queen Elizabeth Diamond Jubilee Trust, Tropical Data, and WHO.