The number of people at risk from trachoma, the world's leading infectious cause of blindness, remained stable in 2020 despite disruptions to community-based interventions caused by COVID-19, the World Health Organization (WHO) reported in its Weekly Epidemiological Record.

The progress update presents 2020 data on the implementation of the WHO-endorsed SAFE strategy (surgery, antibiotics, facial cleanliness, environmental improvements) in trachoma-endemic countries as well as summaries based on district-level prevalence estimates held in the GET2020 database as of 21 June 2021.

The record shows that the number of people at risk of trachoma reduced from 136.9 million in 2020 to 136.2 million in June 2021. This gain was supported by the delivery of antibiotics to 32.8 people in 2020 despite the ongoing COVID-19 pandemic and following WHO guidance for changes in community-based neglected tropical disease (NTD) programmes throughout the year.

Furthermore, in 2020, 42,045 people were managed for trachomatous trichiasis, the late blinding stage of trachoma, worldwide, with 53% of surgeries being conducted in Ethiopia, which accounts for 49% of the global trachoma burden.

Although the number of people at risk of trachoma saw a slight reduction, the delivery of SAFE interventions was severely reduced in 2020 largely as a result of the COVID-19 pandemic. This contributed to a 55% decrease in the number of people managed for surgery and 66% reduction in the number of people treated with antibiotics compared with 2019 levels.

“Despite significant challenges, the trachoma community has demonstrated its resilience and agility throughout the COVID-19 pandemic”, said Dr Angelia Sanders, Chair of the International Coalition for Trachoma Control. “Coordination and cross-sectoral collaboration have supported the development of several tools to assess risk and enable the safe resumption of interventions. However, as new challenges emerge, including decreased domestic and international financing, it is essential that we double down to implement recommendations in the new WHO NTD road map, through integrated, cross-sectoral, country-led programs. These efforts will contribute to resilient health systems able to efficiently use scarce resources and promote future sustainability.”

To date, 11 countries (Cambodia, China, Gambia, Ghana, Islamic Republic of Iran, Lao People’s Democratic Republic, Mexico, Morocco, Myanmar, Nepal and Oman) have been validated by WHO as having eliminated trachoma as a public health problem. The number of people at risk of trachoma remains significantly lower than historical estimates, with a 91% reduction in the number of people at risk since 2002. The number of people requiring surgery for trachomatous trichiasis has decreased by 76%, from 7.6 million in 2002 to 1.8 million in June 2021.

As of 21 June 2021, there were 44 countries for which the most recent district-level prevalence data in the GET2020 database suggest that trachoma is a public health problem in at least part of the country. A further seven countries may require interventions, but in which the necessary investigations in suspected trachoma-endemic areas have not yet been completed.

At a time of incredible challenges brought about by a global pandemic and a changing funding landscape, ICTC wishes to join WHO and other stakeholders in again recognizing and congratulating the considerable efforts of Myanmar (validated as having eliminated trachoma as a public health problem in 2020) and The Gambia (validated in 2021). Their success is good news for both the concerned health ministries and the continued progress of the global trachoma program.