International Coalition for Trachoma Control

Today, 30 January 2022, marks World Neglected Tropical Diseases Day (World NTD Day), a day recognised by the United Nations to advocate for health equity to end the neglect of poverty related diseases.

In January 2020, the World Health Organization (WHO) launched Ending the neglect to attain the Sustainable Development Goals: A road map for neglected tropical diseases. The highly anticipated road map provides a blueprint to control, eliminate, and eradicate NTDs over the next decade, aligning global partners around three fundamental paradigm shifts, including: 1) country ownership; 2) cross-sectoral collaboration; and 3) impact oriented programming.

The paradigm shifts that underpin the road map have been long advocated by many within the trachoma community. Since 1993, the WHO-endorsed SAFE strategy (surgery, antibiotics, facial cleanliness, environmental improvement) has provided a holistic cross-sectoral approach for countries to accelerate and sustain the elimination of trachoma as a public health problem. Now, significant efforts are being made to ensure interventions are integrated into national health systems, which is guided by the International Coalition for Trachoma Control’s transition toolkits.

The integration of trachoma interventions into routine health systems is an essential step to achieve and sustain the elimination of trachoma as a public health problem. Integration of trachoma data into national health

management and information systems not only increases programmatic accountability and country ownership, but helps governments to identify incident cases and manage human resource requirements, including training, to ensure that interventions are targeted efficiently and effectively to at-risk populations. 

Successful examples of comprehensive country-led implementation of the SAFE strategy have come from all trachoma-endemic WHO regions. Most recently, in April 2021, The Gambia was validated by WHO for eliminating trachoma as a public health problem. Success in The Gambia was driven, in part, by the integration of trachoma into the National Eye Care Programme and decisive action to integrate WASH interventions, with its national trachoma task force expanded to include the Ministry of Water Resources, Environment and Education. This facilitated the national trachoma task force to liaise with the Ministry of Water Resources to choose villages for their well digging programme based on the prevalence of trachoma infection determined by the geographical information system. 

Similarly, in September 2020, Myanmar became the second country in the WHO South East Asia Region to be validated by WHO for eliminating trachoma as a public health problem. Myanmar demonstrated the importance of integrating trachoma into routine eye health services, using a three-tiered eye care system of regular surveillance, outbreak investigation, and capacity-building for identifying and managing cases. Following elimination, Myanmar has taken several steps to ensure the sustainability of elimination. Most notably, trachoma is integrated into its National Eye Health Plan, which aligns with the Global Strategy for Prevention of Avoidable Blindness (VISION 2020) and the WHO Universal Eye Health Global Action Plan, which aims to coordinate eye care services and advance the country towards universal health coverage.

The trachoma community has long demonstrated what can be achieved when partners work together towards shared goals, including:

• Through the International Coalition for Trachoma Control, partners have worked together to develop preferred practice documents to ensure that all components of the SAFE strategy are delivered safely and equitably to at-risk populations. The coalition has enabled non‐governmental, donor, private sector, and academic organizations to work together more effectively, by identifying gaps and sharing knowledge, in support of national programmes.

• The global drug donation program, supported by Pfizer through the International Trachoma Initiative, has supported countries to deliver almost one billion treatments since 1998.
  

• Through Tropical Data and implementing partners, 48 countries have been supported to carry out baseline, impact, surveillance and trachomatous trichiasis-only surveys in 2658 evaluation units, examining over 8.3 million people. Data from these surveys provide essential evidence to guide countries to implement interventions efficiently and effectively, and to let them know when interventions can be stopped.

• Lastly, the WHO Alliance for the Global Elimination of Trachoma by 2020 (GET2020 Alliance) has provided technical leadership and coordination to the international efforts aiming to eliminate trachoma as a public health problem.

The combined efforts of these and other global partnerships have contributed to a 91% reduction in the number of people at risk, from 1.5 billion in 2002 to 136.2 million in 2021, with at least one country in each trachoma-endemic WHO region being validated for elimination.

Looking forward, the road to 2030 is clear. The global community have demonstrated its support to the WHO NTD road map 2021-2030, and now, on World NTD Day, we must double down on our commitment to deliver strong country-led, comprehensive and people-centred programmes that leave no one behind. Successes in the global trachoma programme should provide optimism but not complacency. To achieve our targets, we must ensure that programs are delivered equitably and are inclusive of the most vulnerable communities, including people with disabilities, nomadic and indigenous populations, and people affected by conflict and humanitarian emergencies. Achieving road map targets will have an immediate and profound impact on the lives of some of the world’s most vulnerable people. It will take us all a step closer to the achievement of universal health coverage and a more socially just world.