Trachoma, the world’s leading infectious cause of blindness, is an ancient disease that disproportionately affects the world’s poorest communities. Identified in Egypt as early as 15 BC, trachoma is caused by the bacterium Chlamydia trachomatis, and is often spread through contact with eye discharge from an infected person – via hands, towels and sheets and thrives in areas where there is poor sanitation and limited access to clean water for personal hygiene.
Global efforts to eliminate this ancient disease of poverty have been intensified in recent years. Partnerships between health ministries, donors, pharmaceutical companies, implementing partners and research organisations have resulted in the scale up in implementing the World Health Organization (WHO)-endorsed SAFE strategy (surgery, antibiotics, facial cleanliness, and environmental improvement) in most trachoma-endemic countries. This has contributed to a 91% reduction in the global number of people at risk, from 1.5 billion in 2002 to 136.2 million in 2021. Moreover, as of 2021, 11 countries have been validated by WHO for eliminating trachoma as a public health problem across all trachoma-endemic WHO regions – with The Gambia becoming the latest country to achieve this milestone in 2021.
Implementation has been supported by investments to “map” the disease – identifying districts where trachoma is a public health problem. From 2012-2016, the Global Trachoma Mapping Project examined 2.6 million people between across 29 countries – the largest infectious disease survey ever conducted. Progress towards elimination is now regularly measured via Tropical Data, which has supported national programmes to conduct more than 2,438 trachoma surveys across 46 countries since 2016, examining more than 7.6 million people.
The impact of the global trachoma programme has been significant. As the programme has matured, increased attention is now being paid to ensure that progress towards the elimination of trachoma as a public health problem is sustained. It is widely recognised that the trachoma community cannot work in isolation. In order to achieve and sustain progress will require cross-sectoral collaboration and integration of trachoma interventions within routine eye health services. This will ensure effective post-validation surveillance and the management of incident trichiasis cases.
To support the transition of trachoma interventions, the International Coalition for Trachoma Control developed a series of transition toolkits to support health ministries and implementing partners as they work towards the integration of trachoma activities into routine health services, and to enable better coordination with eye health systems.
The elimination of trachoma will require ongoing advocacy to increase political will and mobilise domestic resources. Recent disruptions caused by COVID-19, including the pausing of all community-based interventions has had an impact across national NTD programmes. This has been compounded by reductions to foreign aid, which threaten to stall or reverse progress that has been made.
Ending the neglect to attain the Sustainable Development Goals: a road map for neglected tropical diseases 2021-2030 provides a blueprint for achieving the elimination of trachoma as a public health problem. The road map emphasises the importance of 1) country ownership; 2) cross-sectoral collaboration; and 3) impact-orientated programs. This is complemented by the WHO World Report on Vision which emphasises the importance of integrated people-centred approaches to eye health.
The trachoma community has demonstrated what can be achieved when partners work together towards common goals. Now, more than ever, it is essential that partnerships be broadened to ensure that trachoma is managed within national eye care systems and trachoma programmes are not operating in isolation. Increased political commitment will be essential to ensure that trachoma activities are inclusive and comprehensive, so that all people at risk of trachoma, including people with disabilities and those living in hard to reach areas, can access the services they need - where they need them, when they need them.