November 15, 2016

Disease elimination and eradication: are our silos sustainable?

This post originally appeared in The Lancet.

Visionary goals to end diseases are all around us. Polio, Guinea worm, malaria, and a handful of other diseases have been identified as potentially eradicable – some as quickly as within a generation. Beyond optimistic goals, the day-to-day of disease elimination and eradication is complex and difficult: only one infectious disease that affects humans – smallpox – has ever even been eradicated. Progress has been made in every area that makes disease elimination and eradication possible – from diagnosis and treatment to mapping and modelling. Now, cross-disease discussions on the science, policy, and operational “must-haves” that have gotten us to this point are urgently needed.

A classic example is malaria and lymphatic filariasis (LF), two diseases both spread by the same group and – in some settings – the same species of mosquito.

The malaria community has long debated the use and effectiveness of mass drug administrations (MDA) among at-risk populations, particularly in pre-elimination settings. Meanwhile, the neglected tropical diseases (NTDs) community has been conducting MDAs for decades in its drive to eliminate LF by 2020. Supported by the RTI-led, USAID-funded ENVISION project, 272 million LF treatments have been distributed through large-scale annual treatment campaigns. As a result, 152 million people in 13 ENVISION-supported countries are no longer at risk for the disease.

Further, there could be rich lessons regarding the kind of impact that bednet distributions for malaria might have had on LF transmission in countries endemic for the two diseases.

We know we can’t be overly simplistic, given there are differences even at the basic level of how each disease defines elimination; for some diseases, it’s about reducing transmission to zero, and for others it’s about ensuring disease levels become so low that they are no longer public health problems.

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