Opinion: Eliminating trachoma means more than an end to blindness

For people in communities such as Moroto, a remote district in Northern Uganda, the eye disease trachoma is more than just an affliction associated with pain and irreversible blindness.

Caused by a treatable and preventable bacterial infection that spreads through human contact and flies, trachoma acts as a social and economic anchor in the impoverished communities where it typically takes root. It can keep children out of school, prevent adults from working, and trap families in a cycle of poverty.

As recently as a decade ago, the people of Moroto had little recourse against this neglected tropical disease — which, after repeated infections, can cause eyelids to turn inward and lashes to scrape the eyeball, causing corneal ulcers and irreversible blindness.

In 2008, the prevalence of trachoma infection in Moroto was 57.1 percent. Today, however, the district is making dramatic strides. Trachoma prevalence in Moroto dropped to 12.1 percent in 2016, and we are on track to completely rid the community of this disease in the near future.

Moroto isn’t alone. The last two decades have seen unprecedented progress toward the worldwide elimination of trachoma, thanks to an expansive global partnership and a donation program that has shipped over 740 million doses of an antibiotic effective at clearing the trachoma infection to at-risk communities in 40 countries. Based on current trends, we believe that the global elimination of this disease, which has existed since antiquity, can be achieved.

Much work remains, but our organizations — together with more than 100 trachoma partners around the world — are committed to finishing the fight. Recently, Pfizer announced it will extend its donation of antibiotics to treat and prevent trachoma through 2025, should it be needed, ensuring local nonprofits and ministries of health will continue to have access to an essential tool in eliminating this devastating disease.

As we strive for a world where families no longer have to worry about trachoma, it’s worth reflecting on the role partnerships have played in getting us here, and why it’s so important to the approximately 163 million people still at risk of this disease that we finish the job.

20 years of partnership

Like so many NTDs, trachoma is both a consequence and a cause of poverty. The disease accounts for an estimated $3-6 billion in lost productivity per year, thriving in places with severely limited infrastructure or access to clean water and sanitation. For all these reasons, United Nations Sustainable Development Goal 3 on good health and well-being includes a call to end NTDs such as trachoma by 2030.

Reaching remote communities, such as Moroto, with trachoma interventions requires close collaboration among an array of partners, ranging from private-sector organizations to international nonprofits, to governments and local health workers. These various entities work together to implement the World Health Organization-endorsed SAFE Strategy for trachoma control, which includes: Surgery to manage the blinding stage of trachoma, known as trichiasis; mass treatment with antibiotics; facial cleanliness; and environmental improvements, including access to clean water and sanitation.  

Recognizing the importance of an ample antibiotic supply in implementing the SAFE Strategy, Pfizer co-founded the International Trachoma Initiative, otherwise known as ITI, in 1998, a program of the independent nonprofit The Taskforce for Global Health. For 20 years, ITI has collaborated with SAFE partners around the world to manage the distribution of donated Zithromax.

Today, ITI uses household-level data collected through the Global Trachoma Mapping Project, or GTMP — the world’s largest disease mapping initiative — to determine exactly where, when, and in what quantity antibiotics are most needed.

The donation program also helps to build sustainable health capacity among national, local government, nonprofit, and community health worker partners, who manage the clearance, storage, delivery, and administration of Zithromax to local communities.

The staggering progress driven to date is a testament to the power of public-private partnerships and the collaborative work of the trachoma stakeholders.

Worldwide, the number of individuals at risk of trachoma has decreased 60 percent during the last 20 years. Six countries have already been validated by WHO as having eliminated trachoma as a public health problem, removing a key impediment to sustainable social and economic development. Several other countries, including Uganda, are fast approaching elimination targets.

Progress in Uganda

Last fall, we witnessed firsthand the trachoma partnership’s impact during a visit to Moroto. While there, we observed a mass drug administration where donated Zithromax was provided to the entire community to efficiently reduce the risk of trachoma transmission.

In recent years, the Ugandan Ministry of Health, in collaboration with ITI partners, has engineered a significant scaling-up of its trachoma elimination efforts. Today, 34 of the country’s 38 previously trachoma-endemic districts no longer require mass treatment, while the number of people at risk of trachoma in the country has decreased from 10 million to less than 300,000.

These interventions are especially important in places such as Moroto, which trails other regions of Uganda in economic productivity and development and is prone to severe droughts. Challenges such as these only amplify trachoma’s deep human and economic toll, making the physical limitations and social stigma associated with blindness even more difficult to overcome.

Accelerating toward elimination

A number of challenges remain to achieve our shared goal of a trachoma-free world. The highly remote nature of many trachoma-endemic regions, combined with outside factors such as political instability, humanitarian crises, and other environmental factors, continue to complicate our elimination efforts.

Despite these hurdles, we and the rest of the trachoma community remain confident that elimination is possible. Thanks to better disease mapping, today we know the regions still struggling with trachoma. We have local partnerships in place that can help us reach the remote communities where the disease still thrives. And with Pfizer’s donation recommitment, we know that trachoma partners will have an ample supply of antibiotics to implement the SAFE Strategy and eliminate the disease.

A future without trachoma is within reach in places such as Moroto. While the fight is far from over, the bright, clear eyes of so many children we met during our visit is a testament to the progress made during the past 20 years.

For them, eliminating NTDs such as trachoma is a foundational step in creating a more just, equitable world — one where they have an opportunity to live the healthiest, most productive, and most rewarding life possible.