ATLANTA, Ga – “Elimination has become an enchanted word,” Frank Richards of the Carter Center, said here this morning. He noted the “elimination” of measles in the United States in 2000, in spite of the large numbers of cases that continue to be reported each year.
“Follow the metrics when the “e” words — elimination and eradication — are used,” he urged attendees of a symposium that cataloged challenges and triumphs in campaigns to eliminate guinea worm, polio, malaria and Chagas disease.
The World Health Organization has a three-step process — validation, verification, and certification — in this context. Validation constitutes elimination of the disease as a public health threat, and WHO certifies eradication three years after the last case of the disease, he said.
The stories of near elimination of Guinea worm-disease and polio were both heartening and sobering, with progress narrowing the number of countries with endemic Guinea worm and polio to just a few, but with war, displacement and new vectors making guinea worm eradication elusive. In both cases, the resources needed for elimination were grossly underestimated and the timeline of years needed extended to decades.
The WHO certification of Sri Lanka as malaria-free was the outcome of a one-hundred year campaign, said Ragitha Wickremasinghe of the University of Kelaniya during the session. He highlighted a number of strategies that have often been identified as critical to ending HIV and tuberculosis as major public health threats, including targeting high risk populations and high risk areas with “aggressive diagnosis and treatment”, ensuring access to both, and building strong program management with an emphasis on surveillance. All were critical to success against malaria, as was investment and political commitment and leadership, Wickremasinghe said. Now he worries malaria will be forgotten and re-surge as the country works to contain imported cases. He worries that doctors seldom ask patients for a travel history and many have forgotten how to diagnose malaria. He noted that Sri Lanka dismantled its leprosy programs after victory over that disease was declared and is today faced with thousands of cases each year. He called for vigilance and strengthened systems for outbreak surveillance and wondered if the withdrawal of donor resources would leave his country vulnerable to malaria again.