Control, Eliminate, Eradicate: Global Efforts to Wipe Out Disease

In 1980, the World Health Organization (WHO) announced the eradication of smallpox, the first and only infectious disease to meet this fate. Eradication of a disease is defined as the permanent reduction to zero of the worldwide incidence of infection. The road to eradication includes stops at control, the reduction of disease incidence, prevalence, morbidity or mortality to a locally acceptable level, followed by elimination, the reduction to zero of the incidence of infection in a defined geographical area.

Smallpox has several characteristics that made eradication possible: an effective vaccine which could prevent infection with a single dose, highly visible symptoms with a short incubation period, and transmission occurring only human-to-human. Since the last known case of smallpox, The International Task Force for Disease Eradication has been coordinating efforts to rid the world of infectious diseases. However, each disease is unique and has its own set of challenges on the path to eradication. To illustrate how diseases differ in treatment, interventions and challenges, this article will focus on global efforts to eradicate polio, guinea worm and malaria.

Polio, also called poliomyelitis, is believed to be the next infectious disease in line for eradication because it has been eliminated everywhere except for Afghanistan and Pakistan. Polio is a viral infectious disease transmitted from person to person through the fecal-oral route. The virus primarily affects children under age five, and one in 200 infections can lead to irreversible paralysis. Polio cases have decreased by 99 percent since 1988, and in 2015 there were only 22 reported cases of polio worldwide. This reduction is due to coordinated efforts of The Global Polio Eradication Initiative (GPEI). In order to tackle the two remaining endemic countries with polio, the GPEI developed the Polio Eradication and Endgame Strategic Plan 2013-2018 to rid the world of polio by 2018.

Polio eradication strategy involves the immunization of every child, strong surveillance to detect and interrupt transmission and a long-term plan to ensure vulnerable countries do not see reemergence of infection. In April, a new bivalent oral polio vaccine started being distributed globally. This new vaccine protects against polio types 1 and 3 (type 2 was eradicated in 1999) and is stronger than the previous oral vaccine. Many of the challenges to eradicating polio are due to instability in Afghanistan and Pakistan. The remaining areas with polio infection are isolated and people have limited access to vaccines, and face security problems.

Guinea worm disease, also known as dracunculus medinensis, is caused by a parasitic worm which enters the body through ingestion of contaminated water. When a person drinks the worm larvae living in nearby water sources, the larvae migrate through intestinal walls, mate, and after 10 to 14 months the pregnant female extracts itself painfully from the foot of the host. The adult female worm carries three million embryos, and can measure 60 to 100 centimeters in length. For pain relief, infected people place the affected area in water, releasing the larvae back into the water source for the next victim. There is no treatment to prevent infection or heal a person of guinea worm. While rarely fatal, a person can suffer from infection at the site of extraction leading to skin ulcers and permanent disability. Eradication of guinea worm depends solely on access to clean drinking water.

The good news is that, in 2015, there were only 22 reported cases of guinea worm in four countries (Chad, Mali, South Sudan and Ethiopia). Eradication efforts include detecting cases within 24 hours, health education and ensuring access to safe drinking water. Since 1986, The Carter Center has led the international campaign for guinea worm eradication, and today cases have been reduced by 99.99 percent. Once eradicated, it will be the first parasitic disease to meet this fate, as well as the first disease eradicated without the use of vaccines or medications. Challenges to guinea worm eradication include infections in remote areas where interventions can not reach people, as well as dogs hosting the parasite which has led to increased human transmission in Chad and Ethiopia.

Malaria is an infectious disease of the blood caused by the plasmodium parasite and is transmitted from person to person by the female anopheles mosquito. Once the parasite enters the body, it lodges in the host’s liver, multiples, and enters the blood stream to infect red blood cells. Without treatment, malaria leads to death. In Africa, a child dies every two minutes from malaria and, in 2015, there were an estimated 214 million cases of malaria worldwide (mostly in pregnant women and children). In 2015, sub-Saharan Africa accounted for 88 percent of malaria cases and 90 percent of malaria deaths. Approximately half of the world’s population is at risk of malaria, but the disease is preventable and curable.

The Global Malaria Eradication Program launched by WHO in 1955 was the first attempt at eradicating malaria. The program was criticized for its one-size-fits-all approach, lack of community involvement and lack of research and evaluation on intervention methods. It was abandoned in 1970. Since 2000, improved interventions have decreased the incidence of malaria by 37 percent globally, and mortality rates in children under age five have fallen by 58 percent. Interventions today include rapid diagnostic tests, malaria medications for treatment and prevention, availability of insecticide treated bed nets (since mosquitos carrying the virus feed at night) as well as indoor insecticide spraying. A malaria vaccine is also in development. The new goal is a major reduction of malaria cases and deaths by 2030 and the WHO Global Technical Strategy for Malaria 2016-2030 outlines a plan to achieve this.

Malaria has a longer and more challenging road to eradication when compared to polio and guinea worm, but important achievements are being made in the fight to end malaria. In April, Europe was the first region in the world to be certified as malaria-free by the WHO. This is defined as zero locally acquired malaria cases for three consecutive years. Two major challenges to other regions of the world becoming malaria-free are insecticide resistance by mosquitos and medication resistance by strains of the virus. Another challenge is that a majority of transmissions start with asymptomatic people, requiring medical professionals to diagnose patients who have yet to show symptoms, and then treat them before transmission can occur.

Polio, guinea worm and malaria are unique diseases each with their own unique challenges, much like other infectious diseases that are causing death and disability around the world. While the road to eradication for each disease has many paths and varies in length, global health organizations must continue to collaborate and pursue solutions. Below are several GlobalWA members working towards eradication of infectious diseases. Learn more about these organizations and others on our interactive member map.

Health and Hope Foundation – Health & Hope Foundation (HHF) provides dental, vision, non-surgical medical care and preventative healthcare education tools to impoverished communities who otherwise lack access or means for care. Clinics are on-site and portable allowing for access to rural areas. By teaming with local leaders, specific community needs such as disease prevention, clean water, light, education, sexual safely, safe living conditions and sustainable business are illuminated. Local leaders are developed to address these needs within HHF programs or by linking them with specialized NGOs. www.healthandhopefoundation.org

Malaria No More – Malaria No More (MNM) is working to create a world where no child dies from a mosquito bite. Using strategic advocacy and innovative partnerships to engage global leaders, rally the public and deliver lifesaving tools and education to families across Africa, MNM aims to create the political will and mobilize the global resources required to achieve malaria eradication within our generation. They work with leaders of malaria-endemic countries in Africa, Asia and Latin America to increase the amount of attention and funding they commit to malaria each year, elevating it on the global health and international development agenda. www.malarianomore.org

Medical Teams International – Medical Teams International works to stem the tide of communicable diseases among vulnerable populations in locations where access to health care and medicine is lacking. In Uganda, this means curbing malarial infections, particularly among refugees. Medical Teams was instrumental in quelling the deadly cholera outbreak that swept through Haiti following the devastating 2010 earthquake, and preventing further outbreaks. And in Liberia, Medical Teams has worked to build durable partnerships to strengthen health systems in the fight against Ebola. Through clinical case management, prevention, education and early diagnosis, Medical Teams aims to stamp out the spread of deadly diseases around the globe. www.medicalteams.org

PATH – PATH is a leader in global health innovation. An international nonprofit, PATH saves lives and improves health, especially among women and children, and works alongside countries primarily in Africa and Asia to tackle their greatest health needs. With a network of partners, both in the Pacific Northwest and around the world, PATH advances high-impact, low-cost approaches to not only manage and control stubborn diseases, but to end them completely. Recently, PATH and their partners helped vaccinate more than 235 million people against meningitis A in sub-Saharan Africa — nearly eliminating it as a major health threat in the span of five years. Through the PATH Center for Malaria Control and Elimination, the organization is building on their unparalleled portfolio of malaria tools and projects — including cutting-edge research and development of malaria drugs, diagnostics, and vaccines — to advance efforts toward elimination. PATH’s work in disease elimination also includes diagnostics and other tools to fight polio and neglected tropical diseases like river blindness and lymphatic filariasis. www.path.org.

Pilgrim Africa – With over 16 million cases of malaria per year in a population of only 34 million, Ugandans have the highest malaria transmission rates in the world, and status quo measures are not reducing malaria fast enough. In partnership with Uganda’s Ministry of Health, Rotary International, Seattle #4 Rotary Club and Peace Corps Uganda, Pilgrim Africa is charting a course for the most cost-effective, safest and fastest way to reduce malaria in high transmission settings. Pilgrim Africa’s newest operational research project combines and sequences the most effective malaria interventions for mosquito control and medical management in order to rapidly reduce malaria transmission and maintain the new lower rates. This intervention is predicted by mathematical modeling to remove over 90% of the death and disease caused by malaria and to provide a cost-effective solution at scale. www.pilgrimafrica.org

The Bill and Melinda Gates Foundation – Founded in 1997, the Bill & Melinda Gates Foundation works in developing countries to improve people’s health and to lift them out of extreme poverty. The Foundation’s global health and development work uses advances in science and technology, and works with partners in developing countries to deliver vaccines, drugs and diagnostics. The Gates Foundation works to find new solutions and interventions to improve efficiency and effectiveness and ensure these methods reach those most in need. The Foundation also invests in vaccines for HIV, polio and malaria, as well as supports integrated health solutions for family planning, nutrition and maternal and child health. www.gatesfoundation.org

U.S. Fund for UNICEF – UNICEF, the world’s largest buyer of vaccines, provides immunization for forty percent of the world’s children. Today, infant and childhood vaccination saves up to 3 million children’s lives a year. Conflict, displacement and poverty keep some of the most vulnerable children from getting the vaccines they need. If all children were immunized with existing vaccines, by 2020 we would save nearly 25 million lives. Thanks to UNICEF and partners’ global immunization and vaccine efforts, polio has almost — but not quite — disappeared. In 2014, India joined the ranks of the polio-free, a major achievement thanks to lifesaving polio vaccines, and in 2015, Nigeria reached a milestone when it went a full year without a single case of polio. www.unicefusa.org

VillageReach – VillageReach increases access to quality healthcare by improving the capacity and efficiency of health systems in the world’s most underserved communities. With a particular emphasis in last mile supply chain systems, VillageReach has developed innovative approaches to improve transport and logistics for vaccine delivery and other essential medicines, including HIV medicines and other related supplies to test and treat infectious diseases. www.villagereach.org