Regional Focus in Disease Elimination: Lessons from Guinea Worm Disease

Context

The Carter Center, a leader in the global elimination and eradication of diseases, recently reported that guinea worm disease was close to eradication

Lessons from Guinea Worm Disease: Regional Focus in Disease Elimination

• Decline in Cases of Guinea Worm Disease: 

  • From 3.5 million cases in 21 countries in 1986, to 13 cases in five countries in 2023, marking a 99.99% reduction.

• Present Status: 

• • Second disease after smallpox Present Status and the first one with no known medicines or vaccines. 

• Accomplishment of Sustainable Development Goal: 

  • Ending the epidemics of malaria, tuberculosis and Neglected Tropical Diseases by 2030 is one of the Sustainable Development Goals set by the United Nations.

Focus Disease Elimination

• Disease Elimination Vs Eradication: Disease elimination acts as a precursor to eradication. Disease elimination aims to achieve zero transmission within a defined region.
  • Eradication is the permanent cessation of infection globally. 
• Rigorous Certification Requirements: International agencies set stringent criteria for disease elimination certification. This improves primary health care, diagnostics and surveillance.
  • It will lead to increased involvement of field staff and community health workers, enthused by the clearly defined goal, and attract international support

Challenges involved in the Elimination of Disease

• Disease Elimination is Resource Intensive: Disease elimination should be undertaken cautiously, with thorough cost-benefit analysis and informed political backing, to achieve optimal outcomes with minimal adverse effects.
• Lead to Neglect of other Health Functions: It imposes an onerous load on the system and could lead to the neglect of other important health functions, especially for weak health systems. 

Course of Action for Elimination

• Focus on diseases with high impact and low prevalence.
• When High Prevalence of Disease in Population: The aim should be to reduce their numbers to the level where elimination is practical, through disease control.

Need for Surveillance Systems

• Investment in Surveillance Systems: Government must invest in robust surveillance, strengthen labs, ensure medicine availability, and train workforce for disease elimination.
• Continued Surveillance Post-Elimination: To detect any reintroduction of the pathogen, as eradication is not guaranteed.

Issues to be addressed

• Challenges in Achieving Nationwide Elimination: Achieving nationwide elimination of all targeted diseases within the set timeframe may be difficult due to resource constraints and logistical challenges.
• Focus on Elimination Region Wise for certain diseases: Example:
  • Kala Azar: Is now limited to five States in India, primarily prevalent in a few blocks in two States.
  • Lymphatic Filariasis: India holds 40% of global lymphatic filariasis cases, targeted for elimination since 1997. Focused efforts in specific states can achieve elimination through surveillance, vector control, drug administration, and morbidity management.
• Diseases with Long Incubation Periods and Drug Resistance: It require a reworked, localised, and phased elimination strategy. 
  • Targeting diseases prevalent in specific geographical regions like states, districts, or blocks allows for more feasible elimination efforts.

Way Forward

• Multi Sectoral Collaboration: Encouraging innovation and adopting locally effective solutions for disease elimination is more effective at the regional level.
• Resource Management: Smaller units can reallocate resources more efficiently to manage the additional workload without affecting essential tasks.
• Ownership by Governments: While elimination can proceed regionally, national and state governments should take ownership of the process.
• Phased Approach: Regional elimination efforts should culminate at the national level, with a carefully planned phasing from a country-wide perspective.