Disease Eradication in the 21st Century

Disease Eradication in the 21st Century: Implications for Global Health

Stephen L. Cochi
Walter R. Dowdle
Copyright Date: 2011
Published by: MIT Press
Pages: 336
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  • Book Info
    Disease Eradication in the 21st Century
    Book Description:

    Disease eradication represents the ultimate in global equity and the definitive outcome of good public health practice. Thirty years ago, the elimination of smallpox defined disease eradication as a monumental global achievement with lasting benefits for society. Today, the global commitment to eradicate polio and guinea worm and heightened interest in the potential eradication of other infectious diseases, including measles/rubella, lymphatic filariasis, onchocerciasis, and malaria, dominate public health concerns. But what does it take to eradicate a disease? This book takes a fresh look at the evolving concepts of disease eradication, influenced by scientific advances, field experience, societal issues, and economic realities. A diverse group of experts from around the world, representing a range of disciplines, examines the biological, social, political, and economic complexities of eradicating a disease. The book details lessons learned from the initiatives against polio, measles/rubella, and onchocerciasis. Further chapters examine ethical issues, the investment case, governance models, organizational and institutional arrangements, political and social factors, feasibility of eradication goals, priority setting, and the integration of disease eradication programs with existing health systems.

    eISBN: 978-0-262-30420-7
    Subjects: Health Sciences, Sociology

Table of Contents

  1. Front Matter
    (pp. i-iv)
  2. Table of Contents
    (pp. v-vi)
  3. The Ernst Strüngmann Forum
    (pp. vii-viii)
    Julia Lupp
  4. List of Contributors
    (pp. ix-xii)
  5. 1 The Eradication of Infectious Diseases: Understanding the Lessons and Advancing Experience
    (pp. 1-10)
    Stephen L. Cochi and Walter R. Dowdle

    Humankind has always been fascinated by scourges of disease that cause incalculable misery in the world and have a devastating impact on society, and by subsequent attempts to eradicate such diseases (D. R. Hopkins 2009). The sustained eradication of an infectious disease agent, in which humans are the primary or sole host, was achieved for the first (and only) time in 1980, when the World Health Assembly declared the world free of smallpox, following a campaign that began in 1959 and lasted nearly twenty years. Success in eradicating smallpox worldwide led to an increasingly intensive examination of the concepts and...

  6. Lessons Learned from Current Elimination and Eradication Initiatives
    • 2 Lessons from the Late Stages of the Global Polio Eradication Initiative
      (pp. 13-24)
      R. Bruce Aylward

      Launched in 1988 through a resolution of the World Health Assembly, the Global Polio Eradication Initiative (GPEI) has grown to become one of the most ambitious, internationally coordinated health initiatives in history (Fine and Griffiths 2007), and certainly the largest eradication effort to date. At its peak of field operations, the program directly employed over 4000 people globally, managed an annual budget of approximately USD 1000 million, and maintained active field operations in more than 75 countries (WHO 2003a). Each year, millions of people were engaged to vaccinate hundreds of millions of children in multiple mass vaccination campaigns with oral...

    • 3 Measles and Rubella Eradication in the Americas: Seasoned Strategies for Sustained Success
      (pp. 25-34)
      Jon Kim Andrus, Ciro A. de Quadros, Carlos Castillo-Solórzano, Mirta Roses Periago and Donald A. Henderson

      Among other factors, disease eradication is possible if there is no animal reservoir and excellent, cost-effective interventions like vaccination exist. Certainly, that is the case for both measles and rubella viruses (CDC 1999b). The benefits of vaccination for measles prevention and control have been substantial, since measles traditionally has caused significant childhood mortality and disabilities. In the case of rubella, morbidity associated with congenital rubella syndrome has also been a huge burden on society, particularly in developing countries (Andrus et al. 2006).

      Four of the WHO regions (American, European, Western Pacific, and the Eastern Mediterranean regions) have regional measles eradication...

    • 4 Onchocerciasis: From Control to Possible Eradication
      (pp. 35-44)
      Adrian Hopkins

      The first lesson to learn in any war is to know the enemy. Onchocerciasis was first described in Ghana, where the intense itching and associated skin changes were given a local name of “craw craw” (Figure 4.1). O’Neil (1875) first described the presence of filaria in the skin of those infected. Robels (1917) described a similar disease in the Americas. The relationship with the black fly vector was demonstrated by Blacklock (1926), but the relationship to blindness was a bit more controversial. Hissette (1932) first described the effects of the microfilaria on the eye in the Belgian Congo, with Ridley...

  7. Critical Issues in Determining Feasibility of Eradication
    • 5 Political and Social Determinants of Disease Eradication
      (pp. 47-62)
      Robert G. Hall

      The eradication of an important disease is a pinnacle of collective human achievement, let alone of public health. The ability to free all future generations across the globe from the threat of death and disability from a disease ranks as one of the greatest contributions that can be made by social effort. Disease eradication brings large, multiple, and long-lasting benefits, improving both quantity and quality of life, bringing economic benefit, and political credit to those who directed the effort. The eradication of smallpox, for instance, has been responsible for a major improvement in health in nearly every country, with economic...

    • 6 The Role of Research
      (pp. 63-86)
      Julie Jacobson

      Humankind is developing rapidly, achieving things that could not be imagined in the last century. This progress has changed our planet, leaving us with a wealth of experience and knowledge as well as new challenges. As our world becomes increasingly connected, awareness of diseases and how they affect the human population has increased. This has led to ambitious goals of eliminating select pathogens that have plagued humankind, limiting our health as a species and causing great suffering.

      Our first successful eradication effort with smallpox resulted in many new targets being set. The list of diseases and conditions with targets for...

    • 7 Group Report: Assessing the Feasibility of an Eradication Initiative
      (pp. 89-100)
      Peter Strebel, Eric A. Ottesen, Ciro A. de Quadros, Sherine Guirguis, Robert G. Hall, Linda Muller, Jai Prakash Narain and Ole Wichmann

      The criteria needed to determine whether eradication is able to be achieved have been grouped into three categories: biological, societal/political, and economic factors (Hinman and Hopkins 1998). An additional factor was emphasized by the Global Taskforce on Disease Eradication; namely, the need to demonstrate that eradication could be achieved in a large geographical area (CDC 1993b). A more recent review of lessons learned from eradication initiatives stresses that biological feasibility is necessary but not sufficient. Nonbiological factors such as political commitment, social acceptability, financial affordability, and strong program management are critical components for success (Aylward et al. 2000a).

      Over the...

  8. Issues in the Development of an Eradication Investment Case
    • 8 The Moral Case for Eradication
      (pp. 103-114)
      Claudia I. Emerson

      The eradication of smallpox, hailed as one of the greatest achievements in the history of medicine, continues to inspire efforts to eradicate other diseases that cause immense human suffering and death. It is a testament to the evocative power of eradication that campaigns to eradicate diseases (e.g., polio) persevere despite the many challenges that must be overcome. The challenges are complex: scientific, technical, economic, political and sociocultural. Within the sociocultural strand, we can locate the ethical considerations that relate to disease eradication efforts.

      Some of these considerations reflect ethical issues that arise in the context of mass immunization programs, such...

    • 9 Economic Evaluation of the Benefits and Costs of Disease Elimination and Eradication Initiatives
      (pp. 115-130)
      Kimberly M. Thompson and Radboud J. Duintjer Tebbens

      Global spending on health exceeds several trillion US dollars annually (WHO 2007c), and costs continue to increase with the growing global population, development, and improvements in health services and technology. A recent edition of the “State of the World’s Vaccines and Immunization” (WHO et al. 2009) highlights the enormous health benefits achieved within the last decade from infectious disease prevention due to increased global investment in immunization. As noted in the report, “immunization remains one of the most cost-effective health interventions…[and] by keeping children healthy, immunization helps extend life expectancy and the time spent on productive activity” (WHO et al....

    • 10 Group Report: Developing an Eradication Investment Case
      (pp. 133-148)
      Kimberly M. Thompson, Regina Rabinovich, Lesong Conteh, Claudia I. Emerson, B. Fenton Hall, Peter A. Singer, Maya Vijayaraghavan and Damian G. Walker

      The eradication of a disease offers important opportunities for society, and humankind should aspire to this goal. The eradication of smallpox and the interruption of SARS virus transmission that emerged in 2002, represent significant accomplishments, from which humankind continues to benefit. Eradication initiatives require significant commitments, including major investments of economic and sociopolitical capital. Thus, the decision to commit to an eradication goal should derive from careful consideration of the evidence base and a thorough discussion of the benefits, risks, and costs of eradication compared to the status quo.¹ This chapter discusses the need to develop an eradication investment case (EIC)...

    • 11 Guidelines for Preparing an Eradication Investment Case
      (pp. 149-156)
      Damian G. Walker and Regina Rabinovich

      The termeradication investment case(EIC) was conceptualized by Thompson et al. (this volume) as the virtual counterpart of the GAVI Vaccine Investment Case (GAVI Alliance 2004), which is the body of data presented to the GAVI Alliance upon which an evaluation is based and investment commitments are made to finance the introduction of vaccines for low-income, eligible countries. Although decisions for both investment cases require donor and country financing as well as action, there are significant differences. First, while the GAVI Alliance represents the major fund for purchase of vaccines for low-income countries, no such single parallel organization exists...

  9. Governance
    • 12 Governance Models for Eradication Initiatives
      (pp. 159-174)
      Kari Stoever

      Broadly defined,organizationsare systems of coordinated action among individuals with different interests, preferences, and knowledge (March and Simon 1958). In the context of an organization or network of organizations, as in an eradication initiative,governancerefers to the tools that organizations employ to influence an individual’s contribution toward a goal. Governance often invokes concepts of power, authority, and formal lines of reporting. However, effective governance requires skilled leaders to motivate, persuade, and inspire (Kotter 2001). To catalyze and coordinate collective action in a network of decentralized yet interdependent groups, innovation and flexibility are required.

      The manner by which tasks...

    • 13 Managing Neglected Tropical Disease Partnerships
      (pp. 175-188)
      Andy Wright

      The formation of an effective partnership among all participating parties is a key ingredient for success of eradication and elimination initiatives. The concept of partnerships was discussed at an expert colloquium held at the Carter Center (Dentzer 2008), at which Tachi Yamada, from the Bill & Melinda Gates Foundation, stated: “The largest success of the past decade has been the formation of partnerships between private industry, between government, between affected nations and not-for-profit organizations such as ours” (Dentzer 2008:2).

      GlaxoSmithKline has participated for more than a decade in the global partnership to eliminate lymphatic filariasis (LF), donating albendazole to reach several...

    • 14 Group Report: Elements of Good Governance in Disease Eradication Initiatives
      (pp. 191-200)
      Kari Stoever, Chris Maher, R. Bruce Aylward, Julie Jacobson, Ali Jaffer Mohamed, T. Jacob John, Robert S. Scott and Andy Wright

      In the 21st century, before organizational arrangements are established, disease eradication programs will be subject to a series of prerequisite steps, such as meeting feasibility criteria and establishing a business case, to garner sufficient political will. A core group of stakeholders will need to champion the formative work and establish the initial mechanisms for collaboration. However, to broaden support and manage the collaboration process in a multicultural and nonhierarchical environment, a series of sequential steps are required to co-opt new constituents. Once sufficient buy-in has been achieved, structural arrangements should be identified to assist in facilitating work so that it...

  10. Disease Eradication and Health Systems
    • 15 Integration of Eradication Initiatives and Health Systems
      (pp. 203-216)
      Alan R. Hinman

      Many interventions (e.g., immunizations, prenatal care, tuberculosis treatment, sexually transmitted disease treatment, and family planning services) have been shown to be effective as well as cost-effective in preventing disease, disability, and death. However, they are not uniformly applied throughout the world; poor countries typically have the lowest rate of implementation due to a lack of human or financial resources and system capacity. As a result, in 2010, approximately 7.7 million children under the age of 5 years died (Rajaratnam et al. 2010). Of the estimated 10 million child deaths in 2000, analysis indicated that 63% of these deaths could have...

    • 16 How Can Elimination and Eradication Initiatives Best Contribute to Health Systems Strengthening?
      (pp. 217-234)
      Stewart Tyson and Robin Biellik

      Efforts to eliminate/eradicate communicable diseases have been pursued for more than a century. In the 1950s and 1960s, breakthroughs in pharmaceuticals and vector control were translated into malaria, smallpox, and other disease control initiatives (Mills 1983). These occurred at a time of faith in the potential of targeted delivery of solutions based on good science to realize ambitious global goals as well as what were perceived to be quick wins in global health.

      Programs were introduced into basic health care systems where immunization was typically limited to BCG and smallpox, where there was no effective national disease surveillance, and where...

    • 17 The Impacts of Measles Elimination Activities on Immunization Services and Health Systems in Six Countries
      (pp. 235-254)
      Piya Hanvoravongchai, Sandra Mounier-Jack, Valeria Oliveira Cruz, Dina Balabanova, Robin Biellik, Yayehyirad Kitaw, Tracey Koehlmoos, Sebastião Loureiro, Mitike Molla, Ha Trong Nguyen, Pierre Ongolo-Zogo, Umeda Sadykova, Harbandhu Sarma, Maria Gloria Teixeira, Jasim Uddin, Alya Dabbagh and Ulla Kou Griffiths

      Measles is the prime target as the next disease for a global eradication campaign. Its biological characteristics and effective intervention make it a feasible disease to eradicate at the current point in time (de Quadros et al. 2008). Considerable progress has already been achieved toward the global goal of a 90% reduction in measles mortality by 2010 (Dabbagh et al. 2009). In fact, five of the six WHO regions have already adopted a measles elimination target. Consequently, at the 2010 World Health Assembly, milestones toward measles eradication were endorsed (WHO 2010a).

      One of the key concerns in determining the appropriateness...

    • 18 Disease Eradication as a Springboard for Broader Public Health Communication
      (pp. 255-270)
      Jeffrey Bates, Sherine Guirguis, Thomas Moran and Lieven Desomer

      Health communication has evolved greatly over the past fifty years. Better linkages between social and communication theory, research, and practice have yielded strong evidence for what works best in the field. When communication began to emerge as an area of study, it was guided by claims from the realms of psychology and the social sciences that the mass media could exact immediate and powerful effects. This basic tenet of mass effect informed early health communication efforts and still persists today in many health communication programs. Along with the supposition that mass media could have a dramatic influence on public behavior,...

    • 19 Group Report: Designing Elimination or Eradication Initiatives that Interface Effectively with Health Systems
      (pp. 273-286)
      Muhammad Ali Pate, John O. Gyapong, Walter R. Dowdle, Adrian Hopkins, Dairiku Hozumi, Mwelecele Malecela and Stewart Tyson

      Since the launch of the guinea worm and polio disease eradication programs in 1980 and 1988, respectively, the health and development landscape has changed dramatically. The architecture of global health aid has evolved into a complex entity involving the efforts of multiple donors and various stakeholders in an ever-increasing number of health initiatives. Low-income countries face many challenges: a double disease burden with the unfinished agenda of high levels of preventable and treatable infectious diseases is compounded by a mounting burden of noncommunicable diseases. Institutional capacity is often minimal and resources are limited. In the poorest countries, health systems are...

  11. List of Acronyms
    (pp. 287-290)
  12. Bibliography
    (pp. 291-312)
  13. Subject Index
    (pp. 313-320)