The need for comprehensive approaches

The fight against trachoma involved partnerships early on. In 1998, Pfizer and the Edna McConnell Clark Foundation founded the International Trachoma Initiative, or ITI, — a program of The Task Force for Global Health, an independent not-for-profit — to manage donated stocks of the antibiotic azithromycin, Pfizer’s Zithromax. Since then, ITI has collaborated with a range of governments, academics, nongovernmental organizations, and community volunteers — an early example of a multisector partnership that continues to yield lessons for the entire global health community.

One of those lessons has been for all partners to collaborate closely to reach common goals while avoiding duplication of efforts. “The key about trachoma is really that not one single partner could or perhaps even should undertake all of the activities themselves,” said Simon Bush, director of NTDs at Sightsavers. “It's about bringing the right partners in place.”

The quest for efficiency has catalyzed innovative partnerships.

Since 1998, ITI has managed Pfizer’s donation of over 900 million doses of azithromycin — commercialized under the name Zithromax — which can be used to treat a number of infections. The risk that the donated doses could be lost, resold, or misused is high. This, as well as chronic underfunding for NTDs like trachoma, means ITI has focused on running a highly cost-effective program.

In 2019, International Trachoma Initiative shipped

86.9 million treatments

of Zithromax® to 20 countries.

Source: ITI

“We became very efficient as stewards of the drug by building strong relationships and staying transparent in our global partnerships,” said Paul Emerson, director at ITI.

Recipient countries are required to keep an inventory of their stock, and drugs are only dispatched if the distribution mechanisms are in place on the ground — another lesson learned by the trachoma community. Those controls ensure an unusually low wastage of the drug.

“Damaged in shipment, stolen, expired, and spilled, sending the wrong quantity, sending it to the wrong place … There's a whole number of ways that you can lose drugs,” Emerson said. “We manage to ship to 25-30 of the least developed countries in the world every year, and we lose less than 1% overall.”

Since many communities affected by trachoma live in remote areas, stakeholders needed to get better data on their exact location and how to reach them. This was largely accomplished from 2012 to 2016 by the Global Trachoma Mapping Project, a collaboration between 53 organizations — including NGOs, governments, and those from academia — that was largely funded by the U.K. Department for International Development.

Using smartphone technology, researchers examined 2.6 million people across 29 countries. The data allowed the trachoma community to demonstrate its capability to obtain more accurate information on how and where to dispatch the drugs. As a result, Pfizer gained further confidence and increased its donation from 50 million to 120 million doses annually between 2014 and 2018.

“What that program did was to map trachoma globally. It sounds basic, but you do have to know where the disease is to utilize the donated drug from Pfizer in a cost-effective way,” said Sightsavers’ Bush.

The project has since led to the creation of the Tropical Data initiative, which supports governments in collecting data about NTDs.

Such efforts are made possible by the high level of cooperation demonstrated by members of the trachoma community, which is unique in global health, Emerson said. They are used to sharing data, lessons learned, and best practices and to speaking with a unified voice. This reinforces the messaging around trachoma control and ensures consistency across countries.

“We don't compete for turf. There's no competition between the NGOs to try and support countries [for funding],” Emerson said. “It's done in a harmonized and coordinated fashion, and this creates accountability.”

Credit: Brent Stirton/Getty Images for ITI