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What can the trachoma community teach us about partnerships?
by Devex Editor
3 August 2020
The fight for trachoma elimination was built on close cooperation, efficient spending, and a relentless quest for effectiveness. Could lessons learned from 20 years of cross-sector partnerships become mainstream?
Over 20 years ago, former U.S. president Jimmy Carter went to pharmaceutical giant Pfizer and asked the company to join the fight against trachoma. The disease could not be eliminated without mass administration of antibiotics, which at-risk countries — such as Ethiopia, South Sudan, and dozens of others across Africa, Asia, Latin America, Oceania, and the Middle East — could not afford.
The Carter Center, a nonprofit founded by the former president and his wife, Rosalynn, was leading the fight against a number of neglected tropical diseases and needed the private sector to support its trachoma control program. Pfizer agreed. Thus began one of the longest-standing cross-sector partnerships in global health.
Former U.S. President Jimmy Carter, former Carter Center Board of Trustees Chair John Moores (center), and former First Lady Rosalynn Carter observe a young Ethiopian girl while she washes her face to prevent the bacterial eye disease trachoma. In September 2005, a Carter Center delegation toured Mosebo, an Ethiopian village where the Center works to eliminate trachoma as a public health problem.
Credit: The Carter Center
Trachoma — caused by the bacterium Chlamydia trachomatis — is an NTD that affects an estimated 1.9 million people with blindness or visual impairment around the world. Repeated infections lead to scarring on the inside of eyelids, causing them to turn inward in a process called trichiasis. Eyelashes then rub against the eye, damaging the cornea and eventually altering eyesight. Trachoma is currently the leading infectious cause of blindness worldwide and is both a cause and a consequence of poverty.
Chlamydia trachomatis thrives where there is poor sanitation, especially in remote and isolated areas. It is endemic in dozens of countries, putting 142 million people at risk of catching the disease. According to the World Health Organization, economic losses due to visual impairment caused by trachoma are estimated to range from $2.9 billion to $5 billion each year.
Status of elimination of trachoma as a public health problem, 2019
Source: WHO
China
Afghanistan
Iran
Iraq
Algeria
Morocco
Mexico
Pakistan
Bhutan
Libya
Egypt
India
Oman
Mauritania
Myanmar
Sudan
Mali
Niger
Vietnam
Laos
Yemen
Chad
Guatemala
Eritrea
Senegal
Burkina Faso
Nigeria
Guinea-Bissau
Ethiopia
Guinea
South Sudan
Venezuela
Benin
Somalia
Central African Republic
Ivory Coast
Ghana
Colombia
Cameroon
Uganda
Kenya
Democratic Republic of the Congo
Brazil
Papua New Guinea
Burundi
Peru
Tanzania
Angola
Zambia
Australia
Mozambique
Zimbabwe
Namibia
Botswana
Known to require interventions
May require interventions, investigation needed
Thought to not require interventions, claims to have eliminated
Validated as having eliminated
Thought to not require interventions
To combat the disease, WHO in 1993 adopted the SAFE strategy, named for its four components: surgery to correct trichiasis, antibiotics delivery, prevention activities targeting facial cleanliness, and environmental improvement. In 1996, WHO also launched the WHO Alliance for the Global Elimination of Trachoma by the year 2020, a partnership that supports the implementation of the SAFE strategy.
Since then, progress has been immense. Nine countries have reportedly eliminated the disease, and the number of people living in endemic areas dropped by 91% between 2002 and 2019, going from an estimated 1.5 billion to just over 142 million. In 2018, Ghana became the first country in sub-Saharan Africa to eliminate trachoma.
Credit: Brent Stirton/Getty Images for ITI