Eliminating diseases, one region at a time

March 21, 2024
Posted by: OptimizeIAS Team
Category: DPN Topics

Eliminating diseases, one region at a time

Subject: Science and tech

Section: Health

Context:

The Carter Center, a leader in the global elimination and eradication of diseases, recently reported that guinea worm disease was close to eradication.
From 3.5 million cases a year in 21 countries in 1986, the number had come down to 13 in five countries in 2023, a reduction of 99.99%. This would be the second disease after smallpox to be eradicated and the first one with no known medicines or vaccines.

On disease elimination, its focus

Disease elimination vs. Eradication	Disease elimination focuses on achieving zero transmission within a specified region, contrasting with eradication, which is the permanent global cessation of infection by a pathogen without any risk of reintroduction.
Benefits of disease elimination	Disease elimination enhances public health, particularly for the vulnerable poor, by energizing the health system, improving primary care, diagnostics, and surveillance, and fostering international support. It also generates significant political, bureaucratic, and public commitment.
Challenges in eliminating a disease	The elimination process is resource-intensive and places a heavy burden on health systems, which could lead to the neglect of other important health functions, especially in weaker health systems. This necessitates a careful analysis of costs and benefits and requires strong political support.
Strategic Considerations	While scientifically feasible for many diseases, strategic focus should be on pathogens with significant impact and low enough prevalence to make elimination practical. For diseases with high prevalence, control to reduce their numbers to a feasible level for elimination should be the initial aim. This strategy helps in understanding elimination processes and costs, and in strengthening health systems for the rigors of elimination.
Need for Robust Surveillance Systems	The government’s commitment to disease elimination necessitates substantial investments in surveillance systems to accurately detect every case of the disease. Even after achieving elimination, ongoing surveillance is critical to promptly identify and address any disease reintroduction, given that the pathogen itself has not been eradicated globally.
Targeted Approaches to Disease Elimination	India, which carries 40% of the global burden of lymphatic filariasis, aims for its elimination as resolved by the World Health Assembly in 1997. The disease’s presence in only a few states suggests that a strategic combination of surveillance, vector control, drug administration, and morbidity management could lead to its elimination. Conversely, some diseases with long incubation periods, high prevalence, and drug resistance across many regions require a revised, more localized, and phased approach to elimination. Diseases that can be feasibly eliminated in defined geographical regions—such as states, districts, or blocks—should be targeted first.
Regional Certification and Expansion Strategy	After achieving elimination and receiving regional certification, such areas should be safeguarded (“ring-fenced”) with enhanced control measures in neighboring regions. This strategy allows adjacent areas to progress towards elimination once they meet the necessary criteria, facilitating a gradual expansion of disease-free zones.

Source: TH