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W<br />
108<br />
<strong>THE</strong> PILL<br />
AND<br />
<strong>THE</strong> WILL<br />
Yaws is ripe for global elimination. This is because the<br />
causative bacterium spreads from person to person<br />
and there is no animal reservoir in which it can hide –<br />
it is vulnerable to thoroughly conducted public health<br />
campaigns.<br />
Furthermore, because yaws causes significant<br />
suffering and overwhelmingly affects children – some<br />
75% of infections occur in people under age 15 – there<br />
is a strong moral and practical imperative to eliminate<br />
the disease. Some 10% of those infected, if untreated,<br />
are left disfigured and disabled within five years.<br />
In addition, it is now easier and less expensive<br />
to carry out campaigns against yaws. Since 2012,<br />
a single oral dose of the antibiotic azithromycin has<br />
replaced the previous standard treatment of a single<br />
intramuscular injection of benzathine penicillin. This<br />
latest advance means that health workers no longer<br />
have to deal with hypodermic needles, with their<br />
accompanying transport requirements, sterility and<br />
proper disposal. This is a major advantage when care<br />
often must be administered in rural, underdeveloped<br />
locations.<br />
The term “simple” does not often come up in relation<br />
to tropical diseases, but now that a single pill can<br />
cure yaws, the best approach is a simple one: to batter<br />
it into submission by skipping the diagnostic tests<br />
and giving one 30 mg antibiotic pill to every person<br />
in every endemic region. The problem in conquering<br />
the disease is not medical or technical, it is in finding<br />
sufficient money and commitment. The new international<br />
strategy for yaws – the “Morges Strategy” –<br />
focuses on mass treatment because such an approach<br />
is logical. In fact, it worked during a trial run on the<br />
island of Vanuatu in July 2013.<br />
At least 88 tropical countries and territories were once<br />
endemic for yaws. The eradication campaigns of the<br />
1950s and 1960s targeted 46 countries. Currently,<br />
there are 13 endemic countries.<br />
The dream is to eliminate a disease that has caused<br />
suffering and disability for millions of people for hundreds<br />
of years. Why not do it? India eliminated yaws in<br />
2003 before the antibiotic pills were available – public<br />
health workers there accomplished the feat using the<br />
old treatment of intramuscular injection.<br />
Now that a cheaper, easier method is available,<br />
it is not a question of whether the world can afford<br />
to eradicate yaws, but more a question of how it can<br />
afford not to?
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