FORGING THE CHAIN

C
IT CAN BE DONE
It is not easy but if a country wants to attack a disease
with determination and persistence, using existing
medications and methods, it can be controlled.
India contacted WHO in the mid-1990s about
the possibility of eliminating yaws, which had been
a domestic public health curse for centuries. Health
officials were told it was entirely possible – that it
was simply a matter of organization, funding and
commitment. Wherever a case was identified, they
should treat all in the surrounding community with
intramuscular injections of penicillin. Then they should
return and carry out a second round of treatments to
make sure that there were no new cases. Beginning
in 1996, Indian health workers did just that, fanning
out over the country, ensuring cases were reported,
responding without exception to all of them, travelling
in mobile teams to isolated communities, administering
millions of doses of antibiotics, and keeping careful
and thorough records. It took seven years, but in the
second most-populous country in the world, the last
confirmed infection of yaws was treated and cured in
2003. Active surveillance based on clinical symptoms
and serological tests – necessary for sustaining the
victory – has not identified a single case since.
Visceral leishmaniasis, a tougher challenge
because the disease has numerous non-human reservoirs,
was considered a near-insurmountable problem
in Bangladesh a decade ago. But the country
was determined to face it. WHO, working in cooperation
with Bangladesh’s Ministry of Health and
Family Welfare, introduced the use of a single dose
of AmBisome in major endemic areas of the country.
WHO has continued to provide technical and financial
support, including drug donation, which has helped
to cover the costs of a focused, persistent campaign.
As a result of these efforts, the burden of the disease
has declined to less than one case per 10 000 people
in endemic areas.
Throughout Africa, the noose is tightening around
sleeping sickness. Attacked on numerous fronts based
on its vulnerabilities in different regions, the disease
now infects well below 10 000 people annually, a steep
drop from the estimated 400 000 cases that was estimated
to have occurred annually in the 1990s.
Determination to finish the job and finish it definitively
will be vital this time. It is an issue that has arisen in
the past with tropical diseases. Sleeping sickness and
yaws were nearly eliminated in the 1960s, but when
attention and efforts waned, the diseases resurged
and the “penalty of success” took its toll.
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