By CBM UK
This blog post is part of Global Network’s #G7forHealth series, which highlights the current and potential impact of G7 countries on those suffering from neglected tropical diseases.
Hadiya is 9 years old. When CBM community workers met her in her village in Amhara, Ethiopia, her eyes had been itching and watering for three days. “It keeps her from being able to see others. She can’t see them clearly because of the tears,” explained her father Ali. But it wasn’t the first time Hadiya has experienced trachoma and she’s not alone in her village. 6 out of every 10 children in this region of Ethiopia suffer from an active trachoma infection.
Hadiya’s infection was treated with Zithromax, and her family now knows how face washing can help prevent the disease. CBM’s partner, Organisation for Rehabilitation and Development in Amhara (ORDA), has been working with the community to ensure that the village well is protected with the source capped and a retrieval unit fitted so that the water used for drinking and washing stays clean.
These interventions will make a huge difference to Hadiya. Not only will she be free from the itching and pain of the trachoma infection, but she is no longer at risk of losing her sight to the disease. And in a poor community like Hadiya’s the consequences of sight loss can be utterly devastating. Her chances of completing her education would be much reduced – only 1 in 10 children with disabilities in the global south goes to school. She would be at 2-3 times greater risk of violence or abuse. Her access to healthcare and opportunities to earn a livelihood would be far more limited. Like millions of people with disabilities worldwide, she could very easily find herself trapped in a cycle of poverty and disability.
Neglected tropical diseases (NTDs) such as trachoma are caused by poverty, flourishing under conditions characterised by poor housing and sanitation, unsafe water and limited access to basic health care. But by causing disability, they also lead to increased poverty for individuals and communities. This is why we believe investment in the fight against NTDs should be a priority for the world’s leading economies and why CBM UK — alongside 100+ international institutions and experts working on NTDs — is one of the signatories of an open letter to G7 leaders, asking them to sustain their current support for NTD control and elimination as well as to address current gaps.
Tackling disability is vital to ending extreme poverty, and eliminating NTDs like trachoma is a key way to prevent disability – 2.2 million people are visually impaired due to trachoma, and of them 1.2 million are irreversibly blind.
CBM has been working to prevent and treat blinding NTDs such as river blindness (onchocerciasis) and trachoma for over 20 years. CBM UK is currently involved in the Queen Elizabeth Diamond Jubilee Trust’s programme to tackle blinding trachoma in 10 out of 18 Commonwealth countries where trachoma is confirmed or estimated to be endemic.
Within the Trust’s programme, CBM UK is an implementing partner in Kenya, Uganda and Malawi, aiming to eliminate trachoma as a public health problem in each of these countries. This is done by implementing the ‘SAFE’ Strategy which consists of Surgery, Antibiotics, Facial Cleanliness and Environmental Improvements. The programme has recently completed its first year. During this time, CBM has held a number of community outreach camps to conduct trachoma surgery, which is used to treat the more advanced, blinding stage of the disease. The surgery element of the SAFE Strategy is used to address the backlog of trachoma cases, whilst the other elements are aimed at prevention and stopping (re)infection.
Funding programmes like the Trust’s initiative make a crucial contribution to the World Health Organisation’s (WHO) Alliance for the Global Elimination of trachoma by 2020 (GET 2020). The UK and the other G7 members must now ensure that this moment is sustained to permanently eliminate trachoma and other NTDs.
CBM is in international Christian disability and development organisation improving the quality of life of millions of people living with or at risk of disability in some of the world’s poorest communities. CBM UK programmes include a range of NTD programmes and other disability related programmes in Health, Livelihoods and Inclusive Education.
By Elizabeth Kurylo
Communications manager, International Trachoma Initiative
Every morning and every night, I turn on the hot and cold water taps, adjusting them so the temperature is just warm enough to wash my face. I take for granted that the water will flow. I would be shocked if it didn’t. This easy access to water is a luxury not enjoyed by hundreds of millions of people around the world.
As we mark World Water Day, it is worth noting that 748 million people do not have access to an improved source of drinking water and 2.5 billion do not use an improved sanitation facility. For them, the lack of water can mean poor health, disability and even death.
Water and sanitation is especially important in the prevention and control of trachoma and other neglected tropical diseases (NTDs). Trachoma is an ancient eye disease caused by a bacterial infection. Left untreated, it can lead to blindness. But we can stop it with the World Health Organization-endorsed SAFE strategy – Surgery, Antibiotics, Facial cleanliness and Environmental improvement.
Water is crucial to facial cleanliness, and key to ending blinding trachoma. But in many places where trachoma is endemic, water is scarce, and rationed for uses other than hygiene, such as cooking. Face washing is not a priority.
The global trachoma community has made much progress since 1998, when Pfizer began donating the antibiotic Zithromax®, which treats and prevents trachoma. More than 444 million doses of Zithromax® have been shipped to trachoma endemic countries to date. And seven countries have reported reaching their elimination goals.
Under the leadership of WHO and the Alliance for the Global Elimination of Blinding Trachoma by the year 2020 (GET 2020), national trachoma programs have steadily scaled up implementation. In 2014, WHO’s Weekly Epidemiological Report (WER) said trichiasis surgeries and antibiotic distribution were tenfold higher in 2013 compared to 2004.
The International Coalition for Trachoma Control (ICTC) has galvanized the global trachoma community’s commitment to reaching elimination by 2020. Collaboration on game-changing initiatives with governments, health officials and trachoma endemic communities has led to the mobilization of more than 150 million dollars of new funding from DFID, USAID and the Queen Elizabeth Diamond Jubilee Trust. That is in addition to the national government domestic budget allocations and support already provided by many non-governmental development organizations as well as other donors such as the Lions Clubs International Foundation, Conrad N Hilton Foundation and the Bill & Melinda Gates Foundation. The WASH sector also is collaborating with the NTD sector to achieve shared goals of improving health and eliminating disease.
Still, there is much work to do. An estimated 232 million people in 51 countries live in trachoma endemic areas. Globally, 31 countries are implementing the SAFE strategy to eliminate trachoma, which signifies that 20 countries are still in need of help.
In 2015, ITI plans to ship 115 million doses of Zithromax®, donated by Pfizer. That is more than twice the amount approved for shipment in 2014. “We are doing everything we can to accelerate access to Zithromax® needed by people who are at risk of blindness from trachoma,” said Dr. Paul Emerson, Director of ITI. “We are empowering national programs so that those at risk of going blind from trachoma can be treated.”
Empowering people in trachoma endemic communities to prioritize water for hygiene also has lasting benefits. I saw this in Ethiopia, where I met Amarech Haluka, the mother of three young girls, one of whom had experienced the pain of trachoma. Health workers introduced the SAFE strategy to Amarech’s community, which received donated Zithromax® and education about the importance of using latrines and keeping their faces clean to avoid trachoma. Amarech and her husband got a loan to install a water pump in their back yard, and she now routinely washes her children’s faces twice a day. Even though she cannot adjust the temperature of the water that flows from her pump, her children’s faces are clean, and her family is free of trachoma.
In their Annual Letter, Bill and Melinda Gates have one big bet: The lives of people in poor countries will improve faster in the next 15 years than at any other time in history. And their lives will improve more than anyone else’s.
Considering the tremendous progress made in the fight against neglected tropical diseases (NTDs), we couldn’t agree more. By advocating for the control and elimination of NTDs, the international community is making big strides to improve the lives of the world’s poorest people.
Just last year, 800 million people were treated for NTDs, and the U.S. Agency for International Development (USAID)’s NTD Program successfully delivered its one billionth NTD treatment. Echoing this momentum, NTD treatment continues to be recognized as a key tool for cutting extreme poverty. For example, the G7 and BRICS countries (Brazil, Russia, India, China and South Africa) recently made commitments to accelerate progress toward the global fight against NTDs.
NTDs are the most common affliction of the world’s poorest people, contributing to debilitating blindness, disfiguration and a number of harmful outcomes including school absenteeism, malnutrition and poor maternal and child health. This group of parasitic and bacterial infections is notorious for perpetuating poverty and undermining broader global development efforts. In order to end poverty and improve the lives of the poor, we must prioritize the control and elimination of NTDs.
In their annual letter, Bill and Melinda Gates specifically call for the end of four NTDs: Guinea worm, elephantiasis, trachoma and onchocerciasis. They write:
“Destroying a disease utterly is a very difficult thing to do—so difficult, in fact, that it’s only happened once in history, when smallpox was eradicated in 1980. But if we keep working hard, we can eradicate four diseases by 2030. We can get polio out of Africa this year and out of every country in the world in the next several years. Guinea Worm, an incredibly painful disease whose sufferers spend months incapacitated while worms that can be several feet long burst out of their legs, will also be gone soon, thanks in large part to the leadership of President Carter and the Carter Center. We’ll also see the last of diseases like Elephantiasis, River Blindness, and Blinding Trachoma, which disable tens of millions of people in poor countries. The drugs that can stop these scourges are now being donated in huge numbers by pharmaceutical companies, and they’re being used more strategically thanks to advances in digital maps that show where diseases are most prevalent. Last year these free medicines were distributed to 800 million people.”
Bill and Melinda Gates’ important message injects new energy into the fight against NTDs. Their message is timely, following the recent appropriation by Congress of $100 million toward USAID’s NTD Program for FY 2015 and the launch of India’s ambitious campaign to treat more than 400 million people for elephantiasis, which if successful, could help India eliminate elephantiasis within the next few years and set a bold example for the world.