Abstract

Elimination and eradication (E&E) are the most ambitious public health goals for a program to achieve. In fact, historically, the world has seen many failures in the attempt to eliminate and eradicate diseases. Individual, disease-specific elimination goals have been achieved in some regions (e.g. wild polio in the Americas in 1994 and South-East Asia a full 20 years later and then in Africa in 2020) but there is only one successful human disease eradication program: the Global Smallpox Eradication Program. The World Health Organization’s new 2030 NTD Roadmap titled ‘Ending the Neglect to Attain the Sustainable Development Goals’ which was launched in 2021, targets twelve diverse diseases for elimination or eradication in the years and decades ahead.(1) Traditionally, E&E programs are implemented as extremely vertical programs. Some argue that this verticality is essential to the success of the program and a laser-like focus is required to achieve the goal. Others argue that we need a more integrated, health systems approach. The reality is that we probably need both, applied sensibly into the context in which the program fits. This vertical approach however, has hindered the ability to learn across programs to either benefit from successes or to avoid the same mistakes. For the world to most rapidly eliminate or eradicate its next disease, we will need to learn from previous successes and failures in E&E programs and apply their lessons to other disease efforts including the twelve NTDs targeted for elimination or eradication. To help ensure the best chance of success in current programs, we have reviewed past and ongoing E&E programs, summarized lessons learned, and identified common elements contributing to success and failure. Building on these elements, we created an approach for evaluating E&E programs, proposing a set of review questions designed to identify areas that may require strengthening or adaptation within a program. A proactive independent review of programs based on historic lessons could help avoid unnecessary setbacks and delays, saving time and resources, and building stronger and more resilient programs that adapt to our changing global environment.

Authors: Julie Jacobson, Alan Brooks, Anastasia Pantelias