Trachoma in the Western Pacific – end in sight

Screening for trachoma in Papua New Guinea

Through strong collaborations and evidence, several governments in the Western Pacific can now claim trachoma is no longer a public health problem. For many more, trachoma elimination is in sight.

So where are we with trachoma in the Western Pacific?

• A national assessment of trachoma conducted in Lao PDR in 2013 and 2014 found low prevalence of both trachomatous inflammation – follicular (known as TF) and trichiasis (or TT). Those assessments concluded that trachoma is no longer a public health problem in Lao.
• In Cambodia, rigorous studies of trachoma in 2014 and 2015 concluded that prevalence was below agreed thresholds.
• Mapping (see this paper in PLOS and this one from Ophthalmic Epidemiology) found low evidence for trachoma (and related blindness) in Solomon Islands, Vanuatu and Fiji. In contrast, significant rates of trachoma – both TF and TT – have been found in Kiribati. With the SAFE strategy, it is hoped Kiribati will eliminate trachoma soon. In the Pacific Islands, further research, surveillance and programmes are ongoing with support from the Queen Elizabeth Diamond Jubilee Trust.
• In 2015, Papua New Guinea’s National Prevention of Blindness Committee commissioned mapping and research which found endemic trachoma in some areas. Unlike trachoma endemic countries in Africa, there appears to be little blindness from trachoma, so the disease profile may be similar to neighbouring countries in the Pacific. The significance of this is unclear, and more research is planned.
• In Australia, trachoma remains prevalent in many remote outback communities. With government funding and partnerships in research, health promotion and service delivery, rates of trachoma in children in outback communities decreased from 21% to 4.6% between 2008 and 2015. In December 2016, Australia’s health minister pledged funding to continue elimination activities until 2021.
• At IAPB’s Annual Council of Members meeting in Beijing in 2015, eye health leaders in China announced that comprehensive surveys – supported by the Lions Clubs International and led by the National Institute of Hospital Administration – found trachoma was no longer a public health problem.

Governments and health ministries across the region have stepped up, led research and implemented the SAFE strategy. Donors, NGOs, research organisations, public health workers, water and sanitation experts, surgeons and communities have all contributed to this success. 

Globally, there has also been commitment and collaboration. In 1997, the Alliance for the Global Elimination of Trachoma was formed to bring together governments, international organisations and NGOs. The Global Trachoma Mapping Project, managed by Sightsavers with funding from the UK and US governments, is the largest-ever survey of infectious disease. The GTMP has helped to map trachoma hot spots in the Western Pacific and around the world, and given governments and stakeholders the evidence to plan and respond.

Trachoma has shown that public health problems aren’t solved just in the lab or the clinic. Elimination requires improved water and sanitation and changes to policy, behaviour and systems. Gender issues are more pronounced in trachoma than in other eye conditions, so community-based responses are critical.

By working together, gathering the right evidence, raising awareness and engaging decision-makers, trachoma may soon be a disease of history.