Eliminating diseases, one region at a time 

 1. Guinea worm disease

Guinea worm disease, also known as dracunculiasis, is an infection caused by the parasitic worm Dracunculus medinensis. 

• The disease is transmitted when people consume water contaminated with copepods (tiny water fleas) that carry infective larvae of the Guinea worm.
• After ingestion, the larvae mature and grow inside the human body for about a year before emerging as adult worms.
• The most characteristic symptom is the emergence of a long, thread-like worm through a painful blister on the skin, usually on the lower limbs. This process can be excruciating and disabling.
• Guinea worm disease was historically endemic in several countries in Africa and Asia. However, concerted efforts have significantly reduced its prevalence over the years.
• The Carter Center, along with other global health organizations and governments, has been leading the campaign to eradicate Guinea worm disease. This effort involves various strategies such as promoting water filtration, providing health education, and implementing surveillance and containment measures.
• The reported reduction in Guinea worm cases from millions to just a handful in recent years signifies a major success in the fight against this disease. Such progress is a result of persistent public health interventions and community engagement.
• Despite the progress, challenges remain in completely eradicating the disease. Factors such as remote and inaccessible regions, conflict zones, and water source contamination continue to pose obstacles to eradication efforts.
• Eradicating Guinea worm disease is crucial not only for eliminating suffering and disability associated with the disease but also for demonstrating the effectiveness of public health interventions and global cooperation in combating neglected tropical diseases.

2. Sustainable Development Goals

1. No Poverty End poverty in all its forms everywhere. Strategies include poverty alleviation programs, access to education and healthcare, social protection measures, and economic empowerment initiatives.
2. Zero Hunger End hunger, achieve food security and improved nutrition, and promote sustainable agriculture. Strategies include increasing agricultural productivity, supporting small-scale farmers, promoting sustainable food systems, and addressing malnutrition.
3. Good Health and Well-being Ensure healthy lives and promote well-being for all at all ages. Strategies include universal healthcare coverage, disease prevention and control, maternal and child health services, mental health support, and access to essential medicines.
4. Quality Education Ensure inclusive and equitable quality education and promote lifelong learning opportunities for all. Strategies include improving access to education, enhancing educational quality, promoting vocational training, and reducing disparities in education.
5. Gender Equality Achieve gender equality and empower all women and girls. Strategies include ending discrimination and violence against women, promoting women's participation in decision-making, ensuring equal access to education and healthcare, and empowering women economically.
6. Clean Water and Sanitation Ensure availability and sustainable management of water and sanitation for all. Strategies include improving water quality, increasing access to clean water and sanitation facilities, promoting water conservation, and addressing water-related disasters.
7. Affordable and Clean Energy Ensure access to affordable, reliable, sustainable, and modern energy for all. Strategies include promoting renewable energy sources, increasing energy efficiency, enhancing energy infrastructure, and expanding access to clean cooking technologies.
8. Decent Work and Economic Growth Promote sustained, inclusive, and sustainable economic growth, full and productive employment, and decent work for all. Strategies include job creation, skills development, fair wages, social protection measures, and supporting entrepreneurship and innovation.
9. Industry, Innovation, and Infrastructure Build resilient infrastructure, promote inclusive and sustainable industrialization, and foster innovation. Strategies include investing in infrastructure development, supporting technological advancements, promoting sustainable industrial practices, and enhancing connectivity.
10. Reduced Inequality Reduce inequality within and among countries. Strategies include addressing income inequality, promoting social inclusion, implementing progressive taxation, ensuring equal opportunities, and protecting the rights of vulnerable populations.
11. Sustainable Cities and Communities Make cities and human settlements inclusive, safe, resilient, and sustainable. Strategies include urban planning and management, affordable housing, sustainable transport systems, access to green spaces, disaster risk reduction, and promoting cultural heritage.
12. Responsible Consumption and Production Ensure sustainable consumption and production patterns. Strategies include promoting resource efficiency, reducing waste generation, recycling and reuse practices, sustainable procurement, and raising awareness about sustainable lifestyles.
13. Climate Action Take urgent action to combat climate change and its impacts. Strategies include reducing greenhouse gas emissions, promoting renewable energy adoption, enhancing climate resilience, implementing climate mitigation and adaptation measures, and raising climate awareness.
14. Life Below Water Conserve and sustainably use the oceans, seas, and marine resources for sustainable development. Strategies include marine conservation, preventing marine pollution, sustainable fisheries management, protecting coastal ecosystems, and promoting marine biodiversity.
15. Life on Land Protect, restore, and promote sustainable use of terrestrial ecosystems, sustainably manage forests, combat desertification, halt and reverse land degradation, and halt biodiversity loss. Strategies include afforestation and reforestation, sustainable land management practices, wildlife conservation, combating illegal wildlife trade, and promoting sustainable agriculture.
16. Peace, Justice, and Strong Institutions Promote peaceful and inclusive societies for sustainable development, provide access to justice for all, and build effective, accountable, and inclusive institutions at all levels. Strategies include promoting rule of law, reducing violence and crime, ensuring access to justice, combating corruption, strengthening institutions, and promoting democratic participation.
17. Partnerships for the Goals Strengthen the means of implementation and revitalize the global partnership for sustainable development. Strategies include enhancing international cooperation, mobilizing resources, promoting technology transfer, capacity-building support, and fostering multi-stakeholder partnerships to achieve the SDGs.

3. Focus on Disease Elimination

Distinguishing Elimination from Eradication

Elimination of transmission, aiming for zero transmission within a defined region, differs from eradication, which entails the permanent cessation of pathogen infection with no risk of reintroduction. Both are crucial for enhancing public health, particularly benefiting vulnerable populations.

Benefits of Disease Elimination

Disease elimination serves as a vital public health strategy, energizing the national health system and improving primary healthcare, diagnostics, and surveillance. Rigorous certification requirements by international agencies lead to enhanced involvement of field staff, community health workers, and international support, fostering political and bureaucratic commitment and public support. These efforts ultimately strengthen the health system.

Challenges and Considerations

While disease elimination is scientifically feasible for targeted diseases, it poses challenges and requires substantial resources. The intensive nature of elimination efforts may strain the health system and divert attention from other essential health functions, particularly in weaker health systems. Therefore, careful analysis of costs and benefits, along with informed political support, is essential to mitigate adverse impacts and optimize outcomes.

Strategic Approach to Disease Elimination

Focusing on pathogens with high population impact and low prevalence is strategic for disease elimination efforts. Initially, prioritizing disease control to reduce prevalence levels to a manageable extent sets the stage for practical elimination. This phased approach enables understanding of elimination processes, cost considerations, and strengthens health systems to effectively implement elimination strategies.

4. Importance of Surveillance Systems in Disease Elimination

• The government's investment in developing robust surveillance systems is crucial for effective disease elimination strategies. These systems must capture every instance of the disease, strengthen laboratory capabilities for screening and confirmation, ensure the availability of medicines and consumables, and provide rigorous training to the workforce involved in elimination efforts.
• Even after achieving elimination, continuous surveillance is necessary to detect any potential reintroduction of the pathogen since eradication may not have occurred.
• Achieving elimination for all targeted diseases nationwide within the set time frame may pose challenges. However, it is feasible for some diseases in specific regions of the country. For example, kala azar is now limited to five States, primarily affecting specific blocks in two States.
• India faces a significant burden of lymphatic filariasis, accounting for 40% of global cases. Despite being targeted for elimination by the World Health Assembly in 1997, it remains prevalent in certain States. However, a combination of surveillance, vector control, drug administration, and morbidity management can lead to successful elimination.
• Pathogens with long incubation periods or drug-resistant strains require a reworked elimination strategy, focusing on localized and phased approaches. Diseases prevalent in specific geographical regions, such as States, districts, or blocks, can be targeted for elimination within those areas.
• Upon achieving elimination in defined regions, such areas can undergo regional certification. Subsequently, these areas can be ring-fenced to ensure better control in adjoining areas, paving the way for further elimination efforts when they are deemed ready.

5. Advantages of Regional Approaches in Disease Elimination

• At the regional level, there is a greater opportunity for multisectoral collaboration, encouraging innovation, and adopting locally effective solutions that facilitate disease elimination. Smaller units can redeploy resources more efficiently to manage the additional workload without compromising other essential tasks.
• While elimination efforts can proceed regionally, it is essential for both national and State governments to take ownership of the process. The phasing of regional elimination should be planned systematically to culminate at the national level, considering the perspective of the entire country.
• Regional implementation of elimination strategies requires adequate technical and material support. Progress in regional elimination efforts needs to be closely monitored to ensure effectiveness and address any challenges promptly.
• Certain aspects, such as dealing with disease spread across States and at ports of entry, to control reintroduction, require the authority and resources of the Union government. National coordination is crucial for managing cross-state disease transmission effectively.
• In India, achieving national elimination goals can be most effectively accomplished by initiating elimination at the regional level and gradually scaling up across the country. This phased approach allows for focused efforts, efficient resource utilization, and comprehensive monitoring of progress.