Health Programs

International Task Force for Disease Eradication

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How is The Carter Center involved?

Who are the members of the task force?

The task force is chaired by Dr. Donald R. Hopkins, vice president of health programs at The Carter Center. Members represent leading health organizations worldwide including the Centers for Disease Control and Prevention, the World Health Organization, UNICEF, and others. Other members are experts in specific diseases. See the complete list of members.
 
What determines whether a disease can be eradicated?

According to the International Task Force for Disease Eradication, two of the primary factors that determine whether a disease can be eradicated are scientific feasibility and political support.

The following are some of the conditions that make it scientifically feasible to eradicate a disease:

  • Epidemiologic vulnerability. A disease could be considered vulnerable if it does not spread easily, if there is a natural cyclical decline in prevalence, if there is a naturally induced immunity, if it is easily diagnosed, and if the duration of any relapse potential is short.
  • Availability of effective and practical intervention. Such interventions could include a vaccine or other primary preventive, a curative treatment, or a means of eliminating vector. Ideally, intervention should be effective, safe, inexpensive, long lasting, and easily deployed.
  • Demonstrated feasibility of elimination. A disease that has been documented to have been eliminated from an island or other geographic unit could be a candidate for eradication.
Even if it is scientifically feasible to eradicate a disease, there are nonscientific conditions that must be considered, such as the following:
  • Perceived burden of the disease
  • Expected cost of eradication
  • Synergy of eradication efforts with other interventions
  • Necessity for eradication rather than control
What is the difference between eradication, elimination, and control?

According to the International Task Force for Disease Eradication, disease eradication, elimination, and control are defined as follows:
 
Eradication: Reduction of the worldwide incidence of a disease to zero as a result of deliberate efforts, obviating the necessity for further control measures. True eradication usually entails eliminating the microorganism itself or removing it completely from nature.
 
Elimination: Refers to cessation of transmission of a disease in a single country, continent, or other limited geographic area, rather than global eradication (e.g., polio in the Americas). It is also theoretically possible to eliminate a disease in humans while the microbe remains at large (e.g., neonatal tetanus). Although a disease itself may remain, a particularly undesirable clinical manifestation of it may be prevented entirely (e.g., blindness from trachoma) or new transmission interrupted (e.g., infectious yaws). Control of a disease or its manifestations to a level that it is no longer considered a public health problem, as an arbitrarily defined qualitative (e.g., onchocerciasis in West Africa) or quantitative (e.g., leprosy incidence below one case per 10,000 population) level of disease control.
 
Control: Reduced incidence or prevalence of a disease or condition; control measures are still required.
 
 
How is The Carter Center involved?

Carter Center health programs address five of the diseases identified by the ITFDE for eradication or better control: dracunculiasis (Guinea worm disease), lymphatic filariasis, onchocerciasis (river blindness), trachoma, and schistosomiasis.

Guinea worm disease (dracunculiasis), identified as eradicable when the task force first convened, is a major thrust of Carter Center efforts. "Eradicating a disease that's been around since biblical times is an abstract concept," said Dr. Donald Hopkins, Carter Center vice president for health programs. "It's much more concrete to see the difference in each village, each family, and each person as they watch the disease being eliminated. The individuals' health, their ability to grow crops, the ability of their children to go to school, the wealth of the community, and the person's outlook on life all improve."

Another disease identified as eradicable by the task force is lymphatic filariasis. Through a Carter Center-assisted program in Nigeria, the country with the highest rate of lymphatic filariasis in Africa, men, women, and children are being taught how to relieve the pain of the disease and how to clean and care for infected areas of their bodies. They also are given donated doses of Mectizan® and albendazole, two medications that must be administered once a year for several years to stop transmission of the disease.
 
The Carter Center conducts an extensive river blindness (onchocerciasis) program in Africa, where 99 percent of the disease occurs. In the Americas, The Carter Center leads the effort, assisting the ministries of health in Colombia, Ecuador, Guatemala, Mexico, Venezuela, and Brazil. At its June 2001 meeting, the task force concluded it was scientifically feasible to eradicate the blindness caused by onchocerciasis in the Americas, where it often affects the disenfranchised and poorest of the poor.

The Gates Foundation also asked The Carter Center to convene a special conference of experts to assess the potential eradicability of onchocerciasis and to develop recommendations for demonstration efforts and further research to facilitate eradication or improved control of the disease.  The Conference on the Eradicability of Onchocerciasis took place at The Carter Center in January 2002 (co-sponsored by the World Health Organization); the final report of the conference is now available. 

Although trachoma was judged not to be eradicable, it is amenable to much better control. This is the most important infectious cause of preventable blindness in the world. The Center is assisting trachoma control programs in six African countries.
 
Schistosomiasis is also not eradicable but amenable to better control. The Carter Center is assisting two Nigerian states in integrating more drug administration and health education for schistosomiasis with similar interventions against onchocerciasis and lymphatic filariasis.