Developing Eradication Investment Cases for Onchocerciasis, Lymphatic Filariasis, and Human African Trypanosomiasis: Rationale and Main Challenges

The global health community pays renewed attention to evaluating the feasibility of elimination and eradication of certain communicable diseases [1,2] besides continuing to reduce the burden of ill-health. Eradication depends on both the availability of tools to interrupt transmission, the capacity of health systems to implement these solutions effectively across all populations concerned, the required resources, and sustained political will. While the health and economic benefits of disease elimination and subsequent eradication may be substantial, elimination initiatives represent resourceintensive efforts with associated opportunity costs [3,4]. Given the increasingly intense competition for global health resources, the decision to commit to national/regional elimination or eventual global eradication initiatives needs to be based upon robust analysis of benefits, risks, and costs. Following an initial proposal of the Ernst Strüngmann Forum, convened in 2010 to explore the prospects, feasibility, and challenges of disease eradication [2], a working group developed a Guide to Preparing an Eradication Investment Case (EIC) [5]. The Guide proposes a generic approach applicable to any potentially eradicable disease. Among the diseases tentatively identified as amenable to eradication are several neglected tropical diseases (NTDs) [6]. The vision of eliminating and eradicating selected NTDs has gathered momentum over recent years. In 2011, the WHO Strategic and Technical Advisory Group for Neglected Tropical Diseases and its partners adopted a roadmap for the control, elimination, and eradication of many NTDs. The global financial support for NTDs control and elimination is still comparatively low but has recently started to substantially increase. Following major pledges by the US Agency for International Development (USAID) (350 million USD for the period 2009–2013) and the UK’s Department for International Development (DfID) for 2011–2015 (245 million GBP), the Bill and Melinda Gates Foundation (BMFG) donated 363 million USD for NTDs control and elimination in January 2012 (London Declaration, http://endtheneglect. org/2012/01/ntds-take-spotlight-at-londondeclaration-meeting/).