Progress and projections in the program to eliminate trachoma

Trachoma is a progressive and miserable disease. Initiated by frequent and repeated ocular infections with the bacterium Chlamydia trachomatis, scars on the inside of the eyelids contract, disrupting the lid margin and causing the eyelashes to rotate inwards until they rest against the eye. With each excruciating blink, the lashes damage the sensitive cornea leading to corneal opacity and irreversible blindness. Trachoma has been with us for a long time; it is among the conditions catalogued in the oldest medical text—the Ebers Papyrus. Taking into account life expectancies too short to allow many people to develop cataracts, trachoma was likely the leading cause of blindness before the Industrial Revolution and the consequent increase in life expectancy. In our view, the integrated and holistic SAFE strategy to eliminate trachoma—a strategy based on surgical correction of misplaced lashes, the mass distribution of donated antibiotics, and the promotion of water, sanitation, and hygiene (WASH)—makes the program the most compelling of the neglected tropical disease (NTD) elimination programs. SAFE implementation goes far beyond “just” putting trachoma in the crosshairs for elimination as a public problem. Whilst we are used to the concept of collateral damage, the SAFE strategy comes with considerable collateral benefits. Such benefits include the improved quality of life associated with surgery, particularly for patients who are yet to suffer loss of vision [1]. An annual dose of azithromycin increases child survivorship by reducing mortality from common ailments like malaria, bacterial respiratory tract infections, and diarrhea, the three of which remain the primary killers of children living in poverty—children who do not have routine access to antibiotics [2, 3]. Freedom from trachoma does not have to wait for development. Development is the result of freedom from trachoma.