International Coalition for Trachoma Control

Pakistan has been validated by the World Health Organization (WHO) as having eliminated trachoma as a public health problem.

Trachoma elimination in Pakistan follows more than two decades of action, which included the formation of a National Trachoma Task Force in 2002, the development of a Trachoma Action Plan, and the subsequent launch of the Pakistan Trachoma Elimination Programme to scale up all components of the WHO-endorsed SAFE strategy for trachoma elimination.

Additionally, trachoma elimination was facilitated by Pakistan’s five-year strategy to implement Integrated People-Centered Eye Care (IPCEC) nationwide. This strategy included specific objectives to eliminate trachoma as a public health problem and to undertake surveillance activities to monitor any potential resurgence of active trachoma in endemic areas.

Through the IPCEC programme, Pakistan trained nearly 90,000 female health workers and their supervisors to identify and refer cases of trachomatous trichiasis and provide access to tetracycline eye ointment. Eye health workers undergoing community ophthalmology training were also provided with specialized training on trachoma, which included information on diagnosis, trachoma surveys, and SAFE strategy implementation.

Pakistan’s path to elimination of trachoma as a public health problem faced several unique challenges. Notably, in 2017, the country discontinued azithromycin mass drug administration (MDA) due to circulation of resistant strains of Salmonella enterica Typhi, which causes typhoid. Because azithromycin was the only remaining oral antibiotic treatment option for this strain, Pakistan took the cautious approach of replacing MDA for trachoma with intensified facial cleanliness campaigns in five trachoma-endemic districts, with the intention of safeguarding azithromycin susceptibility in typhoid. The facial cleanliness interventions were intended to reduce transmission of trachoma. They targeted water, sanitation and hygiene (WASH) in schools and included training focal persons and schoolteachers, establishing WASH Clubs and sanitation management committees, and rehabilitating WASH hardware. This contributed to a reported 76% increase in face-washing with soap and a 16% increase in functioning WASH facilities.

“The elimination of trachoma as a public health problem is a testament to what can be achieved with an agile and forward-thinking approach to public health,” said Michaela Kelly, Vice Chair of the International Coalition for Trachoma Control. “Pakistan invested in its community health systems and surveillance systems and implemented an integrated people-centered approach to eye care that prioritizes health equity and sustainability. However, the national program also demonstrated its ability to adapt and increase WASH activities to accelerate trachoma elimination during the disruption of MDA campaigns, highlighting the importance of all components of the SAFE strategy.”

Pakistan is the sixth country in the WHO Eastern Mediterranean Region and the 19th country globally to achieve the elimination of trachoma as a public health problem. Other countries that have achieved this milestone include Benin, Cambodia, China, Gambia, Ghana, the Islamic Republic of Iran, Iraq, the Lao People’s Democratic Republic, Malawi, Mali, Mexico, Morocco, Myanmar, Nepal, Oman, Saudi Arabia, Togo, and Vanuatu.

The most recently published epidemiological data for trachoma, valid for April 2024, show that 103 million people were known to require interventions. This represents significant progress, including a 93% reduction in the number of people thought to be at risk in 2002. Trachoma is targeted for global elimination as a public health problem by 2030 in the 2021-2030 neglected tropical disease road map, which was endorsed by the World Health Assembly in 2020.

Trachoma elimination in Pakistan was supported by multiple ICTC members, including CBM International, the International Agency for the Prevention of Blindness, International Trachoma Initiative, The Fred Hollows Foundation and Sightsavers.