International Coalition for Trachoma Control

The number of people at risk from trachoma, the world's leading infectious cause of blindness, has declined from 142.2 million in 2019 to 136.9 million in May 2020, the World Health Organization (WHO) reported in its Weekly Epidemiological Record (WER).

The progress update presents 2019 data on the implementation of the WHO-endorsed SAFE strategy (surgery, antibiotics, facial cleanliness, environmental improvements) in trachoma-endemic countries as well as summaries based on district-level prevalence estimates held in the GET2020 database as of 1 May 2020.

The record shows that in 2019, 95.2 million people received antibiotics to clear the infection that causes trachoma and 92,622 surgeries were conducted to treat trachomatous trichiasis (TT), the late blinding stage of trachoma. Of the 36 countries that reported TT surgery in 2019, 32 reported gender-disaggregated data, covering 92% of individuals operated on for TT; of these, 67% were female. This is a pleasing indicator of gender equity, given that, compared to men, women have nearly twice the risk of developing TT.

In total, 1,440 districts globally were endemic for trachoma during 2019. These districts qualified for implementation of the A, F and E components of the SAFE strategy. Of the people at risk, 117 million were in WHO’s African Region (86% of the global burden), including 76.2 million in Ethiopia (46% of the global burden). In 2019, WHO’s South-East Asia Region reported no districts known to require the A, F and E components of SAFE for the fourth year in succession.

This year marks the year targeted for trachoma’s global elimination as a public health problem. Since the WHO Alliance for the Global Elimination of Trachoma by 2020 was launched in 1996, nine countries have achieved the elimination of trachoma as a public health problem (Cambodia, China, Ghana, Islamic Republic of Iran, Lao People’s Democratic Republic, Mexico, Morocco, Nepal and Oman). This includes at least one country in each WHO region, demonstrating the effectiveness of the SAFE strategy across different contexts. Four further countries (Gambia, Iraq, Myanmar and Togo) have reported achievement of the prevalence targets for elimination but have not yet been validated by WHO.

“Although we will not achieve the global elimination of trachoma by the end of 2020, this update shows encouraging signs for the achievement of elimination by 2030, in line with the new 2021–2030 NTD road map and Sustainable Development Goal target 3.3”, said Scott McPherson, Chair of the International Coalition for Trachoma Control. “Recent quality-assured surveys have provided evidence of trachoma endemicity among hard-to-reach populations in Afghanistan, Nauru and elsewhere, providing the evidence base to deliver interventions as well as learnings that can be applied in other countries. This process is critical to leaving no one behind”.

The 2020 Weekly Epidemiological Record trachoma update notes that the global elimination of trachoma will not be achieved in 2020 and further work is needed. However, the report does show significant progress including a 91% reduction in the number of people at risk of trachomatous blindness since 2002: a fall from 1516.7 million to 136.9 million. The number of people requiring surgery for TT has decreased by 74%, from 7.6 million in 2002 to 2.0 million in May 2020. This progress would not have been achieved without the commitment to a global partnership between endemic countries, implementing partners, donors, academic institutions and WHO.