Editorial: Dracunculiasis eradication by 2009: will endemic countries meet the target?

Abstract

As the global campaign for eradication of poliomyelitis encounters delays and difficulties (Fine & Griffiths 2007), some eyes are turning to the eradication of dracunculiasis (Guinea worm disease) as the ‘other’ prospect offering a potential high-profile success for public health in the next few years (Al-Awadi et al. 2007). Certainly, dracunculiasis eradication has come a long way in two decades, eliminating the disease from Asia, more than halving the number of endemic countries, and reducing the annual incidence from an estimated 3.5 million in 1986 to only 25 000 today (Hopkins et al. 2005; Barry 2006). The impact of Guinea worm disease on agricultural productivity in some parts of Nigeria was once so powerful and widespread that it could be seen from space (Ahearn & de Rooy 1996); now there are whole countries in Africa where the disease is no more than a fading memory, and a small scar on the legs of the middle-aged. And this has been achieved in some of the most remote and undeveloped communities in some of the poorest countries on the planet. The remarkable success of the initiative over the last two decades can be judged from Figure 1, showing the trend in reported cases of the disease over the years, for eight of the countries which have interrupted transmission. Note the logarithmic scale. The dotted line to the right of the figure shows that most countries have achieved a reduction in incidence by 50% or better in a typical year, and sustained that rate of decline over a protracted period of time. The good progress made so far, and the need to maintain optimism among field staff and funders, has inspired the setting of target dates for eradication, which have suffered from wishful thinking over the years. Already in the early 1980s, the Indian national eradication programme was announcing a postponement of its national target by two years from 1984 to 1986 (CDC 1983). In the event, India did not achieve zero cases until 1997. A global target date was set when the World Health Assembly declared in 1991 its commitment to the goal of eradicating the dracunculiasis by the end of 1995. Even then, there were doubts whether this was achievable (Tayeh & Cairncross 1993). Other target dates were to follow, until a World Health Assembly resolution in 2004 put the target for eradication back to 2009. Such a target date can help to boost the advocacy effort at the international level and in the endemic countries (Cairncross et al. 2002), but setting a target which is not achievable devalues the currency, and diminishes its impact on stakeholders.