Some of our recent articles on TropIKA.net have involved use of the E word – elimination. There comes a time when it becomes realistic for a control programme that seeks merely to reduce case numbers to progress to the more ambitious goal of eliminating an infectious disease as a public health problem. The elimination of malaria from some of the territories where it is endemic is now technically feasible, though many barriers will still have to be overcome.

As we report [1], the health authorities in Zanzibar, where there have been substantial reductions in malaria in recent years, have been asked to decide whether there is sufficient political will to tackle the financial and operational challenges that would have to be overcome to achieve elimination there. Zanzibar is much better placed to realize such a goal than most parts of mainland Africa but it would, nevertheless, be a bold move to make elimination the official policy. If Zanzibar takes this step, could it inspire similar policy switches elsewhere? (Meanwhile, although less is usually heard from South America’s national malaria programmes, the TropIKA.net blog reports that in both Brazil [2] and Venezuela [3] rises in case numbers have been noted, and have been associated with increased exploitation of the rain forest.)

Elimination of the disfiguring and disabling disease lymphatic filariasis (LF) has been set as a worldwide goal for 2020. A meeting [4] of the Global Alliance to Eliminate Lymphatic Filariasis concluded that efforts to meet this deadline are on track. Recent successes in the Philippines [5] provide an example of the progress that has been made. However, researchers in Tanzania [6] found that encouraging reductions in LF, following the launch of a mass drug administration programme, soon levelled off. The study demonstrates that it is essential to monitor elimination programmes to determine how they are performing in specific locations.

But elimination will always need more than a technical fix. As Bill Gates recently noted, there is a “human piece” in global health. Following his intervention as a major donor, the Global Polio Eradication Initiative will introduce new elements into its strategic plan. These include: training for health care workers on hygiene and sanitation; interventions aimed at increasing access to clean water and zinc supplementation; and the sensitization of communities to the importance of personal hygiene, routine immunization and breastfeeding. Gates has been noted for his focus on the use of technology in disease control. As we discuss in a TropIKA.net Editorial [7], his new enthusiasm for the human piece could have far-reaching implications.

Tuberculosis is sadly an example of a disease where there are no prospects for elimination in the foreseeable future, but a recent conference on TB vaccine research did hear that potential new tools against the disease are in the pipeline [http://www.tropika.net/svc/news/20100607/Chinnock-20100607-News-TBVI#page-comments]. A protein that protects against TB has also been [9] identified. Less encouraging news is the finding that, in African countries that have expanded their mining industries, the whole population (not just the miners themselves) faces a higher risk of TB [10]. Also of concern is that, despite the growing rates of multidrug-resistant TB in South Africa, nurses there seem to have very little knowledge of the condition [11].

The remit of TropIKA.net extends beyond the more widely known infectious disease of poverty, such as malaria, TB and polio. We recently highlighted a review [12] that argues for more action against neurocysticercosis – a consequence of tapeworm infection – which is responsible for many cases of epilepsy. A conference [13] on this much neglected condition will take place in Uganda in July.

The TropIKA.net blog continues to publish many items of interest. We report for example [14] that three research institutions in Kenya have combined their expertise to develop a scientific model that can predict surges in malaria. They claim to be able to achieve accuracy levels of 80–100%. Such achievements demonstrate what African scientists can achieve – in Africa – if given sufficient opportunities to do so. It is welcome news therefore [15] that the new $38 million Human Heredity and Health in Africa Project (H3 Africa) will employ African scientists in the search for new insights into genes, environment and health among African populations.

Paul Chinnock
Editor, TropIKA.net