Blindness from Trachoma Nearly Eliminated in Morocco

ITI and Pfizer increase commitment to trachoma control program following review of North African success. $200 million program will target blindness in nine countries.

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Representatives from the ITI and Pfizer will announce the expansion of their trachoma elimination efforts at a press conference in Room #226 of the United Nations Secretariat Building in New York on December 11, 2001 at 1:00 PM. Please call (703) 820-2244 or (212) 490-6460 for details. Limited individual interviews are also available.

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Trachoma-related blindness, which was a risk to 1.5 million people in Morocco just five years ago, will be completely eliminated in the country by 2005 in the most rapid ever single-country blinding trachoma elimination program, the International Trachoma Initiative (ITI) announced today. From start to finish, the ITI will have taken just six years to eliminate blindness from the disease in Morocco.

Trachoma is the world’s leading cause of preventable blindness. Currently, approximately six million people in developing countries are blind from trachoma, and ten percent of the world’s population is at risk of being blinded by it, making it a major public health threat. Since its inception, the ITI has supported the World Health Organization’s (WHO) goal of the global elimination of blinding trachoma by the year 2020.

Successful trachoma elimination in Morocco is due largely to the introduction of a comprehensive public health strategy known as SAFE, a community-based plan that emphasizes the medical, behavioral, and environmental changes necessary to eliminate the disease. Morocco was the first country to use the SAFE strategy on a broad scale.

In 1999, the ITI joined with the Moroccan government to greatly strengthen the country’s existing trachoma control effort. A major part of the ITI’s SAFE strategy is the donation
of the antibiotic Zithromax”, produced by the pharmaceutical research firm Pfizer Inc, for treatment of active trachoma infections.

The quick success of the ITI’s Morocco program has led the ITI’s board of directors and Pfizer to significantly increase the scope of the organization’s commitment to controlling blinding trachoma. The board announced today that it will expand its programs into Ethiopia, Nepal and Niger, bringing the total number of program countries to nine. Together, the nine countries constitute an estimated 20 percent of trachoma cases worldwide.

“The ITI is a unique public-private partnership, and it has shown great success,” said Joseph A. Cook, MD, ITI executive director. “We have established an effective partnership with the private sector, UN agencies, NGOs and governments that has allowed us to preserve the sight of tens of thousands of people at risk of this blinding disease in a very short period of time,” Cook continued. “It took several decades for the United States to control the disease at the beginning of the 20th Century.”

“Pfizer is fully committed to the global elimination of trachoma. In Zithromax®, we have an extraordinary medicine — developed at Pfizer — that makes treatment of trachoma infection easy and effective,” said Pfizer CEO Hank McKinnell. “But a successful campaign that reaches millions of at-risk patients can only be achieved through innovative partnerships that enroll the expertise of health ministries, non-governmental organizations and private industry. The lessons learned in the fight against trachoma are a roadmap for the treatment of unmet medical needs throughout the developing world,” McKinnell continued.

Pfizer, a founding ITI partner, announced that it will increase the donation of Zithromax” and technical support to the ITI to more than $200 million dollars over the next two years alone. This new donation is above and beyond the original $66 million pledge that Pfizer made when the ITI was founded in 1998. Zithromax” has been shown to be effective in treating active trachoma infections with a single, annual oral dose.

Pfizer’s $200 million commitment to the ITI is one of the largest pharmaceutical donations ever.

Morocco is one of 46 countries where trachoma is currently endemic. While the disease was eliminated in the industrialized world as a result of economic development and improved hygiene early in the 20th Century, trachoma still blinds millions of people in developing countries where water, sanitation and good hygiene are problematic.

Since 1998, the ITI, in partnership with Pfizer and the Edna McConnell Clark Foundation, has coordinated a public-private effort—linking prevention with treatment-—to eliminate blinding trachoma in several trachoma-endemic countries. The preliminary success of the ITI and the support of the Bill and Melinda Gates Foundation of Seattle and the Starr Foundation of New York, as well as the United Kingdom Department for International Development, enabled the ITI to expand to the three new program countries.

ITI’s innovative strategy is described by the acronym SAFE: “S” for surgery to treat complications that may cause blindness if left untreated; “A” for antibiotics (Zithromax®) to treat active trachoma infections; “F” to encourage increased face washing to reduce disease transmission; and “E” for environmental changes to increase access to clean water and improved sanitation. SAFE is recommended by the WHO for trachoma control as part of its global trachoma elimination goal.

“We owe much of our success in Morocco to our strong partnerships with Pfizer, the Moroccan government, local and international organizations such as UNICEF, Helen Keller International, as well as WHO and the SAFE strategy,” said the ITI’s Jeffrey W. Mecaskey, program director. “No single element of our strategy would have been successful on its own,” he continued.

“The most important lesson to take from this is that public-private partnerships like ours can be an extraordinarily powerful method of eliminating public health threats while at the same time building the infrastructure necessary for sustained improvement in public health,” Mecaskey said.

Since the ITI became active in Morocco in 1999, the country has decreased trachoma prevalence from 28 to 6.5 percent among the 1.5 million people living in program areas. This reflects a 75 percent reduction of overall disease prevalence. Moreover, preliminary data also suggest that the country may have already successfully eliminated more severe disease, which, if left untreated, leads to blindness.

“Success in Morocco’s fight against trachoma can only be compared to rapid reductions in diseases like polio and measles, which in the 1960s were controlled through childhood immunizations,” Cook said. “The United States, which screened immigrants for trachoma in the late 1800s and early 1900s, did not close its last eye hospital dedicated to trachoma until the late 1930s. However, the use of the full SAFE strategy with Pfizer-donated Zithromax® as the antibiotic has proven that blinding trachoma can be eliminated quickly and efficiently.”

Increasing the Commitment

The ITI board announced its increased commitment today after a detailed review of the Morocco program. The three new countries will join Morocco, Ghana, Mali, Tanzania, Sudan and Vietnam, where ITI-supported programs are already combating the disease.

Pfizer will continue to make Zithromax available for as long as ITI-supported programs continue to make progress toward the WHO’s goal of the global elimination of blinding trachoma. Pfizer’s original $66 million pledge of Zithromax” was the company’s largest international philanthropic venture to date. Increasing that commitment by $200 million underscores the company’s commitment to making long-term investments in sustainable public health efforts.

“One of the most important things American corporations can do in these uncertain times is to remain active in global philanthropy,” Pfizer’s McKinnell said. “We are also supportive of ITI’s intention to build the infrastructure needed to deliver prevention as well as treatment.”

Targeting Trachoma

Trachoma, which is caused by the bacteria Chlamydia trachtomatis, blinds women two to three times more often then men. It can be devastating to communities in endemic regions, blinding people during their prime working years and limiting their ability to provide for their families. Educational and economic achievement often remains low in these areas, hampered in part by the burden trachoma places on families and communities.

Trachoma is easily transmitted from person to person, particularly within families with small children. It first occurs in children, who often transmit the disease to others through frequent contact. Flies may pass the bacteria from person to person. Blindness occurs only after multiple infections, usually when individuals are in their 40s or 50s. Women’s close contact with children may be the factor that makes them more likely than men to be blinded by trachoma.

Without adequate treatment, the inner eyelid becomes scarred. After repeated infection and scarring, the eyelid will turn inward, causing the eyelashes to rub against and damage the cornea, a condition called trichiasis, which leads to blindness.

Since the 1950s, standard therapy has been tetracycline ointment applied directly to the eyes twice daily, for six weeks. With Zithromax®, however, a single annual oral dose treats active infection and is administered under trained supervision, resulting in much higher compliance rates.

Trachoma in Morocco

Two decades ago, trachoma existed throughout Morocco. However, economic development and public health efforts helped limit the disease to the five southern provinces now targeted by the Moroccan government and the ITI. These are Errachidia, Figuig, Ouarzazate, Zagora, and Tata.

Prior to the ITI’s creation in 1998, Pfizer and Clark supported field-testing of the SAFE strategy, including Zithromax®, in Morocco. Over 10,000 patients and family members were treated and millions were reached as part of a countrywide public health campaign, demonstrating the feasibility of a comprehensive community treatment effort.

When the ITI began operations in Morocco, approximately 625,000 children with trachoma needed immediate treatment and, in these southern provinces, where trachoma is endemic, an additional 1.5 million inhabitants are at risk of blindness.

Trichiasis is the result of repeated trachoma infections, which ultimately causes the eyelashes to turn inward and scratch the cornea. If trichiasis is not corrected, it results in blindness. Although Morocco has already cleared 65 percent of the surgical needs, an estimated 6,780 Moroccans still have trichiasis and need corrective surgery to prevent blindness.

In Morocco, the SAFE strategy has been implemented at both the government and the provincial levels. “A key to the success of the program lies in the spirit of partnership and dedication among our health professionals, teachers, and local community leaders,” said Dr. Youssef Chami-Khazraji, chief of epidemiology & disease control at the Moroccan Ministry of Health. “Our staff, along with those from the ministries of water and education, often work in difficult conditions, where they face hurdles such as sandstorms and lack of transportation. Many times, professionals must visit communities on foot.”

ITI’s first phase reinforced Morocco’s current activities, which exist through its National Program for Blindness Control (NPBC). The key to the success of the ITI/NPBC partnership has been working with local teachers, health professionals, and volunteers in the five targeted provinces. Local health personnel have been trained to conduct trichiasis surgery, and the community will be taught about the surgery’s advantages. The population is also being screened and treated for progressive and active trachoma. Efforts also focus on strengthening information, education, and communication activities to improve the local population’s hygiene. Safe water supplies are also being provided wherever possible by Morocco’s Office National de l’Eau Potable (ONEP).

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The International Trachoma Initiative (ITI) is dedicated to the elimination of blinding trachoma, the world’s leading cause of preventable blindness. The ITI approaches its mission—in countries where the World Health Organization has noted that trachoma remains a significant cause of blindness—through targeted support for expanded implementation of the SAFE strategy:

  • Surgery to correct advanced disease (a simple, 15-minute procedure)
  • Antibiotics to treat active infection—using Zithromax®
  • Face washing to reduce disease transmission (three handfuls of water per person)
  • Environmental change to increase access to clean water, improve sanitation, and promote health education to eliminate disease altogether

Founded in 1998 by the Edna McConnell Clark Foundation and Pfizer Inc, the ITI seeks to achieve global elimination of blinding trachoma by putting into action the SAFE strategy, including donated Zithromax”, applied research and program evaluation, and health education and advocacy.

The ITI’s growing success has attracted the support of new partners for trachoma control. The Bill & Melinda Gates Foundation, the UK Department for International Development (DFID), The Starr Foundation, the Conrad N. Hilton Foundation, The Dibner Fund, the Izumi Foundation, and a host of private donors have joined forces with ITI founding partners Pfizer Inc and the Edna McConnell Clark Foundation.

International Trachoma Initiative
441 Lexington Ave., 16th Floor
New York, NY 10017-3910, USA
Telephone: 1-212-490-6460
Fax: 1-212-490-6461
Email: iti@trachoma.org

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