public health/medicine Cochi and Dowdle Disease Eradication in the Disease Eradication in the 21st Century 21st Century Implications for Global Health “What are the distinct benefits of disease eradication programs? Implications for Global Health An investment of this generation benefits all future generations, EDITORS providing ultimate benefi t/cost ratios. Disease eradication programs, EDITED BY at their best, explore and promote cutting-edge science and tech- Stephen L. Cochi and nology, improve delivery approaches, and develop innovative global political liaisons. They bring out the best in global health work. The Walter R. Dowdle implications, considerations, progress, and possibilities are pre- sented in this Strüngmann Forum Report.” William Foege Epidemiologist and author of House on Fire: The Fight to Disease Eradication in the Stephen L. Cochi is Senior Advisor to the Director, Global EDITED BY Disease eradication represents the ultimate in global equity Eradicate Smallpox Immunization Division, at the Centers for Disease Control and Stephen L. Cochi and and the defi nitive outcome of good public health practice. Thirty Prevention. Walter R. Dowdle is Director of the Polio Antivirals years ago, the elimination of smallpox defi ned disease eradica- “This excellent and detailed study on the applicability of eradication Initiative at the Task Force for Global Health in Decatur, Georgia. Walter R. Dowdle tion as a monumental global achievement with lasting benefi ts of disease in the global health fi eld comes at a time when the world for society. Today, the global commitment to eradicate polio and is about to eradicate polio. This in-depth look at the effects on global guinea worm and heightened interest in the potential eradication health is timely, and the Strüngmann Forum is to be congratulated in of other infectious diseases, including measles/rubella, lymphatic underwriting such an event. These fi ndings will be of great interest fi lariasis, onchocerciasis, and malaria, dominate public health to many involved in global health in all its facets, not solely disease concerns. But what does it take to eradicate a disease? This book eradication.” takes a fresh look at the evolving concepts of disease eradication, Kalyan Banerjee infl uenced by scientifi c advances, fi eld experience, societal issues, 2011–2012 President, Rotary International and economic realities. A diverse group of experts from around the world, representing a range of disciplines, examines the “This distinguished panel of authors from many disciplines and 21 professions and with worldwide experience has given us a robust biological, social, political, and economic complexities of eradicat- st Century and holistic view of what it really takes to eliminate and eradicate ing a disease. infectious and parasitic diseases at the regional and global levels, respectively, and it makes a sound and compelling case for investing The book details lessons learned from the initiatives against in these efforts, which are critically important to improve global polio, measles/rubella, and onchocerciasis. Further chapters health and bring an end to unnecessary suffering, disabilities, examine ethical issues, the investment case, governance mod- and death.” els, organizational and institutional arrangements, political and social factors, feasibility of eradication goals, priority setting, and Mirta Roses Periago Director, Pan American Health Organization the integration of disease eradication programs with existing health systems. 978-0-262-01673-5 STRÜNGMANN FORUM REPORTS THE MIT PRESS MASSACHUSETTS INSTITUTE OF TECHNOLOGY CAMBRIDGE, MASSACHUSETTS 02142 HTTP://MITPRESS.MIT.EDU STRÜNGMANN FORUM REPORTS Disease Eradication in the 21st Century Implications for Global Health Strüngmann Forum Reports Julia Lupp, series editor The Ernst Strüngmann Forum is made possible through the generous support of the Ernst Strüngmann Foundation, inaugurated by Dr. Andreas and Dr. Thomas Strüngmann. This Forum was supported by funds from the Deutsche Forschungsgemeinschaft (German Science Foundation) Disease Eradication in the 21st Century Implications for Global Health Edited by Stephen L. Cochi and Walter R. Dowdle Program Advisory Committee: R. Bruce Alyward, Stephen L. Cochi, John O. Gyapong, David Molyneux, Eric A. Ottesen, and Regina Rabinovich The MIT Press Cambridge, Massachusetts London, England © 2011 Massachusetts Institute of Technology and the Frankfurt Institute for Advanced Studies Series Editor: J. Lupp Assistant Editor: M. Turner Photographs: U. Dettmar Design and realization: BerlinScienceWorks All rights reserved. No part of this book may be reproduced in any form by electronic or mechanical means (including photocopying, recording, or information storage and retrieval) without permission in writing from the publisher. MIT Press books may be purchased at special quantity discounts for business or sales promotional use. For information, please email [email protected] or write to Special Sales Department, The MIT Press, 55 Hayward Street, Cambridge, MA 02142. The book was set in TimesNewRoman and Arial. Printed and bound in the United States of America. Library of Congress Cataloging-in-Publication Data Disease eradication in the 21st century : implications for global health / edited by Stephen L. Cochi and Walter R. Dowdle. p. ; cm. — (Strüngmann Forum reports) Includes bibliographical references and index. ISBN 978-0-262-01673-5 (hardcover : alk. paper) 1. Communicable diseases—Prevention. 2. World health. I. Cochi, Stephen L. II. Dowdle, Walter R. III. Series: Strüngmann Forum reports. [DNLM: 1. Communicable Disease Control. 2. Immunization Programs. 3. Socioeconomic Factors. 4. World Health. WA 110] RA643.D575 2011 362.196'9—dc23 2011014567 10 9 8 7 6 5 4 3 2 1 Contents The Ernst Strüngmann Forum vii List of Contributors ix 1 The Eradication of Infectious Diseases: 1 Understanding the Lessons and Advancing Experience Stephen L. Cochi and Walter R. Dowdle Lessons Learned from Current Elimination and Eradication Initiatives 2 Lessons from the Late Stages of the Global 13 Polio Eradication Initiative R. Bruce Aylward 3 Measles and Rubella Eradication in the Americas: 25 Seasoned Strategies for Sustained Success Jon Kim Andrus, Ciro A. de Quadros, Carlos Castillo-Solórzano, Mirta Roses Periago, and Donald A. Henderson 4 Onchocerciasis: From Control to Possible Eradication 35 Adrian Hopkins Critical Issues in Determining Feasibility of Eradication 5 Political and Social Determinants of Disease Eradication 47 Robert G. Hall 6 The Role of Research 63 Julie Jacobson 7 Group Report: Assessing the Feasibility 89 of an Eradication Initiative Peter Strebel, Eric A. Ottesen, Ciro A. de Quadros, Sherine Guirguis, Robert G. Hall, Linda Muller, Jai Prakash Narain, and Ole Wichmann Issues in the Development of an Eradication Investment Case 8 The Moral Case for Eradication 103 Claudia I. Emerson 9 Economic Evaluation of the Benefi ts and Costs of 115 Disease Elimination and Eradication Initiatives Kimberly M. Thompson and Radboud J. Duintjer Tebbens 10 Group Report: Developing an Eradication Investment Case 133 Kimberly M. Thompson, Regina Rabinovich, Lesong Conteh, Claudia I. Emerson, B. Fenton Hall, Peter A. Singer, Maya Vijayaraghavan, and Damian G. Walker 11 Guidelines for Preparing an Eradication Investment Case 149 Damian G. Walker and Regina Rabinovich vi Contents Governance 12 Governance Models for Eradication Initiatives 159 Kari Stoever 13 Managing Neglected Tropical Disease Partnerships 175 Andy Wright 14 Group Report: Elements of Good Governance 191 in Disease Eradication Initiatives Kari Stoever, Chris Maher, R. Bruce Aylward, Julie Jacobson, Ali Jaffer Mohamed, T. Jacob John, Robert S. Scott, and Andy Wright Disease Eradication and Health Systems 15 Integration of Eradication Initiatives and Health Systems 203 Alan R. Hinman 16 How Can Elimination and Eradication Initiatives Best 217 Contribute to Health Systems Strengthening? Stewart Tyson and Robin Biellik 17 The Impacts of Measles Elimination Activities on 235 Immunization Services and Health Systems in Six Countries Piya Hanvoravongchai, Sandra Mounier-Jack, Valeria Oliveira Cruz, Dina Balabanova, Robin Biellik, Yayehyirad Kitaw, Tracey Koehlmoos, Sebastião Loureiro, Mitike Molla, Ha Trong Nguyen, Pierre Ongolo-Zogo, Umeda Sadykova, Harbandhu Sarma, Maria Gloria Teixeira, Jasim Uddin, Alya Dabbagh, and Ulla Kou Griffi ths 18 Disease Eradication as a Springboard for 255 Broader Public Health Communication Jeffrey Bates, Sherine Guirguis, Thomas Moran, and Lieven Desomer 19 Group Report: Designing Elimination or Eradication 273 Initiatives that Interface Effectively with Health Systems Muhammad Ali Pate, John O. Gyapong, Walter R. Dowdle, Adrian Hopkins, Dairiku Hozumi, Mwelecele Malecela, and Stewart Tyson List of Acronyms 287 Bibliography 291 Subject Index 313 The Ernst Strüngmann Forum Founded on the tenets of scientifi c independence and the inquisitive nature of the human mind, the Ernst Strüngmann Forum is dedicated to the continual expansion of knowledge. Through its innovative communication process, the Ernst Strüngmann Forum provides a creative environment within which ex- perts scrutinize high-priority issues from multiple vantage points. This process begins with the identifi cation of themes. By nature, a theme constitutes a problem area that transcends classic disciplinary boundaries. It is of high-priority interest, requiring concentrated, multidisciplinary input to ad- dress the issues involved.