A Record Year for Disease Elimination

Perhaps not the headline most would first think of, but 2023 was a record year for disease elimination. A distinction between eradication and elimination, however, should be made. Eradication of a disease is seen as permanent and worldwide. Elimination of a disease, however, is only talking about a specific geographic area. “Eradication means that intervention measures are no longer required, the agent, which previously caused the disease is no longer present. Elimination of a disease refers to the deliberate effort that leads to the reduction to zero of the incidence of infection caused by a specific agent in a defined geographic are … actions to prevent the disease from transmitting or re-emerging are still required once a disease is eliminated” (1).

Two diseases—smallpox and rinderpest—have been eradicated. As the World Health Organization (WHO) reaches its 75th birthday, its summary of disease burden decries increased heath perils associated with climate change and sustained urban warfare. But the summary also lists a surprising number of achievements.

Society has learned to co-exist in a world with COVID-19, but in March 2023, WHO certified Azerbaijan and Tajikistan malaria-free, followed by Belize in June, while Egypt made huge strides towards banishing Hepatitis C. More than 50 countries eliminated at least one neglected tropical disease (NTD); for example, Ghana eliminated gambiense Human African trypanosomiasis, “a life-threatening sleeping sickness transmitted by tsetse flies that causes significant harm in rural populations living in poverty in sub-Saharan Africa.” New and improved vaccines became available for malaria, dengue meningitis, and cervical cancer. These communicable diseases disproportionately affect the poorest among us (2).

Access and shortages, sometimes due to supply chain failures made obvious by COVID-19 vaccine and therapeutic rollouts, became a topic of concern for rich and poor alike. “For the 2023 update, 85 applications, encompassing over 100 medicines and formulations, were considered by the WHO Expert Committee on Selection and Use of Essential Medicines List (EML). The recommended changes bring the total number of medicines on the EML and EMLc (Essential Medicines List for Children) to 502 and 361, respectively” (3). Multiple sclerosis (MS) treatment was given a boost, with Secretariat of the WHO EML, Dr Benedikt Huttner saying, “given the evidence base and the increased affordability of rituximab, including the availability of prequalified biosimilars, it has been prioritized over on-label alternatives as an essential medicine to treat relapsing-remitting and progressive MS” (3). Two new cancer treatments, pegylated liposomal doxorubicin for Kaposi sarcoma and pegfilgrastim (to stimulate production of white blood cells and reduce the toxic effect of some cancer medicines on the bone marrow). Also of note was inclusion of various polypills for cardiovascular disease (3).

While 2023 was a turbulent year in many respects, the WHO summary report on disease burden and medicines access provides some room for optimism, despite these improvements not making major headlines throughout the year. Perhaps if they did, it would positively encourage more such advances and improvements to the way healthcare is thought of, and delivered?

References

1. Roser, M.; Ochmann, S.; Behrens, H.; Ritchie, H.; Dadonaite, B. Eradication of Diseases, Revised October 2018, Our World In Data, Global Change Data Lab. https://ourworldindata.org/eradication-of-diseases
2. WHO. Global Health Achievements 2023–Reasons for Hope. Press release. WHO.int (accessed Dec. 21, 2023). https://www.who.int/news-room/spotlight/global-health-achievements-2023
3. WHO. WHO Endorses Landmark Public Health Decisions on Essential Medicines for Multiple Sclerosis. Press release. July, 26 2023. https://www.who.int/news/item/26-07-2023-who-endorses-landmark-public-health-decisions-on-essential-medicines-for-multiple-sclerosis