Overview

Since 1996, trachoma has been targeted for elimination as a public health problem worldwide.
The active trachoma criterion for national elimination as a public health problem is a TF1–9 < 5%,
sustained for at least two years in the absence of antibiotic mass drug administration (MDA), in each
formerly endemic EU. Using A, F and E, health ministries and their partners have made
considerable progress towards achieving this criterion in formerly endemic EUs worldwide. In 2002,
an estimated 1517 million people lived in EUs in which EU-wide implementation of the A, F and E
components of SAFE were thought to be needed for the purposes of global elimination of trachoma
as a public health problem; by June 2021, that number had fallen to 136.2 million, a 91%
reduction. Approximately 85% of the 136.2 million people living in EUs needing A, F and E in
June 2021 were in WHO’s African Region.

Alongside this general progress, it is evident that in a small proportion of EUs there is difficulty
sustaining TF1–9 < 5%. Such EUs fall into two broad categories: those in which TF1–9 remains at or
above the elimination threshold (5%) despite implementation of interventions; and those in
which TF1–9 < 5% is achieved at impact survey, but subsequently returns to ≥ 5% during the two-and a-half-year period of surveillance after stopping MDA [data in press]. Using current A, F and E
interventions, modelling suggests a low likelihood of successful elimination by 2030 in at least some
of these EUs.