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Disease Eradication in the 21st Century

Implications for Global Health

edited by Stephen L. Cochi and Walter R. Dowdle

Publication Year: 2011

Experts explore the biological, social, and economic complexities of eradicating disease.

Published by: The MIT Press

Series: Strüngmann Forum Reports

Title Page, Copyright

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pp. 2-5


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pp. v-vi

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The Ernst Strüngmann Forum

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pp. vii-viii

Founded on the tenets of scientific 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 experts scrutinize high-priority issues from multiple vantage points....

List of Contributors

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pp. ix-xii

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1. The Eradication of Infectious Diseases

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pp. 1-10

Humankind has always been fascinated by scourges of disease that cause incalculable misery in the world and have a devastating impact on society, and by subsequent attempts to eradicate such diseases (D. R. Hopkins 2009). The sustained eradication of an infectious disease agent, in which humans are the primary or sole host, was achieved for the first (and only) time in 1980, when the...

Lessons Learned from Current Elimination and Eradication Initiatives

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2. Lessons from the Late Stages of the Global Polio Eradication Initiative

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pp. 13-24

Given the substantial influence that the Global Polio Eradication Initiative can be expected to have on future eradication initiatives, it seems increasingly important to identify and analyze lessons from each phase of this program. The protracted “tail” of the polio eradication initiative currently appears to be disproportionately influencing discussion of, and decisions on, future eradication efforts, particularly with respect to...

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3. Measles and Rubella Eradication in the Americas

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pp. 25-34

This chapter reports on the measles and rubella eradication initiatives in the Americas, where initiatives demonstrate feasibility. Excellent, cost-effective interventions and the lack of an animal reservoir have made it possible to eradicate measles and rubella in the Americas. The driving force behind the eradication of measles, and more recently rubella and congenital rubella syndrome, has been to strengthen national capacity to ...

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4. Onchocerciasis: From Control to Possible Eradication

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pp. 35-44

Our understanding of onchocerciasis has evolved over the last one and a half centuries from a description of an annoying skin disease, called aptly enough “craw craw,” to an understanding of its transmission cycle and important role in blindness. Various control measures have been instituted as new tools have become available, and these have moved the field toward elimination and possible eradication. A review of the evolution ...

Critical Issues in Determining Feasibility of Eradication

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5. Political and Social Determinants of Disease Eradication

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pp. 47-62

Eradication of disease is a major social achievement. To date, six attempts have been made to eradicate diseases in which humans are the primary or sole host, but only one has been successful. Success depends on very high levels of participation, beyond the levels predicted if individual community members act rationally in a self-interested way. Because near-universal participation is a condition of the achievement of...

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6. The Role of Research

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pp. 63-88

Based on multiple global and regional programs that have attempted to eliminate or eradicate disease, this chapter reviews what has been learned to date, identifies gaps in knowledge, and highlights opportunities for learning and debate. The central and important role of research has clearly been demonstrated in historical attempts to eliminate...

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7. Group Report: Assessing the Feasibility of an Eradication Initiative

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pp. 89-100

New global eradication initiatives in the 21st century will face more stringent and rigorous pre-launch review than their predecessors. The assessment of whether a disease can and should be targeted for eradication will involve determination of whether the disease agent meets fundamental biological and technical criteria, demonstration of operational...

Issues in the Development of an Eradication Investment Case

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8. The Moral Case for Eradication

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pp. 103-114

This chapter considers the question of whether there is a moral imperative to pursue disease eradication once we have the means to achieve it. It examines three arguments that support the case for eradication from an ethical perspective: (a) the duty to rescue, (b) the duty to future generations, and (c) the notion of disease eradication as a global...

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9. Economic Evaluation of the Benefits and Costs of Disease Elimination and Eradication Initiatives

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pp. 115-132

As health care costs continue to increase, economic evaluations of public health interventions play an increasingly important role in resource allocation decisions. In some cases, opportunities exist to eliminate and eradicate some diseases; such efforts typically require committing significant amounts of financial resources, with eradication...

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10. Group Report: Developing an Eradication Investment Case

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pp. 133-148

Eradication initiatives offer important opportunities to provide global as well as intergenerational health benefits. Humankind should aspire to the eradication of diseases; however, the decision to commit to an eradication goal should derive from careful consideration of the evidence base and a thorough discussion of the benefits, risks, and...

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11. Guidelines for Preparing an Eradication Investment Case

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pp. 149-156

This chapter describes ongoing efforts to develop guidelines for the development of an eradication investment case (EIC). While a single process for the creation or updating of an EIC will likely not exist, three phases of an EIC are proposed (pre-launch, implementation, and completion) and a number of important assumptions associated with...


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12. Governance Models for Eradication Initiatives

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pp. 159-174

Eradication initiatives are trans-organizational systems (i.e., partnerships, alliances, or coalitions) that enable, and are reliant upon, the joint decisions and actions of participating organizations, each of which maintains its individual identity and goals. Trans-organizational systems are multicultural, nonhierarchal structures that service...

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13. Managing Neglected Tropical Disease Partnerships

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pp. 175-190

A key ingredient for success of eradication and elimination initiatives is the formation of an effective partnership among all participating parties. This chapter examines the mechanisms required to manage the partnerships and the delivery of the interventions needed to achieve the eradication and/or elimination goals. Such mechanisms include...

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14. Group Report: Elements of Good Governance in Disease Eradication Initiatives

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pp. 191-200

This chapter identifies five key elements required to launch, execute, and manage a global eradication initiative, taking into consideration time, resources, and technical expertise in the context of the 21st century. The five elements include conducting a landscape analysis, obtaining the necessary commitments from a diverse group of stakeholders, constructing a framework to support the program, monitoring and managing...

Disease Eradication and Health Systems

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15. Integration of Eradication Initiatives and Health Systems

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pp. 203-216

A wide range of strategies can be used to deliver health interventions, from single interventions to comprehensive preventive and curative services. Increasingly, policy makers, donors, and other development agencies are advocating the integration of interventions to achieve a comprehensive health system. This chapter considers the relative...

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16. How Can Elimination and Eradication Initiatives Best Contribute to Health Systems Strengthening?

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pp. 217-234

This chapter reviews major developments in global health over recent decades, in particular, the influence of targeted disease elimination or eradication initiatives on efforts to build sustainable health services in developing countries. It is based on a review of published literature, comments of health care workers, and personal opinion...

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17. The Impacts of Measles Elimination Activities on Immunization Services and Health Systems in Six Countries

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pp. 235-254

Measles is a prime candidate for global eradication. Explicit goals to control or eliminate the disease have already been agreed upon by many countries and regions. One of the key concerns in determining the appropriateness of establishing the measles eradication goal is its potential impact on routine immunization services and the overall health system...

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18. Disease Eradication as a Springboard for Broader Public Health Communication

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pp. 255-272

In the initial stages of a public health campaign, the mass media is usually very effective in communicating with the majority of the public. Thereafter, focused and intensive engagement is required to reach the underserved, politically, and economically marginalized sectors of society: people who have little social capital, who avoid risks...

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19. Group Report: Designing Elimination or Eradication Initiatives that Interface Effectively with Health Systems

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pp. 273-286

At the outset, disease eradication programs need to define short-, medium- and long-term goals and how these relate to and interact with the existing health system. Potential system synergies need to be evaluated on a country-by-country basis so that eradication efforts can be effectively integrated into existing government systems and processes...

List of Acronyms

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pp. 287-290


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pp. 291-312

Subject Index

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pp. 313-320

E-ISBN-13: 9780262304207
E-ISBN-10: 0262304201
Print-ISBN-13: 9780262016735
Print-ISBN-10: 0262016737

Page Count: 336
Illustrations: 25 figures
Publication Year: 2011

Series Title: Strüngmann Forum Reports