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7 Group Report: Assessing the Feasibility 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 Abstract 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 feasibility in large and/or challenging settings, and a comprehensive review of a number of critical enabling factors required for eradication. This chapter builds on earlier work that describes the biological and technical requirements for disease eradication and focuses in more detail on nonbiological, critical enabling factors. These include durable financing, effective communication strategies , and operational research, each of which plays a cross-cutting role in building and sustaining the necessary political and societal support for eradication. An eradication investment case, program governance, and the interface with health systems are additional enabling factors that are covered in more detail in separate chapters. Before launching a new eradication initiative, a comprehensive review of feasibility is required. If judged feasible, individual champions and a broad-based partnership will be needed to raise the political and financial support required to launch the initiative. The assessment of feasibility is not a “one-off” activity but rather needs continual monitoring and updating as new technologies and information become available. Introduction The criteria needed to determine whether eradication is able to be achieved have been grouped into three categories: biological, societal/political, and economic factors (Hinman and Hopkins 1998). An additional factor was emphasized by 90 P. Strebel et al. the Global Taskforce on Disease Eradication; namely, the need to demonstrate that eradication could be achieved in a large geographical area (CDC 1993b). A more recent review of lessons learned from eradication initiatives stresses that biological feasibility is necessary but not sufficient. Nonbiological factors such as political commitment, social acceptability, financial affordability, and strong program management are critical components for success (Aylward et al. 2000a). Over the last two decades, a wealth of practical experience has been gained from global and regional eradication initiatives that have targeted diseases such as polio, guinea worm, lymphatic filariasis, onchocerciasis, measles, and rubella. The global context in which eradication programs operate has, however , markedly changed during this time. Sudden events, such as high-profile terrorist attacks, large-scale natural disasters, and the 2008 financial crisis, as well as secular trends in the size and age structure of the world’s population and the continuing shift from rural to metropolitan areas, globalization, the decentralization and privatization of health services, and increased connectivity through information technology have changed the landscape dramatically. Support for disease eradication programs has also significantly changed: at ever-increasing rates, highly influential nongovernmental organizations and foundations are now involved, and there has been a corresponding decline in the technical, operational, and financial monopoly previously held by multilateral international organizations such as the World Health Organization, UNICEF, and the World Bank. Over the past decade, the rise in corporate social responsibility has led to an increased involvement of corporations in global public health initiatives. Commensurate with this has been the drive to create innovative financing mechanisms and apply business models and management principles to public health programs. In addition, communication technology has changed considerably . The burgeoning use of social media and the Internet have altered how individuals and communities are able to impact policymaking on health issues and acceptance of the interventions required for eradication. Any side effects from these interventions (e.g., adverse events following vaccination) can quickly achieve prominence on the political and media agendas. Understanding the complex interaction between disease agents and the interventions used in an eradication initiative is crucial. The need to continue control measures indefinitely—albeit of a different kind and on a smaller scale—has increasingly been recognized. In addition, should eradication be achieved, surveillance at some level is necessary and control of laboratory activities involving pathogens must be maintained (e.g., laboratory containment of polioviruses and management of the remaining stocks of smallpox virus). In view of these developments, our group was tasked with assessing the feasibility of achieving an eradication goal in the 21st century. Building on earlier work (Dowdle and Hopkins 1998; CDC 1993b), we address the crosscutting role of sustainable financing, effective communication strategies, and [18.217.60.35] Project...

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