Control and Eradication

A communicable disease can be controlled or eradicated. By controlling a disease, it is kept at such a minimum level that it no longer poses a health problem. Eradication on the other hand sets out to eliminate the disease completely. The difference between control and eradication can be summarized in the following table.

The attraction of putting the entire health effort, funded by international support into the eradication of a disease requires organization of the very highest order. There have been five global eradication efforts, out of which two were successful, the other two almost successful and the remaining one was not successful. The eradication of smallpox worldwide has been one of public

Control

Eradication

Objective

Minimal

Complete

incidence

elimination

Duration

Indefinite

Time-limited

Coverage

Areas of high

Entire area

incidence

Method

Effective

Faultless

Reservoir

Animal or

Human only

environment

Organization

Good

Perfect

Costs

Moderate for a

High for limited

long time

period

Complications

Acceptable

Extremely

serious

Imported cases

Not important

Very important

Surveillance

Reasonable

Very good

health's greatest triumphs against disease. This was only possible because the vaccine was extremely effective, there was no other reservoir but humans and the organization was very good. Recently, an entirely different kind of disease, Guinea worm, has been eradicated from all countries except one (where there is a civil war) by a programme of 'protected-well' construction. Poliomyelitis has been eliminated from WHO regions of the Americas, Europe and Western Pacific and in 2001 only 600 cases were reported from the rest of the world. The global yaws campaign eradicated yaws from large areas of the world, but it is still endemic in some places and on the increase in others. The tremendous progress of the malaria eradication campaign, followed by an equally impressive resurgence of the disease, has been a devastating setback to the doctrine of eradication. (There have been other localized eradication programmes such as Anopheles gambiae from South America.)

With eradication, it is an all-or-none process - if eradication is not complete, then the disease can return to its former levels and all effort has been wasted. In these circumstances, it is preferable to choose the alternative target of control, which will be the method used in the majority of infections.

A new terminology has been introduced by WHO - elimination. This uses a special programme and enhanced resources similar to an eradication programme, but accepts that eradication will not necessarily be achieved. Lymphatic filariasis, Chagas' disease, trachoma, maternal and neonatal tetanus have been designated as suitable for elimination programmes.

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