Elimination of trachoma as a public health problem in India

The World Health Organization has validated India as having eliminated trachoma as a public health problem. Trachoma is one of the leading causes of blindness globally.

“India’s elimination of trachoma as a public health problem is a testimony to the country’s commitment to alleviating the suffering that millions have faced from this debilitating disease,” said Dr Tedros Adhanom Ghebreyesus, WHO Director-General. “WHO has worked closely with India to realize this achievement, and we congratulate the government, health workers and partners who have collaborated to make it possible.”

India joins Nepal and Myanmar in the WHO South-East Asia Region and 19 other countries globally that have previously achieved this feat. Though trachoma is preventable, blindness from trachoma is extremely difficult to reverse. Trachoma continues to be a public health problem in 39 countries and is responsible for the blindness of about 1.9 million people.

Effective country-level investments

In 1963, the Ministry of Health and Family Welfare in India initiated a trachoma control project with support from WHO and UNICEF. The community-based interventions to eliminate trachoma consisted of surgical treatment, topical antibiotic treatment, and water, sanitation and hygiene (WASH) initiatives, along with health education promoting behavior change to decrease transmission. The program further expanded to include accessible interventions in rural areas. After the initiation of the National Program for Control of Blindness and Visual Impairment (NPCBVI) in 1976, trachoma control program activities were integrated with activities of NPCBVI and elimination efforts continued.

“India’s success is due to the strong leadership of its Government and the commitment of ophthalmologists and other cadres of health-care workers. They worked together with partners to ensure effective surveillance, diagnosis and management of active trachoma, provision of surgical services for trichiasis, and promotion of water, sanitation and hygiene, particularly facial cleanliness, among communities to ensure people of all ages can now look towards a trachoma free future,” said Saima Wazed, Regional Director, WHO South-East Asia Region, while congratulating the country at the Seventy-Seventh Session of the WHO Regional Committee for South-East Asia. 

In 2005, trachoma was responsible for 4% of all cases of blindness in India. By 2018, the prevalence of trachoma was down to 0.008%. A series of impact, pre-validation and trichiasis-only surveys were completed in 2024, confirmed that elimination targets had been met in all previously endemic evaluation units. A Regional Dossier Review Group thoroughly reviewed a dossier documenting India’s achievement and recommended WHO to validate national elimination of trachoma as a public health problem.

“Congratulations to India on achieving certification for trachoma elimination as a public health problem! This milestone is a result of strong leadership and many years of efforts at national and state levels in addressing trachoma. The implementation of the WHO-recommended SAFE strategy that includes conducting surgeries and drug administration by the Ministry of Health and Family Welfare and Government of India’s initiative like Swachh Bharat Mission and Jal Jeevan Mission have led to this achievement. India’s success is an inspiration for other nations striving to eliminate trachoma and improve public health,” said Dr Roderico H. Ofrin, WHO Representative to India.

India has also developed a post-validation surveillance plan to ensure sustained impacts of trachoma elimination efforts, including provision of trichiasis surgery, community awareness and promotion of water, sanitation and hygiene, particularly facial cleanliness, as per WHO guidelines.

The disease

Trachoma is a devastating eye disease caused by infection with the bacterium Chlamydia trachomatis. The infection spreads from person to person through contaminated fingers, fomites and flies that have come into contact with discharge from the eyes or nose of an infected person.

Environmental risk factors for trachoma transmission include poor hygiene, overcrowded households, and inadequate access to water, and sanitation facilities.

Repeated infections in childhood lead to scarring of the inner side of the upper eyelids, resulting in inward turning of the eyelid margin, with the eyelashes touching the eyeball. This is a painful condition known as trachomatous trichiasis – if left untreated, it can result in visual impairment and blindness.

To eliminate trachoma, WHO recommends the SAFE strategy [1] to achieve elimination of trachoma as a public health problem.

Progress against trachoma and other neglected tropical diseases is alleviating the human and economic burden that they impose on the world’s most disadvantaged communities.

Globally, India joins 19 other countries that have been validated by WHO for having eliminated trachoma as a public health problem. These are Benin, Cambodia, China, Gambia, Ghana, the Islamic Republic of Iran, Iraq, the Lao People’s Democratic Republic, Malawi, Mali, Mexico, Morocco, Myanmar, Nepal, Oman, Pakistan, Saudi Arabia, Togo, and Vanuatu.

The 2021–2030 neglected tropical disease road map targets the prevention, control, elimination and eradication of 21 diseases and disease groups by 2030.

[1] The SAFE strategy consists of: Surgery to treat the blinding stage (trachomatous trichiasis); Antibiotics to clear the infection, particularly mass drug administration of the antibiotic azithromycin, which is donated by the manufacturer, Pfizer, to elimination programmes, through the International Trachoma Initiative; Facial cleanliness; and Environmental improvement, particularly improving access to water and sanitation.