World Health Organization Declares Australia Eliminated of Trachoma
On April 29, the World Health Organization (WHO) declared Australia as the 30th country to have eliminated trachoma as a public health problem. Trachoma is a bacterial eye infection and the leading infectious cause of preventable blindness globally. Australia was the last developed country where the disease was endemic, with all cases occurring exclusively in Aboriginal and Torres Strait Islander populations.
Background and History
- The elimination effort began with the National Trachoma and Eye Health Program (1976-1978), initiated by ophthalmologist Fred Hollows with Aboriginal leaders Gordon Briscoe, Jilpia Jones, and Trevor Buzzacott, and supported by the Commonwealth government.
- The program examined over 60,000 Aboriginal people across approximately 400 communities, as well as nearly 40,000 others in rural and remote areas.
- Despite initial efforts, trachoma rates remained high. In 2008, Hugh Taylor established the Indigenous Eye Health Unit to focus on elimination. In 2006, the Australian government adopted the WHO "SAFE" strategy.
Elimination Strategy
The WHO "SAFE" strategy was implemented, comprising:
- Surgery for trachomatous trichiasis (in-turned eyelashes)
- Antibiotics for infected communities
- Facial cleanliness
- Environmental improvements (including better sanitation and access to water)
Results and Data
- Trachoma prevalence in Indigenous children aged 5-9 in at-risk communities dropped from 14.9% in 2009 to 1.5% in 2024.
- WHO elimination status requires fewer than 5% of the national population to be affected.
"Trachoma prevalence in Indigenous children aged 5-9 dropped from 14.9% in 2009 to 1.5% in 2024."
Key Factors
- The effort was led by Aboriginal Community Controlled Health Organisations (ACCHOs), with support from non-Indigenous organizations including The Fred Hollows Foundation.
- Success was attributed to community-led action, advocacy, philanthropy, and culturally safe care.
- Dr. Anthony Solomon of the WHO stated that Australia's approach—centering Aboriginal and Torres Strait Islander voices—serves as a model for the global NTD roadmap 2021–2030.
- Tania McLeod, Program Coordinator at The Fred Hollows Foundation, noted that sustaining elimination is challenging because poverty is a root cause.
Ongoing Challenges
Despite the elimination status, several challenges remain:
- Trachoma cases persist in the tri-state area (Western Australia, Northern Territory, South Australia), as well as Kaurindji and Torres Strait.
- Eye health is not a national priority; cataract surgeries are classified as elective and often deferred.
- Access to affordable glasses is limited, with no Medicare Benefits Schedule (MBS) items for school screening or glasses purchase.
- The First Nations Eye Health Alliance is advocating for an MBS item for school screening and improved low-cost spectacle schemes.
"Sustaining elimination is challenging because poverty is a root cause." — Tania McLeod, The Fred Hollows Foundation