Post-Conference Small Group Report*

Below is presented a summary of the discussions of the Small Group which convened in Atlanta on 1-2 June 1998.

Disease "elimination" (connoting something less than global implementation and requiring continued control measures) and "eradication" (connoting global implementation with no need for continuing control measures) have been in use for many years and have become common and useful terms to many public health practitioners. In 1997 the Dahlem Workshop added further legitimacy to these terms. However, discussions at the Conference on Global Disease Elimination and Eradication as Public Health Strategies confirmed the feelings of many that the distinction between elimination and eradication is difficult to convey. The two terms are synonymous in many languages. Adding to the confusion is the imaginative, but imprecise, use of the term elimination as, for example, in "elimination of the disease as a public health problem". The group reviewed the concerns expressed at the Conference and concluded that discontinuation of the term "elimination" be considered, using instead degrees of control leading, where feasible, to eradication. For example:

Control: The reduction of disease in a defined geographical area as a result of deliberate efforts. Control is a relative term that should be quantified to indicate the extent of reduction to be achieved.

Eradication: The absence of a disease agent in nature in a defined geographical area as the result of deliberate control efforts. Control measures can be discontinued when the risk of disease importation is no longer present.

Extinction: The specific disease agent no longer exists in nature or the laboratory.

In effect, the term elimination is replaced by the concept of "regional eradication". The group recognizes that the sentiment expressed at the Conference to revise the definitions comes only a year after endorsement and refinement of the terms at the Dahlem Workshop, where it was suggested that the term regional eradication is contradictory. The debate is unlikely to end here. Words are defined by common usage. The simplified definitions are proposed to reduce misunderstanding and confusion among the intended audience and wider discussion of these definitions in other forums is urged.

Based on suggestions offered during the Conference, the group proposes the following next steps:

• National governments, WHO, and other international agencies should adopt the principles outlined in this report for planning disease control and eradication activities.
• New disease control and eradication initiatives should involve the widest possible consultation to ensure that all opportunities are taken to maximize health gains.
• The Conference Proceedings published as a Supplement to the Bulletin of the World Health Organization should be broadly disseminated to ministries of health, key groups and organizations, and international health agencies.
• The Summary and the Post-conference Small Group report should be submitted to appropriate public health and policy journals and key individuals and organizations and placed on the WHO website.
• Discussion of this report should be included in meetings that address single disease initiatives to emphasize the opportunities for complementarity when control and eradication efforts for multiple diseases are implemented simultaneously.
• A follow-up international meeting should be convened in the year 2001 to review progress and consider new goals in disease control and eradication.

* Members of the small group, listed in alphabetical order, were Stephen Cochi, Ciro de Quadros, Walter Dowdle, Richard Goodman, Peter Ndumbe, David Salisbury, Roland Sutter, and Frederick Trowbridge.

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