BRING ON THE LIGHT:THE COMING DEFEAT OF

Pioneering Research Lays Groundwork for SAFE and ITI

We have arrivedat an unprecedentedmoment.

Blazing a path of destruction across millennia,trachoma remains the world’s leading cause ofpreventable blindness. Endemic in the poorest regionsof Africa and Asia, trachoma plagues the developingworld, affecting 41 million people in 56 countries.Worldwide, trachoma has impaired the vision of orcompletely blinded 8 million people living today.

But trachoma’s days of devastation are numbered.We have the experience and the tools to defeatblinding trachoma—right here, right now. Justlike the historic eradication of smallpox, we havea chance to eliminate a scourge that is decimatinglives, families and communities in the poorestplaces on earth.

An infectious eye disease, trachoma is caused bythe bacterium Chlamydia trachomatis. One of theoldest known infectious diseases, with referencesdating back to ancient Egypt, trachoma spreadsthrough intimate contact, from hands, clothes, or fliesthat carry the discharge from the eyes of one person,most often a child, to the eyes of another. At the turnof the 20th century, trachoma was so serious a healththreat in America that immigrants infected with thedisease were turned back at Ellis Island. By the 1950s,with improved sanitation and living conditions,trachoma had virtually disappeared from theindustrialized world.

Today, trachoma wreaks havoc in the lives of thepoorest of the poor, especially women and children. Itbrings with it discomfort, pain, disability, dependence,and deepening poverty. It does not kill people, it killshope. Trachoma attacks infants as young as a fewmonths of age, and keeps attacking children withrecurrent infections. It ends the education of manyyoung children—girls particularly, who are pulled outof school to help family members afflicted with thedisease. When children grow into adults, darkness fallsand sight is gone. Trachoma infects women at threetimes the rate of men. It strikes people down in theprime of their lives, robbing them of the opportunity

On Track to Eliminate Blinding Trachoma:International Trachoma InitiativeCelebrates Ten Years 1998-2008

1

to be productive. Because it spreads through personalcontact, trachoma can destroy the ability of wholefamilies, indeed entire villages, to thrive or even survive,crippling local economies and perpetuating the cycle of poverty.

But we have arrived at an unprecedented moment. At last, wehave the tools to banish this disabling disease from the earth,tools contained in a proven, four-pronged strategy calledSAFE, for:

The non-governmentalorganization that has takenthe lead in advocating for fullSAFE implementation is theInternational Trachoma Initiative.A pioneering public-privatepartnership, ITI is the leadinginternational agency dedicatedsolely to the elimination ofblinding trachoma. Working inAsia and Africa, ITI collaborateswith a host of international,national and local non-governmental and governmentalagencies to assess the prevalenceof the disease in endemiccountries and to develop andimplement plans to eliminate thedisease using the SAFE strategy.

Since its inception, ITI hasmade great strides—none ofthem alone. ITI was born of theefforts of international giantsin science, medicine, publichealth, governmental andnon-governmental agencies,philanthropy, and business.Its achievements belong to these

extraordinary partners, but also to ordinary people in the developingworld—to local health ministers, grassroots volunteers, physicians,teachers, administrators, mothers, fathers, and many others.

ITI’s special 10th Anniversary Report isan effort to highlight the milestones alongthe way, in the voices of some of thosewho helped to reach these milestones.

It is a tribute to the work done.It is also a rallying cry not to give up beforethe miracle happens, to work together toachieve the goal that is in plain sight:the end of blinding trachoma.

SURGERY to halt the damageand the pain of trachomatoustrichiasis, when eyelashesturn inward, scratch thecornea, and steal sight.

ANTIBIOTICS to treatactive infection andprevent transmission.

FACE-WASHING toreduce the spread ofthe infection.

ENVIRONMENTALCHANGE to increaseaccess to clean waterand improved sanitation.

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The unflagging work of a small cadre of pioneering scientists—devotedto ending blinding trachoma even when no one else was—helped tobring about this extraordinary moment. So did one private foundationthat spent more than a decade, from the 1980s through the 1990s,supporting their work.

“Two things made ITI possible. One was the research that The EdnaMcConnell Clark Foundation supported, which verified that thefour elements of the SAFE strategy were individually effective,and which packaged them all together. We also supported workon a vaccine for trachoma, which we never did find.

“The second thing that made ITI possible was the availability ofazythromycin or Zithromax, and the willingness of Pfizer to takea chance on giving this drug away. Before that, we had tetracyclineointment to treat trachoma,but it had to be appliedtwice a day for sixweeks and thatdidn’t work forchildren or parents.What we neededwas a single-doseeffective antibiotic.”

Joseph Cook, M.D.Tropical Disease ResearchProgram Director,The Edna McConnellClark Foundation,1978-1999First ITI President,1998-2003

“What weneededwas asingle-doseeffectiveantibiotic.”

Pioneering Research Lays Groundwork for SAFE and ITI

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In the early 1990s, Pfizer scientists made history. They discovereda powerful, extremely fast-acting antibiotic that would cure majordebilitating infections: Zithromax. When the people at Clark and Pfizerlearned that the drug was effective against Chlamydia—the genitalstrain of Chlamydia trachomatis, the very same bacterium that causestrachoma—they moved to test Zithromax against the blinding disease.

The result: Zithromax provided what had never been availablebefore—a single-dose antibiotic that would treat and disrupt thespread of blinding trachoma.

“Our scientists came back extremely excited about this developmentand keen to do something. It seemed to us, being the managementof Pfizer, that there was a real contribution we could make. Wedidn’t know how big it would be. We didn’t know how many peoplehad trachoma. We didn’t know how widespread it was, though weknew it was widespread and mainly in developing countries.So we said, ‘Okay, we’ll do something with this.’”

C. L. ClementeExecutive Vice President, Corporate Affairs,Pfizer, 1992-2002First ITI Board Chair, 1998-2004

Pfizer Finds Missing Link

“We didn’tknow howwidespreadit was.”

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The explosion of support from global leaders for using the SAFEstrategy with Zithromax to end blinding trachoma also inspiredthe creation of ITI. That support was rallied by the World HealthOrganization (WHO), a UN agency that targeted trachomaas a priority from the time of its founding in 1948.

“An important milestone was the Global ScientificMeeting on Trachoma Control in 1996. That wasconvened by WHO, with very strong support fromThe Edna McConnell Clark Foundation. This

was the time when it was veryclear that azithromycin wouldpresent a major breakthroughin terms of antibiotic treatmentfor trachoma. A defining

consensus at the end of themeeting was to say that we should

set up a kind of a mechanism, astructure that would allow having the

different stakeholders around a tablein order to discuss trachoma control.”

Serge Resnikoff, M.D., Ph.D.Former Coordinator,Chronic Disease Preventionand Management, WHOMember, ITI Trachoma Expert Committee

That structure became the WHO Alliancefor the Global Elimination of BlindingTrachoma by 2020— “GET 2020”—a large partnership of WHO Member States,non-governmental organizations, researchinstitutions, philanthropic foundations andindustry. In 1998, the 2020 target wasendorsed by WHO’s oversight body, theWorld Health Assembly, which passed aresolution calling on all 193 MemberStates to collaborate with the WHOAlliance in ending blinding trachoma.

The explosion of supportfrom global leaders for

using the SAFE strategy withZithromax to end blinding trachomaalso inspired the creation of ITI.

Global Leaders Pledge to End Blinding Trachoma

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On November10, 1998, P

fizer and The Edna Mc

Connell Clark

Foundationannounced

the formation of the In

ternationalTrachoma

Initiative as the world

’s leading nonprofit org

anization devoted to

eliminatingblinding tra

choma. Hailed as an in

novative public-private

partnershipby the pres

s worldwide, ITI began

its work with approxim

ately

$3 millionfrom Clark, $3 m

illion fromPfizer, and

a commitment by

Pfizer to provide some

$60 millionworth of Zi

thromax over two year

s.

The focus was to be on

five trachoma-endemic,

WHO-identified priorit

y

countries: Morocco, Gh

ana, Mali, Tanzania, an

d Vietnam.

“This was agreat oppor

tunity for Pfizer. It also

was very different

from any other donation pro

gram we had ever been invo

lved

in…[W]e…realized tha

t given thenature of tr

achoma this could

not just bea drug dona

tion program. Treating

trachoma requires

an integrated public h

ealth approach and tha

t was whatPfizer

was interested in supp

orting. Pfizer’s senior

management wanted

to make sure that our

efforts in this area wou

ld have a real impact

on the people in develo

ping counties.”

Paula Luff

Former Senior Directo

r, International Philan

thropy, Pfizer

Harvard Business School Publi

shing:

D. Barret, J. Austin and S. McCarth

y; N9-302-009.

August 16,2001

“At Clark, we realized t

hat a pill isnot enough

because when the

drug distribution is ove

r, you still have the sam

e village with no

water, no sanitation. Su

ddenly it became clear

that with SAFE

and Zithromax, we had

a strategy that potenti

ally could deal with

this diseaseeffectively…

So insteadof a founda

tion leavingthe

field after ten to fifteen

years of research and w

ork, now we actually

had a chance for it to

pay off.”

Michael Bailin

CEO and President,

The Edna McConnell C

lark Foundation, 1996

-2005

ITI Board Member

New Trachoma Initiative Hailed as Cru

cial Development

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Morocco has a long history of trachoma infection, with prevalencerates in the Southeast provinces reaching as high as 46% just 15 yearsago. Since ITI and its partners began an aggressive trachoma controlprogram in those provinces in 1999, Morocco has seen the most rapidprogress towards eliminating blindness from trachoma in a singlecountry in history. Today, with less than 5% active disease in childrenup to nine years old and less than 0.1% of adults needing surgery fortrichiasis, Morocco awaits WHO certification as the first country toremove trachoma as a public health threat using the SAFE strategy.

“In addition to employing the SAFE strategy, the Moroccangovernment saw the importance of investing in employment, theeconomy, tourism, water, sanitation, electricity, roads. Moroccois a great model. While the country and the results are unique insome ways, it was very important to show that the SAFE strategycould work, Zithromax in particular. The world needed proof ofthe principle—Morocco provided it.”

Ibrahim JabrITI President, 2007-2009ITI Vice President, Programs, 2005-2007

Proving Ground: Morocco Triumphs Over Trachoma

“In addition to employing the SAFE strategy,the Moroccan government saw the importanceof investing in employment, the economy,tourism, water, sanitation, electricity, roads.”

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Between 1999 and 2003, ITI brought hope to people in smallcommunities and villages in just a few countries, gathering proofthat the SAFE strategy worked. By 2003, ITI was ready to expand thenumber of countries where it worked, partnerships in those countries,and its role in the SAFE programs. Pfizer’s substantial increase in itsZithromax donation from 10 million doses in ITI’s first five years to135 million for the next five greatly facilitated ITI’s expansion.

“Among ITI’s major accomplishments from 2003 to 2007 was astrategic shift in ITI’s role in trachoma elimination. We movedfrom ITI-owned programs to government-owned, government-ledand government-supported programs. We began to implementSAFE support in 12 countries. This meant scaling up mass drugadministration from 1.5 million people in 2002 to more than25 million four years later.

“Most importantly, we saw community empowerment. The livesof people in several communities where SAFE was implementedhad been transformed. In addition to a drastic reduction in theprevalence of trachoma, we saw less respiratory disease anddiarrhea in children, greater use of latrines, cleaner faces,fewer flies. In one endemic district of Amhara in Ethiopia, thecommunity demanded a school because the children were nowhealthy and needed education.”

Jacob KumaresanITI President, 2003-2007

ITI Expands Across Continents

“Mostimportantly,we sawcommunityempowerment.”

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In a country where 2.8 million Ghanaians are at risk oftrachoma infection, ITI and its partners helped to putGhana on track to become the first sub-Saharan nationto eliminate trachoma using SAFE, and to do so early—by 2010. Ghana’s rate of trachoma infection in childrenages one to nine has dropped dramatically, from as highas 16% to as low as 0.1 to 2.8%—rates well below theWHO-accepted level of 5%, when trachoma is no longerconsidered a public health problem.

Since the Ghana Trachoma Control Program’sinception in 2000, ITI with its partners has supported:

•The performance of 4,542 surgeries for trichiasis,eliminating more than a third of the backlog ofsurgical cases.

•The administration of more than 3.2 millionZithromax treatments to people in all 26 trachoma-endemic districts, achieving a coverage rate of 94%.

“The Ghana Trachoma Control Program has beensuccessful because from the onset, a national task

force was formed, comprised of governmentaland non-governmental organizations, which wasduplicated at the regional and district levels. Theother reason is political will. Ghana’s governmentsupported the Program, providing platforms forour advocacy campaigns, like the campaign forclean water. The talk was not just about trachoma;it was also about guinea worm and diarrhealdiseases. As a result, today, over 75 percent oftrachoma-endemic communities have access tosafe, clean water.

“I cannot end without saying that both managersof the Program and frontline workers have beenvery, very dedicated, even though they are fewin numbers compared to the enormity of thework…This is not a one-man show. It is everybodywho has something at stake in trachoma controlworking together.”

Agatha Aboe, M.D.ITI Ghana Country Representative,2002-Present, Accra, Ghana

GHANA: First Sub-Saharan Nation Poised to Vanquish Trachoma

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Building on trachoma eliminationsuccess in Morocco, ITI by 2008was working with governmentaland non-governmental partnersto support the implementationof SAFE in 18 of the 56 endemiccountries. Every country, everydistrict, has many stories.Here are just four, featuring challengesand victories from the field.

Challenges and Victories From the Field

Where once Vietnam had more than 1,000 trachoma-endemic communes with prevalence rates as high as 27%,today Vietnam is poised to become the first country in

Asia to end blindingtrachoma with SAFE.The rate of activetrachoma in childrenunder nine hasdropped to less than5% in all endemiccommunes. Yet, amajor challengeremains: eliminating

the backlog of surgeries to relieve pain and preventblindness for those with advanced stages of the disease.Both human and financial resources will be needed if thesight of tens of thousands of Vietnamese is to be saved.

Since opening its country office in Vietnam in 2000,ITI with its partners has supported:

•The administration of more than 2.1 millionZithromax treatments in 850 endemic communeswithin the 21 Northern and Central Coastal provinces.

•The performance of 83,830 surgeries for trichiasis,saving the sight of those who would have beenblinded by trachoma.

“The trachoma program in Vietnam completed massdistribution of Zithromax on schedule, curing thedisease and ending disease transmission. Over halfthe people who have been suffering with trichiasishave had surgery, and the country is on track to endblinding trachoma in Vietnam in 2010, a goal set bythe Ministry of Health.

“The strong support and commitment of thegovernment at every level and the heavy involvementof community organizations have been key to oursuccess. But I must highlight the historic mobilizationof schools to teach personal hygiene. This includedgiving each student his or her own towel at schoolto wash their hands and faces, an activity that isabsolutely key to preventing the spread of trachoma.”

Mai Nguyen Phuong, M.D.ITI Vietnam Country Representative,2000-Present, Hanoi, Vietnam

VIETNAM: First Asian Nation Slated to Beat Trachoma

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The Nepal National Trachoma Program(NTP) was launched in 2002 with a largestaff and operations funded by ITI. Thisapproach was expensive and the pace ofcoverage in the endemic districts was slow.In 2006, the NTP began to collaborate in amore integrated, localized way with theMinistry of Health and Population, othergovernmental agencies, and non-governmentalorganizations. This shift from a program runand funded by ITI to a program integratedwith Nepal’s national development plan hasworked well and led to real progress.

“Since 2006, the implementation ofSAFE has been going very smoothly andat a rocketed pace. We have reduceddisease prevalence to less than fivepercent in five districts out of the targetof fifteen. Two more districts are in line

to be declared as having reached thatobjective, and SAFE implementation isongoing in the remaining eight districts.

“But work is not finished.Too many people in endemicdistricts still are unaware ofcommon transmission routesfor trachoma and do not knowthe disease can be cured orcontrolled by a simple surgery,an antibiotic, the use of toilets,and face washing. This requiresa large scale awarenesscampaign and funding—themain challenge in Nepal.”

B.B. ThapaProgram Director,Nepal National Trachoma Program,Kathmandu, Nepal

NEPAL: From Problems to Progress

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Ethiopia is burdened with the largest reservoirof trachoma infection—30% of its population—in all of Africa. The Federal Ministry of

Health and non-governmentalpartners, however,are now workingtogether, tacklingone geographic areaat a time. Today,the trachomaelimination programhas been broughtto nearly half ofthe 600 endemicdistricts.

“Here in Tigray, an extremely remote area,we’ve created a sanitation movement in acountry without latrines. Women suffered

most due to lack of privacy. We told theRegional president about the problem, hecalled a region-wide meeting of stakeholders,and that meeting was cascaded down to thelocal levels. People got so inspired that theywent out and built pit latrines themselves—372,000 of them in only three months.

“The Federal government and Regional healthbureaus hire only girls or women to becomePrimary Health (or Health Extension)Workers to educate their communitiesabout health, health-seeking behaviourand use of available services, and to initiateenvironmental improvements; that’s makinga real difference for trachoma control.”

Gebre Ab Barnabas, M.D., Ph.D.Head, Tigray Health BureauMekelle, Tigray, Ethiopia

ETHIOPIA: Is Success in Sight?

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Partnerships are crucial to success with SAFE and ITI’s work,and the participation of non-governmental organizations iscrucial to those partnerships. NGOs must take the lead, rallyingother local nonprofit organizations to commit to defeatingtrachoma, coordinating their efforts, and monitoring progress.

“The SAFE strategy requires coalition-building. You can’tdo everything yourself. Since most of the agencies activein trachoma started from a prevention of blindnessbackground—like Sightsavers International—they havemandates to do surgery, antibiotics and probably the facewashing. But they don’t have a mandate or expertise to startdigging wells, so you’ve got to build the relationship withother agencies who are prepared to work in those fields.

“Sightsavers International and ITI have worked together foryears. Our program managers work with national programs—ophthalmologists, ophthalmic staff, health educators—indifferent countries. Whenever a country that we’re involvedin is putting together proposals for trachoma control programs,going ahead with surveys on the prevalence of trachoma,ITI can help with its expertise. As to what we bring to ITI,we convened a Trachoma Summit for Sightsavers staff and

other NGOs last year because we felt that all thepartners needed a boost. So it’s quitea symbiotic relationship.”

Catherine CrossFormer InternationalPrograms Manager,Sightsavers International

“Our programmanagers workwith nationalprograms—ophthalmologists,ophthalmic staff,health educators—in differentcountries.”

NGO Partners Play Vital Role

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Wherever trachoma occurs in the developingworld, so do most of the world’s otherNeglected Tropical Diseases (NTDs)—parasiticand bacterial infections that affect 1.4 billionof the world’s poorest people. While they donot kill, their impact is stunning. Whenmeasured in years of healthy life lost, theNTD burden is greater than that of TB ormalaria and approaches that of HIV/AIDS.

For decades, single-disease programs havefocused on implementing single-diseasestrategies. Yet, many of those strategies—whether for trachoma or for other commonNTDs like lymphatic filariasis (elephantiasis),schistosomiasis, onchocerciasis (riverblindness) or soil-transmitted helminths(worms)—cover the same geographic regions,affect the poor, and are implemented by thesame health providers. This has led theworld health community to advocate foran integrated approach as a way to endduplication, better use scarce resources,and speed progress.

“Safe and powerful drugs are being donatedthrough public-private partnerships ormade available at very low cost. Integratedapproaches have been devised for tacklingseveral diseases at once, with limiteddemands of health systems and staff.Delivery mechanisms piggyback on existingsystems…With good technical tools, goodstrategies, national commitment, and thegenerosity of governments, we can finallyget the upper hand on diseases that havebeen considered, for so long, as theinevitable companions of povertyand misery.”

Margaret Chan, M.D.Director-General of WHO,Address to U.S. Agency forInternational Development (USAID)Stakeholders Meeting on NTDs, 2008

Shift from Single-Disease FocusSpells Hope for the Future

Today, ITI is taking thisintegrated approach to NTDsin two ways: through research,and through entering anexciting and promisingorganizational partnership.

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In 2006, ITI received a four-year grant from generous past donor,The Bill & Melinda Gates Foundation, to investigate the effective-ness of integrating treatment of trachoma with another NTD,lymphatic filariasis. Originally focused on specific regions of Mali,ITI’s initiative was expanded in 2008 to include a site in Ethiopia.

“ITI clearly is the center of excellence for getting out andreaching people in the treatment of trachoma. Even thoughwe’re integrating all of these diseases together, we still needsomebody to maintain a disease-specific perspective.Trachoma has an elimination goal by 2020, so we wantto be sure that we don’t lose sight of our goal.

“The other piece is that they have really kept these conceptsof water and sanitation as a central point for trachoma control.When it comes to control of any of these diseases of extremepoverty, which the Neglected Tropical Diseases are, improvedwater and sanitation are the true piece of how we’re going tohave sustainable impact on these communities. The otherprograms have focused on the tool of the drug and haven’tfocused as much on water and sanitation. That’s a realstrength that trachoma brings to the group of the NeglectedTropical Diseases.”

Julie Jacobson, M.D., D.T.M.H.Senior Program Officer,Infectious Diseases Development,Global Health ProgramThe Bill & Melinda Gates Foundation

Gates Funds ITI for NTD Integration Research

“Improved waterand sanitation...that’s a realstrength thattrachomabrings tothe group ofNeglectedTropicalDiseases.”

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While ITI has made a significant contribution to eliminating blindingtrachoma, much more needs to be done. Recognizing that ITI alonecould not scale up and provide the necessary support to help reachthe goal of GET 2020—the elimination of trachoma in all endemiccountries by the year 2020—its Board and management in 2005 leda strategic planning process to determine new approaches.

“Strategies to eliminate blinding trachoma already exist. Butimplementing them fully will require alliances that are broader,tighter, more ambitious, and more dynamic than any that nowexist. This can be achieved by carrying out the SAFE strategyin the broadest sense through integration with other tropicaldiseases, and with a concerted push to improve water supplyand sanitation.”

ITI Prospectus: A New Operating Model Sought in Support of GET 2020

ITI then made another innovative decision: to reachout to select international organizations to find the best-qualified partner to increase ITI’s reach, leverage jointresources, and with the support of the Gates Foundation,significantly expand ITI’s communications andadvocacy activities.

This effort has led to ITI’s bold decision to merge withthe Task Force for Child Survival and Development,which includes among its priorities ending the scourgeof Neglected Tropical Diseases.

“Before our decision to merge with the Task Force,we were supporting countries that carried fivepercent of the global disease burden of trachoma.At best, if we continued what we were doing, wewould probably reach 25 percent by 2010. We had toask ourselves: Are we happy with that? We weren’t,so we searched for organizations we thought couldhelp bring this support beyond 25 percent.

“The Task Force is clearly such an organization.They have the Mectizan Donation Program for riverblindness, supported by Merck & Co.; ChildrenWithout Worms, supported by Johnson & Johnson;and the Lymphatic Filariasis Support Center, withdrugs donated by GlaxoSmithKline. With trachoma,that makes four major NTDs under one roof.

“The opportunities to make real progress areenormous. We believe that ITI and the Task Forcecan achieve the GET 2020 goal while also playingan increasing role in efforts to coordinate responsesto other NTDs worldwide.”

Ibrahim JabrITI President, 2007-2009ITI Vice President, Programs, 2005-2007

This efforthas led to ITI’sbold decision tomerge with theTask Force forChild Survivaland Development,which includesamong itspriorities endingthe scourgeof NeglectedTropicalDiseases.

ITI Takes Bold Step, Partners with Organization Targeting NTDs

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“All of us at the Task Force are excited aboutthis opportunity to work closely with ITI oneliminating blinding trachoma. They haveaccomplished a great deal over the last ten yearsand helped prevent blindness for millions ofpeople worldwide. They have also made importantcontributions to advance the field, such as helpingpeople to believe that it can be done—that thegoal of eliminating blinding trachoma by 2020 isachievable. Sustaining that vision of hope hasbeen vital. Through this merger, we have a greatopportunity to strengthen ITI’s role as ardent andactive spokespersons and leaders for movingahead on all of the elements of the SAFE strategy.

“ITI programs have taught us all about Zithromaxand how effective it can be—even more effective

than people thought initially in terms of helpingto eliminate and prevent trachoma infection inlarge populations. ITI has also gained importantoperational experience that will be key to theelimination effort in the future.

“ITI has learned a tremendous amount in itsfirst ten years, and that’s ten years worthy ofcelebration. More than that, however, we areexcited about the potential of joining forces totake on trachoma at the same time as the otherNeglected Tropical Diseases that the Task Forceworks on daily. We all look forward to scaling uptrachoma elimination efforts and using innovativeapproaches to reach the GET 2020 goal.”

Mark L. Rosenberg, M.D., M.P.P.Executive Director,Task Force for Child Survival and Development

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“We will eliminate trachoma,country by country.”

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In the last five years alone, the number of peoplesuffering from active trachoma has been cut in half—from84 million to 41 million. World leaders have come to recognizethe devastation caused by trachoma and other NTDs, pledgedresources, and promised to work to eliminate them fromthe earth. ITI has played an unparalleled role in thesedevelopments.

But numerous challenges remain. While ITI’s workcontinues in 18 countries, 38 more endemic countries mustbe reached. Millions of people still need surgery for trichiasis.Support is needed for people to teach and supervise thesurgery. Results must be monitored after mass antibioticdistribution to ensure that the disease does not return. Manymore environmental and infrastructure improvements must bemade. And while trachoma blinds, it does not kill; yet, it mustcompete for scarce resources with diseases that do—HIV/AIDS,TB, malaria. This makes it all the more urgent to demonstratethe kind of killing that trachoma does—of sight, productivity,hope for the future.

Widely recognized as the global advocate fortrachoma elimination, ITI, in partnership with the TaskForce for Child Survival and Development, is poised to meetthe challenges ahead.

“Without ITI, the landscape of trachoma elimination andcontrol around the world would look very different than itlooks today. It wouldn’t have anywhere near the visibilityand the impact that it’s had. Now the visibility and theimpact are still much less than we would like, but we’reat a tipping point. As we move along, being merged witha larger, more multifaceted organization and with morepartnerships forming, it’s inevitable there will be amajor effect…We will eliminate trachoma, countryby country.”

Alfred Sommer, M.D.ITI Board MemberDean Emeritus and Professor,Johns Hopkins Bloomberg School of Public Health

Making the Miracle Happen:The Work Ahead

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PARTNERS & DONORSIn addition to governments,individual supporters andcommunity organizations,ITI would like to acknowledge,with our deep thanks, thefollowing partners and donors:

AmeriCaresThe Bill & Melinda GatesFoundationThe Carter CenterCenters for Disease Control andPreventionChristoffel-BlindenmissionConrad N. Hilton FoundationThe Dibner FundEarth Institute, ColumbiaUniversityThe Edna McConnell ClarkFoundationFred Hollows FoundationFondation BouamatouGlobal Network for NeglectedTropical Disease ControlHanoi Women’s International ClubHelen Keller InternationalInternational Agency for thePrevention of BlindnessIzumi FoundationLavelle Fund for the BlindLight for the WorldLions Clubs InternationalLymphatic Filariasis SupportCenterMectizan Donation ProgramMidler Family FoundationOperation EyesightORBIS InternationalPenzance FoundationPfizerPfizer Foundation Matching GiftsProgramThe Rockefeller FoundationRTI InternationalSabin Vaccine InstituteSchistosomiasis Control InitiativeSchwab Charitable FundSightsavers InternationalStarr FoundationUnited Kingdom - DFIDUnited States Agency forInternational DevelopmentUlls del MónUNICEFUnited Way-HanoiU.S. Fund for UNICEFThe William Penn FoundationWorld Health Organization

ITI BOARD OF DIRECTORSRobert L. Mallett, ChairmanH. Lawrence Clark, SecretaryMichael BailinPatricia C. BarronC. L. ClementeJoseph M. FeczkoIbrahim JabrReatha Clark KingAlfred Sommer

TRACHOMA EXPERTCOMMITTEEAlexander CairncrossBrendan DoyleIbrahim JabrSerge ResnikoffBjorn Thylefors

ITI 2008 STAFFSenior LeadershipIbrahim JabrChristina Dykstra MeadAdam Zayan

New York HeadquartersAmos Sam-AbbenyiLaura BarrettAndrea CornwallMalorie FerrickNelia HensonGuan Ying LanLaraine LippeSonia PelletreauJosh RosenfeldMarie-France SemmelbeckDana SlusarenkoBeth Weinstein

Country RepresentativesEthiopia: Amir Bedri KelloGhana: Agatha AboeMali: Telly AntandouNiger: Samna MohamedTanzania: Bernadetha Shilio

Edith Ngirwamungu,2001-2008

Vietnam: Mai Phuong Nguyen

CONTRIBUTORS TO THE REPORTAgatha Aboe; Michael Bailin;Gebre Ab Barnabas; C.L. Clemente;Joseph Cook; Catherine Cross;Ibrahim Jabr; Julie Jacobson;Jeffrey B. Kindler;Jacob Kumaresan; Robert Mallett;Mai Nguyen Phuong; SergeResnikoff; Mark Rosenberg;Alfred Sommer; B.B. Thapa.

CREATORS OF THE REPORTChristina Dykstra Mead, ITIJeremy Green, ITIGeoffrey Knox, EditorAngela Bonavoglia, WriterKaren Simon, Simon Does,Strategic Graphic DesignCopy Editors: Malorie Ferrick,

Ellen Vaz

PHOTO CREDITSFront cover: Sonia Pelletreau

MaliInside cover,Page 1: Sonia Pelletreau

MaliPage 2: Surgery:

Judd FrankelNepalAntibiotics:Ibrahim JabrEthiopiaFace-washing:Harvey WangGhanaEnvironmental Change:Harvey WangMoroccoLower right:Elizabeth GilbertEthiopia

Page 3: Sonia PelletreauMali

Page 4: Robert EsselEthiopia

Page 5: Lauren KleutschNiger

Page 7: Elizabeth GilbertMorocco

Page 8: Harvey WangGhana

Page 9: Sonia PelletreauMali

Page 10: Mark TuschmanVietnam

Page 11: Judd FrankelNepal

Page 12: Elizabeth GilbertEthiopiaRobert EsselEthiopia (inset)

Page 13: Mark TuschmanVietnam

Page 14: Beth WeinsteinEthiopia

Page 15: Robert EsselEthiopia

Page 16, 17: Judd FrankelNepal

Page 18, 19: Amir Bedri KelloEthiopia

InsideBack cover: Elizabeth Gilbert

EthiopiaBack cover: ITI

Vietnam

20

“Ten years ago, ridding the world of blinding trachoma was justa dream. Now the global vision of the world without blindingtrachoma by 2020 is in reach. We still have a lot of work to do,but there is no denying the power of the partnership forgedthrough the International Trachoma Initiative. We take heartin this success and in the opportunity to help restore the healthand well-being of families now and generations to come.Thank you to all of our partners—hundreds of thousandsof people owe their sight to your foresight and commitment,and I know none of us will rest until the job is done.”Jeffrey B. KindlerChairman and CEO, Pfizer

“Very few diseases have been eliminatedin the history of humankind. It is nowrealistic to hope that trachoma can andwill be eliminated within our lifetimes.”

Robert L. Mallett, Chairman of ITI BoardFormer Senior VP, Worldwide Policy and Public Affairs, Pfizer

www.trachoma.org