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“Si no se puede erradicar el pian, olvidémonos de otras enfermedades”

“If you can’t eradicate yaws, you can forget other diseases”

20.3.2013

I landed on the remote island of Lihir in 2010 to be the only doctor for its population of 20,000 people. On one of my very first days working on this small island in Papua New Guinea I met Max, a seven-year-old boy whose body was covered with ulcers. “He has yaws,”  his mother told me, “he hasn't been to school for three months and he has to play by himself because the other children have rejected him.” She was right, Max did have yaws, and the lesions were already affecting the bones of his hands and arms. The standard treatment, involving an injection of penicillin, was painful, so painful that Max, like other children, ran away into the jungle when he saw the nurse coming. It took us two years of research to find a solution to the problem. A single oral dose of an inexpensive antibiotic— azithromycin—proved to be enough to free the children from yaws, curing the skin lesions caused by the infection and preventing the disease from spreading to others who came into close contact with them. In addition, oral azithromycin was much simpler to administer than the treatments used before and there was no risk of transmitting the infection by way of unsterilised syringes.

Yaws is an infectious disease caused by a spiral-shaped bacterium similar to the organism responsible for syphilis. It affects as many as 15 million people in the poorest regions of the world, including more than 2 million children. Following the discovery of the efficacy of azithromycin in 2012, the World Health Organisation (WHO) revised its treatment policies, which had been developed 60 years earlier. The WHO then started a relentless war against yaws, adopting the goal of eradicating the disease by 2020. Today, the 20th of March 2013, some 80 representatives of countries where the disease is endemic are meeting in Geneva (Switzerland) to join forces and coordinate the implementation of this global eradication campaign. A few weeks ago we published details of the strategy in The Lancet.

Unlike the obstacles that hamper the eradication of other diseases, the main problems involved in eradicating yaws are not scientific. The new eradication strategy is based on the total mass treatment of affected populations with a single dose of azithromycin. Within one or two years, a country that has implemented this strategy will be free of yaws at a cost of just $0.70 (€0.52) per person. Yaws meets the scientific criteria for eradicability. However, as a neglected disease, its importance is often overshadowed by a long list of major killers, such as AIDS, tuberculosis and malaria. Thus, the questions that arise are: Will we be able to raise the needed funds? Can we gain the necessary political support? Personally, I believe that this is a unique opportunity. At the end of the day, if we can't eradicate yaws, we should forget about eradicating other diseases.