Conclusions & Recommendations

The TEC raised concerns about how to encourage progress towards elimination in these areas, and how to ensure that ongoing transmission in these areas does not affect surrounding areas that are under treatment. The TEC recommended that ITI include details about suspected endemic areas in country documents and presentations at future TEC meetings; discuss with countries with unmapped areas to understand the support they need; discuss with ICTC how to mobilize funding and partners and develop an approach to get the mapping done

Lack of MDA partners and funding source in these areas is an added challenge.

TEC also raised concerns over “statistically invisible” populations (e.g., migratory populations, refugees, internally displaced persons) which are not adequately represented/sampled in current survey methodologies to ensure equitable access to the Zithromax® donation and surgical services.

The TEC noted that there are still areas that are unmapped – due in part to insecurity, access issues, and lack of funding (e.g., DRC, South Sudan, Lake Chad Basin [Chad and Nigeria], Amazon Basin).

TEC welcomed the participation of colleagues from DFID-ASCEND Lot 1 at TEC 22 and appreciated the information presented. TEC recommends that ITI continue to work with the DFID-ASCEND Lot 1 partnership and invite them to future TEC meetings.

TEC recognizes that there may be a need for mitigation in hyper-endemic areas that warrant continued treatment. TEC would be prepared to review reasonable and evidence-based requests from national programs for additional Zithromax® that conform to local policy and regulatory standards.

TEC recognizes that coronavirus safety adaptations may be required to complete surveys. Such adaptations would ideally be agreed between partners and the Ministry of Health prior to implementation.

The TEC reflected on their principle that the Zithromax® donation is based on demonstrated evidence of need. If it is safe to conduct field activities, scheduled impact surveys should be conducted prior to potential MDA so that the normal data-driven process is not interrupted.

ITI supports country programs to make their own determination when they are ready to restart field activities (surveys and/or MDA) in the context of the COVID-19 pandemic. ITI stands ready to provide Zithromax® when MDA is restarted.

The TEC would welcome requests for operational research on mitigating the effects of skipped treatments in hyper-endemic districts by conducting multiple rounds of MDA in a year with enhanced surveillance. Such proposals should fit the country context, receive country ethical and regulatory approval, and be consistent with MOH/partner resource availability (political will, financial and human resources, and community acceptance).