Conclusions & Recommendations

TEC is grateful for WHO’s swift work to move the guideline development process forward on the use of serology for trachoma assessments. To better support countries’ capacity to utilize serology in their programs, TEC would like to understand the additive costs associated with collection and processing of specimens for serology.
TEC would like to see a similar process for the development of guidelines on the use of infection data so that trachoma programs can benefit from more comprehensive guidance. To support this, TEC would welcome validating large-scale PCR pooling and data on program costs and evidence of comparability across different tests and platforms.

TEC appreciated the detailed update from the Bill & Melinda Gates Foundation on the REACH trials. As results are coming in and the Foundation expresses its interest in scaling up child survival programs, TEC noted the currently inadequate global POS production capacity and would appreciate future updates and coordination between ITI, Pfizer, TEC, and BMGF on this issue and its impact on the trachoma program’s POS needs. TEC welcomes the possibility of future engagement for child survival rollout and further requests clarification of its own role. Recognizing ITI’s excellence in supply chain management, evidence gathering, leadership, and convening, TEC further advocates for ITI to be the primary steward of azithromycin procured and/or donated for trachoma and child survival. TEC notes that ITI would need additional resources to take on this additional workload while maintaining its excellent support to national trachoma programs.

TEC appreciated the update on the ASPECT trial and requests future updates on any changes to study design, funding, and timeline.
Given the delays in possible funding, TEC recommends to ITI to get a revised list of districts where child MDAs are expected in 2024 to facilitate more accurate forecasting.

TEC commends ITI on its work to support countries nearing the end of MDA through their efforts to closely match shipments to expected demand for their anticipated final MDA. Doing so will avoid overstock as MDA finishes.
TEC recommends that ITI:
- investigate reasons for the remaining inventory in Côte d’Ivoire and consider any options to move/use the inventory so it doesn’t go to waste,
- apply lessons learned from Côte d’Ivoire to avoid a large mismatch in the future,
- support countries early in the development of their plans to utilize or destroy (where applicable) in-country Zithromax® as MDA needs decrease or cease altogether,
- update TEC annually on how the process is going, and
- look for opportunities to share lessons learned with other NTD programs.

TEC acknowledges with gratitude the work being done by Pfizer to increase their manufacturing capacity for the trachoma donation. TEC recommends to ITI to review materials (including supply chain training; Zithromax® Management Guide; Memoranda of Understanding with countries) for necessary updates once Pfizer’s production plans are finalized, including the shift from the brand name of Zithromax® to azithromycin and descriptions of the packaging. TEC further recommends to ITI to send letters to all partners and countries immediately upon finalization of these changes to advise them of the details and to request they update all materials as appropriate.

TEC is committed to managing the Zithromax® shortage applying the principles of equity, transparency, and data-driven defensibility. The current allocation approach (80% of Approved; 100% of Surgery; and 95% of Research) will be kept the same for now. Pfizer is actively working to address the supply challenges; however, in the short term, a shortfall will remain resulting in the need for additional reductions to demand and/or delayed shipments. The TEC and ITI are committed to communicating additional information as it becomes available, which may lead to a need to call an extraordinary meeting between TEC, Pfizer, and key partners and donors to address these challenges together.

While drug supplies remain low, TEC encourages consideration of targeting children only following community-wide MDA in areas conducting more frequent than annual treatments.

TEC noted with enthusiasm the number of country applications that are fully reserve requests pending impact surveys, which demonstrates enormous progress across the global programme.

TEC is encouraged by the research investments by the NTD-SC for trachoma, but was disappointed to learn of the intention not to conduct PCR testing. TEC recommends the eye swabs being collected be PCR processed and results triangulated and shared.

TEC notes the upcoming serology meeting and awaits with interest the decisions on complementary indicator thresholds to inform future Zithromax allocation decisions.