That is how a recent article in PLoS NTDs on yaws begins. What are yaws? Beyond being one of my favorite Scrabble words, to be honest I did not really know what it was either. However, I am currently analyzing some health utilization data in Ghana and noticed it as among the conditions presenting with regular frequency in outpatient clinics throughout the country. What the heck is it?
A google image search leads to some incredibly nasty photos, which again I will be kind enough to spare you from viewing. The disease is caused by a bacterial infection, one that can easily and inexpensively treated if caught early, but when not treated can lead to severe deformities or other disabling conditions. It affects mainly children in poor rural areas, in particular in South-East Asia (Indonesia, Timor-Leste, Papua New Guinea) and Africa (Ghana, Republic of the Congo).
I was surprised to learn (or be reminded, as it does sort of ring a bell) that yaws was the second disease ever targeted for eradication by the newly formed World Health Organization back in the 1950s. The program had huge initial impact – by some estimates it was able to reduce burden of the disease by 95%. But full eradication was never achieved. The article argues it was due to a failure to see the project through to the end. Some quotes from this article:
“The failure to achieve complete eradication was due to multiple reasons, notably the premature integration of yaws control activities into the general health services and the disappearance of support for yaws control”
“Basically, the dedicated vertical programs were dismantled before the final blow could be struck, and the resources and commitment for yaws and its surveillance activities also disappeared”
“[Yaws] programs have been deficient in failing to aggressively seek and contain yaws cases and contacts after mass treatment campaigns reduced yaws prevalence to low levels,” wrote Donald Hopkins in 1976, slightly before smallpox global eradication was certified and while yaws was already resurgent.
The WHO, is bringing it back. Yaws eradication that is. New efforts are underway to eradicate the disease, although there are some clinical and biological challenges, the main challenges are seen as political and financial. It can be eradicated, they argue, it just needs attention from policy makers. India has had tremendous success in recent years, which lends to the credibility of the success of such programs, but as the author argues:
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“…a second failure against this vincible enemy could cast discredit and mistrust on other ongoing and future eradication efforts, directed against more pernicious and less vulnerable pathogens.