The challenging concept of eradication: A core concept guiding and frustrating public health

The celebrated 1980 announcement that smallpox had been eradicated was made using the following definition of eradication: "Permanent reduction to zero of the worldwide incidence of infection caused by a specific agent as a result of deliberate efforts: intervention measures are no longer needed." Public health around the world works with this definition of "eradication," setting it as a goal for other infectious disease control programs. The definition is simple. Its application, however, has produced long-running and complex public health campaigns that threaten the commitment of funders, health care providers, and governments. In this paper, the authors demonstrate the disease-specific challenges of eradication through the example of the Global Polio Eradication Initiative (GPEI). While many deem eradication worth its high costs because it is the end of morbidity and mortality from a disease, it does not mean the end of disease control efforts. Public health must be prepared for the possibility of disease reoccurrence in the form of undetected natural reservoirs of disease, lab leaks from stored samples, bioterror attacks using stolen samples, and the synthetic recreation of microbes. This paper clarifies the role of reoccurrence prevention in eradication, calling for its addition in the definition of eradication. L'annonce c & eacute;l & egrave;bre de 1980 que la variole a & eacute;t & eacute; & eacute;radiqu & eacute;e utilisait la d & eacute;finition d'& eacute;radication suivante : << R & eacute;duction permanente & agrave; zero de l'incidence mondiale d'infection caus & eacute;e par un agent sp & eacute;cifique en cons & eacute;quence d'efforts d & eacute;lib & eacute;r & eacute;s : mesures d'intervention ne sont plus n & eacute;cessaires. >> La sant & eacute; publique globale emploie cette d & eacute;finition de << & eacute;radication >>, la fixant comme objectif pour d'autres programmes de contr & ocirc;le des maladies transmissibles. La d & eacute;finition est simple. Pourtant, son application a produit des campagnes de sant & eacute; publique compl & egrave;xes et de longues dur & eacute;es, qui menacent l'engagement des bailleurs de fonds, les prestataires des soins de sant & eacute;, et les gouvernements. Dans cet article savant, les auteurs d & eacute;montrent les obstacles d'& eacute;radication sp & eacute;cifiques & agrave; une maladie transmissible & agrave; travers l'exemple de la Global Polio Eradication Initiative (GPEI). Tandis que l'& eacute;radication pourrait peut-& ecirc;tre m & eacute;riter les c & ocirc;uts & eacute;lev & eacute;s associ & eacute;s puisqu'elle signifie la fin de la morbidit & eacute; et la mortalit & eacute; d'une infection, ceci ne repr & eacute;sente pas la fin des efforts de contr & ocirc;le des maladies. La sant & eacute; publique doit se pr & eacute;parer pour la possibilit & eacute; de la r & eacute;apparition d'une maladie infectieuse en forme de reservoir de maladie naturel non-d & eacute;tect & eacute;, fuites de laboratoires des & eacute;chantillons conserv & eacute;s, attaques bioterroristes utilisant des & eacute;chantillons vol & eacute;s, et la r & eacute;cr & eacute;ation synth & eacute;tique des microbes. Cet article savant clarifie le r & ocirc;le de la pr & eacute;vention de r & eacute;ocurrence dans l'& eacute;radication, et demande que ce role soit ajout & eacute; & agrave; la definition d'& eacute;radication.