A Brief History of PacELF

What is PacELF?
PacELF is the Pacific programme for the Elimination of Lymphatic Filariasis. It was formed in 1999 to coordinate the control efforts in Pacific Island Countries (PICs), and works within the framework of the global programme to eliminate lymphatic filariasis.

PacELF, the first regional filariasis elimination programme, is a network of the twenty-two island countries and territories in the Pacific for the sole purpose of eliminating filariasis in the Pacific by the year 2010. The strategy for achieving this goal is annual mass drug administration (MDA) using diethylcarbamazine (DEC) with albendazole to stop transmission together with clinical management of infections to minimize pathodema in individuals already infected.

Pre-history of PacELF:
Many people have done a substantial amount of work in several PICs over the last few decades to control and eliminate lymphatic filariasis (LF) as a public health problem. In the latter half of the 1990s, a number of events and activities brought LF to a higher profile. Several countries had been working more or less independently on LF control. In Fiji, the late Dr Mataika and his staff made substantial progress in mapping and instigating programs in areas of that country, while in Samoa, the Ministry of Health supported by WHO conducted annual mass drug administration with different drug regimens. In French Polynesia, the Ministry of Health and Institute Malarde, as a pioneer institute of Pacific filariasis, had also been very active in LF control and studies.
Increasing the Profile of LF
Despite these excellent efforts, there had really been no coordinated global or regional plans to control LF. Then, in 1993, the International Task Force for Disease Eradication declared lymphatic filariasis to be one of only six eradicable or potentially eradicable diseases. This decision was based on newly available safe and cost-effective control methods, including improved diagnostic tools, more effective drugs and drug combinations, mosquito control and effective strategies for dealing with end-stage disease. The scene was set for a global effort.

This strategy was formalized in May 1997, when the World Health Assembly passed a resolution urging Member States “to strengthen activities toward eliminating lymphatic filariasis as a public health problem, and requesting the Director-General to mobilize support for global and national elimination activities.” (World Health Assembly Resolution 50.29).

In March 1999, parallel WHO and SPC Pacific regional meetings in Palau took up this call to action. The SPC Heads of Health Services Consultative Meeting resolved: “In keeping with the WHA resolution to eliminate lymphatic filariasis the meeting encouraged the Secretariat to continue discussions with WHO, and other relevant donor agencies to develop and implement a comprehensive strategy to eliminate lymphatic filariasis in all 22 island countries and territories.”

There was similar endorsement by the WHO Ministers/Heads of Health Meeting in 1999. The meeting passed a resolution that “requests the Regional Director to consider the elimination of filariasis as a priority for WHO collaboration to Healthy Islands.”

These meetings served to increase the awareness of the disease as a public health problem and alerted PICs of the need to control or eliminate filariasis.

The birth of PacELF
At this time, both WHO and SPC were well positioned to work together on LF control. WHO had vector borne disease and communicable diseases experts in Manila, PNG, Solomon Islands and Vanuatu. SPC was implementing the Pacific Regional Vector Borne Diseases Project, and had staff based at SPC HQ in Nouméa, and project offices in Vanuatu, Solomon Islands and Fiji.

Dr Kazuyo Ichimori from WHO and Dr Tony Stewart from SPC met in Port Vila, Vanuatu on the 11th April 1999 to discuss how best to enact the resolutions of the WHA and the Regional meetings. They came up with the idea of a regional programme driven by the countries, and coined the name PacELF – the Pacific programme for the Elimination of Lymphatic Filariasis. They secured funding from WHO and through SPC’s vector borne diseases project to hold a meeting of Pacific countries.

This took place in Brisbane on the 28th and 29th June 1999. Participants were public health leaders from those Pacific countries with recent or current transmission of lymphatic filariasis, together with staff from SPC, WHO and other institutions working in the field of elimination of filariasis. This meeting provided a forum for the country representatives from American Samoa, Cook Islands, Fiji, French Polynesia, Nauru, New Caledonia, Niue, Papua New Guinea, Samoa, Solomon Islands, Tonga, Tuvalu, Vanuatu & Wallis & Futuna to discuss current and planned activities globally and within the Pacific Region. Representatives from University of Queensland, James Cook University, SmithKline Beecham and AMRAD ICT also participated.

An important outcome was to achieve consensus on a regional plan of action, and the establishment of a coordinating body to assist with the development of country plans of action.

The fourteen countries attending the meeting refined and endorsed the regional plan, and voted 4 country representatives to form the interim coordinating body, to facilitate implementation between meetings. Thus the world’s first regional LF control programme was born

PacELF Update:
PacELF represents a happy family of Pacific countries working together with support from outside organizations to eliminate Lymphatic Filariasis by 2010. PacELF is a coordinating and support body providing the following services:

• Administrative support and drug distribution
• Health education and advocacy
• Communication
• Training and meetings
• Scientific basis and operational research

The first objective of PacELF is to stop transmission of LF through MDA and vector control. The second is to reduce and control morbidity caused by LF through intensified hygiene, home based patient care surgery. Strategies necessary to meet the objectives include integration pf PacELF activities with other programmes, social mobilization, operational research, partnerships and training.

LF is endemic in 16 out 22 pacific countries. Eleven of the endemic countries have implemented Mass Drug Administration programmes treating a total of 1.67 million people, with a 73% coverage rate. Results from a recent mid-term evaluation in 5 countries show a 39% reduction in filarial antigen and a reduction of more than 91% in microfilaraemia. In 2003, PacELF distributed 73,000 ICT kits, 40,654,000 DEC and 1,930,000 Albendazole tablets to Pacific countries.

Samoa has completed five rounds of MDA. Five countries have completed four rounds (American Samoa, Cook Islands, French Polynesia, Niue and Vanuatu); three countries have completed three rounds (Kiribati, Tonga and Tuvalu); and two countries (Fiji and Wallis and Futuna) have completed their second round. New Caledonia and Papua New Guinea will start their MDAs in 2004. Further investigations continue in countries where the status of LF is doubtful or partially endemic. Non-endemic countries, such as Guam, Nauru, Solomon Islands and Tokelau will soon be conducting final surveys to certify elimination. With many countries completing all five rounds of MDA in the near future, the next step for PacELF is to implement activities that all ensure the achievement of elimination.

Issues to be addressed in 2003 include the following:
1. Integration with helminth, malaria and dengue control
2. Advocacy and political commitment
3. Operation research
4. Surveillance post MDA
5. Morbidity control – survey and treatment
Future Issues:
People are aware that the filariasis elimination programme was built almost entirely on MDA. Only recently, through PacELF, that the significance of having vector control has been realized. Recent meeting at WHO (HQ) reiterated the need to have vector control in specific areas, such as Pacific countries, as part of the elimination process. Effective methods of vector control should be developed in coming years.
Social Mobilization:
It is necessary to keep high coverage of drug distribution for all five rounds of MDA in each endemic country. Social mobilization and awareness campaign to maintain good compliance will be important role for the programme.
Regional Collaboration:
Big immigrant communities in different areas in the region (e.g. New Zealand, Australia, Hawaii) are constantly moving back and forth within Pacific islands countries, so the effective implementation of MDA programs becomes a problem. How to reach them and motivate them to become part of the program poses a great challenge.
Pacific criteria:
The issue on criteria to certify elimination needs to establish a pacific standard for evaluation and elimination. One of the current priorities is to bring a group together to statistically analyze the situation and come up with appropriate standard or criteria best suited for the Pacific.
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