Elimination is local. Eradication is global. Elimination refers to the decrease of a particular disease to a very low defined target number in a particular geographical region. Eradication, however, is defined as the complete and permanent global reduction of a disease to zero. Think of it like this — elimination is a step to eradication. In the history of the world, smallpox is the only disease to be completely eradicated.
Smallpox was the perfect candidate for eradication. It was only transmitted from humans to humans, which is important because diseases that can be spread by animals and soil cannot be eradicated. Additionally, smallpox caused rash, and specific visual symptoms make diseases more diagnosable. The vaccine was also incredibly effective, cheap and accessible.
The last case of wild smallpox was in 1977. When a disease is eradicated, the public health infrastructure to protect populations from said illness diminishes. When no one has the disease, it no longer becomes a threat.
Even today, the eradication of smallpox is coined as one of public health’s greatest accomplishments, but both eradication and elimination are becoming harder and harder to achieve. In fact, measles was eliminated in the Americas in 2016, but the disease has since reemerged. In Venezuela there has been an outbreak of the vaccine-preventable disease which has since spilled over into neighboring countries, according to The World Health Organization and the Pan American Health Organization.
This issue strikes fear into the world of public health because the sudden reemergence of measles is hard to mitigate in a nation riddled with political turbulence. In fact, the country is in the midst of a complex humanitarian crisis. As a result, healthcare professionals are fleeing, and public health infrastructure is crumbling.
The national immunization program was halted in 2010 while access to primary care professionals was also hindered. As of this year, the most affected group has been Venezuela’s indigenous people, and their death toll is increasing. The disease has been reported in Colombia and Brazil, indicating a need for immediate attention and possibly a revocation of its distinction as a “measles-free region.”
Other vaccine-preventable diseases such as diphtheria and polio are also regaining ground in Venezuela, with the lack of accessibility to vaccines causing increases in case counts. Current recommendations include encouraging the current government to push for immediate relief in the name of humanitarian necessity, increased epidemiological surveillance systems to monitor incidence rates and mass vaccination efforts with greater intentionality in low-resource communities.
I want to emphasize the gravity of this situation — diseases that were no longer a problem are coming back. In an increasingly globalized world, the threat of transmission is graver than ever before. Measles, polio and diphtheria are fatal and incredibly contagious. We need to pay attention to Central and South America right now because it is a tragedy that people around the world are dying from diseases that are entirely vaccine preventable because of political power struggles. Additionally, disease knows no borders — there’s no saying if these deadly diseases could affect you and me.