Conclusions & Recommendations

Meeting participants discussed the impact of US government funding cuts on the support previously provided by CDC to countries conducting serological assessments during surveys incorporating complementary indicator(s) (“plus” surveys) and noted the excellent progress made to date in the rollout of the lateral flow assay and the development of the cartridge-based test. Given the critical need for ongoing procurement of tests to support the serology testing needs of countries, along with ITI’s long-established history of supply chain support to national programs based on countries’ trachoma data, TEC requests ITI to explore with Tropical Data, CDC, and DDTD the needs to establish a new system to:
- coordinate with partners to forecast test needs,
- establish a funding mechanism to sustainably support countries to plan, implement and report results from surveys incorporating complementary indicator(s),
- place orders with DDTD,
- manage the supply chain to get the tests to countries, and
provide other support as necessary.

Following the announcement of Virginia Sarah’s retirement from FHF, TEC and meeting participants expressed their gratitude for her outstanding support and dedication to trachoma elimination efforts, particularly through her leadership of the International Coalition of Trachoma Control and her service as a member of the TEC.

TEC congratulates the END Fund for the successes they have achieved since 2021 in the countries supported with ARISE funding, noting in particular the completion of trachoma mapping in the Republic of South Sudan and stopgap funding for Zambia to complete 2021 MDAs that were paused due to early closure of DFID/ASCEND, preventing the expiry of over 33,000 treatments of POS. TEC expressed their gratitude for this important support, and notes with concern the impacts of the end of ARISE funding after December 2025.

TEC expressed deep concern over the withdrawal of funding support by the US government through the significant reduction of foreign assistance funding and closure of USAID. TEC recognized and appreciated the US government’s contributions towards global trachoma elimination and its more than $1.4 billion in support to NTDs since 2006. Partners provided updates on how the current situation is affecting national trachoma programs and brainstormed how to improve joint advocacy efforts, with a suggestion to include messaging about trachoma activities being lifesaving interventions. This would be strengthened by expediting ongoing analyses quantifying the historical contribution of trachoma MDAs to reducing child mortality.

TEC expressed its encouragement regarding the Fred Hollow Foundation (FHF) and their ongoing search for new sources of funding. As it stood in June 2025, FHF’s funding from the Australian government is set to end in June 2026, effectively starting an indefinite pause on trachoma activities in at least three countries in the Pacific.

TEC expresses gratitude to ITI for its work to develop a new application process that enhances interaction with country program managers, streamlines deliberations at TEC meetings, and provides earlier drug demand estimates for forecasting. TEC looks forward to further updates on the application process in preparation for TEC 33 and request that ITI clearly communicate application process changes to countries and partners in advance of TEC 33. TEC requests ITI to ensure that changes to the drug application are clearly communicated to countries and partners in advance of TEC 33.

In light of inherent program delays in conflict areas, the TEC requests that ITI review available data to determine which areas of insecurity might qualify for a modified MDA strategy regardless of meeting the persistent or recrudescent TF criteria, and discuss ways to implement this option with the Ministry of Health and partners.

In light of REACH Network research on the potential benefits of azithromycin for pregnant and intrapartum women, TEC requests that ITI review relevant sections of the revised program manager’s manual, soon to be published, to align it with, and provide references to, these latest research findings.

The TEC appreciated the analysis by ITI team members and the TEC complementary indicator working group and their clear presentation of a suggested framework for guiding TEC decisions on drug allocation when complementary indicators are available. TEC recommends that the framework be adopted as a tool for internal use by TEC and ITI on an interim basis, particularly in areas of persistent or recrudescent TF. TEC recommends ongoing collection and analysis of complementary indicators where resources are available to refine decision-making thresholds, and incorporation of updated information into a refined framework. The TEC appreciates efforts by WHO to convene a Guideline Development Group on the use of complementary indicators in trachoma elimination programs and looks forward to incorporating those recommendations into the drug donation decision making algorithm once available.

TEC acknowledges with gratitude Pfizer’s generous commitment and extraordinary efforts to increase their manufacturing capacity for the trachoma program. In light of the restored supply capacity, TEC recommends that the historical approach to allocation (95% of Approved, 100% of Surgery, and 100% of Research) be restored for all 2025 shipments. TEC further recommends that ITI send letters to all partners and countries to notify them of this change.

TEC appreciates the tremendous progress in the use of photography to document TF and TT and to facilitate trachoma elimination. TEC encourages the continued use of the Gondar Grading Center and Tropical Data’s Photo Library.

TEC and ITI have typically considered survey data more than 10 years old to be ‘stale’ and likely no longer representative of current conditions. In response to a question raised during the meeting as to whether a shorter timeframe would be more appropriate, TEC deliberated on the tradeoffs and situational contexts in which this occurs. TEC determined that, as a working internal principle, even in areas where insecurity or high population movement has occurred, data could still be considered valid for up to 10 years and used in support of requests for azithromycin.