Conclusions & Recommendations

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.

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.

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.

If health ministries are considering a “wait and see” approach (wherein the program continues S, F & E where needed but does not conduct MDA in a district), TEC suggests that they consider the district’s specific context in making a decision between “wait and see” vs. conducting MDA. Factors they may wish to consider include:
History of survey results
Most recent TF prevalence (the “wait and see” approach is especially appropriate in areas with TF1-9 <10%)
TF prevalence of surrounding districts
Existing availability of complementary indicator data, such as serology
Other relevant factors

Countries should also consider consulting with WHO before undertaking a “wait and see” approach.

TEC also encourages health ministries to conduct a survey incorporating complementary indicator(s) following implementation of a “wait and see” approach.

When a survey has been conducted and complementary indicator data are still pending, TEC will maintain the decision of ‘approved contingent on survey data’ (R2) for a district until TF plus at least one of the complementary indicator results are available to TEC and ITI for review. This is because complementary indicator results provide vital data to inform programmatic decision making that inform the appropriate use of azithromycin; require funding, time, and human resources to implement; and require the collection of specimens from individuals. Discussions between the national program, ITI, and the TEC liaison will then be held to understand program plans based on the results so that the contingency can be cleared and the final TEC decision can be made.

In the case of extenuating circumstances delaying or preventing the analysis of the samples collected, programs may request an exception for consideration by the TEC.

In 6 districts (Bore, Kimbibit, Sebeta Hawas, Cheha, Hulbareg, Boloso Bombe), operational research collecting complementary indicators was conducted during TIS (TIS+); the Federal Ministry of Health and Regional Health Bureaus subsequently used that data to decide to put these districts into “wait and see”. TEC encourages the Federal Ministry of Health and Regional Health Bureaus to consider conducting additional surveys incorporating complementary indicator(s) at the end of this period.

TEC further encourages the Federal Ministry of Health and Regional Health Bureaus to consider conducting TIS+ when due in areas where modified MDA strategies were implemented, in persistent or recrudescent woredas, and/or in woredas with TF 5-9%. TEC recognizes that incorporating complementary indicator(s) adds time and cost to surveys, albeit with a view to save time and costs in the future by avoiding unnecessary MDA and subsequent surveys, and encourages the Federal Ministry of Health and Regional Health Bureaus to discuss this recommendation with its partners and donors.

TEC was supportive of the proposal by the Kenya Ministry of Health to conduct “WASH and See” in Kajiado Central and Kajiado South followed by a TIS+ in January 2026 and looks forward to reviewing the results.

TEC encourages the Tanzanian health ministry to consider conducting a TSS+ in Chamwino DC South and Kongwa DC North evaluation units, given their long history of persistent/recrudescent TF. TEC recognizes that incorporating complementary indicator(s) adds time and cost to surveys, albeit with a view to save time and costs in the future by avoiding unnecessary MDA and subsequent surveys, and encourages the Tanzanian health ministry to discuss this recommendation with its partners and donors.

TEC encourages the CAR health ministry to consider conducting surveys that incorporate complementary indicators (“plus” surveys) in Bossangoa and Bouca in 2028 when their next impact survey is due, following completion of their newly-approved modified MDA strategy. TEC recognizes that incorporating complementary indicator(s) adds time and cost to surveys, albeit with a view to save time and costs in the future by avoiding unnecessary MDA and subsequent surveys, and encourages the CAR health ministry to discuss this recommendation with its partners and donors.

TEC noted that activities are sometimes delayed in CAR and further encourages the health ministry to discuss with partners their full funding needs to ensure adequate resources.

TEC noted the recent influx of refugees from Darfur (endemic for trachoma) across the border into Chad. TEC recommends to ITI to follow up with the Chad health ministry to understand the situation in refugee camps and have a dialogue about whether they would be interested in requesting azithromycin to treat refugees in camps where populations from Darfur had a TF prevalence warranting MDA.

TEC further noted that given the incredible progress made in Chad in reducing trachoma prevalence to below elimination thresholds in all other areas of the country, it is very unlikely that there is active ocular C. trachomatis infection remaining in the three districts with TF1-9 ≽5%. Therefore, if funding cannot be identified for implementing MDA in 2025/26, a “wait and see” strategy followed by a survey incorporating complementary indicator(s) is a very reasonable approach.

TEC congratulates the national program of Senegal on reaching the important milestone of completing their dossier for the validation of the elimination of trachoma as a public health problem. The strong political engagement displayed by the Senegal program in the fight against NTDs is well noted. TEC looks forward to hearing that the dossier has been submitted and validated by WHO.