The promised endings and missed targets of global disease elimination

UN member states have committed to the global targets of ending HIV and TB by 2030 and, by that time, to reduce new hepatitis infections by 90 % and hepatitis-related deaths by 65 % as compared with the baseline of 2015. Many commitments have been made, declarations have been signed and initiatives launched. Remarkable progress has been achieved in many disease areas. Overall, however, the world is off track on the 2030 global disease elimination targets, with endgame phases of elimination appearing particularly challenging. Structural, methodological, financial and political obstacles limit progress, particularly – but not exclusively - in low and middle-income settings. Disease elimination is also understood and perceived differently by scientists, political and public health decision-makers and communities, as exemplified by the ongoing divisive debates on the “end of AIDS”. The public health benefits of elimination are obvious, but so are the benefits of “almost reaching elimination”.  The question arises of the political ownership and strength of the global elimination discourse which originated in the MDGs era at a time when global goals were served by an effective global heath multilateralism and strong funding flows from high-income countries. Global targets are perceived differently now, in a dissimilar polarized geopolitical landscape where priority is given to national and regional interests. The new geopolitical context as well as the welcome rise in regional ownership of health matters justify to literally follow the definition of “elimination” programs as endeavours limited to defined geographical areas. Comprehensive elimination programs aimed at eliminating measles, rubella, polio, neonatal tetanus, the vertical transmission of HIV, hepatitis, syphilis and neglected tropical diseases are ongoing in different geographic areas across the globe.