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<p>Disease elimination, as defined by the World Health Organization (WHO), denotes the sustained reduction of pathogen transmission to zero within a defined geographic area through ongoing public health intervention. In practice, however, certification of elimination status has frequently operated as a terminal designation, reshaping funding and signalling that a problem has been resolved. This perspective argues that such a conception is both scientifically untenable and operationally hazardous. Drawing on three concurrent, well-documented resurgences, measles across the Americas and Europe, circulating vaccine-derived poliovirus (cVDPV) in high-income settings, and accelerating global cholera mortality, this paper identifies three mechanistically distinct but institutionally convergent pathways through which disease control gains erode: immunological erosion driven by unvaccinated birth-cohort accumulation, virological re-emergence via vaccine-derived pathogen variants in under-immunised populations, and structural collapse of water, sanitation, and hygiene (WASH) infrastructure in conflict-affected settings. Across all three, a shared governance failure is evident: post-certification frameworks reward achievement rather than mandate sustained maintenance. Four targeted reforms are proposed, pathway-sensitive post-certification monitoring, quantitative threshold-triggered status reviews, integration of structural resilience metrics, and reform of public-facing elimination communication. Disease elimination is better understood as a condition of managed equilibrium than as a milestone: it is not secured by certification, it is continuously earned.</p>

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Disease Elimination Is Not Eradication: Rethinking “Disease-Free” Certification in Global Health amid the Global Resurgence of Measles, Polio, and Cholera

  • 期刊论文

  • 出版模式：

    开放获取

  • 发表日期：

    2026年7月9日

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  • Adanze Nge Cynthia

摘要

Disease elimination, as defined by the World Health Organization (WHO), denotes the sustained reduction of pathogen transmission to zero within a defined geographic area through ongoing public health intervention. In practice, however, certification of elimination status has frequently operated as a terminal designation, reshaping funding and signalling that a problem has been resolved. This perspective argues that such a conception is both scientifically untenable and operationally hazardous. Drawing on three concurrent, well-documented resurgences, measles across the Americas and Europe, circulating vaccine-derived poliovirus (cVDPV) in high-income settings, and accelerating global cholera mortality, this paper identifies three mechanistically distinct but institutionally convergent pathways through which disease control gains erode: immunological erosion driven by unvaccinated birth-cohort accumulation, virological re-emergence via vaccine-derived pathogen variants in under-immunised populations, and structural collapse of water, sanitation, and hygiene (WASH) infrastructure in conflict-affected settings. Across all three, a shared governance failure is evident: post-certification frameworks reward achievement rather than mandate sustained maintenance. Four targeted reforms are proposed, pathway-sensitive post-certification monitoring, quantitative threshold-triggered status reviews, integration of structural resilience metrics, and reform of public-facing elimination communication. Disease elimination is better understood as a condition of managed equilibrium than as a milestone: it is not secured by certification, it is continuously earned.