Perceptions and priorities in disease eradication: dracunculiasis eradication in Africa.

Dracunculiasis, guinea worm disease, is an incapacitating disease affecting people in poor, remote areas of Africa, in Yemen, and a few remaining areas of the Indian subcontinent where there is poor access to protected water sources. The neglect of this preventable disease and its belated recognition are analyzed within the context of changing priorities for health since the 1870s, especially the shift from the paradigm of Imperial Medicine to Primary Health Care. A global eradication effort took off during the 1980s, and, although the original target date of December 1995 has passed, the program has achieved a remarkable recent diminution in the number of recorded cases, over 99% of which are now found in Africa. Eradication policies in Africa are briefly explored in relation to current concerns such as the incorporation of dracunculiasis eradication measures in cash-starved primary health care programs. The wider implications of an eradication campaign which is on the verge of success are also considered.