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The antibiotic is administered in an oral suspension form. Previously, patients had to use tetracycline eye ointment twice daily for as long as ten weeks. While the higher cost of azithromycin once made its use all but impossible in the developing world, that issue was resolved when the manufacturer, Pfizer, announced it would provide the drug at no cost. The International Trachoma Initiative collaborates with public health authorities in each endemic area, as well as with different aid organisations. The programme in Ethiopia , where trachoma prevalence rates are estimated to be as high as 88 % in children under 10 years old, illustrates the interplay of organisations. That country has had trachoma control activities in place for more than 50 years. In that country the ITI works with governmental agencies as well as with ORBIS International, World Vision, UNICEF and the Carter Centre. The BBC World Service Trust, the London School of Hygiene and Tropical Medicine, and Water Aid also participate.
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TRACHOMA, a leading cause of blindness in the developing world, appears to be headed for extinction in some affected areas thanks in large part to an ongoing global eradication programme. The International Trachoma Initiative (ITI) recently marked its fifth anniversary. The initiative represents a collaborative effort by the World Health Organisation, UNICEF, non-governmental organisations and the pharmaceutical industry. The multi-pronged effort includes public education, medical treatment, and surgery in areas of Africa and Asia where the disease is endemic. The programme has already logged impressive successes. In Morocco , the first country to adopt the programme, trachoma has decreased by 90% among children in the last five years. That country hopes to see trachoma eliminated within two years. "We are winning the fight against blindness from trachoma because we have an extraordinary strategy and effective partnerships in our programme countries. Building on the momentum of our achievements to date, we are broadening the scope of the trachoma programmes already in place and will launch at least 10 new country programmes," said Dr. Jacob Kumaresan, president of the International Trachoma Initiative. 
The International Trachoma Initiative is part of a larger WHO programme, the Alliance for Global Elimination of Trachoma by 2020, which itself is part of the WHO's Vision 2020 programme discussed elsewhere in this issue. Since 1998 the programme has provided medical treatment for more than eight million patients in many countries around the world including Morocco , Ghana , Mali , Tanzania , Vietnam , Sudan , Niger , Nepal and Ethiopia . In addition, surgeons have performed 70,000 surgeries for those with corneal damage from trachoma. The initiative requires that participating countries follow the World Health Organisation's "SAFE" strategy. The acronym stands for Surgery for late-stage disease, Antibiotics for active infection, improved Facial hygiene and Environmental change. Improving access to clean water and sanitation is a cornerstone of the campaign. The medical treatment provided by the programme consists of a single dose of azithromycin (Zithromax), a macrolide antibiotic with known anti-chlamydial activity. A single dose can provide protection for as long as 12 months. 
The Ethiopian Health Ministry acts as the overall facilitator. UNICEF oversees the consignment of the antibiotic supplies and facilitates its shipment and delivery. ORBIS International, World Vision and the Carter Centre all share in the distribution of the drug. The Water Aid organisation provides the water supply and sanitary facilities mandated by the SAFE strategy. That group works with ORBIS to develop water sources such as deep and shallow wells and construct water distribution points. The BBC World Service Trust oversees the dissemination information to people in the affected regions as part of the strategy to effect behavioural change over the long term. The London School of Hygiene and Tropical Medicine provides the experience and manpower necessary to monitor and evaluate the various components of the programme. The ITI establishes similar partnerships in each of the countries where it is active. In some cases, such as Tanzania , things are going well. The organisation has distributed more than a million doses of antibiotic during the past three years. The latest surveillance data indicate that the prevalence of the severe inflammatory trachoma has been reduced by as much as 80% in the most endemic regions. In other areas things aren't going as well. Sudan is probably the most difficult case because of the continuing civil war, Africa 's longest running war. The WHO estimates that there are as many as 24 million cases of trachoma in that country. Despite the war, efforts are underway to implement the SAFE strategy. A recent agreement signed by rebels from the south and the Sudanese government offers a rare note of hope in that situation.