From 'control to elimination': a strategic change to win the end game.

Strategies for elimination evolve from early use of available tools, to elaboration of control strategies, through to 'elimination.' Onchocerciasis control in Africa demonstrates this evolution. Early strategies used vector control but later used mass distribution of ivermectin. Elimination in Africa though was not thought to be possible; however, with excellent coverage of ivermectin distribution it was demonstrated that treatment could be stopped on the Senegal Mali border stimulating a new policy of elimination of transmission where possible. This new policy must not be business as usual but will require redefining treatment areas, improving quality of data, and flexibility of strategies to fit the new paradigm.