MDA programs can achieve reductions in morbidity and infection intensity, but these reductions can be transient, and the outcomes have fallen short of World Health Organization (WHO) control and elimination targets ( Deol et al., 2019). In the case of schistosomiasis, efforts have primarily focused on expanding treatment coverage through mass drug administration (MDA). NTDs affect approximately 1 billion people globally, largely the poor, including over 200 million people with schistosomiasis ( World Health Organization, 2020). Over the past two decades, a surge in political will and financial resources has been directed toward reducing the burden of schistosomiasis and other neglected tropical diseases (NTDs) ( World Health Organization, 2012 World Health Organization, 2020 Uniting to Combat Neglected Tropical Diseases, 2022). We review the literature related to these questions and discuss how whole-genome approaches can identify the geographic and taxonomic sources of infection, and how such information can inform context-specific efforts that advance schistosomiasis control efforts and minimize the risk of reemergence. Until recently, these questions were difficult to answer with sufficient precision to inform public health decision-making. We consider two priority questions that can be addressed by integrating epidemiological, ecological, and genomic information: (1) how often do non-human host species contribute to human schistosome infection? and (2) what is the importance of locally acquired versus imported infections in driving transmission at different stages of elimination? These questions address processes that can undermine control programs, especially those that rely heavily on treatment with praziquantel. Here, we focus on leveraging genomic data to tailor interventions to distinct social and ecological circumstances. Recent advances in DNA sequencing technologies make whole-genome sequencing a valuable and increasingly feasible option for population-based studies of complex parasites such as schistosomes. Mass drug administration programs, for example, have reduced the burden of schistosomiasis, but the identification of hotspots of persistent and reemergent transmission threaten progress toward elimination and underscore the need to couple treatment with interventions that reduce transmission. The global community has adopted ambitious goals to eliminate schistosomiasis as a public health problem, and new tools are needed to achieve them.
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