Background “The worst form of inequality is to try to make unequal things equal”—Aristotle Soil-transmitted helminthiasis (STH) is caused by intestinal parasites that require an obligate development period in the soil [1,2], predominantly roundworm (Ascarislumbricoides), whipworm (Trichuris trichiura), and hookworms (Ancylostoma duodenale and Necator americanus), with the recent addition of threadworm (Strongyloidesstercoralis). Historically, these parasites have been among the most common infections in humans, disproportionately affecting the world’s most disadvantaged and marginalized people. The current approach to STH control and elimination as a public health problem is population-based, eschews adequate monitoring, assumes unlimited donated drugs which are not optimal against all STH species, and accepts massive programmatic inefficiencies. Hence, a new paradigm is needed. The burden of infection and morbidity due to these parasitic worms is rapidly declining, likely due to social and economic development and improvements in hygiene and living conditions, as well as the widespread distribution of donated or procured anthelmintic drugs. Despite this progress, there have been few changes in the structure of the global control program. The World Health Organization (WHO), which coordinates drug donations, reports that between 2010 and 2020, over 9 billion tablets were donated and distributed through STH-specific school-based programming, or to entire communities as part of the lymphatic filariasis (LF) elimination program [3]. In addition to the distributions reported by WHO, numerous other organizations, including UNICEF, have procured and distributed billions more deworming tablets. Collectively, there has been over a decade of extensive and continuous not all). The individual and population burden is unequal between localities, driven by the epidemiology of the disease. With the exception ofS.stercoralis [4], soil-transmitted helminths do not multiply in the human host. As such, each adult parasitic worm is the result of an infection, meaning that prevalence, intensity of infection, and morbidity can be considered separate indicators. A single infection event does not lead to high worm burden or morbidity. Light infections may go unnoticed or cause mild symptoms, while tens or hundreds of worms (moderate-to-heavy intensity (MHI) infections) are associated with symptomatic disease. Heavy infections can result in intestinal obstruction (A.lumbricoides), rectal prolapse (T.trichiura), and pronounced anemia (hookworm) [5,6]. Between 2000 and 2019, disability-adjusted life years (DALYs) lost due to STH was reduced by 53%, from over 4.0 million to 1.9 million [7]. MHI infections are no longer ubiquitous in at-risk countries, and morbidity attributable to STH is becoming both less frequent and more focal [8,9]. Six ambitious targets and milestones were laid out in WHO’s 2030 Targets for Soil-Transmitted Helminthiases Control Programmes document (Table 1) [10]. To reach these goals, a new, targeted equity-based approach to deworming is required based on the relevant public health burden, historical drug access, and associated environmental and behavioral risk factors. WHO has shifted routine monitoring and reporting from an output indicator (i.e., coverage of deworming in the target populations) to add outcome and impact measures (i.e., prevalence of any infection and MHI infection). It is argued that this shift will allow programming to be delivered and measured against current epidemiology, not just population size. In many settings, all eligible residents in endemic countries may no longer warrant equal treatment based on current WHO guidelines. Populations in areas with high annual deworming coverage and good socioeconomic development need less treatment overall as compared to populations that have not had good coverage or those that remain impoverished. To maximize reductions in residual morbidity, programs should identify populations at highest risk of MHI infections and focus activities on those groups. This will involve the generation of reliable data and the redistribution of medicines and other resources based on need. This would be an equity-based approach compared to the current equality approach.