American Society for Tropical Medicine and Hygiene Freeing

American Society for Tropical Medicine and Hygiene Freeing the Americas from NIDs: Addressing the Unfinished Agenda Mirta Roses, M. D. , M. P. H. Director Pan American Health Organization Philadelphia, 6 December 2011

Neglected diseases, forgotten diseases. Forgotten populations. What are these diseases, and where are they? Who gets infected? Do health workers really recognize the NIDs? . . .

A Case of Forgotten People, Forgotten Diseases

Neglected infectious diseases affect the most vulnerable people access to health t s a le h it w e s o h T services ral areas and ru te o m re in g in Liv ns urban shantytow lized: without a in rg a m t s o m e Th sanitation d n a r te a w to s s acce Poorest of the po or on about Lack of informati and diseases burden ck of ted; la populations affec st levels he interest at the hig -making n of political decisio Forgotten diseases, forgotten populations n for Lack of innovatio ent atm diagnosis and tre n’t know Health workers do about NIDs This imbalance affects the neediest people

Key neglected infectious diseases in LAC • 12 diseases are targeted under PAHO’s 2009 Resolution on NIDs: – 10 targeted for elimination… – 2 targeted for reducing disease burden…

Ten diseases targeted for elimination as a public health problem Lymphatic Filariasis Onchocerciasis Blinding Trachoma Chagas disease (domestic vectors, blood transfusion) Human Rabies transmitted by Dogs Plague Leprosy/Hansen’s disease Malaria (where possible) Neonatal Tetanus Congenital Syphilis 6

Two diseases targeted to reduce the burden of disease, using available tools • Schistosomiasis (S. mansoni) Persistence in areas or sites with a very high prevalence • Soil-transmitted helminthiasis – Ascaris, Trichuris, human hookworms Limited knowledge of the epidemiological situation 7

Many of these diseases are overlapping: affecting the same people within the same geographical areas 6 NIDs mapped at the first administrative level: • Schistosomiasis • Lymphatic filariasis • Onchocerciasis • Trachoma • Human Rabies transmitted by Dogs • Soil-transmitted Helminthiasis

What is the Burden of Disease in Latin America and the Caribbean for NIDs? Although disease burden in LAC is 8. 8% of the global burden: • Soil-transmitted helminthiasis is widely disseminated: 43 million children at risk • Pockets of transmission of schistosomiasis in Brazil, Saint Lucia, Suriname and Venezuela • Lymphatic filariasis in Brazil, Guyana, Haiti and the Dominican Republic • Onchocerciasis in Brazil, Ecuador, Guatemala, Mexico, and Venezuela • Trachoma in Brazil, Colombia, Guatemala and Mexico 5 million DALYs , higher than the burden of HIV disease in the Region

Other challenge: Antimicrobial Resistance… NIDs NOT Exempt! • Some examples – Leprosy – Leishmaniasis – Mycosis – Trachoma • Special Risks of Resistance – Chronically immunocompromised individuals

How do we reach Elimination? Think of vulnerable peoples. Keep these diseases on the radar. Diagnosis and treatment are necessary but not enough.

We can eliminate NIDs in LAC working first within the health sector…by achieving universal coverage through primary care Regional commitment (PAHO Directing Council resolutions) and advocacy Reduce suffering and impairment of vulnerable populations due to NIDs in LAC National commitment: Formulate and finance Integrated Plans of Action (Po. A) for NIDs Implementation of Po. A at local level + Partnerships Technical cooperation from PAHO to countries to build capacities

…and then Working with Other Sectors to improve living conditions and prosperity Addressing the Social Determinants of Health Leadership of the Health Sector Use Poverty-Reduction Strategies: to reduce inequities and empower communities Political Commitment for Intraand inter-sectoral integration: increase capacity, efficiency of resources Increase Access to water and sanitation, primary education, improved housing Be People-centered and geographically focused: mapping NIDs for decision-making Sensitize and Motivate: with help of Local Leaders, find and reach people at risk in rural areas & shantytowns Promote innovation for diagnosis and treatment Increase Access to health services/primary care Improve health workers skills Inter-programmatic and inter-sectoral Integration: the approach needed

Protect the Medicines we have… Prevention and Mitigation of Antimicrobial Resistance – via Rational Use of Medicines Combating over-thecounter sales Health professionaldirected treatment schemes Monitoring systems Rational use of medicines

Although still “neglected”, we have success stories to share… We need more stories, to reach millions more

Onchocerciasis Colombia has eliminated the disease: no more transmission, blindness or other morbidity due to this disease Ecuador, Guatemala and Mexico are close to elimination Main challenge found in the Yanomami population on the Brazil- Venezuela border

Chagas disease Transmission by the primary vector has been interrupted in 14 countries 20 countries doing blood-bank screening Challenges: screening of pregnant women to prepare for opportune treatment of infected newborns, and access to drugs

Lymphatic filariasis (LF) Three countries have been removed from the WHO list of LF-endemic countries LF Treatment has been integrated with treatment for STH in 3 countries Despite Haiti’s earthquake in 2010, four million people were treated Challenges: Nearly 100% of Haiti’s 10 million people at risk, need to receive treatment once per year

Leprosy/Hansen’s disease All countries except Brazil have eliminated leprosy as a public health problem , measured as an overall national average When broken down further to the level of province/state/department, 19 of 35 countries have eliminated leprosy down to this level Challenges: Elimination in Brazil and sustaining local capacity once the national-level elimination goal is reached (protecting our achievements)

Key actions, innovation, collaboration Integrated Plans of Action (Po. A) for NIDs Use existing tools Internal and external financing Strategic alliances and partnerships Monitoring and evaluation Working in networks and with communities Promotion of research and innovation Training and formation of public health professionals

Together we can see the END of the NIDs! Together we can win the battle! It’s an ethical and moral imperative! Thank you