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

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 Forgotten diseases, forgotten populations Poorest of the poor The most marginalized: without access to water and sanitation Living in remote rural areas and urban shantytowns Those with least access to health services Health workers don’t know about NIDs Lack of innovation for diagnosis and treatment Lack of information about diseases burden and populations affected; lack of interest at the highest levels of political decision-making

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…

6 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

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

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.

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

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

Combating over-the- counter sales Health professional- directed treatment schemes Monitoring systems Rational use of medicines Protect the Medicines we have… Prevention and Mitigation of Antimicrobial Resistance – via 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)

Integrated Plans of Action (PoA) for NIDsUse existing toolsInternal and external financingStrategic alliances and partnershipsMonitoring and evaluationWorking in networks and with communitiesPromotion of research and innovationTraining and formation of public health professionals Key actions, innovation, collaboration

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