Countries in the Americas are making progress toward the elimination of diseases such as malaria, pediatric HIV and congenital syphilis, and tuberculosis. But additional sustained investments—including support from the Global Fund to Fight AIDS, Tuberculosis and Malaria—are critical to allow countries to finish the job, experts said at a Sept. 30 briefing organized by the Pan American Health Organization/World Health Organization (PAHO/WHO).

The Americas has a long and successful record of eliminating diseases. It was the world's first region to eradicate smallpox and eliminate polio, it has advanced regionwide toward the elimination of measles and rubella, and more recently it has targeted neglected tropical diseases such as onchocerciasis (river blindness) and trachoma.

In addition, in recent years pediatric cases of HIV have been declining steadily in the region, and two countries have filed requests with PAHO to validate their elimination of mother-to-child transmission of HIV and syphilis. As of 2014, 15 countries and territories in the Americas are on track to eliminate congenital syphilis by 2015. In May, PAHO established (and is serving as secretariat for) an independent regional committee to validate the elimination of mother-to-child transmission of HIV and syphilis.

Additionally, seven of 21 malaria-endemic countries in the Americas have entered the pre-elimination phase for malaria. Nine countries in Central America and the Caribbean are participating in a joint initiative to eliminate the disease, with support from the Global Fund. Notably, Argentina recently filed an official request to WHO to receive an international team of experts to certify the country as free of malaria, something no country  in the Americas has achieved during the past 40 years.

Four countries in the Americas—Canada, Costa Rica, Cuba, and the United States—have fewer than 100 TB cases per million, considered a "low-burden countries."  They are implementing TB elimination activities targeting vulnerable populations. Other countries with decreasing burden are soon to start implementing these activities with PAHO support.

PAHO Director Carissa F. Etienne said it was important to maintain levels of financing for these efforts, as the final push toward elimination is sometimes "one of the most demanding" periods. She added that countries in the Americas are contributing extensively with their own resources.

Former PAHO Director Mirta Roses noted that, historically, as countries get closer to elimination, there is often a dangerous reduction of resources. She agreed that continued investments are essential.

David Stevenson, Chair of the Global Fund's Strategy, Investment and Impact Committee, said the Fund is discussing new eligibility criteria based on a "development continuum" and an expanded set of indicators. The idea is to move away from strictly income classifications toward programming based on specific challenges in individual countries, Stevenson explained.

Mark Edington, head of the Global Fund's Grant Management Division, said the Fund also is concerned that some countries are close to elimination yet face challenges in continuing action to meet their goals. He said financial support from the Fund should focus on key affected populations, disease "hot spots," and high-impact interventions.

Other participants in the briefing were José Ángel Portal Miranda, Vice Minister of Public Health of Cuba, and Carina Vance Mafla, Minister of Public Health of Ecuador.

Communicable Diseases and Environmental Determinants of Health
www.paho.org/cde