In order to really tackle the NTDs, we need to start taking a careful and systematic look at our health systems, but also take into account the Social Determinants of Health which contribute to their apparent perpetuity. Dr. Mirta Roses remarks at the American Society of Tropical Medicine & Hygiene 2011 Annual Meeting Reception (ASTMH) hosted by Global Network for Neglected Tropical Diseases.

American Society of Tropical Medicine & Hygiene 2011 Annual Meeting  (ASTM&H)

PAHO Director's Talking Points
ASTM&H Reception Hosted by Global Network for Neglected Tropical Diseases
5 December 2011

Thanks to Neeraj Mistry of the Global Network for Neglected Tropical Diseases (GN) and Peter Hotez, outgoing President of the ASTM&H, for the invitation to join you tonight. 

When I was a young physician in Argentina it was not uncommon to encounter young children and their moms reporting to the clinic because their children had expelled worms, Ascaris (and sometimes tapeworms).  Occasionally some of these kids needed surgery to unblock the bundles of Ascaris wrapped in the colon, and some did not survive the massive infections.  Back then we had some basic medicines to treat the children — remember pyrantel pamoate or piperazine? - But of course a number of these kids would be back in a year with the same problem.  Grandmothers used to put on treatment everyone in the home at the end of summer to address this problem.

As I grew more experienced, and began thinking of these problems from a Public Health perspective, I came to realize that these worm infections won't just go away. We have to tackle them systematically, working through the disease surveillance and primary care systems of each of our countries.  Today, 40 years later, the intestinal worms are now known as a very important part of the larger problem of the Neglected Tropical Diseases (NTDs), not only in Latin America and the Caribbean but throughout the world wherever people live in poverty, be it in impoverished rural areas of the Argentina's Chaco, suburban Buenos Aires or Baltimore, as well as Bangladesh and Burundi.

So, in order to really tackle the NTDs, we need to start taking a careful and systematic look at our health systems, but also take into account the Social Determinants of Health which contribute to their apparent perpetuity. As you know, the WHO recently concluded the First International Conference on the Social Determinants of Health, held in Rio de Janeiro, where thanks to many of you the theme of NTDs was on that agenda! I will come back to this in a minute.

I speak of apparent perpetuity because science has advanced in the last 20 years leading to much better drugs for treating many NTDs, though we still have a ways to go to develop better drugs for some diseases like leishmaniasis.  Additionally, operational research on 7 important NTDs has shown the importance of Preventive Chemotherapy for treating the children and women in deprived communities who count among those most at risk and most afflicted by these diseases.

To remove the "Perpetuity"of the NTDs, we must however significantly step up not only our Health sector strategies but our Poverty-Reduction Strategies to increase access to basic sanitation and safe water, primary education and improved housing and drainage.

We cannot do this alone as health professionals, and partnering with other actors, stakeholders and sectors is one of the keys to success. As an example, PAHO has enjoyed a solid partnership with the Global Network and the IDB over the last 3 years.  Many bilateral agencies also contribute significantly to this effort in our Region, among them Canada, Spain and the USA.

The Public-Private Partnerships that have been developed over the last 20 years with several pharmaceutical companies and research cooperatives to scale-up and improve Preventive Chemotherapy have really been key to protecting literally 100s of millions of persons globally from 7 NTDs.  This really deserves a round of Applause.

Now, with the political consensus developed at the Social Determinants of Health Conference in Rio, we are ready for the next stage.  We hope you all will become stakeholders and partners in that effort too.

But tonight I must also take a moment to mention, and to celebrate some specific successes with you, which our Latin American and Caribbean countries have achieved over the last few years:

• Onchocerciasis transmission has now been interrupted or eliminated in 4 of 6 of the endemic countries in our Region, and Colombia is about to be the first country globally to embark on the process of receiving WHO's Certification of Elimination hopefully during the course of 2012.  It will be followed by Ecuador, and then Mexico and Guatemala.

• Schistosomiasis and the soil-transmitted helminthiases (STH) are being carefully mapped by the Minister of Health throughout Brazil now, in anticipation of drastically reducing their burden in that huge country- and hopefully eliminating schisto transmission altogether in some states like Goiais and Rio Grande do Sul.

o Schisto is to be targeted for elimination in several of the low-transmission countries like Suriname and St. Lucia and perhaps Venezuela.

• Lymphatic filariasis (LF) elimination is well on its way in our Region.  Trinidad and Tobago, Suriname and Costa Rica are now removed from the list of LF-endemic countries.  Our proud and strong Haitian friends have treated 4 million of their citizens last year, and by early 2012 it's expected the entire population of 12 M will be treated.

• Blinding Trachoma is nearly eliminated in Mexico, soon to be followed by Guatemala, while the new focus in Colombia will begin treatment in 2012.

• The elimination of the key domestic vectors of Chagas disease continues in several countries, allowing them to be certified free of transmission from these vectors, and nearly all blood banks in the Region now screen for Chagas.

All this has been helped by the political will of the Ministers of Health of our Region, as expressed in their 2009 Resolution to eliminate 10 NTDs and drastically reduce the burden of schisto and STH by the end of 2015.  This Resolution, CD49/R19, the first to tackle a large number of NTDs and other neglected infectious diseases of poverty, is ambitious but do-able with your help.  Please join in! 

Thank you.

Para más información, contactar Katia Diaz, Oficina de la Dirección, Organización Panamericana de la Salud (OPS/OMS)

Communicable Diseases and Environmental Determinants of Health