Your Health! A Good Moment in the Fight Against Chagas

Photo: Ana Ferreira

Good tidings are in the air! The first piece of good news in the fight against Chagas disease is that we now all have the same target in our sights: the third target of Sustainable Development Goal (SDG) 3 approved by the UN, which calls for an end to Chagas disease as a public health problem by 2030.

All have the same target in our sights: the third target of Sustainable Development Goal (SDG) 3 approved by the UN, which calls for an end to Chagas disease as a public health problem by 2030

I must apologise for using the language of war, but it is hard to escape the symbolic power of figurative images like arms and targets when talking about a fight. Today, all of us—all the members of the community fighting to end Chagas disease—have forged a strong alliance with clear priorities. And today, unlike previous years, we are all in agreement on what we are shooting for.

This consensus was very evident in several key moments during the past year. The first was the meeting organised by the Pan American Health Organization in Washington on May 3 and 4, which brought together the most important partners in the fight against Chagas. The consensus report on that meeting recognised that, while the primary route of transmission of Chagas disease is still infection with the Trypanosoma cruzi parasite through an insect bite in rural areas, that “the migration of rural populations to cities in recent years, even outside Latin America, has ‘urbanized’ congenital and transfusion transmission”, modifying the epidemiology of the disease. In addition, there are still outbreaks of oral transmission that have not yet been adequately characterized, such as those that occurred in the Amazon basin.

Foto: Ana Ferreira

In many countries where transmission by vector and blood transfusion has been controlled successfully, the congenital route (from mother to child) may still be the main route of transmission. Control of mother-to-child transmission has, therefore, been prioritized in both endemic and non-endemic areas; currently, this is the most widely accepted global strategy because it offers the greatest guarantees of success. Now we are all shooting for that target. The same goal was emphasised at the last WHO meeting held in Geneva on 19 and 20 November.

In many countries where transmission by vector and blood transfusion has been controlled successfully, the congenital route (from mother to child) may still be the main route of transmission

We know that our weapons are not state-of-the-art. And we do not have as much ammunition as we would like. Diagnostic tests still need to be improved to make them faster, more accessible, and more accurate. Almost 50 years after their discovery, we are still treating the infection with the same drugs: benznidazole and nifurtimox. That is almost equivalent to going into a battle today armed with weapons from World War II. However, current research, in which various members of the Global Chagas Disease Coalition are involved—including ISGlobal, DNDi, and Mundo Sano, among others—has given us hope that these arms will soon be improved through new regimens that will simplify treatment and more reliable tests of cure. And in the longer term, given the work on vaccine development being done at Baylor College of Medicine, we can dream about the final victory day.

But we cannot win this hard battle without fighting shoulder to shoulder with our most important allies: the people affected by the disease. And in early October last year, the associations of people affected by Chagas disease managed to meet in Mexico, despite extremely limited resources, to renew their commitment and raise their voices—reminding us that this disease cannot be overcome without their active participation.

The associations of people affected by Chagas disease managed to meet in Mexico, despite extremely limited resources, to renew their commitment and raise their voices—reminding us that this disease cannot be overcome without their active participation

The approval of benznidazole in the United States at the end of 2017, opened the door to the possibility of obtaining additional funding for a campaign to improve access to treatment, which will soon be launched by the Mundo Sano Foundation and DNDi with the support of the Global Chagas Disease Coalition, among others. A meeting sponsored by Mundo Sano and the Chagas Coalition was held at Harvard University in October 2018 to discuss the new agenda for the fight in the United States. “Rethinking Chagas” (as the event was entitled) led to the formation of a new partnership of all the organisations working on the disease in the United States and the proposal of a pilot plan aimed at controlling mother-to-child transmission as a first step towards reaching the rest of the affected community.

Foto: Ana Ferreira

And finally, the annual meeting organised in Santa Cruz de la Sierra, Bolivia by the DNDi Chagas Platform and the Global Chagas Coalition, with the support of AECID through ISGlobal, published a document called the Santa Cruz Letter setting out four basic requirements to pave the way for the defeat of Chagas disease. One was a call for April 14 to be named International Chagas Day to raise the visibility of a disease that can never again be forgotten and neglected.

Today, more than ever, we are all shooting for the same goals. New resources and new tools coming down the pipeline hold the promise of speeding up access to diagnosis and treatment for everyone who needs it. So, is this not the perfect moment to raise a glass to the defeat of Chagas disease as we can just discern victory on the horizon and moving closer? Here's to your health, my friends.