The Bogotá Manifesto: Will You Join Us in the Fight to Eliminate Chagas Disease as a Public Health Problem?

The Bogotá Manifesto to eliminate Chagas disease brings together six commitments to end a global health problem that affects seven million people.

[This article was written by Javier Sancho (coordinator of the Chagas Coalition) and Diogo Galvao (DNDi).]

Six commitments. Six objectives. Six lines of action. Six measures for assessing our progress. Six possibilities of eliminating Chagas disease as a public health problem by 2030. You, and your organisation, agency or institution, can choose one, two, or three commitments depending on your profile (research, implementation or policy). Or you can sign up to all six. The important thing is to make progress towards the provision of comprehensive care for people with Chagas disease. We have the necessary tools, evidence and convictions. We have plans for better ways to respond to the problem. And we have commitments.

Our commitments are formulated in the Bogotá Manifesto, a document presented by the Chagas Coalition and the Chagas Platform to their partners and allies at a meeting held in Bogotá in September 2022 itemising the priorities and objectives that each organisation or country commits to supporting and furthering. It represents an update on the commitments made in the Santa Cruz Letter in 2018.

Sinforiano Ovelar, an entomologist from the National Malaria Eradication Service (SENEPA), explains which vector transmits Chagas disease during a participatory workshop in the community of Campo Aroma, in the Paraguayan Chaco. Photo: Aleix Cabrera / ISGlobal.

Responding to Chagas by Strengthening Primary Health Care

The first step was to review the progress made to date towards eliminating this neglected disease and to identify the challenges still facing us, especially in light of the impact of the COVID-19 pandemic. Taking into account the results of this review, the Bogotá Manifesto was drawn up to stimulate the relaunch of the proposed actions for tackling Chagas disease with a particular focus on primary health care, the front line where the disease is diagnosed and treated. This was the message chosen by the World Health Organisation (WHO) as the main theme for World Chagas Day, 14 April 2023: to tackle Chagas disease by strengthening the response at the primary care level.

Seven Million People are Waiting for Us to Act

If our efforts are not focused on the primary care level, we know by experience that any intervention will come too late. The evidence shows that 30% of people infected with the parasite who are not diagnosed and treated in time will develop chronic Chagas disease, mainly in the form of cardiac and digestive problems. We also know that these problems can be prevented or resolved if the infection is diagnosed in time and the patient receives prompt treatment. Consequently, about seven million people are waiting for us to act.

What Use is a Manifesto?

A manifesto is useless if it represents nothing more than empty words and a play to the gallery. Nor is this manifesto intended to replace the existing roadmaps that specify the indicators for eliminating Chagas disease as a public health problem by 2030. Rather, its purpose is to outline a path for us to follow and define six areas in which we can make contributions by committing our efforts and resources to the task. We need you and your institution to help. And we are calling on each one of you to join us in making this very attainable dream come true.

Sinforiano Ovelar (SENEPA) and Leonardo de la Torre (ISGlobal) listen to members of the Campo Aroma community during one of the participatory workshops to improve healthcare in the Paraguayan Chaco region. Photo: Aleix Cabrera / ISGlobal.

The Six Commitments of the Bogotá Manifesto

The Bogotá Manifesto calls on governments and organisations involved in the fight against Chagas disease to commit to redoubling their efforts in six priority areas as summarised below:

1. Improving access to comprehensive care by further decentralising health care services and bringing them closer to the homes of those affected. This can be achieved, for example, by adopting simplified diagnostic algorithms for use in primary healthcare and prioritising the systematic implementation of screening in women of reproductive age, pregnant women and infants. The objective is twofold, not only to end congenital transmission but also to detect and treat all the cases in affected communities.
2. Encourage investment in research and the development of new diagnostic and therapeutic tools and to facilitate access to all available tools.
3. Expand and improve the systems of mandatory notification of cases of Chagas and the associated clinical complications. Data is the key to improving the management of the disease on the basis of a better understanding of its mechanisms.
4. Strengthen and facilitate access to training and information resources for both healthcare personnel and affected people.
5. Promote coordination between the various actors involved in providing comprehensive care and guarantee the participation of affected people and their associations in the design and implementation of strategies adapted to the epidemiological, sociological and cultural contexts of their communities.
6. Continue to support activities related to World Chagas Day as an opportunity to highlight global efforts and further efforts to eliminate this parasitic disease as a public health problem.

At the Chagas Coalition, we assess our own work by evaluating it in light of each one of these six commitments. We invite all of the organisations and governments involved in this fight to join us in making this commitment to support existing national, regional and global elimination objectives.

The Bogotá Manifesto is available on the Chagas Coalition website, where you can read it, join the initiative or obtain a copy for distribution.