All posts by Dr. Mirta Roses Periago

Adiós! Goodbye, oncho! Mexico joins two other countries in ending onchocerciasis in LAC

Mission to verify the elimination of onchocerciasis in Ecuador. PAHO/WHO, 2014

Mission to verify the elimination of onchocerciasis in Ecuador. PAHO/WHO, 2014

I cant wait to spread the news. The Latin American and the Caribbean (LAC) region is one step closer to seeing the end of onchocerciasis (also referred to as river blindness): Mexico has become the third country in the world to officially wipe out this disease!

The drive for progress is much of what motivated me during my time as the Director of the Pan American Health Organization, the WHO Regional Office for the Americas. I am excited to continue celebrating these milestones as Neglected Tropical Disease (NTD) Special Envoy, and a life-long advocate for public health.

Earlier this year, I wrote about 7 achievable victories in the fight against NTDs that I hope to see accomplished in 2015. Many of these wishes are coming true.

This week, I am filled with the joyful sense of pride in the accomplishment of Mexico and its partners as I check off Mexico’s certification of onchocerciasis elimination from my wish list. Mexico’s success builds off of Colombia and Ecuador’s certification in 2013 and 2014, respectively, and gives me even more confidence that we will soon see news of a LAC region completely free of onchocerciasis.

Onchocerciasis is a devastatingly debilitating parasitic disease that causes itchiness, rashes, and eye problems, eventually leading to permanent blindness. The parasite is transmitted to humans by the bite of a black fly, which breeds in fast moving rivers, increasing the risk of blindness in nearby communities. What’s more, the disease causes a terrible ripple effect by pulling kids out of school to care for their blind elders, reducing economic productivity, and causing families to move out of fertile river valleys, decreasing agricultural outputs in already impoverished areas.

This momentous occasion moves the LAC region one step closer to eliminating the disease entirely—Guatemala has already submitted a request to WHO to verify elimination, and I hope to soon see more results from the enormous, highly coordinated, south-south cooperative effort between Brazil and Venezuela to stop transmission in the Yanomami communities along their borders.

We should all celebrate working to control this problem for decades and moved toward accomplishing elimination with new tools and new partners for the last fifteen years. 

Eliminating this disease requires unwavering determination. The first step in the elimination process is at least two years of mass drug administration, in which entire communities who are at risk of onchocerciasis are administered Mectizan (ivermectin) every six months. Merck has made an unprecedented pledge to donate Mectizan to everyone in need, for as long as needed. President Jimmy Carter and the Carter´s Center program (OEPA Onchocerciasis Elimination Program for the Americas) have been instrumental, joining PAHO/WHO as well as the communities and health workers in a successful dream team. You can see President Carter’s video message here, congratulating partners for their hard-earned accomplishments.

Once large-scale programs are complete, treatments are delivered to individuals on an as-needed basis. Communities are monitored for an additional twelve years to make sure that transmission of this disease has been interrupted. Finally, after treatment and monitoring, countries stop the treatment intervention and watch for three years to ensure that there is no resurgence in transmission, and then apply for WHO certification that elimination has been achieved.

I was thrilled to be able to celebrate the long-term dedication and resulting accomplishment of all partners contributing to this milestone at an event at PAHO Headquarters last week. Health Ministers from the countries that have eliminated or will soon eliminate river blindness, technical advisors, and global policy leaders were specially recognized for the recent successes and spur motivation to run the race through the last mile all around the world. I was particularly moved when Dr. Etienne, Director of PAHO/WHO, invited me to share the frontline when she received the award. The outstanding accomplishment of the countries in the Americas comes at an excellent time, now that NTDs are officially identified in the recently adopted Sustainable Development Goals. The LAC region has hit the ground running.

Dr. Mirta Roses Periago is the Director Emeritus of PAHO/WHO and a Special Envoy for the Global Network for Neglected Tropical Diseases

A New WHO Report Brings Fresh Data and Ideas on Ending NTDs

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More than 100 million people are affected by one or more neglected tropical diseases (NTDs) in the Latin America and Caribbean (LAC) region. As a former Director of the Pan American Health Organization, I’ve seen the suffering caused by these diseases first-hand. At the same time, I have also learnt what can be achieved when endemic countries and international partners put NTDs – and the people affected by them – front and center in their policies.

The World Health Organization’s Third Report on NTDs, released last month, rightly puts a strong emphasis on equity and shared prosperity – themes that are at the very core of tackling NTDs.

The report, “Investing to Overcome the Global Impact of Neglected Tropical Diseases,” charts a new course by outlining the investments needed to reach the WHO Roadmap goals– a critical guide for the global effort to control and eliminate NTDs by 2020. Importantly, it also examines what needs to be done to achieve universal coverage of all people in need by 2030.

The new WHO report calls attention to progress made, including in the LAC region, which is a source of pride and hope for all involved. The region’s milestones can serve as a model for other endemic countries and show the world what’s truly achievable:

  • In 2013, Colombia became the first country in the world to reach WHO-verified elimination of onchocerciasis (river blindness), followed by Ecuador in 2014.
  • Guatemala and Mexico are on track to eliminate transmission of onchocerciasis, leaving just one border area between Brazil and Venezuela with ongoing transmission of the disease.
  • More than half of the regions countries with endemic Chagas disease have eliminated transmission by the diseases principal domestic insect vector, and 20 of 21 endemic countries have implemented universal blood screening for Chagas.
  • Costa Rica, Suriname, and Trinidad and Tobago are no longer endemic for lymphatic filariasis as of 2011. More than 7 million people were treated for this disease in 2013, most of them in Haiti.

Landmark commitments like the 2012 London Declaration on NTDs and the 2013 World Health Assembly NTD resolution have helped sustain political will towards this effort. These commitments have influenced further action in the Americas, where commitments from the Organization of American States and the Council of Ministers of Health of Central America and the Dominican Republic accelerated the fight against NTDs.

Globally, over 800 million NTD treatments were delivered in 2012 alone– an outstanding result achieved through strong partnerships with pharmaceutical companies, endemic countries, affected communities, bilateral and multilateral organizations and implementing partners.

But, we still must finish what we’ve started and accelerate progress towards the 2020 goals. This will help set the stage for success as we look ahead to achieve universal coverage of everyone in need by 2030.

Many of the people affected by NTDs live in middle income countries, and the report calls for more domestic resources to be mobilized and more equitably distributed, including among the poorest and most marginalized people. Similarly, there is significant scope for development banks and donors, as well as emerging players like the BRICS, to finance NTD efforts by employing innovative models and leveraging public-private partnerships. Cross-sectoral collaboration with the WASH (water, sanitation and hygiene); nutrition; maternal and child health; and education communities is increasing access to NTD interventions, while also enhancing impact and ensuring sustainability.

The WHO report endorses the fact that controlling and eliminating NTDs paves the way for poverty alleviation and shared prosperity for all. As I’ve said before, targets to control and eliminate NTDs must be included in global efforts to address poverty and inequality, including the post-2015 development agenda and the corresponding Sustainable Development Goals.

I encourage you to read the full WHO report here.

A Wish List for 2015: 7 Achievable Victories in the fight against Neglected Tropical Diseases

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By Dr. Mirta Roses Periago

A new year always brings about new hope and renewed commitments. 2015 is a pivotal year for the international community and also for the call to end neglected tropical diseases (NTDs). So, here goes my “wish list” for 2015, which includes seven achievable yet ambitious victories for the global health and development community.

1. A step closer to declaring Latin America and the Caribbean free of river blindness

In 2013, Colombia became the first country in the world, as declared by the WHO to have eliminated river blindness transmission, and Ecuador followed shortly after in 2014. These countries show what can be achieved with unwavering political will and sustained action.

Mexico and Guatemala have stopped transmission of river blindness and are already in advanced stages with the WHO to take the final steps towards verifying elimination.

So, I am confident that Brazil and Venezuela will be successful in targeting the Americas’ final cases of river blindness, located along their borders among the indigenous Yanomami community. Through south south cooperation, they have joined forces to ensure that the all the Yanomami receive access to the treatments they need – tackling the last stronghold of river blindness in the region.

2. Progress towards eliminating lymphatic filariasis in the Latin America and the Caribbean

About 13.4 million people across the Latin American and Caribbean are at risk of lymphatic filariasis (LF), nearly 80 percent of them in Haiti. Despite challenges in recent years, including a cholera outbreak and earthquake, Haiti has been able to reach the entire population – about 10 million people – through mass drug administration (MDA). I hope to see continued support from the Haitian government and partners to interrupt the transmission of LF.

Additionally, I hope to see Brazil eliminate LF from the last active site in the country, located in the state of Pernambuco. Brazil has already eliminated LF in 8 states; this success is a clear reflection of their longstanding commitment and dedication to disease control and public health

3. The Inclusion of NTDs as part of Canada’s Maternal, Newborn and Child Health (MNCH) policies and programs

Many of Canada’s priority partner countries carry significant burdens of malnutrition and NTDs, including Haiti, as well as Indonesia and Tanzania, posing a serious threat to maternal, newborn and child health. NTDs lead to stunting, wasting and the loss of Vitamin A and iron – hindering child growth and causing adverse pregnancy outcomes.

That is why I traveled to Ottawa last fall and called on Canadian policymakers to make sure that they integrate NTDs into their development strategies. Canada can help save lives and make a real difference for women and children by making sure that they have access to NTD treatments. This is a smart policy choice, one that could be financed through the Global Financing Facility for Every Woman, Every Child.

4. Regional Bodies translate promises into concrete action

Canada, Costa Rica and Brazil are among the 35 countries that passed a resolution in the Organization of American States in 2013, pledging to end the suffering of the 100 million people impacted by NTDs in the Americas. Health Ministers from Central America have also recognized the burden of NTDs, most recently at their 2013 regional meeting of the Council of Ministers of Health of Central America and the Dominican Republic (COMISCA).

I hope that the OAS, COMISCA and other regional organizations will leverage these important policy commitments to catalyze greater financial support and partnerships – just as COMISCA did for malaria. In addition to discussing NTDs during their 2013 regional health summit, several countries rallied together to eliminate malaria in the region.

Partners followed suit and the Global Fund invested $10.2 million to support this regional initiative, adding to the national malaria grants already approved.  The results of these commitments are clear: malaria rates have been falling, often times dramatically, across Latin America– and the region is just steps away from eliminating this disease as a public health threat. This is an excellent example of how strong, united regional commitments can accelerate global health efforts – and one that can be applied to the fight against NTDs.

5. BRICS fight NTDs at home and abroad

Last December, the BRICS Health Ministers gathered in Brasilia for the 4thadded NTDs to their collective agenda for the very first time. I am very excited to see the BRICS countries work together to help see the end of NTDs by 2020.

I encourage the BRICS to build on this commitment by continuing to prioritize NTDs within their own countries.  I also hope they will explore ways to fight NTDs across the globe. The New Development Bank could offer a venue for the BRICS to finance NTD control efforts as part of their broader sustainable development projects.

6. G7 leaders make financial commitments to end NTDs by 2020

The G7 is off to an excellent start in 2015. Neglected and poverty-related diseases made it onto the G7 agenda for the upcoming June 2015 Summit. This year is critical for the G7 to take immediate action to close the books on their unfulfilled promise to expand access to NTD treatments.

7. Post-2015 Development Agenda Includes NTDs

I’m looking forward to seeing how the post-2015 development agenda takes shape this year. We absolutely must utilize existing global health solutions – including the NTD treatments generously donated by pharmaceutical companies. I am synthesis report. If NTDs are not clearly identified in the final post-2015 development agenda and the corresponding sustainable development goals, they will once again remain as forgotten and invisible as the people and communities affected by them. Let us make them a health priority so that we can see the end of NTDs by 2020.

How to Ensure we “Leave No One Behind” on the International Day for the Eradication of Poverty

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Today marks the International Day for the Eradication of Poverty. This year’s theme, “Leave no one behind,” is especially important to me as an advocate for the world’s most vulnerable populations. As former director of the Pan American Health Organization (PAHO) and as a Special Envoy for neglected tropical diseases (NTDs), I have called attention to those who are too often left behind: the 1.4 billion people who suffer from NTDs.

NTDs have devastating consequences for the world’s poorest people. They cause anemia and malnutrition, and can lead to blindness, school absenteeism, disfiguration and the loss of livelihoods. Ultimately, NTDs undercut a family’s earning potential, productivity and ability to escape poverty. If we as a global community wish to end poverty, we must control and eliminated NTDs.

In less than a month, the Group of 20 (G20) will gather in Brisbane, Australia to discuss ways to stimulate economic growth among the world’s vulnerable populations. During G20 Summit, world leaders are expected to discuss financial sector reforms, infrastructure and employment opportunities. However, in order to make the largest possible impact on the world’s poor, the G20 should address global health and NTDs.

The G20 should embrace the fight against NTDs and include them among the most cost effective interventions to eradicate poverty and advance its goal to create a “sustainable path for current and future generations.” NTDs undermine the G20’s collective efforts to build human capital, increase employment opportunities, reduce inequality and expand access to agricultural and nutrition initiatives. NTDs can be eliminated by 2020 and the benefits of achieving this feasible goal will be long lasting.

Evidence has shown that debilitating and blinding NTDs such as lymphatic filariasis (LF) and trachoma can significantly affect a person’s income. For example, LF can lead to a total potential productivity loss of $5.3 billion annually.

By addressing NTDs, we can ensure more children remain in school, and more women remain employed and empowered. Women with LF in particular, are vulnerable to stigma, social isolation, lost jobs and diminished wages, further embedding them in poverty. And when children are infected with one or more NTD, their cognitive and learning abilities are reduced making them unable to reach their full potential.

On the International Day for the Eradication of Poverty, I join the Global Network in urging the G20 to recognize NTDs as a key underlying constraint to poverty alleviation and economic growth. In addition, we are urging the G20 to support the inclusion of NTD control and elimination efforts in the final post-2015 development agenda.

In order to ensure that no one is left behind, world leaders must support global efforts to control and eliminate NTDs. Because NTDs already infect the world’s most marginalized populations, we must prioritize their health if we are to end poverty.

For more information on NTDs and the G20, read the Global Network’s report.