by: Alanna Shaikh
It’s 2010, and I still don’t have a jetpack. My car sticks stubbornly to the ground instead of flying. Food is still food, not high-tech pellets. And we still haven’t eliminated Chagas disease.
On July 4th, 2007, the World Health organization launched an effort to eliminate Chagas disease by 2010. The effort included a new network devoted to fighting Chagas, which would expand successful efforts by the Pan American Health organization (PAHO) to control the disease.
Three years later, Chagas is far from eliminated. It is endemic in 21 countries, and over seven million people are currently infected with the disease. True, we have seven more months left in 2010, but it seems unlikely we’ll treat a million people every month this year and get this thing done.
What I find frustrating is that we failed at something with such a clearly defined scope. This isn’t the Millennium Development Goals here. We’re not trying to dramatically change life on this planet. We were just trying to get rid of one treatable disease that’s endemic only in Mexico and South America.
So what happened?
Chagas doesn’t have great drugs to treat it. The two drugs that work on Chagas – Nifurtimox and Benznidazole – aren’t 100% effective. They work best in early stages of the disease – they can cure up to 80% of people of you catch the disease early. If you wait until the Chagas is chronic, the cure rate goes down to 10-20%. That means you spend a lot of time, effort, and money on treatments that don’t work. In addition to wasting health system capacity, it’s not exactly an incentive to come in and get treated. The drugs also work better on kids than on adults.
To make matters worse, Nifurtimox and Benznidazole have unpleasant side effects. They include some digestive stuff from Nifurtimox: stomach pain, anorexia, nausea, and vomiting and some terrifying blood and skin side effects from the Benznidazole: swelling, hypersensitive skin, and anemia. Again, really not an incentive to keep taking your drugs.
Aside from drugs, you can take a surgical approach to Chagas. Needless to say, surgery for the disease is difficult, painful, risky, and expensive. It’s not a feasible approach to seven million people, many of which are children.
If we’re going to eliminate Chagas, we need to develop better drugs. That didn’t happen in time for 2010 eradication, but the situation is not hopeless. The Drugs for Neglected Diseases initiative is working on Chagas. They plan to develop an easier to manage children’s version of benznidazole, investigate combination therapies for Chagas treatment, and develop at least one new drug for Chagas by 2014.
Also we’ll be able to deliver the drug house-to-house via visiting nurses wearing jetpacks.
Seriously, though – how do we make sure that the 2014 goals actually come true? We pay attention. We hold policymakers to their promises, track the progress of the Drugs for Neglected Diseases initiative, and notice if years pass by and the number of people with Chagas is still almost eight million.
Alanna Shaikh is an expert in health consulting, writing about global health for UN Dispatch and about international relief and development at Blood & Milk. She also serves as a frequently contributing blogger to ‘End the Neglect.”
