Viewpoint by
Carolina Batista, Regional Medical Director, DNDi Latin America
Just before the end of 2015, the notorious announcement of the acquisition of benznidazole rights in the USA with the intention to apply for the FDA’s Priority Review Voucher (PRV) has generated innumerous debates and certainly has driven worldwide attention to Chagas. This state of affairs, despite all the buzz around KaloBios’s former CEO, has exposed the dramatic treatment access situation regarding the leading parasitic killer of the Americas. Currently, 99% of the estimated patients endure the lack of diagnostic and medical attention according to PAHO recommendations.
The truth is that despite some advances in the Chagas landscape in the last years, no significant changes in access occurred and major gaps remain between the estimates of the number of people living with Chagas disease and those actually diagnosed and treated.
According to the latest WHO report, approximately 5.7 million people are infected by Chagas disease in Latin America, approximately 30% of which will develop a chronic heart condition that is estimated to cause more than 7,000 deaths annually. Chagas disease causes the highest disease burden of any parasitic disease in the Western hemisphere. Despite the reduction of new cases due to successful vector control and blood safety measures in Latin America, strong emphasis needs to be placed on scaling up diagnosis and treatment.
In an attempt to contribute to changing this paradigm and address current challenges, DNDi has been working with local partners to identify the most appropriate context-specific access strategies and delivery models to scale up access to diagnosis and treatment in Chagas disease.
The process started with the consolidation of available baseline information, revision of country morbidity and mortality data, epidemiological profile, and overall assessment of current policies and basic regulatory aspects of Chagas disease. The first selected countries or regions were Colombia, Mexico, Brazil, the Gran Chaco, and the USA. Aligned with the Global Chagas Coalition, Ministries of Health, academia, international organizations, and other key stakeholders, the objective is to implement country-specific collaborative pilot projects, applying available tools and assessing the feasibility of implementing diagnosis and treatment for infected individuals in selected health centres, and of course to measure the impact. Furthermore, local communities are being engaged and specific health education activities are conducted to mobilize sustainable social support.
The first initiative was launched in Colombia, where DNDi and the Ministry of Health organized a joint seminar in April 2015 to discuss the elimination of barriers to diagnose and treat Chagas disease patients in Colombia. One of the most important outcomes of this meeting was the future collaboration among DNDi, the National Programme and the Colombian Network ‘Red Chagas’ to create the pilot project to enable the implementation of the Chagas Road Map in priority high endemic municipalities.
Throughout the year of 2015, DNDi has worked to provide technical and operational support to the Colombian National Programme to structure the roadmap for those pilot projects. Four endemic areas have been prioritized to yield the operational activities, validated diagnostic protocol, cost-effectiveness studies, and registration of benznidazole, as well as to establish indicators for Chagas disease: Boyacá, Casanare, Arauca, and Santander.
In 2016, the aim is to conduct this Deployment Project also in the USA and Mexico. In each locality, synergies are fostered in such a way as to capitalize on local efforts and expertise to set up a model that works optimally in each environment and is designed to be replicated. Ultimately, the success of this project depends on multi-sectorial collaboration to ensure that far from the headlines of international financial dailies, the needs of patients are being addressed with what is available now, while R&D investment and efforts are being exerted to provide new tools to patients as soon as they become available.
Carolina Batista, Regional Medical Director, DNDi Latin America
