Global health topics are typically presented in the context of extreme poverty in sub-Saharan Africa or Asia. However, today approximately 100 million people in the Western Hemisphere also live on less than $2 per day. About 10 percent of these "bottom 100 million" currently live with a serious and life-threatening neglected disease known as Chagas disease or American trypanosomiasis.
Humans acquire Chagas disease microscopic parasites -- trypanosomes -- through contact with kissing bugs that thrive in poor quality and substandard housing. Trypanosomes selectively attack the heart so that up to one-third of people who acquire them progress and develop a form of heart disease known as a cardiomyopathy associated with heart aneurysms, arrhythmias, and even sudden death.
In poorest countries of Latin America, such as Bolivia, Honduras, and Nicaragua, Chagas disease is the leading cause of heart disease. But it is also very common yet mostly hidden within pockets of extreme poverty in wealthier nations such as Argentina, Brazil, Colombia, Mexico, and even the United States, as well as among Latin American immigrants to Europe, Asia, and Australia.
Chagas disease has further emerged as a major health threat during pregnancy, with an estimated 40,000 pregnant women in North America alone affected. Ultimately 1-20 infected pregnant women will transmit their infection to their infants resulting in a severe and life-threatening congenital infection. Moreover, the health care and other economic costs from Chagas disease exceed $7 billion annually.
There are two medicines currently available to treat Chagas disease -- each was developed decades ago. While they can have serious toxicities and are not 100 percent effective, in many instances these first generation medicines can successfully cure patients and prevent the onset of serious heart disease especially if the infection is caught early. But sadly most people are never tested to see if they have the infection, while less than 1 percent of those infected with Chagas disease ever receive either drug. Thus, Chagas disease is an overwhelmingly hidden public health threat, affecting mostly people who are forgotten because of their extreme poverty.
In response to this public health crisis, a Global Chagas Disease Coalition of organizations has been established, which includes the Drugs for Neglected Diseases initiative (DNDi), Sabin Vaccine Institute and Texas Children's Hospital Center for Vaccine Development and National School of Tropical Medicine at Baylor College of Medicine, Mundo Sano Foundation (Argentina), CEADES (Bolivia), and ISGlobal (Spain). The Coalition receives support and encouragement from the Carlos Slim Health Institute in Mexico, Médecins Sans Frontières/Doctors Without Borders (MSF), the Pan American Health Organization (PAHO), and the International Federation of People Affected by Chagas Disease (FINDECHAGAS).
Our coalition is calling for urgent measures to increase access for patients to diagnostic testing and essential medicines to treat Chagas disease, support for research and development for new and improved drugs, diagnostics, vaccines and other health technologies, and expanded efforts for transmission control.
The Global Chagas Disease Coalition further seeks to raise the profile of Chagas disease and to mobilize the necessary political, financial, and technical resources. Currently Chagas disease is not prioritized by any of the world's major development banks or overseas development assistance agencies, despite the fact that in Latin America it is five times more common than HIV/AIDS and kills more people than malaria. Moreover, Chagas disease does not really benefit from the involvement of high profile celebrity champions who can help to give a face to the poor and destitute who suffer every day. Chagas disease is also the most common neglected disease among the poor living in Catholic-majority countries, but there is still no substantive engagement from the Vatican or other leadership of the Catholic Church.
It would be amazing and life-saving to turn this situation around in 2014. Chagas disease is silently devastating millions of people throughout the Americas -- we need to give a voice to those most in need.
Peter Hotez, M.D., Ph.D., is president of the Sabin Vaccine Institute and the founding dean of the National School of Tropical Medicine at Baylor College of Medicine, where he is also Professor of Pediatrics and Texas Children's Hospital Endowed Chair of Tropical Pediatrics. Prof. Hotez is also the Fellow on Disease and Poverty at the James A. Baker Institute for Public Policy at Rice University. He is the author of Forgotten People, Forgotten Diseases (ASM Press).
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