MSF calls for step up in action against Chagas disease

25 May 2009

Paul Chinnock

Source: Médecins Sans Frontières (see original article)

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Carlos Chagas first described Chagas disease in 1909.

2009 is the one hundredth anniversary of the discovery of Chagas disease, which bears the name of the man who first described it, the Brazilian doctor and scientist Carlos Chagas. Critics say that an opportunity has been missed to improve the diagnosis and treatment of a condition that kills 15,000 people each year.

Caused by the parasite Trypanosoma cruzi, Chagas disease is often relatively mild in its acute form (symptoms may include fever, diarrhoea and vomiting and headaches) but years or even decades after initial infection, an estimated 30% of infected people will develop heart and gastrointestinal tract disease, leading to disability and death. Chagas disease has become an increasing problem in Latin America since the 1960s and cases are seen in travellers to North America, Europe and Japan. This year in Brazil – and elsewhere in Latin America – events have been held to mark the life and work of Carlos Chagas. It was also expected that the 2009 World Health Assembly (WHA), which has just taken place in Geneva, would see agreement reached on an international programme to step up action against Chagas disease but this year’s WHA was cut short, allowing health ministers to return home to focus on H1N1 “swine” flu preparedness; much of the debate at the meeting also concerned swine flu. Discussions on Chagas have been postponed.

Amongst those who have protested the alleged sidelining of Chagas by the WHA, is the leading medical and humanitarian agency Médecins Sans Frontières (MSF). “At the 100th anniversary of Chagas’ discovery we had expected that the WHA would adopt a resolution where all affected countries agree to integrate care of acute and chronic Chagas patients into their primary healthcare systems and to invest more in research,” said Roger Teck, Director of Operations of MSF Spain. “People affected by this neglected disease are once again neglected. However, even though Chagas is now off the WHA agenda, this should not be used as an excuse for inaction. Governments of endemic countries should step up through developing and implementing better national and international protocols to fight against Chagas.”

Chagas programmes have traditionally focused on preventing the disease by controlling triatomine “kissing” bugs, the blood-sucking insects that transmit the disease. But MSF says its experience in Honduras, Nicaragua, Guatemala and Bolivia since 1999 has shown that prevention is far from enough.

“The focus on prevention ignores the needs of those who are already infected and are suffering in silence. In endemic countries, governments should do active screening, diagnose and treat many more patients,” said Gemma Ortiz, MSF’s senior advocacy officer for Chagas. “Access to diagnostics and treatment must be made a priority.”

Dr Ortiz continued: “This is the irony: it’s been 100 years since the parasite causing Chagas disease was discovered. Yet we’re still stuck with two drugs from the 1960s for treatment and no tests to see if it’s cured. It's hard putting 15,000 who die a year on hold, or that 14 million suffering from this disease are ignored and silenced because other preparations are going on”.

MSF has also urged WHO member states to review a range of alternative financing mechanisms such as prize funds to stimulate research and development for better tools to diagnose and treat Chagas patients in all stages of the disease. The organisation says that the lack of commercial incentives to invest in research and development has been responsible for the neglect of Chagas.

There have also been criticisms of the relative lack of attention given to many other diseases by the 2009 WHA, because of swine flu – see reports from the Chicago Tribune and Reuters. However, a WHO spokesperson has pointed out that: “H1N1 influenza is not taking up the major portion of discussions and just because a topic is not discussed here does not mean WHO programmes are going to stop. They will continue exactly as before”.http://blog.tropika.net/tropika/2009/04/14/chagas-centenary/

For more on Carlos Chagas and the centenary of his discovery of Chagas disease see the following TropIKA.net blogs – 1 , 2 .