A Call for Action

On October 2nd, 2009 in Los Angeles, DNDi, MSF and the University of California Los Angeles (UCLA) Program in Global Health convened a one-day symposium on Chagas disease, bringing together clinical researchers, drug developers, health professionals, policymakers, donors, and activists. Conference participants agreed that there is an urgent need for specific actions to scale up diagnosis and treatment of the disease and
to increase research and development for new and better medical tools.

Chagas disease remains the leading parasitic killer in the Americas. Considering the unmet needs of millions, it is time for a variety of actors to mobilise to push forward urgent measures and concrete solutions. This could include, for example, implementation of the recently adopted resolution for elimination of neglected diseases, including Chagas, by the Pan American Health Organization (PAHO) Directing Council; adopting a resolution on Chagas disease at the World Health Assembly (WHA) in 2010; and including funding for Chagas programmes in the U.S. government’s Global Health Initiative.
Participants of the Los Angeles symposium called on governments, intergovernmental agencies, researchers, drug and diagnostic developers, nongovernmental organisations, patient groups, and funders to take action in two key areas:

Scale up diagnosis, treatment, and patient access to care
Millions of people infected with Chagas are not tested and do not receive treatment in both endemic and non-endemic countries. Urgent actions and measures to increase the medical response to Chagas must be taken to:

• Implement routine testing, diagnosis, and treatment of Chagas in health care systems, treating all children and offering treatment to adults.
• Obtain regulatory approval of benznidazole and nifurtimox, as well as the future new paediatric formulation of benznidazole, in both endemic countries and non-endemic countries. This will require coordination and harmonisation of regional regulatory efforts and the inclusion of neglected tropical diseases, specifically Chagas, in the WHO/PAHO prequalification process.
• Secure availability of benznidazole and nifurtimox as well as diagnostic tests by:
  • reinforcing diagnostics and drug procurement systems, forecasting needs, and supply chains
  • implementing the Strategic Fund (revolving fund) to secure long-term affordability of existing drugs in endemic countries rather than relying on a system based on donations
  • exploring approaches, like differential pricing systems, for non-endemic countries
  • ensuring access and affordability of future new formulations, including paediatric benznidazole.


• Formalise and promote international clinical guidelines for the use of the existing drugs for all stages of the disease.
• Ensure monitoring and evaluation systems for better epidemiologic data collection to determine the prevalence of Chagas disease.
• Support research into appropriate models for the delivery of prevention, diagnosis, and treatment of Chagas within health systems in endemic settings.
• Increase political commitments, funding, and human resources for Chagas patient care programmes.

Boost research and development for new tools
Existing tools available to health staff and national programmes are lacking or inadequate, while research and development (R&D) for Chagas is virtually non-existent. A recent study showed that less than 0.5% (US$ 10M) of all worldwide neglected disease R&D funds was devoted to Chagas disease in 2007, and over half was spent on basic research. There is an urgent need to develop new treatments and diagnostics that are safer, more effective, affordable, and adapted to patient needs. Actions and measures to boost and sustain innovation must be taken to:

• Foster innovation for new tools for Chagas disease that include:
  • continued development of new treatment regimens or combinations that shorten treatment duration
  • developing new diagnostic tools, including a definitive test for cure and a better rapid diagnostic test
  • facilitating access to knowledge for new classes of compounds and existing drugs marketed for other indications.


• Increase capacity for clinical research to evaluate and guide the development of new tools and facilitate their use.
• Support new approaches for the regulation and approval of new treatment tools, including fast-track mechanisms and use of existing biomarkers, to speed up access to new discoveries.
• Increase public and private funding for Chagas-related R&D including:
  • Push mechanisms that include investments for all stages of R&D for new diagnostics and drugs in both the public and private sectors, including in endemic countries
  • Pull mechanisms like securing the market through the Strategic Fund (revolving fund) for endemic countries and differential pricing for developed countries, and exploring innovative incentives to catalyse R&D (e.g. price funds, FDA priority review vouchers, etc.).
  
  
• Commit political leadership
  • Adopt a WHO resolution on Chagas disease that addresses the need of more R&D
  • Implement PAHO resolution for elimination of neglected diseases and other poverty related infections.