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Final remarks

It was not our purpose to make a deep discussion of the social aspects involving HCD, but to summarize, in few words, how much they are present in the production, in the impact, and in the management and control of this so important and so neglected disease. It can be expected for the endemic countries that over the next 20 years, if the control actions and strategies are sustained, transmission will be controlled in most parts of the region.

Other consequences concerning the reduction of morbidity and mortality will also depend on the improvement of the public health system. Undoubtedly, we need more research to face new epidemiological and clinical situations, as well as to improve specific treatment and cure assessment. On the control side, the key words will be sustainable epidemiological surveillance, effectiveness of actions in perido- mestic ecotopes, and, particularly, a better approach to congenital disease preven- tion.16,23,26 All these questions involve naturally the regional capacity of research, since HCD does not have an exciting market and does not affect the so-called First World.1,23 Finally, considering the next future of HCD in the Americas, some risks and challenges must be pointed out in this small discussion:

a. The disease will be definitely controlled in endemic areas according to political sustainability, which means2:

  • • Economic development
  • • Social development
  • • Environmental protection
  • • Cultural diversity.

b. As a price of the reached success and of the decreasing of disease visibility, as well as of the political and administrative inconsistency in endemic regions, some risks must be appointed182327:

  • • The loss of regular structure of the programs and of the surveillance
  • • The progressive loosing of human resource
  • • The loss of epidemiological information
  • • The absence or weakness of the educative component
  • • Several difficulties for the counter reference of cases
  • • The absence of a “basic basket” for “chagasic” people
  • • The difficulty to maintain regular programs in the present decentralized health systems
  • • The loss of research priority
  • • The loss of consistency in the university curricula.

c. Some very concrete constraints can be detected both at control and clinical programs at the present moment, such as16:

  • • The punishment of success
  • External enemies: They do not provide more support; they withdraw resources
  • Internal enemies: The programs are not changed to the new phase and they do not adapt to the risks of success; the same continues to be done
  • • Risks are based on believing that success is permanent and that it’s unnecessary to adapt.

Finally, we have evidence that all these constraints and risks can be overcome by means of the technical and political association of the more authentic protagonists. On the side of the war against HCD, the primary round did not emerge from the politicians, the health authorities, or the “chagasic” people. Since Carlos Chagas, the main efforts for HCD recognition and control resulted from the Latin American scientific community, also incorporating valorous partners from Europe and the United States. In the last two decades, such efforts have been directed by other very important partners and strategies, with a special distinction for the so-called Intergovernmental Initiatives for Chagas Disease Control. Such a framework represents a new logic for a sustainable and more effective control approach.16 The association among endemic countries can be considered the most visible political advance since Carlos Chagas stated, in 1911, that HCD might be considered a problem for the State.28 In particular, the role of WHO, PAHO, and some NGO associations like MSF has been more and more fundamental for the sustainability of the fight against HCD.1,22,27 It will be a real human and social tragedy if these organizations withdraw Chagas disease from their agenda over the next 20 years. In conclusion, we must admit that the overcoming of Chagas disease clearly involves not only a technical logistic and a political affaire, but also several aspects of social ethics.1-3,23

 
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