Fiocruz signs agreement with Unitaid against Chagas disease

Remembered for the second consecutive year, World Chagas Disease Day was marked in Fiocruz on 14/4, with an event that had not only tributes to those who helped in the research and fight against the disease, but also with the look on the future. In addition to the tributes to the researchers of the institution Zilton Andrade and José Rodrigues Coura, who have died, there was the agreement with Unitaid of CUIDA Chagas virtual signing, a project that aims to eliminate the disease congenital transmission in Latin American countries. The initiative, which includes co-financing from the Brazilian Ministry of Health and support from the Fiocruz Support Foundation (Fiotec), also involves Paraguay, Bolivia and Colombia.

Included in the global health calendar in 2019 and celebrated for the first time last year, the date had as its theme in 2021 the Integral and Universal Action for those affected by Chagas disease. The disease is still endemic in 21 Latin American countries, affecting six to seven million people and leading to 14,000 deaths a year. The social inequalities that facilitate transmission and hinder combat were remembered by several participants. In the video event, broadcast by Fiocruz's YouTube channel, Ambassador Maria Luisa Escorel, Permanent Mission of Brazil to the UN representative, and also the board of Directors of Unitaid vice-president (an organization focused on expanding access to diagnoses and treatments), recalled the country's efforts in creating the date. "To celebrate World Chagas Disease Day is to celebrate the science strength in the vulnerable service. It is also to remember how much health diplomacy can do for well-being," he said.

Mariângela Simão, deputy director-general of the World Health Organization (WHO), reinforced the need to ensure access to quality health services. She pointed out that the disease is curable if diagnosed early and that vertical transmission can also be avoided. "This is not an impossible dream," he said. "Actions by the health system are necessary for this disease in the future to be seen as a past disease."

Health Minister Marcelo Queiroga was represented by Flávio Werneck, advisor to the Ministry of International Affairs, who stressed the importance of the work developed in partnership with Unitaid. "This is the kickoff in the Brazil-Unitaid bilateral relationship. The organization can lend its weight to the treatment of neglected diseases”, he said.

International Consortium

The project CUIDA Chagas - United Communities for Innovation, Development and Care for Chagas Disease, coordinated by the Evandro Chagas National Institute of Infectious Diseases (INI/Fiocruz), will cover childbearing age women, pregnant women, and newborns. "In Brazil, Chagas disease causes more deaths than any other parasitic disease," said the minister's aide. For the project to come to fruition, the Ministry of Health entered with US$ 4 million.

In all, the consortium led by Fiocruz has an investment of US$ 19 million secured by the partnership between the Ministry of Health and Unitaid. The National Institute of Laboratories of Bolivia also participates in the consortium; as well as the National Institute of Health of Colombia; the National Eradication Service on Palutismo, Paraguay; and the Foundation for Innovative New Diagnostics (Find). It also has the technical support of WHO and the Pan American Health Organization (PAHO), in addition to the civil society participation, through the International Federation of Associations of People Affected support of by Chagas Disease (Findechagas). "The initiative will bring benefits to those affected, especially in Latin America, and teachings beyond the continent", said Nísia Trindade Lima, Fiocruz president. "This is a dream that comes from Carlos Chagas," she concluded.

Philippe Dunaton, Unitaid's executive director, said the project represents a change in diagnosis and disease therapy terms, seeking faster treatments with fewer toxic effects. "This combined work with other countries can change the disease for women course, children and entire populations", Dunaton said.

Principal researcher of the initiative and Laboratory of Clinical Research in Chagas Disease of INI/Fiocruz head, Andréa Silvestre celebrated "project launch that appears aligned with the global goal of eliminating the disease as a public health problem by 2030". According to Andréa, early detection and access to treatment with high chances of cure in young people and children may significantly decrease the heart diseases, hospitalizations and deaths related to the disease numbers.

The project will be implemented in 34 municipalities, ten in Bolivia, six in Brazil, 13 in Colombia and five in Paraguay, selected according to public health priorities. Primary care will be the intervention central focus, integrated with pre-existing initiatives involving reproductive, maternal, neonatal and child health. "It is estimated that in each country there are about 60,000 childbearing age women in the selected territories with the possibility of being evaluated over the four and a half years of the project, thus reaching 240,000 women attended," said the researcher.

Patients voice

Gabriel Parra-Henao, Deputy Director of Public Health Innovation at the INS of Colombia; Hernán Rodriguez Enciso, Director General of Senepa, Paraguay; and Maria Renee Castro Cusicanqui, Deputy Minister of Health Promotion, Epidemiological Surveillance and Traditional Medicine of Bolivia, representing Inlasa, were unanimous in highlighting how ambitious the project is and that the change it can bring in diagnosis and therapy terms are fundamental in the fight for this neglected disease elimination. Marta Fernandez-Suarez, director of Research and Development at FIND, said the initiative has been expanding investments in tropical diseases clinical diagnoses and that participating in the project is a unique opportunity to collaborate in eliminating the disease vertical transmission.

Bringing the patients' voice, the Findechagas representative, Joanda Gomes, gave an emotional report of her life when she recalled that she began working at the age of nine in sugarcane farming and that at 12 she discovered that she had the disease. "From a very young age I learned to take care of myself, take medications, use pacemakers. I had the opportunity to have two daughters and I thank this project for the results it will bring so that future mothers and children can treat themselves and avoid the disease", she said.

Unitaid representative Maurício Cysne recalled that CUIDA Chagas is innovative because it is the first project that the organization finances in the field of neglected tropical diseases, leaving the investment axis in AIDS, tuberculosis and malaria. "These neglected diseases are on the international political agenda and are extremely important to WHO. Investments are needed to combat them, and that is what we are doing in this partnership with Fiocruz", he said. According to Maurício, the project goes beyond the 240,000 women in the study: the goal is then to bring the results to other countries.

For Fiocruz's Vice President of Health Production and Innovation, Marco Krieger, this important advance represents the best in the science for public health use. "Studying Chagas disease is a tradition we have in Latin America. There are several contributions over the decades such as the fight against the vector insect that eliminated, in many countries, the disease active transmission, and was the interaction between scientific knowledge and health systems result", he recalled.

20 years of Fio-Chagas

CUIDA Chagas is added to other Foundation projects related to the disease, as well as benefiting from studies conducted by them. One of these programs is Fio-Chagas, whose progress was presented by the Vice President of Research and Biological Collections, Rodrigo Correa, and by the researcher André Luiz Roque, its coordinator. Fio-Chagas: 20 years of achievements and current challenges showed the program evolution, which brings together all researchers working in areas related to the disease and which has national and international partners. A story that began in 2000, in the search for an integration between the works of the Oswaldo Cruz Institute (IOC/Fiocruz) and the René Rachou Institute (Fiocruz Minas) and that was growing, with the realization of 14 meetings, lectures for undergraduate and post students and the portal creation - which today also focuses on people affected by the disease, with the associations and reference centers participation, but without giving up scientific content, represented in online books.

Tributes

The day was also marked by tributes. In addition to a video about their careers, Zilton Andrade, a researcher at Fiocruz Minas, and José Rodrigues Coura, from the Oswaldo Cruz Institute (IOC/Fiocruz), were celebrated by people who worked with them.

Marilda Gonçalves, director of the Gonçalo Moniz Institute (Fiocruz Bahia), recalled the trajectory of Zilton, who was born in Santo Antônio de Jesus, Bahia, in 1924, and founded the School of Pathology of Bahia. The doctor had a special interest in pathologies related to Chagas disease and schistosomiasis. He worked on research on Chagas disease, showing how the parasite promoted changes in cells, tissues and organs. "His publications are fundamental references in the international scientific literature," Marilda noted of the researcher, who was director of the Gonçalo Muniz Institute and died in July 2020 at age 96.

José Paulo Leite, director of IOC/Fiocruz, was honored by Coura, one of the Society of Tropical Medicine founders. Born in 1927 in Taperoá, in the sertão of Paraíba, he arrived young in Rio de Janeiro to study and ended up becoming "one of the most influential researchers on the planet", said Leite. Director of the IOC, he helped to capture talent for the Institute and drew the world's attention to Chagas disease by showing that it was also present in more developed countries.

Virtual Library

The event also included the Virtual Library Collection of Triatomine Control launch, which aims to concentrate documents, articles and other publications that can contribute to the training of teams that work in the insects transmitting Chagas disease control. The library was created through a partnership between Fiocruz Minas and the Institute of Communication and Information in Health (Icict/Fiocruz).

The “Consciência e Arte” table closed the program with presentations addressing new strategies for diagnosis and treatment through the IntegraChagas Brasil project and the importance of the ordinance that determines the chronic cases compulsory notification. The video Who was who said..., about the Chagas disease discovery, produced by the Laboratory of Scientific Audiovisual (Labaciências /UFF), and the Integrachagas project website were released. In addition to Andrea, participated in the activity Lauricio Monteiro da Cruz, director of the Department of Immunization and Communicable Diseases of the Department of Health Surveillance (SVS/MS).

IntegraChagas Brasil is a strategic project that aims to expand access to the chronic disease in primary health care (PHC) detection and treatment, coordinated by INI, in partnership with the Federal University of Ceará (UFC). The initiative, requested and funded by the Ministry of Health, aims "for the first time, strategic surveillance and health care actions that will be implemented and validated in an integrated manner in the territories, with the support of the Health Surveillance Secretariat and the Secretariat of Primary Health Care, the Ministry of Health", said the coordinator.

The project should begin to be implemented in five municipalities indicated as priorities by the Ministry: Espinosa and Porteirinha (MG), São Desidério (BA), Iguaracy (PE) and São Luis de Montes Belos (GO). It is estimated to benefit approximately 6,000 adults and children from the five municipalities.