Community Input
The challenges in Chagas disease are frustratingly plentiful, both from an operational standpoint – how to make use of the accessible resources and tools in the field to prevent new infections or treat existing ones - as well as from a research perspective.
Several recent publications have drawn attention to Chagas disease and T. cruzi, mostly highlighting the impact on public health in the Americas and the major achievements that have been made in infection control in certain areas. What is still missing is a discussion of the key challenges ahead and how these might be surmounted – essentially how the community can promote the long-term and sustainable control of Chagas disease. The WHO recently announced a plan to “eliminate” Chagas disease in the Americas by 2010. Although this is a laudable goal, it seems doomed to failure from the start – how can a disease be eliminated in 2.5 years when there is no good estimate of the full impact, no real plan for how elimination would be achieved, and no truly effective tools for diagnosis, treatment and assessment of the effectiveness of interventions?
I hope that this forum will serve as a starting point for collecting community input and ultimately for establishing a list of priorities. The Chagas disease community, although not small, is also not terribly strong, due to its wide dispersion, lack of consensus on several important issues, and its constant state of poor funding. These factors contribute to the difficulty in setting priorities for research and implementation. Nevertheless, there are good reasons to try; providing input into WHO planning for its 2010 goal is one. The U.S. National Institutes of Health is also in the midst of setting research priorities for T. cruzi and other infectious diseases and there is the opportunity to contribute to those (although this has to be done soon as the initial planning session is being held the last week in September!). There are also new forums, such as PLoS Neglected Diseases, for the better dissemination of research and implementation agendas. Perhaps most importantly, establishing some priorities may help guide where existing resources go and even attract new resources for research and implementation.
On an attached page I have begun a Research Agenda. Although this starting list reflects some of the discussions involved in the generation of a editorial piece (Tarleton, Reithinger, Urbina, Kitron and Gurtler. “The Challenges of Chagas Disease – Grim Outlook or Glimmer of Hope?” – to be published by PLoS Medicine) it is just a rough starting point with big gaps to be filled. The mechanism for providing further input and discussion is through the blog page – where potential agenda additions can be presented and discussed. Perhaps with some interchange, a cohesive set of priorities which most of the community can agree on will emerge.
Rick Tarleton