The World Health Organization on Nov. 18 declared an end to its global health emergency over the spread of the Zika virus, saying instead that the virus is a dangerous mosquito-borne disease that should be treated as an ongoing threat rather than as an emergency. Meanwhile, global health experts have pointed to antimicrobial resistance, or AMR, as one of the emerging health concerns in the hemisphere. What are the next major health challenges the Americas will have to face in the near and long term? Are enough resources being allocated to health, and how should officials weigh the importance of one health crisis over another?
Francisco Becerra, assistant director of the Pan American Health Organization (WHO regional office for the Americas): "The countries of the Americas face numerous and varied health challenges. Some take the form of crises, such as Zika and other infectious epidemics. Others are longer-term, such as the rise in chronic diseases like diabetes, cancer and cardiovascular disease, a trend related to population aging and changing lifestyles. Growing antimicrobial resistance falls in the middle; it is an ongoing process that ultimately could have catastrophic health consequences. The Pan American Health Organization (PAHO) has been working with its member countries to strengthen their health systems to be better able to handle both ongoing health challenges and health crises. After all, the Ebola epidemic in Africa taught us the importance of strong health systems to respond well to a health crisis. Key efforts in this regard include strengthening disease surveillance, laboratory diagnosis and epidemiological alert and response systems in line with the International Health Regulations (IHR), the internationally agreed framework that defines how countries should report and respond to disease outbreaks of potential international concern. For its part, PAHO—together with WHO—has recently taken steps to improve its own preparedness for disasters and health crises by combining its disease alert and response function with its disasters program into a single new Health Emergencies Department. Health system strengthening also requires increased efficiency and quality of health services, strong regulatory systems (for example, to ensure rational use of antibiotics), evidence-based use of medicines and health technologies and the right education, training and distribution of health workers. To achieve all this, there does need to be greater financial investment in health and in human resources for health."
Ricardo Izurieta, associate professor in the Department of Global Health at the College of Public Health of the University of South Florida: "The history of the eradication and control of plagues in the Americas should be analyzed from the perspective of its successes, challenges and failures. The region led the world in the eradication of various infectious diseases including smallpox in 1971, poliomyelitis in 1994, rubella in 2009, congenial rubella syndrome in 2015 and measles in September 2016. River blindness has been eliminated except for specific foci in the Brazilian border with Venezuela. Malaria and yellow fever control has been another achievement in some countries including Ecuador and El Salvador. In 1991, the control of cholera, a deathly diarrheal disease, reported the lowest number of deaths in the whole history of its pandemics. Nevertheless, the persistence of deprived socioeconomic conditions among vulnerable populations were the culture media for the re-emergence of cholera during the 2010 and 2016 Haiti outbreaks, a death foretold in the times of cholera. Acute diarrheal and respiratory infections are persistent diseases that can be defeated with vaccines, water and sanitation. But new challenges have arisen; the overuse of antibiotics in humans and livestock is creating super-bacteria that produce enzymes with the capacity of neutralizing potent antibiotics that are considered ‘silver bullets’ in the fight against infections. A main failure has been the incapacity to stop the reintroduction and dissemination of the Aedes aegypti mosquito after its successful eradication in the 1950s. With this mosquito as their vector, may dengue, chikungunya and Zika continue their rampant spread in the continent? Will yellow fever and Mayaro be the coming plagues?"
Katherine E. Bliss, senior associate in the Global Health Policy Center of the Center for Strategic and International Studies: "Through a history of collaborative resource management and integrated planning efforts, countries in the region have achieved numerous firsts in public health, including eliminating polio, rubella and measles. But the spread of the mosquito-transmitted Zika virus, unknown in the region prior to 2015, has illuminated the challenges the region’s health systems face in ensuring equitable access to quality health care for the poorest populations. Zika poses particular risks for pregnant women and their babies, who may be born with microcephaly and other neurological complications, yet the outbreak shows that the access of the most vulnerable women to adequate vector control efforts, contraception and reproductive health care are a persistent challenge. That the WHO has downgraded Zika from an ‘emergency’ to an ‘ongoing threat’ signals that health institutions across the affected countries will need to bolster their efforts to prevent, diagnose and treat Zika—and strengthen their services to the most impoverished communities. The reported resurgence of malaria in Venezuela is also cause for concern, particularly for neighboring countries, and it reflects the broader deterioration of Venezuela’s health sector in the midst of economic crisis. As countries in the region determine how to budget their health resources, ensuring funds are available to manage health emergencies while sustaining strong immunization programs; continuing to work toward universal health coverage; implementing the recommendations outlined in the Global Action Plan on Antimicrobial Resistance; and preparing for longer-term challenges associated with the aging of the region’s population, all remain critical."
Barry Featherman, senior director for international government affairs at Gilead Sciences: "Last July, I had the honor to serve as the co-chair of the regulatory authorities breakout session at the Public/Private Sector Roundtable on Zika at the United States Department of State. That meeting brought together more than 170 participants from the private sector, faith-based organizations, multilaterals and public agencies. The objective of that meeting was to look at ways in which we can work collectively to combat Zika, which is just one of the health challenges that we face in the hemisphere. Other mosquito-borne maladies include disease such as dengue and chikungunya. The State Department program last summer is illustrative of the need to leverage the collective knowledge of the NGO community along with the public and private sectors to continuously combat disease emergencies. This obviously must be combined with effective means of prevention as well as a more systematic implementation of testing and treatment regimes. Some examples of other types of disease burdens that affect our hemisphere continue to be the numbers of people with diabetes and obesity as well as HIV and viral hepatitis. Diagnosis of these disease burdens and linkage to care will serve to create a more economically viable hemisphere for all of our citizens."