 Good afternoon and welcome to CSIS. I'm Steve Morrison from CSIS And I'm delighted to be able to welcome you here today We have had the good fortune over the last several years to collaborate at several different times with the Saban Institute and and those Organized into the global network for neglected tropical diseases and I Think it was four years ago That former secretary Tommy Thompson and and and Dr. Peter Hotez were here a year ago a little over a year ago We had a session jointly with our Africa program Looking at a number of different Africa focused issues here And so it was a real thrill to be able to pull this together today With many of our friends that we know Mirta Rosas from her days at Pajo And others So thank you for joining us Catherine Bliss Are my close colleague here at CSIS has kindly agreed to run this event to moderate it and And so I'm going to turn the floor over to Catherine To introduce our guests and and and get things running. Thank you so much Steve, thank you and good afternoon to everyone We're here today to talk about persistent health challenges in Latin America and the Caribbean and opportunities for regional and international Collaboration on the particular challenge of neglected tropical diseases that cluster of diseases including hookworm Tricoma schizosomiasis Lymphatic pyloriasis and others which affect approximately 1.4 billion people worldwide and are most often associated with poverty and a lack of access to water and sanitation Now as most of you know the Latin America and Caribbean region is home to approximately 600 million people In recent decades have seen remarkable political and economic transformation in the region Transitions to democracy in the 1980s and 90s have been followed by significant economic growth and expanded social sector investments in many places And yet even as poverty rates have fallen and most of the countries in the region are now classified as middle income There is still significant inequality within countries many Countries such as Brazil, Mexico, Colombia and Costa Rica among others have expanded access to help services to cover wide sectors of the population But there remain gaps in coverage particularly in rural and peri-urban areas So with 195 million people in the region still living in poverty and facing limited access to such services of health care and water and sanitation, the challenge of ending neglected tropical diseases in the region is significant Yet there have been a number of very important policy developments in addressing NTDs in the region In 2009 the member states of the Pan-American Health Organization at the 49th Directing Council passed a resolution calling for the elimination of neglected diseases and other poverty-related infections in the region In 2012 public and private sector representatives endorsed the London Declaration to identify goals and objectives in eliminating 10 NTDs by 2020 And recently Colombia articulated very specific elimination targets for river blinds So here to help us make sense of the challenges and opportunities posed by NTDs in a politically and economically dynamic region are four experts who will share their views on the important political technical and practical opportunities that exist for advancing action on NTDs in Latin America and the Caribbean It is my pleasure to introduce to you President Álvaro Arsú, former president of Guatemala and current mayor of Guatemala City Mexico City would be a little too far to the north Dr. Mirta Roses Carriago, former director of the Pan-American Health Organization Mr. Carl Meacham, director of the CSIS America's program and Dr. Neeraj Mistri Managing director of the global network to end tropical neglected tropical diseases There are two things I should note before we go ahead and get started with what I hope will be a dynamic Conversation between the the panelists first and then with you the audience and the first is that both president Arsú and Dr. Roses are special envoys for neglected tropical diseases on behalf of the global network to end neglected tropical diseases and are using their their experience perspective and voices to really advocate for greater attention on behalf of the issues in the region and the second is that you may have noticed that there were some Headsets as you came in and there's a little booth here in the back And we are carrying out simultaneous translation from Spanish into English and English into Spanish And so if you would like to take advantage of the the headsets Let me invite you to go ahead and pick one up outside if you didn't do so already the channel for English is 28 And the channel for Spanish is channel 36 So if you need one of those I think you can also just let someone know in the back And there will be some additional equipment available for you So let's go ahead and get started and dr. Roses I want to turn to you first and and ask you as former director of the Pan-American health organization You worked closely with ministers of health throughout the hemisphere on a very broad range of issues during your tenure over 10 years There was chronic non-communicable diseases The H1N1 outbreak Just you know a variety of of ongoing challenges as well as emergencies that cropped up over the period So if you could tell us a bit about you know Where is the issue of neglected tropical diseases fit into the broad set of challenges that that their region faces? How do you see the health ministries working with some of the the domestic? agencies focused on social sector improvement and poverty reduction working together and You know if you could tell us a bit about the experience of you know one of the countries in the region I know Brazil has been doing a particular Focus because there are at least seven of the NTD's you know in Brazil and the ministries are working closely together If you could tell us a bit about that case as well to start us off To really come with a framework You have large countries the Tiny small island states in the Caribbean and so on so it's it's really quite a different Region the good thing is that what we do in this region then always resonating the rest of the world because some country is related to one of our country's population size or you know geographically or economical We came with a framework to try to avoid the list of diseases and Make it easy for the public and the politicians and we came with the three parts The strategy or framework for cooperation at the unfinished agenda Protecting the achievements and facing the new challenges so that we could you know accommodate some of the things in a very simple And even countries with the same diseases maybe they were at the different stage in this But immediately when we put the unfinished agenda some of the things of course That came in the millennium development goals like maternal mortality child mortality came immediately But also why the countries were concerned about chronic diseases immediately in the unfinished agenda. They identified the neglected because in the region we have a Relatively reduced burden of disease for many of these You know seven or ten, but we have pockets in most of the We're still you know Diseases that have been going for centuries and have very difficult names Are located, you know and like hidden in the most neglected populations in the port of the poor They have a quite a burden of treatment discrimination, you know because of the impact they have you know the villages before me did whatever and they are also linked, you know kind of Backyard So really that that brought the attention back again We put it then in the health agenda for the Americas, which was a major call for the next 10 years 2007 2017 that was approved in within The general Organization of American States so endorsed by all the heads of government And it was in one of the eight areas the whole health agenda is about equity and poverty reduction And so they fight against neglected diseases that affect Disproportionately the poor the women the indigenous people the Afro descendant the children, you know, so all of these Priority vulnerable populations came into the area of reducing risk and But another disease one of the eight areas And so it started creating the momentum for preparing the resolution you mentioned in 2009 And I think that now we have seen a tremendous progress First of all making it a little more visible Creating the commitment and at the same time all the likes in partnerships resources, and I think the other And Finally, you know, we have with all this partnership Move it the agenda globally also, you know linking to the global agenda the resolution calls for elimination 2015 and if we do that Create a lot of energy and trust that the world will be able to do it in 2020 that is a global goal The interesting thing and you mentioned that is in our countries we have worked, you know And the Pan-American Health Organization the saving is the USA ID the global network and IDB the bank Development banks and so on and many other partners including the faith-based organization and NGOs in the different countries In linking it with other strategies that are the major development approaches Particularly poverty reduction strategies and frameworks. So in the case of you mentioned Brazil They were already working because in fact it is the country where most of these The people affected are because of the population size, of course, and they have done a tremendous progress because of their social protection measures, you know and poverty reduction strategies But in the last three four years They were able to do two things Integrate the diseases with the new strategy proposed, you know by the Pan-American Health Organization the World Health Organization So we said of looking, you know one team for each disease working in isolation They integrated mapping, you know the different diseases and understanding that they coincide sometimes two three four five diseases in the same community and linking it to the poverty reduction national development plan and This you know gathering all the other interesting part with those who are endorsing human rights. Well, this is a human right Those who are on mother and children. This is a question of mother and children. Those who are on poverty issues they can nutrition issues. Yes Every cheerful development. Yes, you can You can have a lot of friends around leveraging The cost and one thing I want to say is that Colombia is going to be the first country in the world That is going to be certified May 14 three from Uncle Sarcastic, which means that we as a region we are so advanced that we have to wait for the WTO and the partners to Certify the protocol of certification because nobody believes that there was going to come the day when we could certify And so the protocol was not prepared and we took the world by surprise, which is something in the region we're used to Well, thank you very much President Arsou, let me turn to you and and and follow up on some of what Dr. Rosas has said you have a Unique experience of public service in in the region on the NTD challenges and in the region You've been president of Guatemala and represented Guatemala at regional and international meetings And you're now very focused on local level challenges as as mayor of the capital city So with all of the agendas on on a president's, you know Within a president's portfolio or on a mayor's Set of set of issues to consider. Where do NTDs fit in? With those challenges and what sectors beyond the health sector? Do you see having a role to play in your perspective as a as a president as a mayor as an executive? How do you bring those different sectors together to to focus on the NTD issues? Yes, yes, yes, can you hear me? Can you hear me? Can you hear me? Where well raise the raise the volume To a governor governor who believes that they can manage the circumstances Until his period his government period. It's over. He finds out that the circumstances drove him of course Many of us recognize that Because we feel that that can finish our political career the population wait for for that the President we have the solution to all the problems Health education culture, etc. And the truth being is that it's not like that. It is not like that We tried as in my case. I Am a graduate of science and letters. I am that I don't have a professional title. You hear they provide you with titles But you try to associate And and be able to accompany yourself with with the experts within each of the Topics of the national life and to me it's been I have been doing very well in the Charges that have been appointed to God has been helping me to continue doing this Themes one time I received a call as From our former ambassador from a US ambassador and what am I blankie mr. Blankie? He is a great facilitator. He a great He was a great partner and in accomplishing the piece that we all Accomplished after 38 years After a conflict amongst brother for which there were a lot of blood was spilled Like Cain and able we accomplished peace, but people were expecting that with peace Mona from sky will fall immediately and the pressure was really intense and budget was very small and in general we were obviously Fed up because we needed to supply the immediate Needs that the population had and None of them appear And none of them is pure this type of neglected diseases that we Qualified as not being important so they did not coincide with the percentage of analysis of health and Logically we put it in the back burner But through time for when you start to feel to look at this type of diseases You would look at it such as circumstantial diseases and places that are really poor Where there was no portable water the drainage were not sufficient One day I received the phone call of Donald Plantee and he told me look I am proposing recently About six months ago more or less I have proposed So that you could be a special envoy for an organization that's called Sabin and Sabin Sabin and it's an organization that is dedicated or it will dedicate itself Oh, it will continue dedicated and combating the Diseases and facious diseases tropical and facial cysts that Have been Neglected and I asked him what are they and he gave me all these names and I could never identify a single one And what am I good for? I? Am not a doctor. I'm a graduate. I Finished my presidency and I have no other things to say to the international community and none We need you so that you can open doors and use your name So in your experience and and and you try a trajectory so that you can open a space the credibility of this Organization and the importance of this topic and little by little I have I have been fine I have been learning that I believe that the main problem that the organization has is to Focus the reflectors towards those diseases because those that who can help those that who can provide a help We consider ourselves not vulnerable to those diseases because we live in an environment Where the infrastructure of health? Exeter it's acceptable and we don't see a threat as you such as How would you say an HIV TV and and many of those diseases that are more sexy and on a marketing level and Let's say let's work on this topic and that's the reason we're here and I have Accompany myself with two prominent people that that are very knowledgeable about this topic and we had also found doctors Specialists that have provided that provided us with presentations very important and very alarming at the same time, but The principal challenge is going to be that with that information we are going to provide the importance and Make sure that the Minister of Health Provide their attention because I imagine that because of their proposals they're going to be more interested in and in Caring for the hospital budgets the immediate medical attention and that is a number the numbers and the index The numbers indicates that yeah, there's a problem, but it's nothing of matter of life and that What do we do? Well, we're here to tell you listen this problem has a great a great Incidents especially in marginalized areas within our population we would have to Say we had to take away the a tropical Theme because I think that this is not only a tropical disease But also in other areas that are not tropicals and to tell the international community that listen help us with this Topic and this matter Otherwise, we're not going to accomplish. We're not gonna be able to capture Those reflectors and such a sensitive theme. It's a great challenge and that is the reason that I'm here I'm only a politician my mother who was born in Detroit used to tell me overall Sticking on the political note for a minute or two. I wanted to turn to to Carl And follow up on some of the observations both the doctor Roses and president are so But you're looking at international collaboration on on the NTD issues And ask you to comment a bit on perhaps the the role that the US government can play in the region on these issues We know that the US agenda and relationship with the Americans is very complex. There are security issues trade issues you know lots of lots of different and compelling reasons for engagement and So at the same time, you know, we see that some of the US programs some of the US aid health programs in some countries are kind of graduating and being Changed or transformed and so I wanted to ask you to say a bit about the the arguments or the the reasons for US engagements on this issue and and what some of the Some of the most compelling cases to to Congress and the administration might be sure sure you can hear me, right? First Yeah First I just want to thank you for having invited me to to be on this panel with the president and with the other distinguished guests This is a really interesting issue because it seems that funding for this issue within the US government is actually going up The F-150 account which is the account that the State Department Has jurisdiction over for For an assistance for the region is about two billion dollars for Latin America So when I said it's going up, it's going up from Being in the high millions, so I think it's 89 million fiscal fiscal 2012 Was about 89 million dollars for for NTD's So it's not a lot But it's going in the right direction and a lot of that has to do with champions that you have I think in the US Congress that are advocating for these issues that find these issues to be compelling ones to follow I think we were talking a little earlier about senator Leahy and his staff and he's the chairman of Well, he was the chairman of the Appropriations Committee of foreign ops was his Subcommittee, even though now he's with judiciary But you know having a champion in the US Congress to really focus on these issues is very important particularly Because the US Congress is going through its own difficulties With getting things done in a broader way. So that's super important as it relates to this as far as regional collaboration I think the folks that are up here I have sort of outlined really well What's happening what the good news is you talked a little bit about what's happening in Colombia and the the progress It's being made there the work that's going on in Brazil is very important The president talked a little about what's happening in Guatemala and how he dealt with that You know you asked a question as to why we should be focusing on this Which I think is a great question For the US government because we can actually find the solution to these problems. It's not like it's a bridge too far It's actually possible with a little bit of investment a little coordination and a little attention to actually Do something that that will make a difference in helping a whole bunch of people So that that's really I think the most compelling reason for us to be engaged in this now Recently the president went to Mexico and Central America that was last week and You see that the administration is taking another kind of approach to the region It looks like they're turning the page and they're really sort of giving the region an upgrade and so far as its relationship the issues the bigger issues that were talked about during the trip Had to do with immigration issues Had to do with energy Had to do with security But the countries that are visited is in particular countries in Central America These are traditional friends of the United States and you would think that you would be able to really sort of pursue Greater interests with these countries and this should be one of those interests. It seems like the natural kind of issue One of the issues that you asked as well Was that if the United States sort of make an exception? in In the assistance, I guess frameworks for countries that are dealing with these issues You know Within the regime of development, I think you mentioned that it's not just development. They can be mother-to-child Issues it can be a whole series of issues that sure have to do with development But also sort of touch all the other different areas that we deal with just in day-to-day living So I don't know if it's an exception, but I think what we can do a better job of Doing is is really talking about the broad Reach that these issues have and that they touch a lot of folks And that we actually have an opportunity with a little bit of sustained Attention focus and not a lot of money To to find the solutions to these problems So I think that's what I would sort of focus on as being my opening remarks I think that sort of describes well what the greater environment is with regards to the region Broadly what the focus of the region is that there's possibilities to find the solution to these issues I think you guys have already started so it's it's not like we're like like you really need the United States To be leading on this I think you need for us to to partner up with you though in areas where where you might need a little bit more help So I think that that I'll keep my remarks to that and in the Q&A or in the conversation If there's anything else you'd like me to touch on I want so thanks. Yeah, well, thank you Dr. Mystery I want to turn to you and you're the director of the global network to end tropical diseases And I wanted to ask you to to say a bit about the network how you're managing advocacy around in the region and In particular to say what kind of challenges you face in terms of raising awareness about this And and also if you could comment on you know the extent to which there are lessons that can be learned from Latin America And the Caribbean that are applicable to other regions and vice versa if there are some lessons from Experiences in Asia and Africa that might be relevant here Thank You Catherine and once again, thanks to CSIS. We always delighted to partner and collaborate on issues As many of you might know this the global network was established in 2008 and the mandate was specifically to build a political world Raise awareness and raise resources for the fight against neglected tropical diseases The saving the the global network is based at the Saban vaccine Institute, which actually makes it For interesting day-to-day operations in that under Saban, we have a research and development program We have financing models. We have vaccine and Immunization advocacy and then we have the global network. So having the juxtaposition of these various elements of the science policy agenda Makes for interesting conversation So I think when we look at the global health agenda global health and development agenda we like to think that what goes on to the agenda is based on Safety efficacy and Quality of interventions and I think the fourth hurdle which we talk about in terms of interventions is cost-effectiveness We want to make sure that whatever we put on the agenda has those four elements in reality Though what determines the agenda on the ground is the issue with the loudest noise gets the most attention And I think that's been the problem of the challenge with NTDs that despite Affecting one and a half billion people around the world living on less than a dollar 25 a day Compared to issues like HIV for example a really important issue affecting 35 and estimated 35 million people NTDs have had has had a disproportionate amount of attention and the reason is that these are marginalized Communities that have no political voice These are economically disempowered people So they you know not really on the agenda of political campaigns and that they're not a voting constituency And I think one of the most devastating issues about this About NTDs is that there's a lot of social stigma attached to people living within a neglected tropical diseases If you look at the fact that they disfiguring They're deforming they debilitating and they essentially slow people down So any efforts that we have at actually promoting any form of socio-economic growth and development are undermined if we don't Address a neglected tropical diseases and dr. Rosa's eloquently talked about the links between all these particular issues So that's why we embarked on a huge advocacy campaign and it's not just a question of rationally presenting the data We have to make noise about this and to that end we'd like to have dr. Rosa's president Arzoo and president Lagos from Chile Who's also joined the campaign and they joined? President Kufo the former president of Ghana who joined the global network as a special envoy Almost a year ago and has had huge impact in actually raising this on the global as well as the national political agenda Because it's through that stature it's with this level of leadership that we actually going to get entities on the national agenda Parallel to these efforts the global network has embarked on a very ambitious social media campaign Because what we find is corresponding to the political agenda is the is the social consciousness It's what people taxpayers like yourselves As well as people in endemic countries if there's a broader social consciousness of these issues We find that there's a strengthening of the issue on the political agenda And then I want to lastly make a point As part of introductory comments on on this whole approach of integration Now neglected tropical diseases are a group of 17 diseases and we talked about the seven communists Which account for 95% of the global NTD burden? Traditionally what would happen is community health workers and scientists would address these issues Vertically so each group of scientists would attack their own particular disease now We have integrated platforms for these diseases Which is through community health workers who like dr. Rosa said go in and treat For three or four up to seven diseases in a local community in addition to that it's the school-based platform That's has become a very important platform for community access for interventions Now this is why the global health community needs to pay attention to this Because we're moving the global health agenda to health systems strengthening We're thinking about building the personnel and building hospitals and clinics and trickling down to the last mile With neglected tropical diseases We starting hut-to-hut village-to-village door-to-door and accessing populations So I like to say that we building the health system from the bottom up And that's a value add to the broader global health response not just for neglected tropical diseases So thank you, you know you you mentioned the importance of high-level political leadership and also the role of you know kind of mobile using social media to mobilize taxpayers and others and you know one of the lessons from the Experience of or the history of HIV over the past couple of decades is the importance of the voices of patients themselves And I you know I wanted to ask all of the panelists The special envoys, you know would would want to comment on this You know what what is the role of the patient's voices? You know we've heard that that there is so often not only stigma associated with with these Diseases but also and the fact that it makes it you know More difficult for for people on a daily basis to to carry out their their daily activities And so how how realistic is it to to really engage the voices of those who suffer from entities? And what are some of the the opportunities that that might present for really kind of as you've said? Making a lot of noise on the ground So I'll start and hand over to my colleagues What we've done at the global network is we've deployed a lot of photographers and filmmakers to the field to actually Capture the capture the voices and capture the very local context where this for access to water sanitation hygiene Etc very rural communities and we capturing that footage and actually Presenting that on behalf of our patients or the communities affected by these diseases We also have innovative partnerships for example with the inter-american Development Bank and PAHO that Through which we running programs on the ground and they capturing footage as well From from from affected communities So that's one way in which we actually bringing the good the voices to the fall and the other is by proxy us as practitioners Who are working on the ground or our partner organizations working on the ground are speaking on behalf of these affected communities With the poverty reduction Because people are interested and they have different Causes no The advocate for different issues so that try to relate to that also with indigenous people and indigenous leaders You know because they are affected as well as Communities in our region like in the case of Colombia and so I think that one of these Messages Bringing all these allies, you know who have related causes It's also a strong message a moral imperative. We have the knowledge. We have the resources big pharma has donated You know the birth they the high cost is On drag and this has been available and donated for for decades now So as president I was saying it's not that much investment that it needs the car was mentioned It's not that much investment that it needs more coordinated effort, but I think it's also that that the politicians and the country themselves the whole population the institutions will represent we need Success stories and I think that in our region. This has been also an opportunity to bring good news Because when you listen for instance to some, you know This enchanted frustration with Haiti or you know other four countries And then you know that they have an integrated program now with the malaria and failure Isis and there is a possibility that they have down done a major round and they have reached every person You know into the warming campaign or with the integrated vaccination program that the country has been able to do that On the ground, you know It kind of dispels some of the frustration and the negative Spirit but also politicians need to have things that will be achieving their very short political term And I think that this is what we have been telling them, you know here You can promise something that we the right orientation and command you can achieve before you leave And I think that the message we are passing also in terms of our generation of public health practitioners and the rest This is something your generation can leave as a legacy to the next generation We can kill the bull don't pass the ball So a bit of a challenge to to the generation. They you know, you can really pull this together President Arsou as a special envoy and and also as mayor would you comment on on this potential for the voices of the people into the advocacy realm First of all This has nothing To do with what a politician's need to need which is notoriety It is not captivated in general for public official that's looking for a re-election of his Charge or he wants the favor of his citizens Because the indexes index is very low according to them and they don't in reality. They don't see the possibility that the Media that the media was at you Therefore that's why the challenge is huge. There are passive subjects that are only going to receive the medicine That has been donated by the labs as I understand Something very very basic the investment. It's not extremely high in the active subjects that are in who's here meeting here So that means that this will have an impact and the way that whoever is here can provide it the The enough support and that's one's to going to make us Reach our goals next time you can invite us on a meeting like this We can provide it with the indexes And hopefully the microphones should be working much better and We should evaluate and we should evaluate Towards where we should focus our steps as a world We can expand or simply just to say mission accomplished We finish what we will we set out to accomplish because those are diseases that we can really annihilate with very few resources very few action, but here the mayor plays a very important role The mayors are persons that are known around the community that go out on the street and everybody identify them Hello, Mr. Mayor or they insult him Because they know him They know him they they know me even if I'm wearing my motorcycle helmet I'm wearing a helmet and they call me. Goodbye arzu. So that means the mayor is a very Principal role. He speaks to the people. He follows the people especially in the marginalized communities. There's a species of Con Consit with a right where they they judge they qualify themselves sometimes is good sometimes is not good, but sometimes The assistant never reaches them. So they feel obligated to heal themselves so That's clear and and it happens less and less but in my country in particular in my country when the conqueror Is The Pedro Alvarado with a long face. He was required to come back to Spain to inform of the Territory that he had just conquered the king Carlos the third there's so many Carlos is dead They asked they asked the conqueror look listen How is this territory that you just found and he grabbed a sheet of paper He did it like this and he put it on top of the table and he goes it's just like this Imagine yourself how difficult it is and I come by Denver As a sea there are no mountains, but in Guatemala It's a country that has mountains that you hit your nose against the mountains And it's very difficult to carry water to build roads to build electrical Networks communications now is not that hard because the satellite and there are When I started the presidency There were four Telephones for every hundred inhabitants in Guatemala and we privatized the telephone companies Up until now they criticized me because of that But now in Guatemala you have double telephone Satellite telephones and even though we have a Number of diseases that are quite high for instance, we had 48 Times 1000 of Mortality from children's of zero to five years old. I brought Cuban doctors Yes, I Don't know if it's proper to say this that I brought Cuban doctors, but Yes, I have already beat up Castro and Compared to the time that he's been in power. I think I'm three years over him. He allowed me to bring 800 Doctors to Guatemala they we lowered the mortality rate for children's the Cuban doctors Got under horses. They went up the mountains even our own doctors They were not able to do that those Cuban doctors will go into the department heads and they would set up their clinics But they would never reach the place the local doctors But the medical doctors were able to reach those areas and we lower it down to 23,000 to 24 per thousand the mortality rates on children's and that is the reality with this we could reach it quickly if we had the willingness from the people of the communities and the mayors For which one of them And the territorial area areas can see the sensitivity of the problems And they have big bellies and the children's and I don't know if it elephantiasis and All their type of diseases that are qualified within the seven diseases and they have very complicated names But there exist Undoubtedly they exist therefore the importance of this Is it depends on you depends of the person that we have visited yesterday today people that External relations at the Senate That they show us that phase of interest But I don't know if they put that face on every person that comes and meets with them But they showed us that face with this in regards to the secretary of health today the department of state the secretary of state the director the sub-director of the Sub-secretary and she knew about the topic and They spoke about it and they had more knowledge than myself So that means that they are conscious of this and they're willing to help as the secretary of the organization of American states for instance For which we had a meeting this morning and he offered all of his Effort and determination so that the general assembly that will take place in Guatemala within one month more or less That should be one of the topics that should be Exposed there will be a meeting of a health minister in Costa Rica But I believe that if the communication that is being represented here. It's able to Translate the importance of this topic then we could accomplish that if not we're not gonna accomplish and that's a reality We're gonna stay Looking around the same topic everything is going to depend as to how much the communication that we make in regards to this Theme and the seriousness that I speak too much I want to turn to one last kind of series of questions for the group before we open to audience Question and commentary because I know many of you have thoughts and have worked on these issues quite a bit You know we at the beginning, you know, we talked a bit about the London declaration in 2012 That is really seeking to mobilize international action on neglected tropical diseases in 2009 the directing council at PAHO Articulated a series of goals and objectives for the region Dr. Roses talked about some of the the work that's been carried out in Colombia in the past year and also in Brazil with the integration of the health and poverty reduction agenda, so I just wanted to ask you all to Reflect a bit on what some very concrete actions individual governments in the region can do in the next five years to really see To see some achievements on this issue with it articulating national plans Is it identifying one specific set of issues? Is it really revamping the health system? And then also are there any specific events on the regional political horizon that might offer Opportunities you've just mentioned a bit, but are there you know other events on the agenda in the next five years that could Offer, you know a real chance for for some visibility and action on the cities of Opportunities right now because we are in the countdown 2015 And so I think that that creates a momentum of urgency What can we really close and achieve? In the final report of 2015 and then at the same time we are opening the process for the debate on What is going to be the post 2015 agenda and so that there's another possibility there? Particularly we hope that we are going to close most of our Affinity that in this region by 2015 particularly with But you know the rest of the world global Goal is 2020. So things have to be incorporated in the Next post 2015 agenda at the same time. There are other important initiatives like, you know the child survival Initiative that you know we have to put that and the summit coming and other Discussions were Particularly Which is important because I think that That you can bring break really the cycle of poverty by eliminating Even other investments, you know are lost if we don't address the issues, you know, like particularly And the Infestation by Programs like nutrition programs like early childhood development education and so on have no impact because The underlying condition Of course, we do have also a Large way to go in terms of water and sanitation, but we can take it back also on all the effort that is being done With a function of water and sanitation So I think that what we're looking at is all these opportunities and all these platforms so that we leverage we offer, you know, the possibility of partnering and a Win-win situation for everybody We have to work In a very realistic and pragmatic approach in the next five years, and I think that with the certification and the mapping At least in our region, we can even have and announce this access is progressively So if you can see certain communities, if you can see certain provinces or states In larger countries, like, you know, we have been doing with Chagas disease Some of the diseases that are more expanded, you know you can create that that feeling of Empowering, you know, progressively on success. So if you close the book on all the circumstances that I think that we are going to do that first of all the others, most probably That's one thing, you know, so when you pick a disease, you pick some communities where the progress can be made more easily and Go on with this wave of enthusiasm and empowerment that you create. So this is basically the approach that everybody on board, you know, is taking together and Creating progressively more and more trust, confidence and enthusiasm that this can be achieved No, and on this and the creation of awareness, I think it's Super important to have an organized campaign along the lines of what you were saying to talk to different people in Congress So you're really directing the efforts that are going on there To yield the best results Members in Congress do a lot of things and have a lot going on. So I think it's important that The most clarity that you can provide the better it will be President Arsoul mentioned something about that the That this effort doesn't really get the attention that other efforts could get and I think he's Right on the political sides, especially if you're dealing with a term of office But what you can get is a return on your investment in a short period of time, which is what you were saying So you as a political as a legislator you can actually say I started this Initiative and I got a return on it. I was actually able to to solve a problem So that that I think is the other side of Being involved in this but creating the awareness in an organized way I think is extremely important, especially now when this issue is not getting all the attention That it could be getting in Congress and with a little more attention You could touch a lot more lives is what I'm hearing from from all of you I feel that you have said everything yes undoubtedly this has to do with a side effect As you would call it important First of all it unifies the community a job that you can do in conjunction and association with other Local government the agencies to collaborate with their community and I am certain that if all of the volunteers And the interior of the country if all of the If all of the volunteers if you can Present in this very important and and you can show Important is their collaboration We perhaps we can offer a visa to the US if they help us out Or and I'm sure that we're going to have a great support and the level of the manual Level to accomplish this and I feel that Everybody has mentioned anything the technical aspect and I feel that the US gave me the impression that they see this Topic seriously, they're interested they're interested and I am sure that they're going to support this type of agendas and this type of meetings Ministerial meetings for which it is very important because with this Central American government with the Ministry of Health when they meet casually the host country and Minister will go and tell him look I have interested in this topic. So that that creates something that It's gonna be hard for them to not to pay attention and little by little we're going to be generating Importance on this topic, and I think that's the key. It's a little bit complicated, but it's like trying to start from zero and at the level of our own countries I Everyone to go to n7.org Which is the campaign that we actually have for neglected tropical diseases, but the tagline for the campaign is together We can see the end and I think that's the most important thing that present ours who also Touched on which is a sense of community and when it comes to these huge global challenges that we face No single sector or no single actor is actually going to be able to take this on on their own So the most important message that we can send to national governments In countries endemic of these entities is that they not in this alone We need to have the sustained and continued support from the US government because it signals NTDs as an NTD NTDs as a global health priority Together with the UK government the US and the UK are the anchor donors to the NTD response And we need that continued commitment When we look at this it's a public-private partnership So national governments can actually get drugs from the drug companies who've committed in the range of hundreds of billions and some even up to a Billion doses. So these drugs are available and governments and don't need to pay for them And and particularly for Latin America PAHO is providing incredible technical assistance to countries to develop these national plans for NTD control But I think what governments national governments need to actually do is co-invest in these national plans We need that level of political commitment Which very often comes from a financial contribution towards these plans and I think that's going to be a level of support from the national level That's going to actually be reciprocal to the the donor governments actually coming in and with Latin America Many countries being transitional economies. I think they're in a good position to do that And then looking at that sense of community from Latin America to the broader global response to NTDs We are looking to the international community to see what's going on and what's going on And we're looking to the models that emerge from Latin America Where the Latin America and the Caribbean where the targets are for 2015 in the region globally we're looking at 2020 and and the case of Columbia for example is the case study We are examining to see how we apply that model to other countries where we want to eradicate Oncosa crisis similarly the immunization weeks and school-based programs in Latin America have been running for decades now And we need to emulate those methodologies in in different places. So once again I think it's together we can see the end and we need that community response Well, I know there's a considerable amount of expertise and interest in these issues in the room So I'd like to turn now to the audience to those questions and comment to to our speakers today Let me ask you to Wait there is a microphone that will be passed around because we are capturing this for our web Audience and and for our recording and let me also ask you to please state your name and affiliation I'll ask this in Spanish and I'll go ahead and translate in English Señor presidente soy navija casi directora general de humanitas global somos un agencia de desarrollo aquí en washington y acabo de regresar de su lindo país el miércoles Pasado que estuve en reunión convenió con el presidente Molina y el liderazgo del ministerio de salud Mi pregunta es tomando You more fortunate than I am because I haven't been able to talk to him You more fortunate than I am because I wasn't able to talk to La pregunta para usted de su punto de vista político si usted cree que la entrada más estratégica para un enfoque en eliminar enfermedades tropicales es por medio de una conversación que se enfoca en el desarrollo de capacidad Y sistemas de salud que pueden ser activados para otras intervenciones y no exclusivamente una conversión que se enfoque En el tratamiento o en la eliminación de enfermedades tropicales lo traduzco en inglés para para Great, okay Mr. President my name is Nabiha Kazi. I am managing director of humanitas global development group here in Washington DC I explained to the president I was just in Guatemala on Wednesday My question was from his political point of view if he thinks a much more strategic Entrance for a conversation around eliminating neglected tropical diseases is actually conversation around a capacity building and systems building that could be Activated for the purpose of other health interventions instead of an exclusive focus on Eliminating neglected tropical diseases. So that was my So I think I had called on someone over here first Hi, I'm Andy coval the president and founder of Med Farm a generic pharmaceutical company And after Merck which began its donation in 1986. We are the second Farmer company to be a pioneer As Merton knows we're not big pharma. We're little pharma. We're generic But we have done more than most of the big pharma Up to now we have provided treatments for 450 million children around the world from Asia And that has been mostly through donation or through friends. I Want to comment on one country that responds to some of the issues of Merck and Nourage After El Nino we happen to win The World Bank tender to supply medicines when the World Bank found there were no medicines in Ecuador And after three years of supplying all of some 86 essential drugs to Ecuador We began a program with a local NGO Infa that ultimately went from treating 500,000 to a million to 2 million to 5 million and to 7 million The point I want to make with regard to Nourage is that over the years every Presidential candidate right left center every mayor every governor when they campaign Said if we win we will expand the deworming program because it became a possession of the people a Program the people and I think that's a critically important part of any successful program. I Want to now go back to Ecuador we grew the program to reach 7 million now. We're on a new phase With private funding I assigned an agreement with the Minister of Health and the Minister of Defense For the first time to go into the Amazon and Along the border with Peru and including parts of Peru to treat children The program I committed to when I signed the agreement Last November is to treat Two million children this year four million next year eight million and it will include Trading all the members of the family and that I think is kind of first Not many governments have been prepared to commit to that the other edition is the government there has recognized But you also have to treat animals So we have a program we're now negotiating with the Minister of Agriculture to treat domestic animals Which come under Ministry of Health and farm animals which come under and with that I think we're going to create an incredible example for all of the Americas Thank you Thank you, I'm John Lister with India Globe in Asia today my question is that mr. President as far as a World Health Organization or United Nations is concerned how much they are working or they are doing in Newer country or in your region and also mr. Mystery How much is this tropical problem in South Asia, especially particularly in India and What you think Indian government or the Global Community or United Nations is doing about this or World Health Organization. Thank you. Hi, my name is Milton Okay, and I am a consultant for International Center for Journalists here in Washington DC and my question Basically, is this what role do you assign to the media in order to create awareness about these diseases? Thank you Thank you. So we've got a series of questions broadly related to the question of you know, is it better to integrate these Work on the neglected tropical diseases into the broader category of health system strengthening or or should they really kind of remain standalone campaign issues There was a question about the advocacy and the the challenge of NTDs in South Asia and India in particular We have the comment and discussion about the integration of some of the the campaign in Ecuador on the Ecuador-Peru border integrating Not only children and the family but also domestic animals and and the Ministry of Agriculture So kind of looking at that broader multi-sectoral approach and then a question about the role of the media and how you integrate Journalists and and I suppose a broad range of media into the awareness and discussion I captured this fairly well You know We had a resolution in 2009 and now Preparing I think that that will be important Again But also You know Success Steps, you know, and I think it's very important what you mentioned about the role of some of the NGOs and other The problem is that they were all fragmented segmented isolated Not synchronic which you need also for having an impact And now I think that with one road map for everybody one monitoring a process one reporting process Everybody sitting at the table with one integrated plan, you know to guide the action the impact is going to come in the short time And finally, you know, it's the challenge that was pulled about, you know, this is a long-standing It's older than me and older than public health I think what to do with particle and horizontal program in our region We were the first one to show that and I think You can do vertical programs in such a way that you straightening a system or you can do it in such a way that you we can and and so it's not either The is this or that but how you do it. So it's not that much the world That is the how you do it and I think that we prove that Immunization programs and immunization campaign can strengthen the health system can bring confidence more resources and also can articulate empowerment of the communities and so on That in the end will sustain the system strengthening. So it's not one thing or the other is how you do it How you articulate and really I think that in this particular case We have an option. Do we wait for the infrastructure to completely change in water and sanitation? We will take some years and some investment You have to do it and you have to start you have to start yesterday But that you have to do that But if we have like we have in immunization if you have drug treatment and Care that you can use that you cannot postpone it until the rest of the social More an imperative to act and apply what you know now Thank you, you're right So I'll touch on a few elements that dr. Rose's didn't touch on Firstly the efforts are based all on WHO's roadmap to get to 2020 targets and the London declaration is founded on that particular roadmap Together with that we work very closely with all the regional offices of the World Health Organization So for the Asia Pacific region were pro and Southeast Asia zero India perhaps has one of the biggest public health programs in the world through the lymphatic full arises program And they're doing on average about 300 million doses. Yeah, or 300 million people are being treated for lymphatic full arises Zero working with the government is actually looking at scaling up now to about 500 million And and and I think this also links to the the question of health systems or systems of some sort What works really well is the school to the school feeding program in India? And a lot of the school feeding programs include an annual deworming of the children And and we've seen Tremendous collaboration at the state level between the Ministry of Health and the Ministry of Education Which is critical if you want to deliver health interventions through the school system So certainly excellent work going on in India Deworming the the deworming load is is huge in India and and they are quite remote locations, but Looking at existing things like the national rural development program Which is addressing things from anemia to maternal and child health, etc. That's where NTD control is actually fitting in I I Particularly think that the health system can also be looked from the point of view of the reactive service and the proactive service The reactive service is when patients come to us in the health system to which we respond to their needs The proactive is when we actively go out there to deliver a behavior change lifestyle Modification messaging and do preventative medicine or primary health care And that's where the NTD responses actually at its strongest and many people think it's just about mass drug administration That's not true. The community health workers are distributing bed nets which are attacking malaria But they're also reducing the rates of lymphatic polarizes spread We cannot get down to zero transmission of LF if we don't do mass drug administration and bed net distribution It's the Qlex mosquito that actually transmits it So so they're doing that together with doings like things like education on hand and face washing Proper nutrition in certain school-based platforms in addition to immunization. It's vitamin a supplementation schools are even building a little vegetable patches around the school promoting agriculture from which they're getting adequate nutrition for the children so I think on the ground The workers together with NGOs and governments are embracing their realities and coming up with really comprehensive responses and strengthening the platforms There are they and then to touch on the role of media. I think there's a critical role on on many levels One is the political level if you want to get an issue in front of a politician put it in the newspaper and Refinding that it's not just the traditional or usual suspects like foreign affairs or health affairs or the economist But it's the Marie Claire's and those sorts of magazines that actually put it in the populist mindset That's one the second thing is the role of media can actually influence behavior change and especially in communities What works really well in Latin America is is public health when the government does a public health program There's high uptake. That's not the same in other parts of the world and using the media to actually promote health Messages and behavior change And lifestyle change issues is very important and that's certainly a level of collaboration. We have to move to Carl do you have any thoughts on the the role of the the US media and how that can be Yeah, I mean I would add to what you just said I think Targeted media is very important not just you know a Story on NTDs for the sake of having a story of NTDs I mean if you know that a meeting is coming on when a decision is going to be made that will determine assistance if you know that a Meeting is coming that will determine an agenda That's when you want to get a focus on on the media And and you want to get that targeted kind of attention on that particular issue In the type of media that a member of Congress or that a member of the executive branch is gonna is gonna be looking at I think that that's incredibly important So yes, I think that's the right way and now there's so many other different types of media as well the sustained use of social media is Also super super important and has its own sort of cycle to it So I would agree But we cannot forget, you know the traditional media like radio President our suit the question on on the health systems and and the vertical or horizontal approaches was One that that was directed you're welcome to answer On any of us So that the theme of You manage this team very well, I'm not gonna talk about the technical aspect of technology of DHA and VH and those numbers that It sounds like the names they they put on on fighter planes So I have not been able to involve myself or learn about them, but I feel I have I have I feel There is a graffiti in Argentina that was put out and it says enough of reality. We want promises That means that undoubtedly the politicians always is going to make offers because they're asking that the Population the voting population asking for that, but even but even so this topic The politicians will be Fractured with this because in the upper communities this type of Diseases were such as like bad eyes that perhaps the parents did something That's why the child is going through that so it is not to exploit that electorally and That's because of that. That's precisely one of the problems that That the to have to convince the communities that work towards that goal because ordinarily They know that the child's can have Big stomachs or that they don't want to eat or they don't have any energy. They don't want to go to school. They don't want to learn and very little say that This is the product of the worms that got inside him at night through the food through the river Because people in Guatemala 80% of the rivers are contaminated in Guatemala They're contaminated because of the development that that have been brought to the communities because now The drainage you make a canal and and and it gets deposited on the rivers before We would even use it as fertilizer But development brings a lot of problems to the communities inside the country, but it's imperceivable for people so that means That we had to do a job a Base that we can show him perhaps graphically through a slide Perhaps now you can bring a computer and you can Show him a video to explain him With with cartoons at the level of a Sesame Street So that they could know about the problems that his children his grandchildren Will live to that so that they should not be living The at the level of the persons that live in the urban areas It is very complicated because generally politicians all only Want to see ourself on the newspaper to show people that we have no horns nor things like that but This is not gonna. It's not going to allow them A seven diseases with very difficult names offered To cover that great challenge and to exterminate that disease. No It's better. How are you gonna bring us a tractor to the community? How are you gonna bring us access? How are you gonna bring us electricity to our community that? sells more than the from an electoral point of view speaking from an electoral point of view Then to offer solutions and and to this type of problems officially Renee Lauer one of the persons that have a company me He's one of the person that worked for Merck for about ten years And he's a conscious of the labor that Merck have used to do outside the lucrative aspect And to convince this huge pharmaceutical companies as to the importance of this topic and more or less to convince the government that There will be less children's as the hospital and emergency. There will be less waste on health services better proportionality intellectually when children's go to school and And that is more sellable and more Factual and to show them that The way it's been Explained that this disease can be an inhaled And that's what they have told me seven of them And that is important generally to offer And and and then we find out that things have been focused on border areas the for instance AIDS eight one of the biggest challenges of this disease focus was the Border steps that in Central America is We're the same we have the same DNA all of the Central America have that DNA the similar DNA But we cannot find a way to to associate ourself and those border towns the Environment that generates because trucks cannot Pass through the borders at night so many things happen at night and Some of those places become very very happy place, but very dangerous for the Infection such as AIDS to a spread and those are the things that we have to face and here Here we could combat this and we could annihilate it and it doesn't cost much and that's what's most important We haven't come to this meeting with personalities Celebrities to ask for money. Well, if you want to give us of course, which is very important But more or less. Yes, sure. Why don't you give us money? Yeah, but don't don't put that on the on the newspaper, please It's important to have that All right, but it's not vital. It's cheap. It's cheap To attack diseases Joining us this afternoon and ensuring their perspective political practical and technical challenges and opportunities related to Ending neglect to tropical diseases in the Americas. I want to thank you the audience for joining us this afternoon And let me ask you to join me in thanking our panelists We have captured this including the the translation for our web for archiving on the web and so if you Want to go back and review this or share the information with with some of your colleagues Please look for us on the CSIS website and smart global health dot org and if you wouldn't mind taking a moment there are some There was a paper on your chair when you came in just to provide us with some feedback on on the event We would appreciate it. Thank you very much