Chagas disease in non-endemic countries: ‘sick immigrant’ phobia or a public health concern?

Abstract

In recent years, the literature on neglected tropical diseases (NTDs) has advanced in significant ways: there is a renewed sense of urgency in World Health Organization reports, new specialized journals have been launched, and advocacy groups are leveraging social media to gain attention to the burden of NTDs around the world. But as the literature in this field develops, there is a danger of an important split between work that recognizes the profound geopolitical patterning of NTDs, and focuses accordingly on structural factors that lead NTDs to thrive in some areas of the world and not in others; and, alternatively, work that 'securitizes' global health and thereby focuses on the 'risk' posed by NTDs to populations in non-endemic countries. This article examines this schism through the example of Chagas disease.

Public-Private Partnerships and the Landscape of Neglected Tropical Disease Research: The Shifting Logic and Spaces of Knowledge Production

“…Imai et al 2019 ; Jackson, Pinto, and Pett 2014 ). Indeed, one of the first scholarly articles warning about possible public health risks associated with imported Chagas disease in Europe dates back to the 1980s (Pehrson, Wahlgren, and Bengtsson 1981 ), but it was not until the 2010s that European medical and public health experts reached a certain level of consensus about its epidemiological status (De Maio, Llovet, and Dinardi 2013 ; Eurosurveillance editorial team 2011 ). Reviews in the fields of cardiology (Strasen et al 2014 ) and transfusion medicine (Angheben et al 2015 ) determined that the disease already constituted a “new threat” in non-endemic countries due to its implications for the provision of healthcare and safety of blood transfusions.…”

“…Such approaches, indeed, have been used to understand Chagas disease’s evolution from object of scientific inquiry to legitimate public health concern in both endemic (Kreimer 2015 ; Kropf 2009 ; Zabala 2010 ) and non-endemic countries (e.g. De Maio, Llovet, and Dinardi 2013 ) but not to address the specific role of public-private partnerships in altering or reinforcing such processes.…”

Chagas Congenital Screening in Switzerland: Processes of Recognition and Knowledge-Sharing

“…Further, despite the increased coverage and capacities of the diagnosis and treatment of congenital cases of CD in Latin America (PAHO 2017), the prevalence of its vertical transmission remains high (Santana et al 2020). Yet, since CD affects an estimated six to seven million people, we might expect this prevalence to be reflected in the research agenda or public health priorities (Manderson 2012), but this neglected disease remains "under-diagnosed, under-studied and under-treated" due to poverty and lack of political will (De Maio et al 2014). These aspects, along with the lack of training on CD in many educational settings, contribute to a lack of awareness and inadequate clinical mastery.…”

The kiss of death – Unearthing conversations surrounding Chagas disease on YouTube

“…Chagas is spread by the feces of the triatomine bug, also called the kissing bug, which is deposited near the bite site during and immediately after blood feeding. These insects thrive in the nooks and crevices of the poorly constructed, mud-thatch homes of poorer communities where the disease is found (Grijalva et al, 2015;De Maio et al, 2014).…”

“…Inadequate sanitation and living conditions, caused by poverty, leave the victims susceptible to Chagas disease. Once Chagas disease is contracted it can lead to a lifetime of disability and pain, lowering the individual's ability to improve their socio-economic conditions (De Maio et al, 2014). Thus, perpetuating the stigma and discrimination associated with people living in poor housing conditions that favor infestation (Bern et al, 2011;Rojas-de-Arias, 2001).…”