Progressing toward the elimination of mother-to-child transmission (EMTCT) of HIV and syphilis in the Caribbean: Belize was certified by WHO as having eliminated EMTCT of HIV and syphilis in 2023. Jamaica and Saint Vincent and the Grenadines have been assessed for the elimination of EMTCT of HIV and syphilis and were recommended for validation by the Regional Validation Committee. Certification of these countries is expected in the first semester of 2024. The prior EMTCT of syphilis and HIV in Antigua and Barbuda, Bermuda, Cayman Islands, Cuba, and Saint Kitts and Nevis was also recertified. PAHO’s country, subregional, and regional teams collaborated with WHO and Member States to reach these important milestones. 

Optimizing treatment for HIV and tuberculosis: PAHO’s technical cooperation with countries on antiretroviral (ARV) treatment resulted in increased uptake of generic therapies based on dolutegravir (DTG). DTG-based treatments procured from the Strategic Fund increased from representing 43% of all ARV therapies in 2021 (166 499 annual treatments) to 82% in 2023 (290 263 annual treatments). PASB championed the expansion of shorter TB treatment regimens and shorter preventive treatment. This effort resulted in 11 countries acquiring pretomanid, BPaL (bedaquiline, pretomanid and linezolid), and BPaLM (bedaquiline, pretomanid, linezolid, and moxifloxacin) for treatment of drug-resistant TB, and 13 countries now have shorter preventive treatment regimens in place.

Advancing toward malaria elimination in the Americas: Belize achieved WHO certification of its malaria-free status in 2023. Suriname completed a second consecutive year without indigenous transmission of malaria, becoming the first Amazonian country to report zero malaria cases for a year. PASB provided technical cooperation to endemic countries to strengthen national capabilities in the surveillance, detection, and prevention of malaria. Additionally, it offered direct support and evaluations from experts in the field, as well as coordinated efforts among partners and institutions for malaria elimination, such as the Regional Malaria Elimination Initiative. 

Recovering measles and rubella elimination in the Americas: The Americas was the first world region to eliminate rubella and measles, in 2015 and 2016 respectively. However, Brazil and the Bolivarian Republic of Venezuela reestablished endemic transmission of measles due to outbreaks that lasted for more than two and four years, respectively. In November 2023, the Measles and Rubella Elimination Regional Monitoring and Re-Verification Commission, with PAHO as the secretariat, reverified the Bolivarian Republic of Venezuela as a measles-free country after circulation of the virus had been interrupted for four years. In addition, having received evidence of the interruption of the measles outbreak in Brazil, the Commission classified that country as pending verification. The Region of the Americas is on its way to recovering one of its most important public health achievements, the elimination of the endemic measles virus from the entire Region. All countries have maintained the elimination of rubella and congenital rubella syndrome since 2015, which is also an important achievement.

Employing innovative vector control strategies to prevent deaths due to dengue: In the context of the Grade 3 global emergency due to dengue, the dissemination and implementation of PAHO cooperation packages for clinical management made it possible to maintain low case fatality rates, at the targeted 0.05%.

Taking action to eliminate trachoma: PAHO began a new five-year collaboration with the Government of Canada ($12 million) to eliminate trachoma as a public health problem in 10 countries. The first year featured a strong emphasis on planning, coordination, development of methodologies and protocols, and implementation of integrated interventions. There was also a focus on integrating gender, cultural diversity, equity, and human rights approaches into the activities undertaken.

Advancing the Disease Elimination Initiative: The Director launched an internal inter-programmatic initiative in support of the existing work and relaunched the initiative at the 60th Directing Council in 2023. The effort goes beyond the disease-centered approach to ensure that health systems can address root causes, which are often the same for multiple diseases.

Reaching over 70% coverage of the COVID-19 vaccine in the Americas: The Region achieved this milestone as of 31 December 2023, with technical support from PAHO and longstanding partners such as the United States Government and Global Affairs Canada. Countries now include the vaccine as part of their basic vaccination schedules, while prioritizing the most vulnerable groups. A total of 2.19 billion COVID-19 vaccine doses were administered in the Americas thanks to the PAHO Revolving Fund, which enables equitable access to vaccines. Countries such as the Plurinational State of Bolivia, Colombia, and Costa Rica indicated successful integration of COVID-19 vaccination within primary health care.

Strengthening capacities for antimicrobial resistance surveillance: PASB played a key role in helping countries transition from reporting aggregated surveillance data to isolate-level data on antimicrobial resistance (AMR). This was done through the standardization of protocols and procedures in collaboration with the Latin American and Caribbean Network for Antimicrobial Resistance Surveillance (ReLAVRA+). The effort strengthened country capacities to improve the detection of emerging resistant pathogens or mechanisms, prompting an immediate containment response. This in turn reduced morbidity and mortality from infectious diseases and helped contain outbreaks of multidrug-resistant organisms. PASB supported the strengthening of fungal surveillance capabilities in countries by providing technical expertise for the establishment of surveillance systems and corresponding data collection and information systems. Additionally, the Bureau helped establish the first external quality assurance program for invasive fungal infections in Latin America and the Caribbean. This program is based at the Malbrán Institute in Argentina, which is a PAHO/WHO Collaborating Center on AMR.

Increasing political commitment to programs and interventions for infection prevention and control: The COVID-19 pandemic highlighted gaps in infection prevention and control (IPC) programs and practices and the growing burden of healthcare-associated infections, including those caused by multidrug-resistant organisms. In response, PASB provided tailored recommendations aimed at containing outbreaks, strengthening local IPC capacities, and guiding more targeted public health interventions. Moreover, PASB provided technical expertise for a pilot project to integrate AMR surveillance, IPC programs, and antimicrobial stewardship. This pioneering initiative, named INTEGRAR, was implemented in six hospitals in Paraguay.

Advocating for stronger governance of AMR National Action Plans: The AMR country self-assessment survey (TrACSS) in 2023 indicated that 90% of countries in the Region have formalized AMR multisectoral committees for the implementation of their AMR National Action Plans (NAP). These countries expanded their NAPs under a One Health approach by strengthening governance and regulatory frameworks and conducting costing exercises for NAPs. These efforts aimed to achieve greater accuracy in budgeting activities and advocated for government funds to be allocated to NAPs, ensuring the long-term sustainability of AMR activities. PASB, through the CCHD initiative, supported Argentina and the CARICOM countries to revitalize their national multisectoral committees. This renewal allowed the countries to resume or update NAP development and implementation and to expand their AMR surveillance and IPC capacities.

Strengthening food safety systems: During the biennium, monitoring and surveillance of foodborne illnesses in Latin America and the Caribbean was strengthened under the One Health approach. This included use of the States Parties Self-assessment Annual Report, section C13, to strengthen capabilities around food safety emergencies. PASB provided technical support in improving risk analysis capacities for food safety (risk management, risk assessment, and risk communication) through in-person training, and also assisted in improving laboratory capacities through chemical and microbiological proficiency tests organized by the Interamerican Network of Food Analysis Laboratories. Additionally, five countries (the Plurinational State of Bolivia, El Salvador, Guatemala, Guyana, and Honduras) have leveraged the Codex Alimentarius to enhance their food safety systems. Codex provides international standards, guidelines, and codes of practices for food safety and quality to ensure fair trade practices.

Advancing toward the elimination of canine rabies: Rabies control and prevention interventions were implemented in border areas of Brazil and the Plurinational State of Bolivia. PASB provided technical cooperation to begin the dog-mediated human rabies validation process in Argentina, Brazil, and Colombia. The 17th Meeting of Directors of Rabies Programs in the Americas (REDIPRA 17) was held in Colombia with the participation of official delegates from the health and agriculture sectors in 27 countries of the Region, and during this meeting the Regional Plan for the Elimination of Canine Rabies was approved.

Increasing production of and access to antivenoms through the Strategic Fund: The PAHO Strategic Fund has expanded its list of approved medicines to include lifesaving antivenom produced in both public and private national laboratories in the Region. This expansion aims to enhance countries’ access to antivenoms, particularly for emergency response situations. Countries and their national snakebite and envenoming programs now have access to regionally produced antivenoms through the Strategic Fund. Regarding the production of antivenoms, PASB coordinates the Latin American Network of Public Antivenom Manufacturing Laboratories (RELAPA), which works to enhance the quality of antivenom production in the Plurinational State of Bolivia and the Bolivarian Republic of Venezuela, ensuring the availability of high-quality medicines.