The Lancet Global Health, 

The Lancet Global Health

Elsevier - Publisher Connector 

Editorial
www.thelancet.com/lancetgh   Vol 4   November 2016 e761
Disease, conﬂ ict, and the challenge of elimination in 
the Americas
Good news from the Americas illuminated the global 
health scene in September. As the Ministers of Health 
from the western hemisphere gathered in Washington, 
DC, USA, for PAHO’s 55th Directing Council, a series 
of announcements conﬁ rmed the New World’s role as 
a pioneer of sorts in disease prevention and control. 
Repeating the pattern that began with smallpox in 
1971, polio in 1994, and rubella in 2015, the region 
of the Americas was declared the ﬁ rst in the world to 
be free of endemic measles on Sept 27. This feat was 
achieved through 14 years of unrelenting eﬀ orts to reach 
the farthest pockets of unvaccinated populations and 
document the end of transmission of a virus that still 
caused over 110 000 deaths worldwide in 2014, mostly in 
children under 5 years of age. It is a laudable achievement 
and a testament to the success of yearly national 
immunisation campaigns and eﬀ orts to educate the 
populations of the region on the innocuity and eﬃ  cacy 
of vaccines. The conﬁ dence in this essential global health 
tool in the countries of the Americas is highlighted in a 
recent article published in EBioMedicine, which shows that 
countries of the region reported low levels of scepticism 
on the dimensions surveyed, including the importance of 
vaccination and the safety and eﬀ ectiveness of vaccines. 
The fact that other countries or regions do not show the 
same conﬁ dence, and the related impact on vaccination 
coverage, underscore the fragility of the elimination 
status and the importance of persistently promoting the 
value of vaccines at the global level.
Achievements such as these educate us on the 
feasibility of reaching elimination goals. They perhaps 
also provide additional thrust for eﬀ orts towards harder 
to reach, more uncertain milestones. The Ministers of 
Health concluded their gathering at PAHO with a set of 
agreements on the prevention, control, and elimination 
of diseases in the Americas, including a plan of action for 
malaria elimination with ambitious goals for the next 
4 years. Elimination, if reached, would be a ﬁ rst step in 
a major global health quest: the eradication of malaria, 
a disease that currently threatens half of the world’s 
population, and in 2015 killed almost 500 000 people 
worldwide. Perhaps the Americas can show us once 
again how it is done.
While the region celebrated the elimination of 
one scourge, another—namely the devastating 
52-year civil war in Colombia—was also on the brink 
of history. Over the years, and within the confines 
of Colombia’s borders, the conflict has touched on 
many issues that are now at the forefront of global 
health and development. Rapid urbanisation, fuelled 
in large part by the displacement of millions fleeing 
violence, led to the creation of slums and all their 
related health issues. Those who stayed in conflict 
zones, many of them of indigenous and African 
descent, were left in a health services vacuum and 
now suffer the consequences, on maternal and child 
health in particular, and in terms of inequalities. A 
historic peace agreement between the Colombian 
Government and the Revolutionary Armed Forces of 
Colombia (FARC) was signed in Cartagena on Sept 26. 
Yet on Oct 2, the Colombian people narrowly rejected 
this agreement in a national referendum, sending 
back to the negotiation table a document considered 
by some as too lenient towards the FARC. 
So the promise of stronger social cohesion and 
human rights is not to be delivered just yet in Colombia, 
but the implications of the peace process and their 
potential impact on health must not be overlooked. 
Nobody denies the radical impact peace could have on 
these populations, and the now defunct agreement, 
negotiated with the active participation of women’s 
and minority groups in a process deemed by some as a 
model, had the consideration of health and  inequalities 
threaded throughout its terms. So wherever the 
process goes in Colombia from this point forward, 
that experience and the point reached on the way to 
peace remain a much needed sign of hope in a world 
where violence is on the rise. War and violence, or the 
absence thereof, are now integral building blocks of the 
development agenda since their inclusion in SDG16. 
In Colombia and elsewhere, peace—just like health—is 
a delicate balancing act that requires constant work, 
but we must remain convinced that it is attainable. 
■ The Lancet Global Health
Copyright © The Author(s). Published by Elsevier Ltd. This is an Open Access 
article under the CC BY license.
For EBM’s article on vaccine 
confidence see http://www.
ebiomedicine.com/article/
S2352-3964(16)30398-X/pdf
For PAHO’s plan to eliminate 
malaria see http://www.paho.
org/hq/index.php?option=com_
content&view=article&id=12543
&Itemid=1926&lang=en


Disease, conflict, and the challenge of elimination in the Americas 

Directory of Open Access Journals