I was first aware of Chagas disease when I was studying at the school of Medicine. During a class, a professor of clinical medicine showed that, despite the scientific and technological advances made in other health issues, the epidemiological map of cases was very similar to that reported several years before by Salvador Mazza. In my case, it meant the best example of what I would later know as a “neglected disease”. That experience accompanied me during the rest of my undergraduate career and my residency, and was particularly strengthened during my fellowship years in perinatal infections, because vertical transmission of Chagas had already become the main route of generation of new cases in our country. 

At that time, and for that population of pregnant women, newborns and infants, there was a very good diagnosis technique available to detect these new cases of Chagas during the first days of life, a direct method known as micromethod or strout. This test is performed manually and requires specific personnel training and enough time available to perform the procedure and its corresponding individual reading. Every possible diagnosis involved considerable efforts and the results were rarely obtained during the first weeks of life. 

However, two encouraging events happened in 2007. On the one hand, research about techniques for the detection of DNA of microorganisms was in full development and new thermocyclers, usually used to measure HIV load, seemed to be more readily available, which allowed greater decentralization and consequent increased access. On the other hand, in that year, the Chagas Disease Law was passed in Argentina, which meant a very important achievement in terms of positioning the problem on the national health agenda. 

Time passed and my connection with Chagas disease continued from a new approach, Public Health, which allowed me to work on the strengthening of the perspective of Chagas and its relationship with professional skills during the training period of residencies for health professionals. This involved physicians as well as other professionals of the health team, since Chagas as a health issue is a perfect model that requires a comprehensive and interdisciplinary approach. Thus, attempts to solve this issue with a solely biological perspective are insufficient.

Some years later, I had a very valuable experience directly linked to management at the primary care level. It was a direct opportunity to work, once again, on a strategy that I had used during my career at the hospital, but on this occasion, it incorporated Chagas. The known initiative for the Elimination of Mother-to-Child Transmission of HIV and Syphilis decided to include Chagas disease and hepatitis B (EMTCT Plus). In addition, the update of the strategy involved a positive aspect: a large proportion of the actions had to be performed at the primary care level. By that time, an additional event made the scenario more encouraging: the pediatric formulation of benznidazole was close to being approved. The availability of this presentation would allow us to make children treatment simpler, facilitating dosage calculation and consequently offering more appropriate treatments for infants with early diagnosis, and minimizing the impact of parasite infection with practically no adverse effects on the child. At that time, having an additional direct diagnosis technique available, one that helped improve the opportunities of detection in infants born to seropositive mothers, gained more importance and the micromethod, the only method, depended on the availability of trained technical staff devoted to the diagnosis. Such human resources were scarce in the Metropolitan Area of Buenos Aires, where it is estimated that 36% of the total population of the country is concentrated. That is, even in urban areas where a large part of the target population lives, the availability of the diagnosis was limited. 

Some years later, the fact that I had the opportunity to work and make decisions with direct impact on national-level health policies, and that I had acquired important experience at the primary care level, along with the growing evidence generated by that time, allowed me to participate significantly in the decision-making on the incorporation of the molecular technique for the detection of Tripanosoma cruzi to the Chagas diagnosis Algorithm of the EMTCT-Plus strategy in 2022, as an additional alternative for the early diagnosis in babies of less than 10 months of age. This incorporation allows large maternity hospitals or laboratories across the country to collect and process samples and obtain results daily or weekly from all the babies born alive that are exposed in our country. Thus, it was possible to decide to incorporate a technique with high levels of sensitivity and specificity recommended by the maximum national health authority. Argentina is the first country in the region to incorporate this option to the diagnosis algorithms of the EMTCT-Plus strategy in the country. In that year, and after 15 years of the approval of the Chagas law in 2007, in an attempt to strengthen the health agenda for Chagas at the national level, the regulatory decree of the law was presented and signed. Thus, key rules of the law that enhance the importance of guides for the prevention, care, diagnosis and treatment of Chagas disease were operationalized. Therefore, the guides and their possible updates harmonize indications that arise from scientific evidence and are a reference regulatory framework to achieve the elimination of the disease in the near future. 

Despite the short journey, I consider that the goal of eliminating of Chagas disease can be achieved in the near future, and this certainty is based on facts. While the process has taken years, we have made progress that we can summarize in the following facts. Given the advances in the elimination of vector transmission in our country, at present most of the new cases are vertically transmitted. Indeed, according to the epidemiological analysis, every year between 800 and 900 babies are born with Chagas in Argentina. It is known that 98% of the births in our country occur in institutions, i.e., a hospital or maternity ward. There are two alternative detection methods for the diagnosis during the first days of life. In addition, there is a very efficient antiparasitic treatment with practically no adverse effects on children and adolescents; thus, every baby born with the disease has the possibility to receive an appropriate treatment with chance of cure and, therefore, a life free of disease. Similarly, this treatment gives every women of child-bearing age the possibility to avoid transmission to her future children as well as to attenuate the impact of the chronic forms of the disease. In summary, I am certain that in Argentina, why, what for, when and who are clear aspects in the approach to Chagas disease. Now we only need to commit to the “how”, with this “how” being the doubt that challenges us ethically and encourages us to attempt to achieve elimination.