Francisco Becerra-Posada

Dengue remains the most important arboviral disease in the Americas and a growing global public health threat. The region experienced the largest dengue epidemic in recorded history during 2023–2024, with more than 13 million reported cases in 2024 alone, reflecting the combined effects of rapid urbanization, climate variability, population mobility, persistent social inequities, and weakened vector-control programs. This review summarizes and expands on the principal discussions of the First Dengue Summit of the Dengue Initiative of the Americas, held in Cartagena, Colombia, in September 2025. Major themes included the changing epidemiology of dengue; implementation and development of new-generation vaccines, including TAK-003 and Butantan-DV; advances in digital surveillance, outbreak forecasting, and clinical management; and integrated vector-control strategies. Particular attention is given to Wolbachia-mediated population replacement, supported by evidence from a cluster-randomized trial in Indonesia and large-scale quasi-experimental evaluations in Colombia and Brazil, which show substantial and sustained reductions in dengue incidence and hospitalization. In the Aburrá Valley, Colombia, city-wide deployment in Bello, Medellín, and Itagüí was associated with reductions exceeding 90% in notified dengue incidence where Wolbachia became established. The review also examines mathematical modeling, artificial intelligence, climate-informed surveillance, and integrated public health approaches. Persistent challenges include financial sustainability, healthcare inequities, climate change, insecticide resistance, and heterogeneous surveillance and health-system capacity. Coordinated, multisectoral, sustainable strategies that integrate vaccination, vector control, surveillance, community participation, and healthcare strengthening are essential to reduce the dengue burden and improve regional resilience.

Dengue remains the most important arboviral disease in the Americas and a growing global public health threat. The region experienced the largest dengue epidemic in recorded history during 2023–2024, with more than 13 million reported cases in 2024 alone, reflecting the combined effects of rapid urbanization, climate variability, population mobility, persistent social inequities, and weakened vector-control programs. This review summarizes and expands on the principal discussions of the First Dengue Summit of the Dengue Initiative of the Americas, held in Cartagena, Colombia, in September 2025. Major themes included the changing epidemiology of dengue; implementation and development of new-generation vaccines, including TAK-003 and Butantan-DV; advances in digital surveillance, outbreak forecasting, and clinical management; and integrated vector-control strategies. Particular attention is given to Wolbachia-mediated population replacement, supported by evidence from a cluster-randomized trial in Indonesia and large-scale quasi-experimental evaluations in Colombia and Brazil, which show substantial and sustained reductions in dengue incidence and hospitalization. In the Aburrá Valley, Colombia, city-wide deployment in Bello, Medellín, and Itagüí was associated with reductions exceeding 90% in notified dengue incidence where Wolbachia became established. The review also examines mathematical modeling, artificial intelligence, climate-informed surveillance, and integrated public health approaches. Persistent challenges include financial sustainability, healthcare inequities, climate change, insecticide resistance, and heterogeneous surveillance and health-system capacity. Coordinated, multisectoral, and sustainable strategies that integrate vaccination, vector control, surveillance, community participation, and healthcare strengthening are essential for reducing the dengue burden and improving regional resilience.

Latin America and Africa face complex public health challenges shaped by social, environmental, and epidemiological factors. This study conducts a comparative analysis of publicly available national health strategies and national policy documents from 52 countries in Africa and 12 countries from Latin America, supplemented with data from the World Health Organization (WHO) and Pan American Health Organization (PAHO). The analysis focuses on five domains: social determinants of health, environmental health, infectious diseases, non-communicable diseases (NCDs), and immunization. This study examines how these health priorities are represented in national policy frameworks. Across the reviewed country sample, national policy documents tend to emphasize challenges related to health care access, the growing burden of NCDs, and environmental risks. In selected Latin American countries, migration-related pressures, health system fragmentation, and uneven vaccination coverage are primarily highlighted. In selected African countries, policy priorities tend to focus on communicable diseases, infrastructure limitations, and large zero-dose populations. The study underscores policy priorities and highlights opportunities for cross-regional learning. Strengthening primary health care, improving domestic health financing, and enhancing environmental health governance emerge as key areas for policy development. These findings support the value of comparative policy analysis in informing context-sensitive and equity-oriented health strategies.

Objective. Analyze the impact of the COVID-19 pandemic on influenza vaccination coverage in some countries in the Americas. Methods. This descriptive ecological study included Argentina, Chile, and Uruguay and analyzed information on influenza vaccination coverage in the countries during 2018–2023. The study reports annual estimates of influenza vaccination coverage expressed as a percentage of the population. The sources used were those reported by the Pan American Health Organization/World Health Organization and the ministries of health of the countries studied. Results. Comparatively, vaccination coverage rates according to risk groups among Argentina, Chile, and Uruguay show a downward trend without reaching optimal vaccination coverage for 2018 to 2023. Increased vaccination rates were reported in 2020 for all age and risk groups, except in Uruguay for children under 5 years of age. Among pregnant women, Argentina reported higher coverage in 2020 with 77%, Chile 90% (2018), and Uruguay 55% (2020). Among health workers, all three countries reached their highest coverage in 2020 (100%) but reported a decrease for 2022. Conclusion. The studied countries have observed a decrease in post-COVID-19 influenza vaccination coverage. Therefore, they are working to achieve optimal coverage, not only in influenza risk groups but across the entire population. Data on influenza vaccination coverage are limited in some cases. The availability of new vaccines can provide greater immunogenicity, efficacy, and effectiveness. However, they represent a challenge for the Expanded Program on Immunization, which requires cost-effectiveness studies to evaluate new vaccines while experiencing restricted national budgets.

Introduction Zero-dose children (ZDC) are defined as those that have never been reached by routine immunization services. In Latin America, almost 2.7 million infants younger than 1 year of age, have incomplete vaccination schedules, and vaccine preventable diseases such as measles or polio have increase worldwide. ZDC are reported to reside in high risk and fragile settings, including remote-rural areas, urban slums, and conflict-affected areas. Identifying the problem and settings in each country is mandatory to propose possible solutions to the immunization coverage situation. Areas covered In November 2023, a group of experts of the Latin America Society of Pediatric Infectious Diseases (SLIPE) analyzed the global and regional reality of ZDC, and present in this document an updated reality of the Latin American region and the weight of the possible interventions to overcome this problem. Expert commentary Communication is a key element to improve vaccination coverage, as it is quality and use of vaccination data. Campaigns that deliver targeted and effective messages to communities and families, provide education about vaccination, avoid missed vaccination opportunities, and coordinate efforts across different sectors and communities, among other strategies, could improve the current immunization situation.

Annual influenza vaccination has been carried out for several years in the countries of the Southern Cone following the recommendations of the Pan American Health Organization and the Technical Advisory Group on Immunizations of said Institution. Although flu vaccination is always a challenge, a fact that provides predictability in its development for the countries of the Southern Cone is the seasonality of the influenza virus in that region. The target groups for vaccination have been changing and are currently they present some differences such as the age of vaccination in children and the inclusion of other groups of adults. We used on administrative coverage of influenza vaccination reported to PAHO/WHO by countries. In this study we seek to analyze the impact of the COVID-19 pandemic on influenza vaccination coverage in Latin America, specifically in Argentina, Chile and Uruguay. The study period was from 2018 to 2023. Although countries have been observing a decline in pre and post COVID-19 influenza vaccination coverage, countries are working to achieve optimal coverage, not only in established influenza risk groups, but in the entire population. Data on influenza vaccination coverage are limited in some cases. The availability of new vaccines that can provide greater immunogenicity, efficacy and effectiveness also represents a challenge for Expanded Program on Immunization EPIs in terms of the need to evaluate their incorporation, which requires cost-effectiveness studies in a context of availability of new vaccines for other vaccine-preventable diseases and restricted budgets.

Influenza behavior depends on several characteristics: the agent itself, the host response, and environmental changes that determine seasonality, presentation, disease severity, lethality, and intensity of contagion. Vulnerable populations, such as the elderly, people with underlying diseases, and incomplete vaccination status, can influence disease presentation and epidemiology. These information changes are necessary for existing surveillance systems. Special surveillance of human and animal diseases is necessary, considering recent outbreaks and epidemic waves of viral diseases such as avian influenza. This study analyzed the impact of the COVID-19 pandemic on influenza vaccination coverage in Mexico and Central America. We used existing data and information in the countries and what was reported to WHO and UNICEF on administrative coverage of influenza vaccination reported by the countries, and the PAHO surveillance databases for influenza and other respiratory viruses. Influenza vaccine application varies in Central American countries and Mexico. Vaccination schedules have been adapted following WHO and PAHO recommendations, and considering the epidemiological, organizational conditions and financial realities of each country. Surveillance systems must be prepared for a possible “tridemic” in humans involving influenza, SARS-CoV-2 and respiratory syncytial virus (RSV). Influenza-associated disease was considerably affected during the COVID-19 pandemic. Given the preventive measures implemented, cases were unusually low during 2021-22, but cases increased sharply in 2022-23 caused by influenza A and influenza A H1N1 pdm09, with some isolated cases of influenza B.

Introduction Zero-dose children (ZDC) are defined as those that have never been reached by routine immunization services. In Latin America, almost 2.7 million infants younger than 1 year of age, have incomplete vaccination schedules, and vaccine preventable diseases such as measles or polio have increase worldwide. ZDC are reported to reside in high risk and fragile settings, including remote-rural areas, urban slums, and conflict-affected areas. Identifying the problem and settings in each country is mandatory to propose possible solutions to the immunization coverage situation. Areas covered In November 2023, a group of experts of the Latin America Society of Pediatric Infectious Diseases (SLIPE) analyzed the global and regional reality of ZDC, and present in this document an updated reality of the Latin American region and the weight of the possible interventions to overcome this problem. Expert commentary Communication is a key element to improve vaccination coverage, as it is quality and use of vaccination data. Campaigns that deliver targeted and effective messages to communities and families, provide education about vaccination, avoid missed vaccination opportunities, and coordinate efforts across different sectors and communities, among other strategies, could improve the current immunization situation.

The Global Health Consortium at Florida International University developed an end-to-end solution framework based on the input of a diverse panel of experts from middle-income country (MIC) government agencies, public health think tanks, academia, and nonprofit organizations to identify mechanisms to help MIC governments and stakeholders increase access to novel vaccines for infectious diseases. The resultant layout can be deployed to improve vaccine discovery and development, strengthen regulatory processes, and boost vaccine production, access, and implementation. Mechanisms include policies and incentives MIC governments can use to stimulate vaccine investment and activity, as well as actions government agencies can take together with other stakeholders to coordinate efforts or build capabilities. Through a series of individual virtual interviews, we engaged diverse experts from MIC government agencies, public health think tanks, academia, and nonprofit organizations who understand the vaccine ecosystem, immunization policies, and population health financing at global, regional, and country levels. Responses were mapped, and in-depth questions were prepared for a group virtual discussion. This paper is the result of such a group discussion. The panel identified clear opportunities for MICs to improve locally-driven innovations and future access to novel vaccines. It proposes a solution framework for countries considering investing in vaccine research and development and innovation to use as a guide to evaluate the steps they could take to improve such an environment and incentivize innovation in vaccine development. It is hoped that this end-to-end solution framework will become a key resource to help MICs strengthen policies and take more actions to make such improvements.

Objectives and importance of study: The importance of health policy and systems research (HPSR) has been acknowledged since 2004 and was recognised by the United Nations World Health Assembly in 2005. However, many factors influence its development. This paper aims to analyse the impact of politics and political determinants on HPSR funding in selected countries of Latin America and the Caribbean. Methods: Using a standardised protocol, we performed an analysis of available data and financing structures for health research and HPSR, based on research in eight countries, including interviews with key stakeholders (n = 42). Results: Dollar depreciation and gross national product growth in the region may play a role in how governments fund research. There have been shifts in the political spectrum in governments, which have affected research coordination and funding in positive and negative ways. HPSR funding in some countries was dependent on budget decisions and although some have improved funding, others have regressed by decreasing funding or have completely cancelled financing mechanisms. Caribbean countries rely mainly on institutional funding. HPSR is recognised as important but remains underfunded; stakeholders believed it should be used more in decision making. Conclusion: Although HPSR is recognised as valuable for decision making and policy development, it does not have the financial support required to flourish in Latin America and the Carribean. Data on health research financing were not easy to access. There was little or no evidence of published reports or papers about research financing, health research funding, and HPSR funding in particular in the studied countries. Because of the fragility of health systems highlighted by the coronavirus disease 2019 (COVID-19) pandemic, HPSR should be of great relevance and value to both policy makers and funders.