Report for Latin American Member Countries

Latin America

11 November 2019

1. Current Status of 1) Volume of Nuclear Medicine Staff

Data Source: NUMDAB (Nuclear Medicine Database, IAEA) as of 2015 2) Volume of Nuclear Medicine Procedures

Data Source: NUMDAB (Nuclear Medicine Database, IAEA) as of 2015

3) Nuclear Medicine Centers : 200 Institutions in Latin America

Data Source: NUMDAB (Nuclear Medicine Database, IAEA) as of 2019

2. WFNMB Strategic Plan – Global

Universal health coverage leaving no COUNTRY behind • Quality care • Technology having emerged till now • Medical devices Availability, Affordability, Access, Equity, Innovation • Essential Medicines : Radiopharmaceuticals • Essential Medical Devices : SPECT or PET-CT Human Resources and Workforce • Training Curriculum for NM Physicians (IAEA) • Research Education Network

3. WFNMB Strategic Plan – Regional

Seeding and then Scale-up to the Individual countries’ needs Nuclear Medicine in the Context of Each Country’s Health Status • For Latin America and Caribbean countries, raising health workforce with possibility of Continuing Medical Education (CME) • Using IT infra with digital/mobile Healthcare possibility for Non- Communicable Diseases (NCDs) controls

4. Action plan for Latin America

• Raising a pioneer in each catching-up country (of Latin America) • Making critical mass of countries’ nuclear medicine physicians/scientists (in certain Latin Americas) • Using educational infra and contents (for example using RedCLARA)

5. Collaboration with AMRO/PAHO (Pan-American Health Organization) PAHO: 35 countries (1,014M population) • For central America or catching-up small countries, raising health workforce with possibility of CME • Using IT infra with digital/mobile Healthcare possiblity for NCD controls PAHO’s Radiological Health Program1 As part of the Health Systems Based on Primary Health Care (HSS), the Radiological Health Program includes: 1. Dignostic Imaging Services 2. Radiation Therapy Services 3. Health Technology Assessment and Management. – Incorporation of technology in Radiomedicine 4. Radiation Protection and Safety, and Radiological Emergencies 5. Quality Assurance in Radiology Facility Persons in Charge PAHO Regional Advisor in Radiological Health Dr. Pablo Jiménez

Mission - To strengthen the assessment, incorporation, regulation, management, and utilization of appropriate health technologies in medical imaging and radiotherapy services. - To provide technical cooperation to ensure radiation protection for the public, workers, patients and the environment.

Activities As part of the Health Systems Based on Primary Health Care (HSS), the Radiological Health program includes: 1. Diagnostic Imaging Services 2. Radiation Therapy Services 3. Health Technology Assessment and Management – Incorporation of technology in Radiomedicine 4. Radiation Protection and Safety, and Radiological Emergencies 5. Quality Assurance in Radiology Facility

1 Source: https://www.paho.org/hq/index.php?option=com_content&view=article&id=919:radiological-health- program&Itemid=42232&lang=en

6. Collaboration with IAEA IAEA Activities in Latin America and Caribbean: Human Health - ARCAL (Acuerdo Regional de Cooperacion en America Latina: The Regional Cooperation Agreement for the Promotion of Nuclear Science and Technology in Latin America and the Caribbean)  Objectives2 1. Improve efficiency and quality in the use of new technologies for the diagnosis and treatment of diseases. 2. Lack of appropriate technology management systems for planning, incorporation and maintenance of biomedical equipment. 3. Insufficiency of technologists in radiotherapy and nuclear medicine to cover the growing need linked to the emergence of new centers in the region. 4. Insufficient human resources in medical physics, in imaging services (nuclear medicine and radiology). 5. Insufficiency of comprehensive, functional and operational National Cancer Control Plans (PNCC). 6. Growing childhood obesity in the region, and it’s relationship with the incidence of non-communicable diseases, caused in part by the problems of malnutrition in early childhood.

Figure 8. Global inequity in access to radiotherapy units, from L Stevens presentation in 2019 IAEA Scientific Forum for 'Cancer Control' Sep 2019 - For Radiotherapy, USD 35.5 million mobilized by PACT (IAEA) since 2004 and $ 97 billion were requested to fill in the gap5

2 https://www.arcal-lac.org/sobre-nosotros/areas-tematicas/salud-humana/

7. National Research Education Network of Latin America 1) RedCLARA RedCLARA – Cooperación Latino Americana de Redes Avanzadas

American Cooperation of Advanced Networks)

Connected Institutions and Countries 3

3 https://www.redclara.net/index.php/en/

Appendix 1. WFNMB Officially approved as WHO Non-State Actor Period 2019-2021

(WHO Non-State Actor: WHO engages with non-State actors in view of their significant role in global health for the advancement and promotion of public health and to encourage non-State actors to use their own activities to protect and promote public health)

Persons in Charge WFNMB Focal Point WHO Designated Technical Officer Dr John Prior Dr Maria del Rosario Perez, WFNMB WHO Representative (2019~) Scientist , Dept. Public Health, Environmental and Social Determinants of Health, Radiation Program

Objective Support WHO on the identification and rational use of nuclear medicine technologies and devices for diagnostic and therapeutic purposes (e.g. application of nuclear medicine for the management of Non-Communicable Diseases (NCD)) including technical contribution to WHO scientific meetings, drafting/review of WHO technical documents, supporting advocacy and awareness raising.

Activities 1. Support WHO in the development of WHO publications on health technology and medical devices 2. Support WHO in the dissemination of information on WHO's messages, policies and programmes regarding nuclear medicine technologies and devices 3. Support WHO in the dissemination and technical implementation of the WHO lists of priority medical devices after their publication

2. Summary of Voices of Country Health Ministers in WHA 72 29 among 35 countries from American Regional Office (AMRO, office , USA)

Latin America countries under PAHO/AMRO WHO, Red-colored World Health Assembly (WHA) 72 Plenary Meeting, Transcription by DS Lee countries have population more than 50M 1) Countries population over 50 million in Latin America: , Mexico4 - Brazil: Neglected diseases and NCD. Fair pricing of medicines by pharmaceutical industry. BRICS campaign for breast feeding boosting vaccine coverage and Tuberculosis network. - : Reform of health care policies is ongoing. High level commission report that identifies health care deerminants and tried to mitigate shortcomings in global health has been launched. 2) South American Countries - : Chronic child malnutrition has fallen to 20% with innovative approaches and budgetary allocations. - UHC with access to high quality as human right (, Peru, , ). - Digital health coverage (Argentina, ) - Reform on taxation system (Paraguay) 3) Central American Countries - : Out-of-pocket to UHC. 1.3M migrants for 18 months requires another $110M - Health coverage for over 90% of the population (Colombia, ) / Vaccination Coverage for over 90% of the population () 4) Caribbean Countries - Climate Change is big concern; enhance climate resilience of health system - Food and Obesity (Barbados) and New Smart diagnostic center (Saint Vincent and the Grenadines) 5) Integrated approach with AMRO/PAHO (Pan-American Health Organization) and other national/international aspects - PAHO strategic vaccine fund (Paraguay) - Multi-dimensional strategies to mitigate sustainable development is needed - Accepted strategies for access to UHC promoted by PAHO including the adoption of care management model () - Develop climate change adaptation policy - Human resource development/ training on relevant health professionals (Suriname)

4 Imgaes were made using mapchart (Creative Commons) utility available free in http://mapchart.net/

3. Synopsis of Country Reports 63rd IAEA GC 31 Countries from Latin America and Carib

IAEA member (green) non-member Nuclear Weapon-Free Zone Treaty Nuclear Power Reactor current (black) (red) OPANAL(Organismo para la Proscripción or under construction (blue) and de las Armas Nucleares en la América Research Reactor in planning (red) Latina y el Caribe) 1) Agency for the Prohibition of Nuclear Weapons in Latin America and the Caribbean (OPANAL) promoted Nuclear Non-Proliferation Treaty (NPT) and Comprehensive Nuclear-Test-Ban Treaty (CTBT). All the 33 countries signed. Brazilian-Argentine Agency for Accounting and Control of Nuclear Materials (ABACC), too, keeping common system of accounting and control of nuclear materials. 2) ARCAL (The Regional Cooperation Agreement for the Promotion of Nuclear Science and Technology in Latin America and the Caribbean): 21 countries 3) 19 countries among 31 IAEA member countries reported Nuclear Issues: status and prospects of Nuclear Medicine/Radiotherapy/Nuclear Power Plant-Research Reactor

Collectively, JCPOA (Joint Comprehensive Plan of Action) was emphasized.

Country-wise - Argentina: 3 operational nuclear power reactors with capacity to radioisotopes - Brazil: Reactors capable of radioisotopes and radiopharmaceuticals, Insect control. - Bolivia: NM centers and radiotherapy in La Paz, Santa Cruz and El Alto with cyclotron and research reactor - : Radiopharmaceutical production capacity - Dominican Republic: 4 PET center and 3 cyclotrons. Mediterranean fruitfly control. - : Cancer control - Guatemala: Sterile insect and cancer control - : Fruitfly eradication - Mexico: Theranostic radiopharmaceuticals. Support of Costa Rica and - Peru: Improve diagnostic and treatment capabilities of cancer using medical radioisotopes, cervical cancer cure.