Venezuela's socioeconomic and political crisis has caused a huge upsurge in malaria cases, undoing years of progress in battling the disease and endangering neighbouring countries. The study, by Dr Adriana Tami (University Medical Center Groningen, Netherlands and University of Carabobo, Valencia, Venezuela) and Professor María Eugenia Grillet (Central University of Venezuela, Caracas, Venezuela) --together with an international network of scientists -- says that final estimates for 2018 could show more than 1 million cases of malaria in Venezuela alone. The data is being presented at this year's European Congress of Clinical Microbiology & Infectious Diseases (ECCMID) in Amsterdam, Netherlands (13-16 April).
Over the last two decades, Venezuela has transitioned into a deep socioeconomic and political crisis. Once recognised as a regional leader for public health and vector control policies and programming, Venezuela's healthcare has fallen into a state of collapse, creating a severe and ongoing humanitarian crisis. Economic and political mismanagement have precipitated hyperinflation rates above 1 million per cent, impoverishment of its people and long-term shortages of essential medicines and medical supplies.
In particular, public health provision has suffered with an exodus of trained medical professionals and long-term shortages in medicines and medical supplies. As a result, the country -- which was once a leader in public health policies and disease control in Latin America -- is now facing a re-emergence of many deadly diseases on a scale scientists describe as "an epidemic of unprecedented proportions". In this context, diseases that were previously well-controlled, such as malaria, are turning into epidemics of unprecedented magnitude.
In this new study, Venezuelan scientists and clinicians, and a global network of health scientists assessed the impact of Venezuela's healthcare crisis on malaria and other vector-borne diseases and the spillover to neighbouring countries. The researchers draw on new Venezuelan public health records, the health records of bordering states (Brazil, Colombia), The data show that between 2000-2015 Venezuela witnessed a 4.6 fold increase in malaria cases (from 29,736 cases in 2000 to 136,402 in 2015), followed by a 71% increase in 2017 (411 586 cases) compared with 2016 (240 613). These figures were reported earlier this year in The Lancet Infectious Diseases.
By 2017, malaria cases in Venezuela represented more than half of cases in the entire WHO region of the Americas: these updated numbers (from the latest World Malaria Report in 2018), show the proportion from Venezuela to be 53% (519,209/975,700). This is an increase of more than 20 times since the year 2000, when Venezuela accounted for only 2.5% (29,736/1,181,095) of the cases in the continent.
The most recent estimates come from the Alianza Venezolana por la Salud/ Red Defendamos la Epidemiologia Nacional: a group of recognised clinicians and epidemiologists, including 4 ex-Ministers of Health. These estimates, covering January to June 2018, show 600,000 new cases of malaria in Venezuela alone in just these six months, and latest estimates (as yet non-final) suggest the country will report over 1 million new cases of malaria for the whole of 2018.
The authors say that high malaria incidence in Venezuela is positively correlated with an increase in illegal mining activities and forest exploitation (which take place largely in mosquito endemic areas) which are in turn strongly linked to the ongoing socioeconomic crisis.
In response to Venezuela's rapidly decaying situation, a massive population exodus (more than 3 million people) is ongoing towards neighbouring countries including Brazil and Colombia, causing a spillover of cases. Brazil has reported an escalating trend of imported cases from Venezuela from 1,538 (2014) to 3,129 (2017) with some areas reporting up to 80% of imported cases from Venezuela. Colombian data is still to be verified to reveal the origin of imported cases, but it can be said with certainty that cases are being imported from Venezuela, it is just not possible to say exactly how many.
The authors conclude: "The continued upsurge of malaria in Venezuela is becoming uncontrollable jeopardising the hard-won gains of the malaria control programme in Latin America. We urge national, regional and global authorities to take immediate action to address this worsening epidemic and prevent its further expansion beyond Venezuelan borders."