The South American country's economic and political crises have helped usher in the return of a once eradicated illness, researchers report.
CARACAS — Malaria has made an alarming comeback in Venezuela after being all but eliminated. But trying to find a doctor who'll talk about it isn't easy. Most avoid conversations with journalists, and those who are willing to speak prefer to remain anonymous.
"Researchers are forbidden from giving out any epidemiological data, and so to cover their tracks, they publish indirectly, in partnership with international authors," says Álvaro Acosta, a specialist in molecular parasitology and professor at the Liverpool School of Tropical Medicine who has been living outside Venezuela for 27 years now.
The last time the government provided official figures on malaria was in November 2016, when it counted 245,000 infections and one death. More recently, the World Health Organization counted 655,000 cases for 2017, with 790 deaths. But researchers like Acosta and Oscar Noya, head of the Center for Malaria Studies (Centro de estudios sobre Malaria) at the Central University of Venezuela, suspect the figures are much higher. After conversing with colleagues, they estimate that there may be as many as 2 million cases, including relapses.
The panorama today is different.
The sad paradox about this exponential rise, says Acosta, is that Venezuela was the first country recognized as having eradicated malaria from most of its territory, attaining the very low rate of one case per 100,000 inhabitants in 1955. Most observers credit Arnoldo Gabaldón, a prominent healthcare official of the period, for that success.
After completing a Ph.D. at the Johns Hopkins University, Gabaldón returned to head the Malaria Division at the Venezuelan Health Ministry. His program included paying commissions to physicians distributing quinine, the first anti-malaria drug, and undertaking epidemiological studies and mosquito control programs that included zonal spraying with DDT, a pesticide now banned for being too toxic.
The panorama today is different. In a 2017 editorial in the journal PLOS Neglected Tropical Diseases, Acosta and several co-authors observed cutbacks in preventive healthcare in the decade after 2000 under the late Hugo Chávez, and even more under his successor, Nicolás Maduro.
The article's lead author, Peter J. Hotez of Baylor University in Texas, sees this as illustrating the collapse of healthcare amid a collapsing economy. A dearth of medicines and pesticides, but also fuel shortages that hamper movement, are obstructing mosquito control programs. Adding to the problem, Hotez explains, is that a number of experts have left the country.
New breeding grounds
Very little remains of the facilities and programs from Gabaldón's time, and what is left is under strict political control. Acosta says the School of Tropical Medicine at the Central University of Venezuela, where Dr. Noya works, has been vandalized three times. "They arrive with sticks and destroy everything," he says. "Computers, fridges, and freezers with -80 degrees temperatures where strains of fungi and parasites are kept. What's been lost is unthinkable and completely irredeemable."
Scientists are not the only ones who have been ransacked. The state of Bolívar near the border with Brazil has become a hotspot for illegal mining. The concentration of migrants in mining areas, their living conditions and the desolate landscapes mining forges, all favor malaria. As excavators dig the earth, they leave craters that duly become recipients of rainwater and thus refuges for mosquitoes.
Life in Venezuela continues under the threat of the mosquito-borne illness — Photo: Carlos Santos Colorado
Hotez says miners arrive unprepared. "They've never had contact with malaria," he explains. "Their immune systems aren't familiar with it and they live in the open air. There is a terrible problem with the mining industry and malaria in Venezuela."
A doctor who asked not to be named and works in one of three hospitals treating malarial infections in the city of Bolívar, in that state, says that every day half the patients entering the emergencies ward have malaria. "They can be diagnosed as soon as they come through the door," he says, referring to visible symptoms like trembling and clothes soaked in sweat.
Many, he says, were likely infected in the mining villages of Las Claritas and Tumeremo, some 296 kilometers away from Bolívar. The doctor's calculations are that about 33% of the infected were miners, followed by housewives who visit mining zones to sell lunches or other items. But the inability to exactly locate infections make control difficult, he adds.
The drugs don't work
Patients have told him they had to go to other towns for treatment as there was none in mining towns. Either that or the treatment options are controlled by "mafias' who often sell fake or expired pills for bits of gold. Patients, the doctor says, often arrive with advanced stages of the diseases. "With some, it has affected the brain," he says.
The physician is particularly concerned about increasing resistance to drugs due to a lack of proper checks on treatments. Many people come and are treated, but soon relapsed, he's noted. The physician thinks fake medicines, or patients saving up their prescribed drugs, maybe creating resistance in the Plasmodium parasite that causes malaria.
The inability to exactly locate infections make control difficult.
There are precedents for resistance to drugs or DDT, in northern parts of Latin America in the 1950s and later, in Cambodia and Taiwan. With confirmed reports of some mosquitoes on the Brazil-Venezuelan border becoming resistant to Sulfadoxine/pyrimethamine, there are real grounds for concern that Venezuela could also breed resistance to artemisinin, the fastest acting product against malaria.
As patients keep moving inside Venezuela and beyond, resistant strains could travel with them. Indeed, as Acosta and Hotez have already warned, malaria is no longer just Venezuelan health problem. It's increasingly becoming a regional threat.