Venezuela crisis threatens disease epidemic across continent - experts

Collapse of Venezuela’s healthcare system could fuel spread of malaria and other diseases across region

Experts have warned of an epidemic of diseases such as malaria and dengue on an unprecedented scale in Latin America following the collapse of the healthcare system in Venezuela.

Continent-wide public health gains of the last 18 years could be undone if Venezuela does not accept help to control the spreading outbreaks of malaria, Zika, dengue and other illnesses that are afflicting its people, experts have warned in a report published in the journal Lancet Infectious Diseases.

Venezuela was once a regional leader in malaria control, but as healthcare has collapsed there has been a mass departure of trained medics, the report says, creating a public emergency “of hemispheric concern”.

“These diseases have already extended into neighbouring Brazil and Colombia, and with increasing air travel and human migration, most of the Latin American and Caribbean region (as well as some US cities hosting the Venezuelan diaspora, including Miami and Houston) is at heightened risk for disease re-emergence,” says the paper.

The lead author, Dr Martin Llewellyn, based at the University of Glasgow, has called for global action. “The re-emergence of diseases such as malaria in Venezuela has set in place an epidemic of unprecedented proportions, not only in the country but across the whole region,” he said.

“Based on the data we have collected we would urge national, regional and global authorities to take immediate action to address these worsening epidemics and prevent their expansion beyond Venezuelan borders.”

He said that the figures were probably an underestimate because the Venezuelan government had shut down the institution responsible for collecting data for the World Health Organization.

“Venezuelan clinicians involved in this study have also been threatened with jail, while laboratories have been robbed by militias, hard drives removed from computers, microscopes and other medical equipment smashed,” he said.

People wait outside a health centre in San Felix, Venezuela, as they wait to get treatment for malaria.
People wait outside a health centre in San Felix, Venezuela, as they wait to get treatment for malaria. Photograph: William Urdaneta/Reuters

Malaria cases, in a country certified to have eradicated the disease in 1961, rose by 359% between 2010-15, from 29,736 to 136,402. They surged 71% from 2016-17, to 411,586, because of a decline in mosquito control and a shortage of antimalarial drugs.

The epidemic has been supercharged by the rise of illegal mining in the jungle near the southern border with Brazil, where reservoirs of the disease survived despite its official elimination nationwide.

Venezuelans had flocked to the area in recent years to dig and pan for gold in wildcat mines, as the economy collapsed and hyperinflation eroded salaries for professionals and workers.

Stagnant water in pits and unsanitary camps provided a perfect breeding ground for mosquitos, and malaria was soon endemic at many of the mines. Some miners and their families have endured dozens of bouts of the disease.

One woman working near the town of Tumeremo said her four-year-old had already had 13 bouts of malaria. After the last one, doctors warned her: “You have to choose – your daughter or the mine.” She moved to a different pit, but the family cannot afford to leave the area.

The transitory nature of mining work means the area’s problems have gradually affected vast swathes of the country, as infected workers took the disease home with their gold, reintroducing malaria to areas where it had been eradicated.

“I’ve never been to the mines,” said David Guevara, a 39-year-old builder queuing for malaria treatment in the industrial port of Ciudad Guyana, nearly 125 miles (200km) from the nearest mining camps.

It is his second episode of the disease. “There are no controls [on malaria] now,” he said. “And it’s the children who are paying for this.”

Workers dig in search of gold at an illegal mining camp near Tumeremo in Venezuela’s southern Bolívar state.
Workers dig in search of gold at an illegal mining camp near Tumeremo in Venezuela’s southern Bolívar state. Photograph: Carlos Garcia Rawlins/Reuters

There was rarely any malaria in the city before 2015, but now the government clinic where he is seeking medical help is always busy.

“It’s an epidemic here now. It’s a lie that you have to go to the mines to get it,” said Marina Gutierrez, a 25-year-old who has had eight bouts of malaria over the last year and was at the clinic to seek help for her daughter. “She had only just finished treatment two weeks ago. She got rid of it and then it came back.”

Geraldine Flores blames a serious case of malaria for her son’s premature birth. She went into labour with Yelbi Josue after she came down with the disease when she was seven months’ pregnant and working at the mines.

Chagas disease, one of the leading causes of heart failure in Latin America, may be resurgent, says the review. Dengue has risen more than fivefold between 2010-16. Six increasingly large epidemics were recorded between 2007 -16, compared with four in the previous 16 years.

Chikungunya and Zika outbreaks have epidemic potential, say the authors. There were an estimated 2 million suspected chikungunya cases in 2014, more than 12 times the official estimate.

“We call on the members of the Organisation of American States and other international political bodies to apply more pressure to the Venezuelan government to accept the humanitarian assistance offered by the international community in order to strengthen the buckling health system.

“Without such efforts, the public health gains achieved over the past 18 years could soon be reversed,” said Llewellyn.

Additional reporting by Clavel Rangel

Contributors

Sarah Boseley Health editor and Emma Graham-Harrison in Tumeremo

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