Venezuela is facing an escalating malaria crisis, even as the infection rates have continued to decline across most of the rest of the planet.
The situation is a shocking reversal in a country that was once seen as a flag bearer for global malaria eradication. Once the Americas’ most malaria-infected country, the disease was almost wiped out between the 1960s and the 1980s.
Now, however, while infection rates have been in decline across the rest of the Americas, malaria is exploding in Venezuela and cases are being exported across its borders as people flee conditions in the country.
This weekend’s re-election of Nicolás Maduro – Chavez’s political heir – suggests that any imminent change of policies may be unlikely.
Venezuela’s rising malaria rates are one of the most visible aspects of growing problems within the country’s healthcare system, with maternal mortality and cases of HIV and tuberculosis increasing as access to treatment has collapsed.
And the bleak irony – say analysts – is that the alternative system of health clinics in the country’s slums, set up by the late socialist president Hugo Chávez to bring healthcare to Venezuela’s poorest, may have contributed to the country’s dire provision.
The combination of corruption, the lack of quality healthcare and the economic crisis has created a time bombMarianella Herrera, Venezuela Health Observatory in Caracas
The catastrophic state of Venezuela’s malaria situation was underlined last month in comments by the head of the World Health Organization’s global malaria programme, Pedro Alonso, who reported that the incidence of this mosquito-borne disease in 2017, at 406,000, had jumped up 69% from the previous year’s figure and is in turn five times higher than the 2013 rate.
“In the Americas, it’s not just Venezuela. We’re actually reporting increases in a number of other countries. Venezuela – yes this is a significant concern. Malaria is increasing … in a very worrying way,” said Alonso.
Venezuela’s complex health emergency mirrors the country’s long-running political and economic crisis, and is marked by a shortage of drugs and materials for control of the disease, allied with a politicisation of healthcare and population movements driven by extreme poverty.
Cases have been appearing in the capital, Caracas – traditionally an area with a low incidence of malaria – where they have been imported by people returning from jobs in mines in the country’s south.
Writing recently in the journal Science, Venezuelan malaria expert Maria Eugenia Grillet outlined what was driving an “alarming” and “unprecedented” increase in cases of malaria.
Grillet blamed “economic and political mismanagement”, which she said had “precipitated a general collapse of Venezuela’s health system, creating an ongoing humanitarian crisis with severe social consequences”.
She added: “The malaria epidemic has been fuelled by financial constraints for the procurement of malaria commodities – such as insecticides, drugs, diagnostic supplies and mosquito nets – and surveillance activities, internal migration associated with illegal gold mining, and lack of provision and implementation of services.”
Those issues, say other experts, have been exacerbated by the Venezuelan government’s refusal to acknowledge the scale of the problem.
Most controversial will be the claim, made by health experts in Venezuela, of the contribution of the Misión Barrio Adentro clinic system established by Chávez and staffed by Cuban doctors – which is accused of undermining the country’s long established healthcare system.
Marianella Herrera, head of Venezuela Health Observatory in Caracas, echoes Grillet’s observations.
“Venezuela is one of four countries in the world, along with South Sudan, Yemen and Nigeria, where malaria is increasing sharply.
“The question is – why is it happening in Venezuela, which was the first country to eradicate malaria?
“The answer is that many of Venezuela’s health programmes have been weakened by the governments of the last two decades, in particular the prevention strategies for malaria, like DDT-spreading and health education.
“When they built the Barrio Adentro they did not integrate the new health system … Now the combination of corruption, the lack of quality healthcare and the economic crisis has created a time bomb.”
A second issue, according to Herrera, is the peculiarity of malaria-reporting in Venezuela, where many in the most affected areas suffer multiple reinfections.
“If you are a person who had malaria five years ago and go again to a malarial region and get reinfected, that gets reported as the same case, with the risk you do not get treated.”
A final issue is the way in which access to healthcare has become tied to the governing party via the carnet de la patria now being requested in addition to the traditional national ID.
The problems in Venezuela’s failing health system were also highlighted by a report late last year by the Toronto-based Icaso, which focused on the “triple threat” to the country of worsening malaria, TB and HIV provision.
Co-author Mary Ann Torres told the Guardian: “In large part, there is complete lack of government interest both because the current government has used healthcare as a political weapon and also because it does not want to admit that the first country to claim malaria elimination has a malaria crisis.
“They have not declared an emergency because that would be to admit that the Chávez revolution has failed, and failed miserably.”
Torres also warned that the nature of the crisis, which has seen up to 37,000 crossing the borders daily into other countries, had huge implications for Venezuela’s neighbours.
Working on the report, Torres said they had come across shocking stories.
“We heard about people breaking [an anti-malarial] pill in four because that was all they could get for their family.”
She fears too that the scale may not actually be known. “The worst part of the epidemic is in the south-east at the border with Brazil, which is where the mines are.
“It is very difficult to get data because everything there is so controlled. We have only heard rumours: that the military is selling nets or selling treatment, or exchanging treatment for other things.”
While the government has said little, even pro-regime websites like Venezuelanalyis.com have begun conceding the scale of the problem, although it blames “recent sanctions imposed by the US, Canada and the EU” for hindering Venezuela’s ability to pay for imports of food and medicine.