Shrinking the Malaria Map

UCSF Global Health Group’s Malaria Elimination Initiative (MEI)

The Global Fund Allocates Funds to Address Malaria Resurgence in Venezuela

30 January 2020

On January 16, 2020, the Global Fund indicated that Venezuela will receive $19.8 million dollars for anti-malaria efforts between 2020 and 2022. The announcement followed the Global Fund’s initial decision last year to provide a three-year malaria allocation to Venezuela, whose status as an upper-middle income country would have otherwise made it ineligible to receive a grant. The Global Fund’s exceptional approval of funding for Venezuela seeks to address a deadly malaria resurgence, symptomatic of the political and economic crisis that has devastated the country in recent years.
“Venezuela was an example of malaria elimination in the past,” says Patty Sanchez Bao, Senior Officer for Global Health at the United Nations Foundation. “This is an unfortunate situation in which the political instability and the failures [have] affected the health system [and] definitely affected malaria efforts. [This] can show you how sensitive malaria is to the realness of the world.”

Hyperinflation, economic collapse, and governmental policies have fueled population movement to mining areas in Venezuela, where mosquito breeding sites, lack of sanitation, and outdoor living conditions have accelerated malaria transmission. Internal migration has also catalyzed the spread or reintroduction of the disease to previously malaria-free areas. Malaria morbidity in Venezuela increased by 893% between 2007 and 2017. With 471,995 estimated malaria cases and 423 estimated deaths in 2018, the country accounted for 51% of all cases in the World Health Organization (WHO) region of the Americas. In 2019, 323,392 cases were reported between January and October. Countrywide transmission is driven by the malaria situation in the three states of Amazonas, Sucre, and Bolívar, which collectively accounted for 90% of all cases in 2018.

The malaria resurgence in Venezuela has been exacerbated further by the erosion of public health capacity and systems. Shortages of diagnostic staff and supplies hinder malaria surveillance activities, while limited availability of antimalarial medicines and delayed or conditional treatment initiation fuel ongoing malaria transmission and complications. Logistical and operational challenges also restrict drug distribution, access to diagnostic and treatment services, and case management. Moreover, the quality, quantity, and distribution of such key vector control methods as bed nets and insecticides are substandard or limited.

Venezuela’s Master plan for strengthening the HIV, tuberculosis and malaria response in the Bolivarian Republic of Venezuela from a public health perspective will likely determine priorities for the use of Global Fund resources to address the above challenges. The Master Plan emphasizes improvements in governmental coordination; access to early diagnosis and immediate treatment; malaria care delivery and case management; surveillance and information management; vector control measures; and procurement of essential malaria drugs and commodities. In order to promote a transparent, multi-stakeholder process, a UN agency is expected to be heavily involved in coordinating and managing the Global Fund grant.

While critical in the absence of other funding sources, the Global Fund allocation to Venezuela cannot fully address the roots or implications of its political crisis, which threatens to disrupt malaria prevention and control efforts in nearby countries. Due to the international migration of four to five million Venezuelans between 2014 and 2019, Brazil, Colombia, and other host countries are experiencing a rise in imported malaria cases. In Brazil, such cases increased in number from 1,538 in 2014 to 3,129 in 2017. Cases imported from Venezuela accounted for 65% and 96% of all imported cases reported in Brazil and Colombia respectively during the first half of 2019. Peru and Ecuador also recorded imported malaria cases in 2018.

Such transmission patterns could reverse or prevent national and regional progress towards malaria elimination. In the WHO region of the Americas, Paraguay and Argentina have been certified as malaria-free, with El Salvador expected to receive certification soon. Additionally, several regional and global initiatives aim to accelerate elimination trajectories in South and Central America, as well as the Caribbean. “Every country in the region is committed to malaria elimination,” notes Patty. “There are regional strategies and guidelines and commitments, but these are always mobile targets because the world keeps changing…It’s not only reducing cases that countries are focusing on, but [also] creating the system to sustain zero.” If regional elimination efforts are to succeed, Venezuela must work with other countries to share critical surveillance data, strengthen health systems in border areas, and establish or enforce people-centered, humane mechanisms for addressing the health effects of international migration.