When climate change couples social neglect: malaria dynamics in Panamá

Abstract

A major challenge of infectious disease elimination is the need to interrupt pathogen transmission across all vulnerable populations. Ethnic minorities are among the key vulnerable groups deserving special attention in disease elimination initiatives, especially because their lifestyle might be intrinsically linked to locations with high transmission risk. There has been a renewed interest in malaria elimination, which has ignited a quest to understand factors necessary for sustainable malaria elimination, highlighting the need for diverse approaches to address epidemiological heterogeneity across malaria transmission settings. An analysis of malaria incidence among the Guna Amerindians of Panamá over the last 34 years showed that this ethnic minority was highly vulnerable to changes that were assumed to not impact malaria transmission. Epidemic outbreaks were linked with El Niño Southern Oscillations and were sensitive to political instability and policy changes that did not ensure adequate attention to the malaria control needs of the Gunas. Our results illustrate how the neglect of minorities poses a threat to the sustainable control and eventual elimination of malaria in Central America and other areas where ethnic minorities do not share the benefits of malaria control strategies intended for dominant ethnic groups.

• Anopheles albimanus
• climate change
• earth sciences
• ecology
• Gunas
• malaria
• Plasmodium
• social exclusion

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When climate change couples social neglect: malaria dynamics in Panamá

We dedicate this work to the Gunas of Comarca Madungandí, with whom we are working to find suitable methods for malaria elimination from their communities, and the República de Panamá. We thank the Departamento de Control de Vectores del Ministerio de Salud, República de Panamá for their sustained support and cooperation with the malaria research performed by Instituto Gorgas in Comarca Madungandí. We also thank ETESA for sharing meteorological data. We thank Ms Milixa Perea from the Graduate Program in Epidemiology and Tropical Health at Universidad Latina de Panamá for Figure 1A. Ms Chystrie Rigg from the ICGES helped with the elaboration of Figure 1B. Luis Fernando Chaves is thankful to Ms. Junko Sakemoto for her administrative support at Nagasaki University. This study was supported by Instituto Conmemorativo Gorgas de Estudios de La Salud (José E Calzada, Lisbeth Amarilis Hurtado and Lorenzo Cáceres) and Nagasaki University-Program for Nurturing Global Leaders in Tropical and Emerging Communicable Diseases (Luis Fernando Chaves).

Note: Supplementary Information for this article can be found on Emerging Microbes and Infections' website (http://www.nature.com/emi/).