Vectors With a Vengeance: How Venezuela’s Political Crisis Opens Doors to Disease

Since 1961, when it became the first World Health Organization (WHO)-certified country to eliminate malaria in most of its territory¹, Venezuela has been a leader in controlling vector-borne diseases in Latin America. The country’s commitment to eradicating the transmission of malaria was evidenced through its systematic and integrative infection and vector control, case management, preventive diagnosis, patient treatment, mass drug administration, use of volunteer community health workers, and sanitary engineering practices, such as housing improvement and water management.¹ In fact, the success of Venezuela’s public health intervention helped stimulate interest in eliminating malaria worldwide in the 1960s.¹

However, Venezuelans have endured a decade of political, economic, and social unrest, which has left the country in crisis. Once prosperous, Venezuela’s economy has been devastated by years of political repression, economic mismanagement, and corruption.² Most significantly demonstrated when Juan Guaidó, a National Assembly leader, declared himself the president earlier this year, in place of then current President Nicolás Maduro.²

Diseases on the Rise

Vector diseases are mosquito-borne viral illnesses, which are typically transmitted by female mosquitoes. Recent research has concluded that the ongoing humanitarian crisis in Venezuela may be fueling the resurgence of vector-borne diseases, such as malaria, Chagas disease, dengue, and Zika virus.

A study published in The Lancet evaluated healthcare data from Venezuela and found:¹

• Malaria: Between 2000 and 2015, there has an estimated 359% increase in malarial infections. This was followed by a 71% increase between 2016 (240,613 cases) and 2017 (411,586 cases), as a result of a decline in mosquito-control activities and medication shortages. This may be the largest increase in cases of malaria reported worldwide. Further, endemic malaria transmission is beginning to spread across the entire country, rather than remaining in isolated pockets.
• Chagas disease: One of the leading causes of heart failure in Latin America, Chagas disease may be resurfacing, with active Chagas disease transmission the highest it has been in 20 years. For example, based on samples collected between 2008 and 2018, seroprevalence in children aged <10 years was approximately 12.5% in some communities, compared with an all-time low of 0.5% in 1998.
• Dengue: The incidence of dengue increased more than 5-fold between 1990 and 2016. Research has identified an average incidence of 211 cases per 100,000 people between 2010 and 2016. The largest epidemic occurred in 2010, when 125,000 cases — including 10,300 with severe manifestations — were reported.
• Chikungunya: Outbreaks of this disease with epidemic potential also appear to be occurring more frequently. An estimated 2 million suspected cases of chikungunya, were reported in 2014 (incidence 6975 cases per 100,000 people) — more than 12 times higher than official national estimates.
• Zika: There is evidence that the incidence of Zika, a mosquito-borne viral infection that is particularly concerning in pregnant women, also appears to be growing. The estimated incidence of Zika during its epidemic peak is 2057 cases per 100,000 people.
• Leishmaniasis: There are several forms of leishmaniasis, a parasitic disease spread by the bite of phlebotomine sand flies. The most common forms are cutaneous leishmaniasis, which causes skin sores, and visceral leishmaniasis, which affects several internal organs, including the spleen, liver, and bone marrow.³ After a steady decline from 2006 to 2011, cases of leishmaniasis sharply increased in 2012. While the current incidence of the disease is unremarkable nationally, since 2006, endemic regions have expanded substantially.