Opinion – Marcia Castro: Eliminating malaria in Brazil demands respect for the Amazon

On the 11th, the Ministry of Health launched the National Malaria Elimination Plan with the goal of eliminating local transmission by 2035. In 2021, 139,967 cases of malaria were registered in Brazil, 99% in the states of the Amazon region. Although mortality is low, the human cost of the disease is high and includes loss of work and school days, adverse events in pregnancy, among others.

The elimination plan consists of four phases with specific objectives. The first, called the phase-out phase, aims to reduce the number of new malaria cases to less than 68,000 by 2025.

The second, the consolidation phase of the reduction, aims, by 2030, to reduce the number of deaths from malaria to zero, reduce the number of new cases to less than 14,000 and eliminate falciparum malaria.

The third phase aims to keep the country free of malaria deaths and falciparum malaria transmission from 2030 onwards, and to eliminate malaria transmission by 2035.

The fourth and final phase, called prevention of re-establishment of transmission, aims to keep Brazil free from the disease.

The plan is welcome. However, there are challenges and the recently launched project lists five: expansion of primary care in actions to combat the disease, rapid diagnosis and treatment in remote areas, adaptation of surveillance actions to a scenario of elimination, technical training and combating malaria in indigenous areas and mining.

Brazil has the commitment and motivation of local teams, in addition to the technical and scientific capacity to overcome part of these challenges. Until 2019, there was direct integration between the National Malaria Control Program and scientists through a technical advisory committee.

Unfortunately, the newly launched plan does not provide for the reinstatement of the old advisory committee or the creation of a new one, even though this is one of the recommendations in the elimination guide provided by the Global Malaria Program.

The expansion of primary care requires strengthening and improving the financing of the SUS, in addition to innovative ways of incorporating technology. This would make it possible to improve and expand access in remote areas, without demanding high fuel costs for travel, an expense that most municipalities in the Amazon cannot afford. However, the current spending ceiling limits these actions.

One of the great challenges, however, are the current government’s strategies regarding environmental and indigenous issues, which represent a historic setback and have contributed to the increase in deforestation, the expansion of illegal mining and the violation of indigenous peoples’ rights.

These strategies contribute to the increase in malaria, and call into question the feasibility of eliminating the disease in Brazil by 2035.

Data from the Ministry of Health confirm this concern. From 2007 to 2018, on average, 13% of malaria cases were observed in indigenous areas and 5% in mining areas.

From 2019 to 2021 (current government), the averages increased to 31% and 10%, respectively. In 2021, 33% of cases were reported in indigenous areas, an increase of 31% compared to 2018, while 15% of cases were in mining areas, an increase of 274% compared to 2018.

Never since 2007 has the percentage of cases in these areas been so high. Although the number of malaria diagnoses has been declining since 2018, the only areas that register an increase each year are indigenous and mining areas.

If the “cattle” continues to pass through the Amazon, a scenario of Brazil without malaria is a utopia. There is no way to eliminate malaria without respecting the forest and the people of the forest.