In May of last year, I wrote in this column that there is no way to eliminate malaria without respecting the forest and the people of the forest. Actions by the current government to curb illegal mining and deforestation, in addition to rebuilding the health system and its fundamental pillars, bring hope to the National Plan for the Elimination of Malaria, whose goal is to eliminate local transmission by 2035.
Of course, there are many priorities after years of dismantling. However, I think that putting Brazil on the path to eliminate malaria by 2035 should be a commitment of the current government.
Although mortality from malaria in Brazil is low (50 deaths out of 130,000 cases in 2022), the social and economic cost is high. Public spending on the health system with malaria in 2019 exceeded BRL 500 million. This does not include the social and economic costs due to the loss of quality of life and missed work and school days.
Therefore, eliminating malaria does not represent a cost, but an investment whose return impacts social and economic development and frees up resources that can be used in other health priorities.
Brazil can (and should) take important steps towards elimination using existing structures and technologies. For example, the incorporation of community health agents as an additional support to malaria control is essential for speedy diagnosis and treatment. In addition, the recent approval of the drug Tafenoquine is a huge advance as it reduces a treatment of up to 14 days to just one dose.
The use of surveillance data to guide the local response is a global recommendation. Brazil, compared to other countries with malaria transmission, has quality information systems. In addition, the deforestation alert system not only facilitates environmental monitoring, but also informs critical areas for possible malaria outbreaks.
The use of this data to inform control policies still needs to improve. Soon, the national malaria control program will train local teams to meet this and other crucial management demands.
It is important to highlight that 30 municipalities concentrate 80% of malaria cases, and only 16 municipalities represent 80% of falciparum malaria cases, responsible for the most lethal forms of the disease. Geographical concentration facilitates the implementation of elimination actions. Furthermore, with improved use of surveillance data, Brazil can advance subnational certification of disposal in several areas of the country.
The political commitment to eliminate malaria also helps prevent control actions from being relaxed due to the decline in the number of cases, something that has been observed historically.
There are emerging challenges that can compromise elimination efforts, such as drug and insecticide resistance and reduced sensitivity of rapid tests. In addition, a mosquito that transmits malaria adapted to the urban environment, originating in Asia, has rapidly expanded across the African continent and it is not unlikely that it will reach Brazil, as has happened in the past.
Therefore, the time window for eliminating malaria in Brazil is now.
Eliminating malaria will be a health, social, environmental, economic and humanitarian achievement. An achievement that will drive elimination efforts in other countries across the Americas. A legacy of uniting different sectors of government and society, and rebuilding a political commitment to human rights and the reduction of inequities.
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