Assessing the role of global environmental change on malaria elimination and resurgence in South America.

Malaria is a vector-borne disease of significant global public health concern, which despite ongoing elimination efforts is resurging in areas of the world that had previously suppressed transmission. Resurgence in South America has been attributed to the political and humanitarian crisis in Venezuela, which is causing spillover of cases to neighbouring countries. Environmental change, including climate and land use modifications, have been implicated in driving malaria transmission, especially in the Amazon region which is undergoing widespread ecological changes as a result of development policies that promote deforestation.
Although much research has focused on identifying the predominant drivers of malaria incidence in South America, less attention has been directed towards understanding how environmental change impacts the risk of resurgence and elimination efforts. This is a crucial knowledge gap that needs to be addressed to tackle the current increasing malaria trends and assess future risk.

In an integrated approach that considers multiple components of global environmental change, I will use powerful Bayesian statistical models to investigate the impact of climate and land use changes, interventions and socioeconomic factors on malaria risk in South America. Firstly, exploratory models are used to understand to the risk of malaria resurgence in a border region of southern Ecuador that, until recently, had eliminated malaria. Secondly the interaction between environmental factors and socioeconomic pressures in driving rapid resurgence will be investigated in a malaria hotspot in Venezuela, which is undergoing intensive deforestation and socio-political change. Finally, responses of malaria vectors to anthropogenic environmental change in South America will be characterized in a meta-analysis and a regional model framework will be developed to understand the synchrony of malaria epidemics and the threat of resurgence. These findings will be important in understanding future malaria risk under different environmental change scenarios, as well as informing malaria elimination efforts in the region.