Objectives

The primary goal of this project is to provide key entomological and epidemiological data that can inform malaria elimination campaigns in Panama. This project proposes to conduct fundamental research on the current state of malaria epidemiology in Panama, focusing on new malaria vectors in Eastern Panama (i.e., the Darien). This project will be conducted in collaboration between Duke University and the Institute of Scientific Research and High Technology Services of Panama (INDICASAT- AIP). We will obtain additional technical support from the Clinton Health Access Initiative (CHAI) and the Ministry Of Health in Panama. We leverage an existing study with funded by NASA to support the malaria elimination programs in Panama and Honduras, and eventually to support malaria control throughout Central America and the Caribbean. 

Rationale

Panama joined the Regional Malaria Elimination Initiative (RMEI) in 2017, one of eight countries in Central America and the Caribbean; at that time, only 689 cases of malaria were reported in Panama and elimination seemed imminent. Since joining RMEI, malaria has re-emerged as a major public health problem, with over 7000 cases reported in 2022, a 14-fold increase from 2018. There are no definitive explanations as to why this increase has occurred. Hypotheses range from increased testing, pandemic-related disruption of health services, supply chain issues, and tension between international and national priorities for setting control strategies. However, there are also a number of epidemiological factors that have been overlooked; for example, evidence suggests that Anopheles darlingi has expanded into the Darien from Colombia, which is a much more effective malaria vector than indigenous species such as An. albimanus and An. punctipennis. In addition, since 2010, there has been a major change in international migration through Panama: the total number of migrants moving through the Darien Gap began to increase around 2014, but by 2016, the percentage of migrants coming from malaria endemic-countries increased from around 15-20% to over 75%. This was exacerbated in 2021 and 2022 when the number of migrants unexpectedly jumped to exceed 10K per month with over 90% coming from malaria endemic countries. From an epidemiological point of view, there are many potential repercussions – introduction of new malaria strains, increased population at risk capable of transmitting malaria, extension of malaria transmission periods, increased habitat for malaria vectors, increased internal migration whereby Panamanians are selling products to migrants, and more. The impact of migration on the Panamanian communities where malaria is endemic has not yet been evaluated. Malaria ecology appears to have fundamentally changed in Panama, which could signal that previously successful interventions for control have reduced impact. As resources are currently being mobilized for a renewed pushed toward elimination, it is imperative to evaluate potential challenges regarding vector behavior, insecticide resistance, malaria diagnostic sensitivity, and treatment response.