Border regions are especially sensitive to the transmission of diseases. Despite being used to stop people from crossing from one country to the other, they cannot prevent the dissemination of viruses and other infectious diseases. Additionally, border regions are generally marginalized regions, whose populations are vulnerable to the country's inequalities - including in terms of public policies. Borders are a point of contact between countries and regions, and can be entry routes for epidemics.
In this context, Brazilian and French institutions have partnered to create an International Mixed Lab (LMI Sentinel), which will work to fight vector-borne diseases in Amazon border regions. LMI is an initiative of the French Research Institute for Development (IRD in French) together with Fiocruz, through the Instituto de Comunicação e Informação Científica e Tecnológica em Saúde - Icict/Fiocruz (Institute for Scientific and Technological Communication and Information on Health) with the support of Fiocruz Global Health Center (Cris-Fiocruz), and the Federal University of Brasília (UnB).
By using field research, geoprocessing, remote sensing and information technology, the project will start monitoring the relationship between climate change and malaria on the border between Amapá, in the North of Brasil, and French Guiana. The lab represents an opportunity to develop new technologies and methodologies, acting as a comprehensive information system that will gather data on the species of existing vectors, level of water in rivers, deforestation, urbanization, migrations, changes in the use of soil, among other things that influence disease transmission. Subsequently, the system will also cover surveillance of other vector-borne diseases, like zika, dengue and chikungunya, and other border regions, like the border between the state of Amazonas, Colombia and Peru.
Malaria is a severe public health problem in the Amazon region. In French Guiana, the number of cases reaches approximately 1,400 per year. Oiapoque, in Amapá, has approximately 4,000 cases every year, considered one of the regions where malaria is more frequently transmitted in the Americas. Additionally, after near one decade of malaria reduction in the Americas, the entire region recorded an increased number of malaria cases last year - in Brazil, the number of cases increased 50%.
Malaria surveillance is crucial exactly because of that. Historical series show that when the number of cases drops, control programs tend to relax, and the disease eventually returns. Evidence shows malaria cycle is associated with environmental conditions.
"We have observed that after a hot and rainy summer, with high level of water in rivers, we have a winter with a high rate of malaria. From the sentinel site, we can, for example, create an alert system, using some mathematical models to check for potential problems that might occur in the region", explains one of the project coordinators, Cristovam Barcellos, from Icict/Fiocruz. Barcellos said the project is in line with the UN Sustainable Development Goals, having the end of malaria by 2030 as one of its targets.
The Lab was launched on September 24th, at Fiocruz, and will broaden the ongoing efforts of the Cross-Border Observatory for the Environment, Climate and Vector-Borne Diseases, which has already been operating as an IRD 'young team' since 2016. Composed of 15 permanent members (8 Brazilian members and 7 French members) and 10 associate members in addition to 14 temporary members, LMI Sentinel will initially operate for 2 years, which may be extended for up to 8 years.
"This effort builds on other Fiocruz initiatives to control vector-borne diseases and climate change", said the Advisor of the Vice-Presidency for Research and Biological Collections of the Foundation, Eduardo Grault, during launching.
Personnel training is another LMI Sentinel priority. The lab will promote exchange opportunities and graduate master, doctorate and post-doctorate students, in addition to training local players on surveillance. The interface between geography and health, through the joint efforts of the Brazilian Climate and Health Observatory (OC&S-Fiocruz) and Universidade de Brasília Lab of Geography, the Environment and Health (Lagas-UnB), brings the Ministries of Health and Education together, to which both institutions are linked. IRD supports and internationally promotes the lab, which won a bid of the institution and was given a 40,000 euro budget per year to fund the mobility of its researchers.
"Each one of these institutions, with their missions, works to improve the health of Brazilians. They complement one another", said Helen Gurgel, professor at UnB and one of the project coordinators. Environmental risks, such as pollution, climate change and raining cycles, influence diseases in approximately 80%. Therefore, an integrated, systematic and multi-scale approach is needed to effectively respond to an ever-growing challenge.
Existing online platforms, like UNA-SUS and IRD-SESSTIM, will be used to train personnel and share the methodologies created by the Lab, which also intends to influence the public policies of both countries, in favor of a more effectively coordinated action towards surveillance.
"We need to build, maintain and strengthen a cross-disciplinary approach, both in terms of research, public policies and operational actions to control the disease on different scales", explains Emmanuel Roux who also coordinates the project and is a representative of Espace pour le Développement (Espace-DEV), linked to IRD.
Roux says this is also a form of South-South cooperation, as Brazil will become part of an international health geography network, with plenty of representatives in West Africa, such as Burkina Faso, Senegal, Benin and Ivory Coast.
About IRD: The Research Institute for Development (IRD) is a French public institution created after World War II to promote development. IRD is bound to two ministries, the Science, Technology and Higher Education Ministry and the International Relations Ministry.