The campaign took place in northern Brazil during the construction of the Belo Monte Dam in the Xingu River, one of the largest hydroelectric dams in the world. From 2013 to 2017, the initiative slashed annual malaria rates from more than 1,200 cases to fewer than 60. But the program ended, and within a few years, infections had rebounded to more than 700 cases a year. This time, they were concentrated in the rural communities surrounding the river in the city of Altamira.
However, the study found that the malaria resurgence wasn't simply a result of how much forest had been cut down. Instead, cases tracked most closely with the forest edge, the boundary where intact forest meets cleared or open land. There, mosquitoes get everything they need to thrive: shade from the tree line, sunlit pools of standing water for their larvae, and people living or working close by.
"What made Altamira compelling was that the timing gave us something rare, close to a natural experiment," study co-author Eloise Skinner, an epidemiologist and postdoctoral research fellow at the University of Queensland in Australia, told Live Science in an email. The results of that natural experiment could help Brazil in its efforts to eliminate malaria from the country in the next decade, she said.
A program tied to temporary funding
As thousands of workers moved in, local health authorities and the dam's developers rolled out an intensive control program that involved spraying insecticides indoors, using mosquito nets, and deploying rapid diagnosis and treatment when cases did emerge. The goal was to head off outbreaks spread by Nyssorhynchus darlingi, the mosquito that carries the malaria-causing parasite in the Brazilian Amazon.
Cases plummeted despite the influx of workers, but once construction wrapped up and the program lost its funding, malaria came back.
Nyssorhynchus darlingi, the mosquito that spreads malaria in the Amazon, breeds in partially shaded bodies of water. (Image credit: Sabrina Simon)From the observations, the forest edge consistently emerged as the strongest predictor of increased malaria cases. For every 1% increase in the perimeter of the forest edge, malaria cases rose by roughly 0.7%; for every 1% increase in Altamira's population, who are located at the forest edge, cases rose by about 1.4%.
"When the funded program wound down, malaria came back to the communities that are hardest for the health system to reach," Skinner said. "The city stayed protected, most likely because fast diagnosis and treatment are easier to deliver and keep going in a town."
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Brazil aims to eliminate locally acquired malaria by 2035. Skinner said Altamira's near elimination of the disease, and its rebound within a few years of the control program ending, is a warning for that effort. When a community contains a strong environmental driver for malaria, like forest-edge ecosystems, stopping a control program short is sure to let the disease climb back.
"Because the resurgence wasn't diffuse, we can predict where malaria is likely to return first," Skinner said. "The message for a 2035 goal isn't only that elimination needs sustained investment. It is that where the environment drives risk, that risk is predictable, and planning for it from the start is what lets the money go where it matters most."
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