title: When climate change couples social neglect: malaria dynamics in Panamá.
abstract: A major challenge of infectious disease elimination is the need to interrupt pathogen transmission across all vulnerable populations. Ethnic minorities are among the key vulnerable groups deserving special attention in disease elimination initiatives, especially because their lifestyle might be intrinsically linked to locations with high transmission risk. There has been a renewed interest in malaria elimination, which has ignited a quest to understand factors necessary for sustainable malaria elimination, highlighting the need for diverse approaches to address epidemiological heterogeneity across malaria transmission settings. An analysis of malaria incidence among the Guna Amerindians of Panamá over the last 34 years showed that this ethnic minority was highly vulnerable to changes that were assumed to not impact malaria transmission. Epidemic outbreaks were linked with El Niño Southern Oscillations and were sensitive to political instability and policy changes that did not ensure adequate attention to the malaria control needs of the Gunas. Our results illustrate how the neglect of minorities poses a threat to the sustainable control and eventual elimination of malaria in Central America and other areas where ethnic minorities do not share the benefits of malaria control strategies intended for dominant ethnic groups.
authors.affiliation: Departamento de Parasitología, Instituto Conmemorativo Gorgas de Estudios de la Salud (ICGES), Apartado Postal No. 0816-02593 , Ciudad de Panamá, República de Panamá
authors.forename: Lisbeth Amarilis
authors.initials: LA
authors.lastname: Hurtado
authors.affiliation: Departamento de Entomología Médica, Instituto Conmemorativo Gorgas de Estudios de la Salud (ICGES), Apartado Postal No. 0816-02593 , Ciudad de Panamá, República de Panamá
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Cáceres
authors.affiliation: Institute of Tropical Medicine (NEKKEN), Nagasaki University, 1-12-4 Sakamoto , Nagasaki 852-8523, Japan ; Programa de Investigación en Enfermedades Tropicales (PIET), Escuela de Medicina Veterinaria, Universidad Nacional, Apartado Postal No. 304-3000 , Heredia, Costa Rica.
authors.forename: Luis Fernando
authors.initials: LF
authors.lastname: Chaves
authors.affiliation: Departamento de Parasitología, Instituto Conmemorativo Gorgas de Estudios de la Salud (ICGES), Apartado Postal No. 0816-02593 , Ciudad de Panamá, República de Panamá
authors.forename: José E
authors.initials: JE
authors.lastname: Calzada
keywords: Anopheles albimanus; Gunas; Plasmodium; climate change; earth sciences; ecology; malaria; social exclusion