Abstract
This commentary offers a note of caution about the negative social impact that may be inadvertently generated through malaria elimination activities. In particular, the commentary is concerned with the practice of describing people who remain at risk of malaria in low transmission settings as ‘hotpops’ or ‘reservoirs of infection’. The authors argue that since those at risk of malaria in elimination settings are often already socially marginalized – such as migrants, indigenous groups, ethnic minorities and poor rural communities – that care should be taken to avoid implementing programmes in ways that may inadvertently add to the social stigmatization of those most at risk of malaria in a low transmission setting. Programmes should avoid using language that identifies particular groups as a source of infection, and instead begin a broader shift in orientation toward engaging constructively with communities within elimination strategies. Programmes should promote monitoring and evaluation to ensure that unintended negative consequences such as stigma do not occur; advocate for appropriate resourcing (human, financial, other) to minimize the risk of short cuts being used to achieve an end game that may discriminate against specific groups; and strengthen community engagement activities in elimination setting to avoid targeting stigmatized groups and to empower communities to prevent outbreaks and re-introduction of malaria. In this way malaria elimination can be achieved without stigmatization.
Highlights
As malaria incidence declines globally, malaria is becoming increasingly concentrated in particular localities and demographic groups [1]
While malaria is not stigmatized in itself, this commentary offers an early warning about the adverse social impacts that may result if programmes are implemented in a way that inadvertently legitimizes already held social prejudices against marginalized peoples who are at risk of malaria
The authors propose four central points: (i) Malaria elimination is likely to increasingly involve marginalized people and, social and ethical considerations should be more strongly integrated into elimination strategies; (ii) malaria is not in itself stigmatized, there is the potential for stigma to arise within an elimination context if marginalized groups become seen as sources of ongoing infection and imported malaria; (iii) Language matters as it frames the perceived implications of disease; and (iv) There is a potential to achieve malaria elimination with minimal adverse social impact, if social perspectives are incorporated into programme strategies as more countries head towards elimination
Summary
As malaria incidence declines globally, malaria is becoming increasingly concentrated in particular localities and demographic groups [1]. It is important for programmes to recognize that as malaria elimination advances, those who remain at risk of malaria are likely to be people who are already in some way socially disadvantaged, as is often the case for migrants, displaced persons, ethnic minorities and rural communities that remain poor when the broader society is experiencing economic growth This exclusion may result from poverty, lack of citizenship, racism, exclusion from services, language barriers, class discrimination or other forms of social prejudice [12,14,16,18]. This should involve avoiding the use of highly negative language such as ‘hotpops’ and ‘reservoirs of infection,’ that explicitly identifies particular groups as a cause of ongoing transmission This is urgent in situations where migrants are described as sources of imported malaria while their health needs remain marginal to discussion [14,35].
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