Rising Gold Prices Threaten the Feasibility of Malaria Elimination in Guyana

Abstract

Guyana reported a significant rise in malaria nationwide between 2008-2014. The surge was attributed by public health authorities to a temporal increase in gold mining activity in forested regions, without evidence of impairment of national control strategies. However, systematic analysis of the association remains lacking due to the remoteness of both malaria and mining, and collection of reliable data becomes exceptionally difficult. To overcome this challenge, we investigated the relation between international gold price and falciparum malaria transmission in Guyana between 2007-2019, using statistical inference and time series analysis. We also evaluated the association between falciparum cases and the El Nino-Southern Oscillation pattern, previously suggested as a major malaria driver. The proportion of falciparum malaria cases among temporary residents was highest during the years of peak gold price, consistent with circulation of individuals related to mining activity. Further, cases among all demographics showed a strong positive correlation with gold price but only in regions with mining camps. The highest cross-correlation occurred earlier among individuals representative of mining laborers, suggesting that transmission in mining camps is followed by infections in the community. Upon these findings, we were able to reliably forecast falciparum malaria trends using only gold price as the predictor variable. Last, the La Nina climatic events showed an additional, smaller positive correlation with malaria transmission. Our analyses evidence that the 2008-2014 falciparum malaria surge observed in Guyana was mainly driven by an increase in gold mining, while climate factors might have contributed synergistically. We propose that international gold price is a useful indicator of future cases of malaria. We conclude that the feasibility of malaria elimination in Guyana and in other areas in the Amazonian where malaria and gold mining overlap should be evaluated against the challenges posed by rapidly rising gold prices. Funding: PMD was supported by the Ramon Areces Foundation fellowship. PMD and COB were supported by NIH/NIGMS, grant number 5R35GM124715-02. Declaration of Interest: None to declare. Ethical Approval: Ministry of Public Health, Guyana granted access to non-identifiable surveillance data obtained from the Malaria Program /Vector Control Services under Institutional Review Board exemption. Further, Institutional Review Board exemption was obtained from Harvard School of Public Health (Boston, US), Human Research Protection Program, Protocol number IRB18-1638.