Many a mile comes plague

August ends with bad news. Twelve Greek municipalities - Farkadona, Trikala, Palamas, Tempe, Achaean and Thebes (central Greece); Evrotas and Andravida-Kyllini (Peloponnesus); Chalcis (Euboea); Marathon (Attica); and Lagada and Pylaia (Thessaloniki region) - have banned blood donations because of malaria.

Greece was declared free of malaria by the World Health Organization in 1974. From 1974 to 2010, an average of 39 cases per year - mainly imported - were reported. In 2016, 65 new cases of malaria had been detected. Most of them (50) concern immigrants coming from the Indian subcontinent or African states.  Eleven cases involve Greek citizens returning from malaria-affected countries. Yet there are alsofour domestic cases. Imported cases are not, per se, worrisome (e.g., the UK had 1,400 cases of malaria in 2015, all imported). Domestic cases, on the contrary, imply the actual presence of the malaria parasite in a given region. Greek and international newspapers commented that malaria's return – after 40 years -  is probably due to the fact that the Greek public authorities can no longer afford mosquito-spraying programs. In other words, malaria should be included among deleterious consequences of the crisis of the Euro zone. Some media also suggested that malaria have been probably brought over by the large influx of migrants who have entered the country in the last years. "Many a mile comes plague", to quote Shelley.

No doubts that poor economic conditions are likely to be one of the major causes of the reemerging of malaria infection in Greece. The suspension of mosquito-spraying programs is likely to have negatively impacted, together with an overall deterioration of public health and social wellbeing. It is also probable that the malaria parasite was reintroduced by immigrants (although genotypic data would be necessary to state it with certainty). There is, however, an important piece of information that most commentators omit to mention. 

Most municipal spraying schemes to combat mosquito-borne diseases have been cut back in early 2010 and current figures are not the worst on record. The Hellenic Center for Disease Control and Prevention reported 96 malaria cases (imported 54 -  domestic 42) in 2011; 93 (imported 73 -  domestic 20) in 2012; 25 (22 imported - domestic 3) in 2013; 38 (all imported) in 2014; 85 (79 imported –domestic 6) in 2015. Where is then the rationale of the current emergency? In case, a crisis should have been declared during 2011 outbreak. Instead one had to wait till 2016 (4 cases of domestic transmission against 42 in 2011) for seeing the health crisis officially declared and blood donations suspended in twelve districts. Rather bizarre, isn't it?

Would it be too mischievous to suspect that the malaria emergency is occurring now also because of the refugee political crisis? The health emergency caused by refugees is probably one of the cards played in the complex negotiation, directly involving the Greece borders, between the European Union and Turkey.

One of the main problems with risk communication in public health and, notably, in outbreaks is that politicians can hardly resist the temptation to use communicable diseases as political weapons, to blackmail other countries and internal political opponents.  To be sure, one is not morally authorized to call it "bioterrorism", nevertheless it would be worth inventing an appropriate word to stigmatize such a vile habit.