Epidemiological evolution and historical anti-malarial control initiatives in Colombia, 1848-2019.

Abstract

The evolution of epidemiological transmission and the control measures implemented in Colombia have been the result of complex global and regional economic and political processes that occurred at different historical moments, since the dawn of the country's republican life. The development of economic activities for the production, exploitation and export of agricultural products, minerals and raw materials demanded in the international market, favored the necessary conditions for the emergence, expansion, resurgence and persistence of the endemic epidemic of malaria in the different stages studied. A common and fundamental element in the different defined historical moments was the importance given to malaria as an economic problem due to the negative externalities it imposed on the labor force. In addition, due to the role it played as a barrier that limited the exploitation of natural resources and raw materials of interest; as well as the impact that it caused to the flow and commercial exchange. The previous situation was framed with the growth, consolidation and geostrategic expansion of the United States, as the main commercial partner of the region, and its interest in the exploitation of resources and raw materials, cheap labor, the need to create new markets, which coincided with the goals of modernization and economic strengthening of Colombia. Taking into account different relevant milestones that occurred in the 1848-2019 period, the following stages were defined: Epidemiological emergence and re-emergence of tropical fevers in places of economic exploitation, 1848-1899;Emergence of a new paradigm, control in enclaves of economic interest, ports and cities, 1900-1949;Control to eradication, intensified control-eradication, prevention and control, 1950-1999;Prevention, control and elimination of malaria, 2000-2019. Historically, antimalarial control initiatives in the country have been directed, restricted and prioritized in places of political and economic importance. The technical-scientific intervention measures implemented in the different stages studied have been uncritically replicated without adapting to the epidemiological scenarios existing in the country. Finally, the antimalarial control measures implemented in Colombia have been imported and adopted from international health initiatives as a result of commitments and obligations acquired in the global commercial context.