Political stability and health system resilience as determinants of malaria control: A comparative analysis of Ecuador and Venezuela (2000-2023)

Political stability and health system resilience as determinants of malaria control: A comparative analysis of Ecuador and Venezuela (2000-2023) | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Political stability and health system resilience as determinants of malaria control: A comparative analysis of Ecuador and Venezuela (2000-2023) Jose Daniel Sanchez Redroban This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8273645/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background: The post-2000 period in South America presents a striking paradox in malaria epidemiology: Ecuador achieved >>99 % reduction in malaria incidence approaching elimination, while Venezuela experienced one of the most severe resurgences in modern public health history. This study examines the systemic determinants underlying this divergence. Methods: We conducted a comparative case study analysis using epidemiological data from WHO and PAHO reports (2000-2023), integrated with political stability indices, health expenditure data, and governance indicators from World Bank databases. A multi-dimensional analytical framework assessed political stability, health system capacity, surveillance infrastructure, international cooperation, and community engagement strategies. Results: Ecuador reduced malaria cases from 106,641 (2001) to 757 (2023), achieving 99.3 % reduction through sustained political commitment (Political Stability Index: -0.34), consistent health expenditure (7-8 % GDP), robust surveillance systems (SIVE-Alerta), and strategic binational cooperation. Venezuela experienced a 1,217 % increase in cases (35,500 in 2000 to 467,421 in 2019) associated with political instability (PSI: -1.19), health expenditure collapse (8.1 % to >30,000 healthcare workers, surveillance system dismantlement, and expansion of illegal gold mining affecting 100,000 people. Venezuela accounted for >>50 % of regional cases and 73 % of malaria deaths by 2019, with massive case exportation threatening regional elimination goals. Conclusions: This analysis demonstrates that health system resilience--defined as capacity to withstand political and economic shocks--is the fundamental prerequisite for successful disease elimination. Technical interventions, regardless of sophistication, fail without stable governance, sustained investment, and institutional continuity. The Venezuelan crisis exemplifies how state collapse creates synergistic conditions for explosive disease transmission and regional destabilization. Global health strategies must integrate governance and political stability indicators into risk assessment frameworks for disease elimination programs. Full Text Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8273645","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":563685831,"identity":"73aa4d44-91f3-4e62-b251-b92f3984c5e4","order_by":0,"name":"Jose Daniel Sanchez Redroban","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABBUlEQVRIiWNgGAWjYDCCAyBUAGLxAHEFAwMbkJIgrMUApuUMgwRRWhjgWhjbIKrxauE7fvbggQ8GdfLm7GcPPvw573AdHwPzwds8DDbyuLRInslLODjD4LDhzp68ZAPJbYeBDmNLtuZhSDNswKHF4ECOwWEegwOMG27wmEkYgrXwmEnzMBxOwGWLwfk3Bof/GNTZA7WY/0icA9LC/w2o5T9uLTeAtjAYMCeCbGE42AC2hQ2o5QBOLZI33hgc7DE4nLzhTI6xZMOxdMk2ZjZjyzkGyTj9wnc+x/jDj4o62w3Hzxh+/FFjzS/f3vzwxpsKO5whhgUwgx1MgoZRMApGwSgYBRgAABXKVDTg9pRKAAAAAElFTkSuQmCC","orcid":"","institution":"Universidad Tecnológica Indoamérica","correspondingAuthor":true,"prefix":"","firstName":"Jose","middleName":"Daniel Sanchez","lastName":"Redroban","suffix":""}],"badges":[],"createdAt":"2025-12-03 20:53:11","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-8273645/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8273645/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":98751958,"identity":"4caa325e-9171-4ae9-a263-e92b67f9c3ca","added_by":"auto","created_at":"2025-12-22 09:13:40","extension":"json","order_by":0,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":6622,"visible":true,"origin":"","legend":"","description":"","filename":"8ead64f5f29f4bb9bf204a38c68e770a.json","url":"https://assets-eu.researchsquare.com/files/rs-8273645/v1/3e1aa1527955da704dd43473.json"},{"id":104398169,"identity":"7f94b352-ecf2-495e-ac08-c767c3de5365","added_by":"auto","created_at":"2026-03-11 12:00:09","extension":"pdf","order_by":1,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":496474,"visible":true,"origin":"","legend":"","description":"","filename":"MalariaEcuadoryVenezuela.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8273645/v1_covered_137270fb-6cfa-4b7f-9c0c-a1ea193f12d6.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Political stability and health system resilience as determinants of malaria control: A comparative analysis of Ecuador and Venezuela (2000-2023)","fulltext":[],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":false,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":true,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":true,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"","lastPublishedDoi":"10.21203/rs.3.rs-8273645/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8273645/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eBackground: The post-2000 period in South America presents a striking paradox in malaria epidemiology: Ecuador achieved \u0026gt;\u0026gt;99 % reduction in malaria incidence approaching elimination, while Venezuela experienced one of the most severe resurgences in modern public health history. This study examines the systemic determinants underlying this divergence.\u003c/p\u003e\n\u003cp\u003eMethods: We conducted a comparative case study analysis using epidemiological data from WHO and PAHO reports (2000-2023), integrated with political stability indices, health expenditure data, and governance indicators from World Bank databases. A multi-dimensional analytical framework assessed political stability, health system capacity, surveillance infrastructure, international cooperation, and community engagement strategies.\u003c/p\u003e\n\u003cp\u003eResults: Ecuador reduced malaria cases from 106,641 (2001) to 757 (2023), achieving 99.3 % reduction through sustained political commitment (Political Stability Index: -0.34), consistent health expenditure (7-8 % GDP), robust surveillance systems (SIVE-Alerta), and strategic binational cooperation. Venezuela experienced a 1,217 % increase in cases (35,500 in 2000 to 467,421 in 2019) associated with political instability (PSI: -1.19), health expenditure collapse (8.1 % to \u0026lt;1.18 % GDP), exodus of \u0026gt;\u0026gt;30,000 healthcare workers, surveillance system dismantlement, and expansion of illegal gold mining affecting 100,000 people. Venezuela accounted for \u0026gt;\u0026gt;50 % of regional cases and 73 % of malaria deaths by 2019, with massive case exportation threatening regional elimination goals.\u003c/p\u003e\n\u003cp\u003eConclusions: This analysis demonstrates that health system resilience--defined as capacity to withstand political and economic shocks--is the fundamental prerequisite for successful disease elimination. Technical interventions, regardless of sophistication, fail without stable governance, sustained investment, and institutional continuity. The Venezuelan crisis exemplifies how state collapse creates synergistic conditions for explosive disease transmission and regional destabilization. Global health strategies must integrate governance and political stability indicators into risk assessment frameworks for disease elimination programs.\u003c/p\u003e","manuscriptTitle":"Political stability and health system resilience as determinants of malaria control: A comparative analysis of Ecuador and Venezuela (2000-2023)","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-12-22 09:13:29","doi":"10.21203/rs.3.rs-8273645/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"f51eb136-d0e7-4e3a-a30e-7a657e42f5a8","owner":[],"postedDate":"December 22nd, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-02-26T19:54:47+00:00","versionOfRecord":[],"versionCreatedAt":"2025-12-22 09:13:29","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8273645","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8273645","identity":"rs-8273645","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}