Following the racist controversy over the role of migration sparked by the death from malaria of a young girl in Trento, is there something that genuinely warrants attention?
A young girl from Trento died of malaria at a hospital in Brescia during the night between Saturday 2 and Sunday 3 September, having previously been admitted first to Portogruaro and then to Trento with complications arising from the fact that she had diabetes, while on holiday with her parents in Bibione, in the province of Venice. According to reconstructions, the girl is believed to have contracted malaria at the hospital in Trento. Her death sparked widespread controversy over the possibility that the cause of the infection could be attributed to migrants arriving in Italy from regions where the disease is endemic. At the hospital in Trento, two children originally from Burkina Faso had been admitted for malaria, in different wards from the girl from Trento, after returning from a trip to their country of origin.
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The reality of the facts, however, is very different from the claims put forward by those who fuelled the racist controversy, given that the disease cannot be transmitted from one person to another. A reality that makes it almost impossible to trace the cause of this episode, which has very few precedents in our country. It is therefore essential to understand whether the anopheles mosquitoes present in Italy have or have not acquired the ability to transmit malaria efficiently.
Malaria is a disease for which no vaccine exists. This fact makes it one of the most lethal in the history of humanity. Its appearance dates back thousands of years, yet no one has ever managed to establish exactly what its origin was. A person who contracts malaria suffers damage to the kidneys and liver, and the disease generally manifests with a high fever. If diagnosed and treated promptly, the patient recovers without excessive complications. All too often, however, malaria affects people living in rural areas of regions such as sub-Saharan Africa and, to a lesser extent, South-East Asia, where it is difficult if not impossible to receive adequate care in time. For all these reasons, the World Health Organization estimated that in 2015 there were 212 million cases worldwide, resulting in the deaths of 429,000 people. A figure still very high, but down by almost 30 per cent compared to 2010, thanks to significant investment by international and philanthropic organisations, including that of Microsoft founder Bill Gates, who has made the fight against malaria one of the most important causes of his foundation.
Gates and his wife Melinda, however, have as their enemy to defeat not so much malaria as mosquitoes. It is these tiny insects that are the vectors — that is, those responsible for transmitting malaria to humans — along with other diseases such as yellow fever, dengue, chikungunya and Zika. This is why mosquitoes are the most lethal animals to humans, with 830,000 deaths a year.
Among mosquitoes, those that can be responsible for transmitting these diseases — if infected — are the females of the anopheles genus (Anopheles), which live in the aforementioned regions and in a few other parts of the world. A human being cannot transmit malaria to another human being unless there has been large-scale blood contact, for example through a transfusion. According to Fabrizio Pregliasco, an infectious disease specialist and virologist at the Department of Biomedical Sciences for Health at the Università degli Studi di Milano and medical director of the Istituto ortopedico Galeazzi in Milan, reached by the monthly magazine Vita, there are three hypotheses for contagion, all extremely rare: "Either infected mosquitoes were released from the luggage of a tourist from some endemic area and somehow reached the girl. Or there was blood contact with someone who was infected. Or, finally, one of our own anopheles mosquitoes managed to cause the infection."
These hypotheses therefore dismantle any theory aimed at blaming migrants, refugees or asylum seekers who arrive in our country by sea and dock at ports in the southern regions of our country. Despite the insinuations of certain Italian newspapers, which sparked a rather heated debate, it is not the fault of those fleeing (for example) sub-Saharan Africa on boats that a young girl died of malaria in a hospital in Trento at the beginning of September. The real issue is understanding how it is possible that a 4-year-old girl, who had never been abroad, let alone to areas where there is a likelihood of contracting the disease, was infected in Italy, given that we do not have "autochthonous" endemic malaria here, because there should be no infected anopheles mosquitoes capable of transmitting malaria.
This situation leads us to another question. Is it possible that local anopheles mosquitoes (which are nonetheless present in small numbers in Italy) have reached the stage of being "infected" despite the low number of malaria cases recorded in Italy? Because even though "autochthonous malaria" does not exist, Italy still records a few hundred cases per year (726 per year in the period from 2011 to 2015, according to data from the Ministry of Health) where the disease developed following travel abroad. In the case of Italians who were infected, they had often travelled for work, tourism or voluntary work. In the case of foreign nationals (around 80 per cent of the total), these are mainly people who had come to Italy to visit relatives or friends. Only 4 people died.
It is now therefore essential that entomologists — those who study insects — establish whether the possibility exists that this type of mosquito has returned to Italy or not. Many reports studying the effects of climate change on health state that diseases typical of tropical regions could spread to areas where they are currently absent, due to rising temperatures and the tropicalisation of the climate in some areas that were previously mild or temperate. Also according to the World Health Organization, the spread of malaria is heavily influenced by climate, even though "measuring the health effects of global warming is very difficult." Despite this, the WHO estimates that climate change could cause 250,000 additional deaths per year between 2030 and 2050. Of these, 60,000 would be caused by malaria itself, while the rest are divided between child malnutrition, heatstroke and dysentery.
Among the causes of the spread of malaria is the so-called "tropicalisation," which could "reintroduce or increase the transmission of malaria in countries with tropical or temperate climates (such as those of the Mediterranean, ed.) that have eliminated or managed to keep under control the transmission" of the disease, according to the article entitled "Climate change and malaria – A complex relationship," which appeared as early as 2010 in the United Nations magazine.
"The use of sensationalist headlines with no factual basis against foreign nationals, as well as undermining the credibility of journalism, violates the consolidated text of journalists' duties, particularly regarding the dissemination of health-related news, generating unfounded fears in public opinion. Generalisations aimed at inciting feelings of hatred and resentment on racial grounds conflict, beyond ethics and professional rules, with the primary mission of journalism, which must be able to build readers' trust by always respecting the substantial truth of the facts and the protection of others' identities"
(Nicola Marini President Odg, Beppe Giulietti President Fnsi, Raffaele Lorusso Secretary Fnsi)
While avoiding any form of alarmism and ruling out the possibility of human error, it would at the very least be welcome if media outlets were to attempt to investigate or to "seize the opportunity" to produce quality reporting and raise public awareness about one of the most serious threats to human safety — such as climate change — rather than cultivating fear, hatred and tension among people. Because if a 4-year-old girl from Trento died of malaria in 2017, and like her hundreds of other children around the world, the main reason is that no vaccine exists and we must continue on the path of research so that an antidote may be found soon.