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Beyond diversity loss and climate change: Impacts of Amazon deforestation on infectious diseases and public health

Abstract

Amazonian biodiversity is increasingly threatened due to the weakening of policies for combating deforestation, especially in Brazil. Loss of animal and plant species, many not yet known to science, is just one among many negative consequences of Amazon deforestation. Deforestation affects indigenous communities, riverside as well as urban populations, and even planetary health. Amazonia has a prominent role in regulating the Earth’s climate, with forest loss contributing to rising regional and global temperatures and intensification of extreme weather events. These climatic conditions are important drivers of emerging infectious diseases, and activities associated with deforestation contribute to the spread of disease vectors. This review presents the main impacts of Amazon deforestation on infectious-disease dynamics and public health from a One Health perspective. Because Brazil holds the largest area of Amazon rainforest, emphasis is given to the Brazilian scenario. Finally, potential solutions to mitigate deforestation and emerging infectious diseases are presented from the perspectives of researchers in different fields.

Key words
Amazon rainforest; biodiversity; emerging infectious disease; deforestation; pathogens; public health

INTRODUCTION

The Amazon Basin is the largest river system in the world, encompassing more than 7 million square kilometers distributed between Brazil, Bolivia, Colombia, EcuadoDORNAS FP, RODRIGUES FP, BORATTO PVM, SILVA LCF, FERREIRA PCP, BONJARDIM CA, TRINDADE GS, KROON EG, LA SCOLA B & ABRAHÃO JS. 2014. Mimivirus circulation among wild and domestic mammals, Amazon Region, Brazil. Emerg Infect Dis 20: 469-472.r, French GuianaANA - AGÊNCIA NACIONAL DE ÁGUAS. 2019. Agência Nacional de Águas autoriza utilização do rio Xingu para Belo Monte, 2019. Available at: https://www.ana.gov.br/noticias-antigas/agaancia-nacional-de-aguas-autoriza-utilizaassapso.2019-03-15.1595176417. Access on September 23, 2019.
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, Guyana, Peru, Suriname, and Venezuela. With enormous biodiversity, most of Amazonia is located in Brazil, representing the largest biome of a country know by its thriving nature (Garda et al. 2010, PeresPARRIAULT MC, VAN MELLE A, BASURKO C, GAUBERT-MARECHAL E, MACENA RHM, ROGIER S, KERR LRFS & NACHER M. 2015. HIV-testing among female sex workers on the border between Brazil and French Guiana: the need for targeted interventions. Cad Saude Publica 31: 1615-1622. et al. 2010, LatrubesseLACERDA MVG, VAL FFA & MONTEIRO WM. 2019. Dilemma in the Brazilian tropical medicine: ‘Is speed more important than direction?’ An Acad Bras Cienc 91: e20190132. et al. 2017, Metzger et al. 2019).

Amazonia is a unique biome in many aspects, with importance in different spheres of life. This biome’s huge diversity of animal and plant species is per se a strong justification for its preservation. In addition, many benefits to human life come from direct or indirect interactions with Amazon ecosystems. Indigenous and traditional peoples live and preserve ecosystems and their cultures through the forest. For urbanized communities, among other benefits, the Amazon forest is a source of food, chemical compounds for the deveESCOBAR H. 2019. Amazon fires clearly linked to deforestation, scientists say. Science 365: 853.lopment of medicines, and raw materials for a wide variety of industries. The Amazon rainforest is also crucial for maintaining planetary health due to its pivotal role in regulating the Earth’s climate. In a broader perspective, protecting Amazon ecosystems is essential for biodiversity preservation, climate regulation, energy production, food and water security; it is also important for pollination, natural/biological control of pests, the region’s economy and human health, not forgetting to mention its aesthetic and cultural value. Amazon ecosystems have an important role for the dynamics and control of zoonotic diseases and vector-borne infections, a very important, although sometimes neglected, point which will be discussed in detail throughout this article (Suffredini et al. 2004, AlhoALHO CJR. 2012. The importance of biodiversity to human health: An ecological perspective. Estud Av 26: 151-165. 2012, BieskiBIESKI IGC ET AL. 2015. Ethnobotanical study of medicinal plants by population of Valley of Juruena Region, Legal Amazon, Mato Grosso, Brazil. J Ethnopharmacol 173: 383-423. et al. 2015, BakerBAKER JCA & SPRACKLEN DV. 2019. Climate benefits of intact Amazon forests and the biophysical consequences of disturbance. Front For Glob Change 2: 47. & Spracklen 2019, Metzger et al. 2019, Moraes et al. 2019, Valli & Bolzani 2019).

Global warming is an aspect of cliLEROY EM, EPELBOIN A, MONDONGE V, POURRUT X, GONZALEZ JP, MUYEMBE-TAMFUM JJ & FORMENTY P. 2009. Human Ebola outbreak resulting from direct exposure to fruit bats in Luebo, Democratic Republic of Congo, 2007. Vector Borne Zoonotic Dis 9: 723-728.mate change that has consequences for the spread of human infections (Shuman 2010, WattsVIEIRA CB, DE ABREU CORRÊA A, DE JESUS MS, LUZ SLB, WYN-JONES P, KAY D, ROCHA MS & MIAGOSTOVICH MP. 2017. The impact of the extreme Amazonian flood season on the incidence of viral gastroenteritis cases. Food Environ Virol 9: 195-207. et al. 2018). “Climate change” refers to changes in climate properties (temperature, precipitation, extreme events, and wind patterns) that persist for a long period of time (deDE ANDRADE FAG, GOMES MN, UIEDA W, BEGOT AL, RAMOS OS & FERNANDES MEB. 2016. Geographical analysis for detecting high-risk areas for bovine/human rabies transmitted by the common hematophagous bat in the Amazon region, Brazil. PLoS ONE 11: e0157332.cades or longer) (Liang & Gong 2017). The Earth’s average temperature is increasing at least in part due to anthropogenic actions, such as the emission of greenhouse gases from industries and extensive use of fossil fuels (LevitusLEITE-FILHO AT, PONTES VYS & COSTA MH. 2019. Effects of deforestation on the onset of the rainy season and the duration of dry spells in southern Amazonia. J Geophys Res Atmos 124: 5268-5281. et al. 2001, Huber & Knutti 2012, Powell 2015, Letcher 2019).

A robust body of evideDASZAK P, CUNNINGHAM AA & HYATT AD. 2001. Anthropogenic environmental change and the emergence of infectious diseases in wildlife. Acta Trop 78: 103-116.nce shows that deforestation of AmaLORENZ C, AZEVEDO TS, VIRGINIO F, AGUIAR BS, CHIARAVALLOTI-NETO F & SUESDEK L. 2017. Impact of environmental factors on neglected emerging arboviral diseases. PLoS Negl Trop Dis 11: e0005959.zon forest is a fundaDANTAS-TORRES F. 2008. Bats and their role in human rabies epidemiology in the Americas. J Venom Anim Toxins incl Trop Dis 14: 193-202.mental driver of climate change (ShuklaSCHULER-FACCINI L ET AL. 2016. Possible association between Zika virus infection and microcephaly - Brazil, 2015. MMWR Morb Mortal Wkly Rep 65: 59-62. et al. 1990, Werth & Avissar 2002, Malhi et al. 2008, KhannaKEESING F ET AL. 2010. Impacts of biodiversity on the emergence and transmission of infectious diseases. Nature 468: 647-652. et al. 2017, Lovejoy & Nobre 2018, Baker & Spracklen 2019). About 20% of the original Amazon forest cover in Brazil has already been deforested (INPE 2019). Recently, policies, laws, agreements, funds, and practical actions focused on Amazon protection have been weakened in Brazil, encouraging deforestation (Carvalho et al. 2019, Ferrante & FearnsideFARIKOSKI IO, MEDEIROS LS, CARVALHO YK, ASHFORD DA, FIGUEIREDO EES, FERNANDES DVGS, SILVA PJB & RIBEIRO VMF. 2019. The urban and rural capybaras (Hydrochoerus hydrochaeris) as reservoir of Salmonella in the western Amazon, Brazil. Pesq Vet Bras 39: 66-69. 2019, Pereira et al. 2019, Seymour & Harris 2019). It is evident that, after a period when conservation policies were intensified in Brazil, which resulted in positive impacts on Amazon protection (West et al. 2019), deforestation in the region started to grow again (ArtaxoARTAXO P. 2019. Working together for Amazonia. Science 363: 323. 2019, Fearnside 2019). Along with environmental problems and the weakening of environment-related policies, lack of science funding will also cause economic losses for the country (Magnusson 2019). The current degradation status of the Amazon rainforest is already very serious, but, if this situation is not appropriately handled, the forest and climate situation on Earth will become increasingly worrying.

The association between anthropogenic action in the Amazon rainforest, climate change, alterations in vector dynamics, human migration, genetic changes in pathogens and the poor social and environmental conditions in many Latin-American countries can give rise to the “perfect storm” for the emergence and re-emergence of human infectious diseases in Brazil and other Amazonian countries. The recent Zika virus epideDE OLIVEIRA ALVES N ET AL. 2017. Biomass burning in the Amazon region causes DNA damage and cell death in human lung cells. Sci Rep 7: 10937.mic and the spread of denguGRISOTTI M. 2016. The challenges of health care in relation to the Belo Monte Dam context. Ambiente & Sociedade 19: 287-304.e, chikungunya and yellow fever cases are just a few examples of diseases that affect countries in the Amazon region and even other regions of the globe (EllwangerELLWANGER JH & CHIES JAB. 2016. Emergent diseases in emergent countries: we must study viral ecology to prevent new epidemics. Braz J Infect Dis 20: 403-404. & Chies 2016, Lima-CamaraLEVITUS S, ANTONOV JI, WANG J, DELWORTH TL, DIXON KW & BROCCOLI AJ. 2001. Anthropogenic warming of Earth’s climate system. Science 292: 267-270. 2016, Schuler-FacciniSANCHEZ JF, CARNERO AM, RIVERA E, ROSALES LA, BALDEVIANO GC, ASENCIOS JL, EDGEL KA, VINETZ JM & LESCANO AG. 2017. Unstable malaria transmission in the southern Peruvian Amazon and its association with gold mining, Madre de Dios, 2001-2012. Am J Trop Med Hyg 96: 304-311. et al. 2016, DonaliALI S ET AL. 2017. Environmental and social change drive the explosive emergence of Zika virus in the Americas. PLoS Negl Trop Dis 11: e0005135.sio et al. 2017, Goldani 2017, GregianiniGOVEIA CO, SOUZA E GUIMARÃES RJP, NUNES MRT, DIAS IHL & ENK MJ. 2019. Schistosomiasis Mansoni in the Amazon Region: malacological surveys of intermediate hosts for the identification of disease transmission areas in Belém, Pará, Brazil. JPP 7: 51-60. et al. 2017). Amazonian fauna hosts a huge diversity of well-known pathogens, as well as many other potential new or even unknown pathogens (VasconcelosTUNDISI JG, GOLDEMBERG J, MATSUMURA-TUNDISI T & SARAIVA ACF. 2014. How many more dams in the Amazon? Energy Policy 74: 703-708. et al. 2001, AbrahãoABRAHÃO JS ET AL. 2010. Vaccinia virus infection in monkeys, Brazilian Amazon. Emerg Infect Dis 16: 976-979. et al. 2010, DornasDONALISIO MR, FREITAS ARR & VON ZUBEN APB. 2017. Arboviruses emerging in Brazil: challenges for clinic and implications for public health. Rev Saude Publica 51: 30. et al. 2014, BonatoBONATO L, FIGUEIREDO MAP, GONÇALVES LR, MACHADO RZ & ANDRÉ MR. 2015. Occurrence and molecular characterization of Bartonella spp. and hemoplasmas in neotropical primates from Brazilian Amazon. Comp Immunol Microbiol Infect Dis 42: 15-20. et al. 2015, Soares et al. 2015, BarrosBARROS BCV ET AL. 2018. Rotavirus A in wild and domestic animals from areas with environmental degradation in the Brazilian Amazon. PLoS One 13: e0209005. et al. 2018, da SilvaSEO M, CHAI JY, KIM MJ, SHIM SY, KI HC & SHIN DH. 2016. Detection trend of helminth eggs in the strata soil samples from ancient historic places of Korea. Korean J Parasitol 54: 555-563. et al. 2018, FernandesFEARNSIDE PM. 2017b. Deforestation of the Brazilian Amazon. In: Shugart H (Ed), Oxford Research Encyclopedia of Environmental Science. New York, USA: Oxford University Press. https://doi.org/10.1093/acrefore/9780199389414.013.102.
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et al. 2018, Farikoski et al. 2019, Franco Filho et al. 2019, Medeiros & Vasconcelos 2019). Although several of these pathogens may have low epidemic potential in humans, this abundance of microorganisms in the Amazon region indicates that emergence of new infections from the forest is a constant threat to human health.

The link between “environmental imbalances” and “emerging infectious diseases” is already well established in the literature (Daszak et al. 2001, Weiss & McMichael 2004, Jones et al. 2008). However, descriptions and discussions regarding the factors involved in the emergence of infectious diseases due to deforestation specifically in the Amazon region are still scarce. As an attempt to foster this discussion, we review problems and activities associated with the Amazon deforestation and their impacts on the dynamics of infectious diseases and on human/public health.

Many examples cited in this article refer to the Brazilian context. However, such examples can be, at least in part, extrapolated to other countries in the Amazon region due to the similarity of social and environmental aspects. Finally, a problem as complex as the impact of Amazon deforestation on infectious diseases needs to be addressed using the One Health concept, in which characteristics of human, environmental, and animal health are considered in a unified way to detect, understand, and solve public health problems (Lee & Brumme 2013, Halliday et al. 2015, Ellwanger et al. 2017, Destoumieux-GarzónDESJEUX P. 2004. Leishmaniasis: current situation and new perspectives. Comp Immunol Microbiol Infect Dis 27: 305-318. et al. 2018). This article therefore approaches Amazon deforestation and the impacts on infectious diseases from different fields and perspectives, such as genetics, human health, microbiology, veterinary medicine, public health, and ecology (Table I). The selection of the studies included in Table I respected the authors’ suggestions, which were based on each author’s background in a given field of study. Following this approach, the studies in Table I exemplify, from different disciplines, how the Amazon deforestation can impact different aspects of infectious diseases.

Table I
Selected examples of problems and phenomena associated with Amazon deforestation and their impacts on infectious diseases.

PROBLEMS AND ACTIVITIES ASSOCIATED WITH AMAZON DEFORESTATION AND THEIR IMPACTS ON INFECTIOUS DISEASES

Climate change and extreme weather events

The Amazon rainforest plays a pivotal role in regulating Earth’s climate (BonanBONAN GB. 2008. Forests and climate change: forcings, feedbacks, and the climate benefits of forests. Science 320: 1444-1449. 2008, MalhiMACHOVINA B, FEELEY KJ & RIPPLE WJ. 2015. Biodiversity conservation: The key is reducing meat consumption. Sci Total Environ 536: 419-431. et al. 2008). In this sense, Amazon deforestation leads to regional and global average temperature rise (Baker & Spracklen 2019, CohnCHECKLEY W, EPSTEIN LD, GILMAN RH, FIGUEROA D, CAMA RI, PATZ JA & BLACK RE. 2000. Effect of El Niño and ambient temperature on hospital admissions for diarrhoeal diseases in Peruvian children. Lancet 355: 442-450. et al. 2019, PrevedelloPINHEIRO FP, BENSABATH G, ANDRADE AHP, LINS ZC, FRAIHA H, TANG AT, LAINSON R, SHAW JJ & AZEVEDO MC. 1974. Infectious diseases along Brazil’s Trans-Amazon highway: surveillance and research. Bull Pan Am Health Organ 8: 111-122. et al. 2019), and changes in the Amazon biome are associated with an increase in the frequency of extreme weather events, such as droughts, altered rain patterns, heat waves, cold waves, and severe storms (NepstadMORSE SS. 1995. Factors in the emergence of infectious diseases. Emerg Infect Dis 1: 7-15. et al. 2008, SenaSANTOS VRC, MEIS J, SAVINO W, ANDRADE JAA, VIEIRA JRS, COURA JR & JUNQUEIRA ACV. 2018. Acute Chagas disease in the state of Pará, Amazon Region: is it increasing? Mem Inst Oswaldo Cruz 113: e170298. et al. 2014, WuWILCOX BA & ELLIS B. 2006. Forests and emerging infectious diseases of humans. Unasylva 57: 11-18. et al. 2016, Stoy 2018, Leite-Filho et al. 2019). Deforestation also facilitates forest fires, since degraded areas are naturally more susceptible to combustion. Intentional fires are a frequent problem in the Amazon region (AlencarALENCAR AA, BRANDO PM, ASNER GP & PUTZ FE. 2015. Landscape fragmentation, severe drought, and the new Amazon forest fire regime. Ecol Appl 25: 1493-1505. et al. 2006, 2015, Nepstad et al. 2008, Escobar 2019). Pollutants resulting from deforestation and agricultural fires represent a serious health threat in a broad perspective. Particulate matter emitted from the burning of biomass in the Amazon region exposes humans to an increased risk of DNA damage, gene mutations, inflammation, and cancer (de Oliveira Alves et al. 2017, de Oliveira Galvão et al. 2018). Not surprisingly, the incidence of respiratory diseases in the southern portion of the Amazon region increased substantially in 2019 (BarcellosBARCELLOS C, XAVIER D, HACON S, ARTAXO P, GRACIE R, MAGALHÃES M, MATOS V, MONTEIRO AM & FEITOSA P. 2019. Queimadas na Amazônia e seus impactos na saúde: A incidência de doenças respiratórias no sul da Amazônia aumentou significativamente nos últimos meses. 3º Informe técnico do Observatório de Clima e Saúde. Observatório de Clima e Saúde Instituto de Comunicação e Informação Científica e Tecnológica em Saúde (ICICT), Fundação Oswaldo Cruz (Fiocruz). Available at: https://climaesaude.icict.fiocruz.br/sites/climaesaude.icict.fiocruz.br/files/informe_observatorio_queimadas.pdf Accessed on 30 August, 2019.
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et al. 2019). Fires and extreme weather events cause damage to the forest ecosystem, creating a cycle of destruction.

The most recent assessment report of the Intergovernmental Panel on Climate Change (IPCCHUBER M & KNUTTI R. 2012. Anthropogenic and natural warming inferred from changes in Earth’s energy balance. Nat Geosci 5: 31-36.) estimates that under the most likely scenario in the absence of dramatic mitigation actions (scenario RCP8.5) global average temperature would increase by 4.8 °C at the end of this century as compared to the 1996-2005 period, while in the Amazon during the dry months from June to August the average increase would be 6-8 °C (IPCC 2013, p. 1343). This would have significant impacts on human health, including the worsening of chronic health conditions, as well as the spread of infections (BalbusBALBUS J, CRIMMINS A, GAMBLE JL, EASTERLING DR, KUNKEL KE, SAHA S & SAROFIM MC. 2016. Ch. 1: Introduction: Climate Change and Human Health. The Impacts of Climate Change on Human Health in the United States: A Scientific Assessment. U.S. Global Change Research Program, Washington, DC, p. 25-42. et al. 2016, HaconGULACHENSKI A, GHERSI BM, LESEN AE & BLUM MJ. 2016. Abandonment, ecological assembly and public health risks in counter-urbanizing cities. Sustainability 8: 491. et al. 2018). Climate change resulting from deforestation of the Amazon rainforest and other tropical forests may favor the emergence of parasitic, fungal, viral and bacterial infections through the following basic mechanisms: first, by climate-derived ecological disturbances interfering with the maintenance of pathogens in their natural environments and hosts; second, by favoring the presence, distribution and proliferation of disease vectors in forest and urban areas, and third, by changes in temperature and rainfall patterns favoring pathogens’ survival and reproduction and/or their ability to infect the human host. Changes in temperature also modify the ability of pathogens to infect vectors and to replicate in these animals (Patz et al. 2000, HalesHACON SS, DE OLIVEIRA BFA & SILVEIRA I. 2018. A review of the health sector impacts of 4 °c or more temperature rise. In: Climate Change Risks in Brazil. Springer, Amsterdam, the Netherlands, p. 67-129. et al. 2002, VittorVARGAS A, ROMANO APM & MERCHÁN-HAMANN E. 2019. Human rabies in Brazil: a descriptive study, 2000-2017. Epidemiol Serv Saude 28: e2018275. et al. 2006, BarcellosBARCELLOS C, MONTEIRO AMV, CORVALÁN C, GURGEL C, CARVALHO MS, ARTAXO P, HACON S & RAGONI V. 2009. Mudanças climáticas e ambientais e as doenças infecciosas: cenários e incertezas para o Brasil. Epidemiol Serv Saude 18: 285-304. et al. 2009, AltizerALTIZER S, OSTFELD RS, JOHNSON PTJ, KUTZ S & HARVELL CD. 2013. Climate change and infectious diseases: from evidence to a predictive framework. Science 341: 514-519. et al. 2013, ConfalonieriCOHN AS, BHATTARAI N, CAMPOLO J, CROMPTON O, DRALLE D, DUNCAN J & THOMPSON S. 2019. Forest loss in Brazil increases maximum temperatures within 50km. Environ Res Lett 14: 084047. et al. 2014, Carvalho et al. 2015, FlahaultFERNANDES MEB, DA COSTA LJC, DE ANDRADE FAG & SILVA LP. 2013. Rabies in humans and non-human in the state of Pará, Brazilian Amazon. Braz J Infect Dis 17: 251-253. et al. 2016, Samuel et al. 2016, Wu et al. 2016, LorenzLIMA-CAMARA TN. 2016. Emerging arboviruses and public health challenges in Brazil. Rev Saude Publica 50: 36. et al. 2017, NavaMORDECAI EA ET AL. 2019. Thermal biology of mosquito-borne disease. Ecol Lett 22: 1690-1708. et al. 2017, CasadevallCASADEVALL A, KONTOYIANNIS DP & ROBERT V. 2019. On the emergence of Candida auris: climate change, azoles, swamps, and birds. MBio 10: e01397-19. et al. 2019, Duarte et al. 2019a, Duarte & Giatti 2019, Khan et al. 2019, RaoPLOWRIGHT RK, PARRISH CR, MCCALLUM H, HUDSON PJ, KO AI, GRAHAM AL & LLOYD-SMITH JO. 2017. Pathways to zoonotic spillover. Nat Rev Microbiol 15: 502-510. et al. 2019, Silva et al. 2019). For example, if the average temperature of a given region increases, the spread of disease vectors, such as mosquitoes, could be favored, and this spread could lead to the colonization of new geographical areas previously inaccessible to these vectors. Favorable temperatures for replication of pathogens in vectors also contribute to increase vectorial capacity, resulting in greater spread of infections in humans. Moreover, the rise of temperatures and the intensification of extreme rain can contribute to higher survival and spread of pathogens that cause successive diarrheal diseases among humans (Checkley et al. 2000, Duarte et al. 2019a). This is a particularly worrying scenario given the rapid unplanned urbanization and the lack of basic sanitary conditions in the Amazon region (Freitas & Giatti 2009). Also, humans who enter habitats of pathogens and become infected with a certain pathogen may subsequently introduce the infection into urban environments.

The dynamics of soil-transmitted helminths is also strongly influenced by deforestation and climate change (WeaverVLAHOV D, GALEA S & FREUDENBERG N. 2005. Toward an urban health advantage. J Public Health Manag Pract 11: 256-258. et al. 2010, Hernandez et al. 2013, SeoSCHEFFRAN J, BRZOSKA M, KOMINEK J, LINK PM & SCHILLING J. 2012. Climate change and violent conflict. Science 336: 869-871. et al. 2016, BlumBLUM AJ & HOTEZ PJ. 2018. Global “worming”: Climate change and its projected general impact on human helminth infections. PLoS Negl Trop Dis 12: e0006370. & Hotez 2018). Helminth diseases are important problems in the Amazon region (SouzaSORRIBAS MV, PAIVA RCD, MELACK JM, BRAVO JM, JONES C, CARVALHO L, BEIGHLEY E, FORSBERG B & COSTA MH. 2016. Projections of climate change effects on discharge and inundation in the Amazon basin. Clim Change 136: 555-570. et al. 2007, Hotez et al. 2008, Confalonieri et al. 2014, Gonçalves et al. 2016).

Extreme weather events have substantial economic consequences and destabilize the order and functioning of affected human communities, especially in developing countries. This destabilization causes multiple problems in terms of environmental sanitation, creates social instability, and weakens the public health system. This is aggravated by the fact that public health facilities in Amazonian countries are precarious even before a climate disaster occurs. Together, these consequences contribute to the emergence and spread of zoonotic diseases, new human infections, and proliferation of endemic diseases (Epstein 2001, MirzaMENESES CAR ET AL. 2019. Molecular characterisation of the emerging measles virus from Roraima state, Brazil, 2018. Mem Inst Oswaldo Cruz 114: e180545. 2003, HendrixHALES S, DE WET N, MAINDONALD J & WOODWARD A. 2002. Potential effect of population and climate changes on global distribution of dengue fever: an empirical model. Lancet 360: 830-834. & Salehyan 2012, Scheffran et al. 2012, MaystadtMALHI Y, ROBERTS JT, BETTS RA, KILLEEN TJ, LI W & NOBRE CA. 2008. Climate change, deforestation, and the fate of the Amazon. Science 319: 169-172. & Ecker 2014, Watts et al. 2015, Ma & Jiang 2019, Ridde et al. 2019).

Habitat loss and pathogen spillover

Deforestation and uncontrolled urbanization are linked to habitat fragmentation and lack of adequate supplies of food and water. This ecological situation induces wildlife migration to alternative habitats, which can include both urbanized and de-urbanized environments. Human activities in forest areas put humans in close contact with wildlife (Mackenstedt et al. 2015, Wilkinson et al. 2018). As a consequence, humans have closer interactions with wild species and their pathogens, facilitating the occurrence of classic zoonotic diseases and the “jump” or “shift” of new pathogens between different host species, an event called “spillover.”

Pathogen spillover can introduce new infections in the human population. In this process, many physical, molecular and ecological barriers must be overcome by the pathogen during the jump between different hosts. In other words, spillover is a complex event that depends on the phylogenetic distance between hosts, the frequency and intensity of contacts between species, and genetic factors of both pathogens and hosts, among other factors. Although complex, this phenomenon is common in the history of humankind; accordingly, most human infectious diseases originate from wild animals, which served as sources of pathogens (Taylor et al. 2001, KruseKOVATS S ET AL. 2003. Methods of assessing human health vulnerability and public health adaptation to climate change. Copenhagen, Regional Office for Europe (EURO) - World Health Organization, 112 p. et al. 2004, OlivalNEIDERUD CJ. 2015. How urbanization affects the epidemiology of emerging infectious diseases. Infect Ecol Epidemiol 5: 27060. et al. 2017, Plowright et al. 2017, EllwangerELLWANGER JH & CHIES JAB. 2018a. Zoonotic spillover and emerging viral diseases - time to intensify zoonoses surveillance in Brazil. Braz J Infect Dis 22: 76-78. & Chies 2018a, 2019). Following spillover, if the pathogens encounter favorable conditions, the infection is disseminated among humans (Morse 1995).

Some pathogens are capable of infecting a broad host range and can easily adapt to new hosts, including humans. This kind of adaptation will be more common with generalist than with specialist pathogens. Specific characteristics, such as the RNA genome (high mutation rates) or transmission by vectors, give pathogens a greater plasticity to infect new hosts and find new ecological niches (Nichol et al. 2000, Johnson et al. 2015). However, not all pathogens establish sustained transmission among humans following a spillover event. The characteristics that make a pathogen transmissible between different species may differ, at least in some aspects, from those that increase transmissibility among humans. Regarding viral infections, human-to-human transmission occurs more easily a) with pathogens showing the capacity to cause chronic and non-lethal infections, b) with airborne/respiratory viruses, and c) by non-segmented, non-enveloped, and non-vector-borne viruses (GeogheganGARDA AA, DA SILVA JMC & BAIÃO PC. 2010. Biodiversity conservation and sustainable development in the Amazon. Syst Biodivers 8: 169-175. et al. 2016, Walker et al. 2018). However, vector-mediated transmission can sustain viral epidemics among humans; the endemicity of dengue in Brazil, malaria in the Amazonian region, and Zika virus in Latin America illustrate this aspect.

Habitat loss and the related invasion of wild animals and/or its vector-associated fauna to urban areas lead to domestic animals such as dogs and cats encountering wild species more often and may serve as “bridges” for the circulation of pathogens between wild animals and humans (EllwangerEBI KL, KOVATS RS & MENNE B. 2006. An approach for assessing human health vulnerability and public health interventions to adapt to climate change. Environ Health Perspect 114: 1930-1934. & Chies 2019). Close contact between wildlife, humans and domestic animals will occur more intensely in urban areas near the forest (WhitemanWATTS N ET AL. 2015. Health and climate change: policy responses to protect public health. Lancet 386: 1861-1914. et al. 2007, Ellwanger & Chies 2019). For example, bat-transmitted human rabies occurs frequently in the Amazon region (da Rosa et al. 2006, MendesMARQUES-DA-SILVA SH, RODRIGUES AM, DE HOOG GS, SILVEIRA-GOMES F & CAMARGO ZP. 2012. Occurrence of Paracoccidioides lutzii in the Amazon region: description of two cases. Am J Trop Med Hyg 87: 710-714. et al. 2009, Gilbert et al. 2012, Vargas et al. 2019). These cases are probably associated with deforestation, livestock and agricultural expansion in the region and the associated increase of the contact of humans with wildlife (Schneider et al. 2001, Dantas-Torres 2008). Therefore, the current Amazonian landscape, characterized by rainforest, environmental degradation, and close contact of humans and domestic animals with wild species, is quite favorable for pathogen spillover.

Vector dynamics

In some specific macro- and micro-regions around the world, climate change may decrease the presence of disease vectors, especially mosquitoes. Extreme temperatures can be detrimental to the development of mosquitoes, and extreme weather events, such as droughts, can limit mosquito-breeding sites. However, in most cases, deforestation, the increase in global average temperature and other climate changes will favor the proliferation of disease vectors (for example, Aedes aegypti and Aedes albopictus) in different regions of Brazil and in other Amazonian countries. These changes can facilitate the transmission of arboviruses, such as Chikungunya, Dengue, Yellow fever, Oropouche, Mayaro, Rocio, Saint Louis, WestWALKER JW, HAN BA, OTT IM & DRAKE JM. 2018. Transmissibility of emerging viral zoonoses. PLOS ONE 13: e0206926. Nile, and Zika virus infection (Hales et al. 2002, Lima-Camara 2016, Wu et al. 2016, Burkett-CadenaBURKETT-CADENA ND & VITTOR AY. 2018. Deforestation and vector-borne disease: Forest conversion favors important mosquito vectors of human pathogens. Basic Appl Ecol 26: 101-110. & Vittor 2018, Lorenz et al. 2017, Hacon et al. 2018, Klitting et al. 2018, Sakkas et al. 2018, TeslaTAKKEN W, VILARINHOS PTR, SCHNEIDER P & SANTOS F. 2005. Effects of environmental change on malaria in the Amazon region of Brazil. In: Takken W, Martens P & Bogers RJ (Eds), Environmental Change and Malaria Risk: Global and Local Implications. Springer Netherlands, 2005. p. 113-123. et al. 2018, KhanKATSURAGAWA TH, GIL LHS, TADA MS & SILVA LHP. 2008. Endemic and epidemic diseases in Amazonia: Malaria and other emerging diseases in riverine areas of the Madeira River. A school case. Estud Av 22:111-141. et al. 2019, Kraemer et al. 2019, Rao et al. 2019). As an example, yellow fever is a disease traditionally associated to the forest, but it can easily adapt to the urban environment and the risk of re-emergence of yellow fever in urban areas is therefore of concern, especially in cities near forest areas. In South America mosquitoes of the genera Haemagogus and Sabethes are involved in the sylvatic cycle of yellow fever, and A. aegypti is involved in the urban cycle of transmission of this disease (CardosoCARDOSO BA, FONSECA FO, MORAES NETO AHA, MARTINS ACGS, OLIVEIRA NVDS, LIMA LNGC, DIAS GADS & SAAD MHF. 2017. Environmental aspects related to tuberculosis and intestinal parasites in a low-income community of the Brazilian Amazon. Rev Inst Med Trop Sao Paulo 59: e57. et al. 2010, Klitting et al. 2018).

As a counterpoint to the restrictions discussed above, higher temperature and rainfall may shorten the development time of mosquito larvae, favoring their proliferation (Lima-Camara 2016, Wu et al. 2016). Moreover, an increase in the frequency of extreme weather events, such as severe storms and floods, will favor the introduction and dissemination of disease vectors specifically in urban environments due to an increase in mosquito breeding sites, thus aggravating the transmission of infectious diseases (Lima-Camara 2016, Wu et al. 2016, Khan et al. 2019, Rao et al. 2019). The effects of climate change on vectors can be minimized or exacerbated according to human activities, such as those concerning land use and urbanization (MordecaiMETZGER JP ET AL. 2019. Why Brazil needs its Legal Reserves. Perspect Ecol Conser 17: 91-103. et al. 2019).

When recent data are compared with those from 1990, climate change has already increased vectorial capacity for dengue transmission by 3% for A. aegypti and by 5.9% by A. albopictus. These data suggest that continuous climate change may aggravate the epidemiological situation of arboviruses (Watts et al. 2018). Vectors of parasitic diseases such as malaria and leishmaniasis may also be affected by climate change (Githeko et al. 2000, Carvalho et al. 2015, Peterson et al. 2017) and deforestation. In this regard, Amazon deforestation has been associated with a higher human-biting rate of Anopheles darlingi, an important malaria-transmitting vector (Vittor et al. 2006); consequently, malaria transmission is linked to Amazon deforestation (MacDonaldLOVEJOY TE & NOBRE C. 2018. Amazon tipping point. Sci Adv 4: eaat2340. & Mordecai 2019). Leishmaniasis is caused by parasites of the genus Leishmania and is another disease strongly associated with the forest environment. Notably, human entry into the forest for deforestation exposes humans to sandfly (phlebotomine) bites, which transmit leishmaniasis (Desjeux 2004, AlvarALVAR J, YACTAYO S & BERN C. 2006. Leishmaniasis and poverty. Trends Parasitol 22: 552-557. et al. 2006, Palatnik-de-Sousa & Day 2011).

When addressing malaria, deforestation and climate change can either increase or decrease the spread of the infection, depending on the amount of forest cover, rainfall patterns, temperature ranges, and landscape characteristics (Githeko et al. 2000, OlsonNETO PLF ET AL. 2019. Syphilis among newly diagnosed therapy-naive HIV patients in Belém, Pará, Amazon region of Brazil. AIDS Res Hum Retroviruses 35: 511-512. et al. 2009, TuckerTAUIL PL. 2006. Perspectives of vector borne diseases control in Brazil. Rev Soc Bras Med Trop 39: 275-277. Lima et al. 2017, Laporta 2019). Looking specifically at the deforestation factor, the initial process of deforestation generally increases human contact with malaria vectors, causing higher rates of infection. However, after an advanced stage of deforestation is reached, human contact with the vectors can decrease, reducing opportunities for disease transmission (Tucker Lima et al. 2017). Finally, urbanization and peri-urbanization of transmission cycles of malaria are also affected by deforestation and climate change, representing common issues in the Amazon region (TakkenSTAGGEMEIER R, ALMEIDA SEM & SPILKI FR. 2011. Methods of virus detection in soils and sediments. Virus Rev Res 16: 16-22. et al. 2005, TauilSTOY PC. 2018. Deforestation intensifies hot days. Nat Clim Change 8: 366-368. 2006, GilGIATTI LL & CUTOLO SA. 2012. Acesso à água para consumo humano e aspectos de saúde pública na Amazônia Legal. Ambient Soc 15: 93-109. et al. 2007, Tada et al. 2007, Costa et al. 2010, Oliveira-Ferreira et al. 2010, AlmeidaALMEIDA ACG ET AL. 2018. High proportions of asymptomatic and submicroscopic Plasmodium vivax infections in a peri-urban area of low transmission in the Brazilian Amazon. Parasit Vectors 11: 194. et al. 2018).

Agricultural intensification and land-use change

Agriculture and land-use change are extensive phenomena in Amazonia. The intensification of these activities has promoted significant alterations in the region. In Brazil, the supervision of agricultural activities in Amazonia is flawed and allows intensified conversion of forest to agriculture and cattle pasture (BaronaBARONA E, RAMANKUTTY N, HYMAN G & COOMES OT. 2010. The role of pasture and soybean in deforestation of the Brazilian Amazon. Environ Res Lett 5: 024002. et al. 2010, Machovina et al. 2015, Carvalho et al. 2019, Seymour & Harris 2019).

Agricultural practices are associated with the emergence of viral, bacterial, and parasitic infections since these activities can, among other mechanisms, affect the maintenance of pathogens in their natural hosts, alter the dynamics and population number of vectors and increase the ecological contact of humans with pathogens (PatzPALUMBO M, JOHNSON SA, MUNDIM FM, LAU A, WOLF AC, ARUNACHALAM S, GONZALEZ O, ULRICH JL, WASHUTA A & BRUNA EM. 2012. Harnessing smartphones for ecological education, research, and outreach. Bull Ecol Soc Am 93: 390-939. et al. 2000, 2004, FoleyFERRANTE L & FEARNSIDE PM. 2019. Brazil’s new president and “ruralists” threaten Amazonia’s environment, traditional peoples and the global climate. Environ Conserv 46: 261-263. et al. 2005, Wilcox & Ellis 2006, JonesJOHNSON CK ET AL. 2015. Spillover and pandemic properties of zoonotic viruses with high host plasticity. Sci Rep 5: 14830. et al. 2013, GottdenkerGORAYEB A, LOMBARDO MA & PEREIRA LCC. 2009. Condições ambientais em áreas urbanas da bacia hidrográfica do Rio Caeté Amazônia oriental - Brasil. Revista da Gestão Costeira Integrada 9: 59-70. et al. 2011, 2014). Incidence of malaria has been linked to extractive activities and agricultural settlements in the Amazon forest. Malaria in some areas is closely associated with deforestation and unplanned development of new agricultural settlements (GuimarãesGRILLET ME ET AL. 2019. Venezuela’s humanitarian crisis, resurgence of vector-borne diseases, and implications for spillover in the region. Lancet Infect Dis 19: e149-e161. et al. 2016, SouzaSONTER LJ, HERRERA D, BARRETT DJ, GALFORD GL, MORAN CJ & SOARES-FILHO BS. 2017. Mining drives extensive deforestation in the Brazilian Amazon. Nat Commun 8: 1013. et al. 2019). We can speculate that deforestation for pasture and agriculture is the main factor contributing to the emergence of infectious diseases in the Amazon region. These land-use transformations occur on a large scale and are directly linked to various known drivers of infectious diseases, such as habitat loss and human insertion in forest environments. Lack of sanitation and health facilities add complexity to this situation.

Mining

Mining is another major driving force of deforestation in Amazonia and is also a constant source of conflicts between indigenous populations and invaders. The Amazon region is well known for its mineral resources, which include copper, tin, nickel, bauxite, manganese, iron and gold. Mining has a great impact on the environment; besides deforestation resulting from the mining activities within mining lease areas, extensive deforestation also occurs off-lease as a consequence of population growth, urban expansion, infrastructure construction, industrial growth and other factors associated with greater economic activity (Sonter et al. 2017).

Informal mining is associated with water and soil pollution. Also, people living near mining sites or working in informal mines are more exposed to mosquitoes. The disease burden associated with mining includes mercury intoxication, respiratory diseases, diarrhea, vector-borne diseases such as malaria and other infectious diseases (BauchBAUCH SC, BIRKENBACH AM, PATTANAYAK SK & SILLS EO. 2015. Public health impacts of ecosystem change in the Brazilian Amazon. Proc Natl Acad Sci USA 112: 7414-7419. et al. 2015, Terças-Trettel et al. 2019).

Rainfall, flooding, and water contamination

Altered rainfall patterns and floods are consequences of extreme weather events associated with Amazon deforestation and climate change. Climate change is associated with current and projected extreme hydrological events in the Amazon region (Marengo & Espinoza 2016, Sorribas et al. 2016).

The risk of infection and the spread of malaria in the Amazon region are influenced by rainfall patterns and river water levels (Olson et al. 2009, Wolfarth-Couto et al. 2019). The presence of pathogens in water (considering quantity and diversity) is modified by hydrological events, modulating the exposure of humans to such pathogens. As a result, many infectious diseases spread during rainfall, periods of high river levels and floods, including leptospirosis and gastroenteritis, which are important public health problems not only in the Amazon region but also in other parts of Brazil (GracieGOTTDENKER NL, STREICKER DG, FAUST CL & CARROLL CR. 2014. Anthropogenic land use change and infectious diseases: a review of the evidence. Ecohealth 11: 619-632. et al. 2014, RodriguesPREVEDELLO JA, WINCK GR, WEBER MM, NICHOLS E & SINERVO B. 2019. Impacts of forestation and deforestation on local temperature across the globe. PLoS One 14: e0213368. et al. 2015, Nava et al. 2017, VieiraVAN VLIET N, QUICENO-MESA MP, CRUZ-ANTIA D, DE AQUINO LLN, MORENO J & NASI R. 2014. The uncovered volumes of bushmeat commercialized in the Amazonian trifrontier between Colombia, Peru & Brazil. Ethnobio Conserv 3: 7. et al. 2016, 2017, Duarte et al. 2019b, Duarte & Giatti 2019, Naing et al. 2019, Péres et al. 2019).

Rapid population growth from migration to urban areas is associated with poor sanitation and water pollution, which are common in Amazon cities (GoveiaGOTTDENKER NL, CALZADA JE, SALDAÑA A & CARROLL CR. 2011. Association of anthropogenic land use change and increased abundance of the Chagas disease vector Rhodnius pallescens in a rural landscape of Panama. Am J Trop Med Hyg 84: 70-77. et al. 2019, MendesMARENGO JA & ESPINOZA JC. 2016. Extreme seasonal droughts and floods in Amazonia: causes, trends and impacts. Int J Climatol 36: 1033-1050. et al. 2019). This scenario contributes to the transmission of various water-borne diseases, including gastroenteritis and viral hepatitis. These diseases have very important economic impacts in the Amazon region because, in addition to directly affecting the health of infected individuals, water-borne diseases also overload the public health system and cause workday losses (ConstenlaCONFALONIERI UEC, MARINHO DP & RODRIGUEZ RE. 2009. Public health vulnerability to climate change in Brazil. Clim Res 40: 175-186. et al. 2008, BragaBRAGA WSM ET AL. 2009. Prevalence of hepatitis A virus infection: the paradoxical example of isolated communities in the western Brazilian Amazon region. Rev Soc Bras Med Trop 42: 277-281. et al. 2009, MachadoLUNA EJA. 2002. A emergência das doenças emergentes e as doenças infecciosas emergentes e reemergentes no Brasil. Rev Bras Epidemiol 5: 229-243. et al. 2013, Prado & Miagostovich 2014, Duarte et al. 2019b). Water-related issues in the Amazon region also facilitate the spread of mollusks that are part of the schistosomiasis transmission cycle (Goveia et al. 2019).

Human agglomeration, urbanization and de-urbanization

Historically, the expansion and clustering of population in towns, villages, and cities were factors that allowed the emergence of epidemics among humans (WaldmanVIANA RL, DE FREITAS CM & GIATTI LL. 2016. Environmental health and development in legal amazon: socio-economic, environmental and sanitary indicators, challenges and perspectives. Saude Soc 25: 233-246. 2001, BañulsBAÑULS AL, THOMAS F & RENAUD F. 2013. Of parasites and men. Infect Genet Evol 20: 61-70. et al. 2013, ZanellaWOLFARTH-COUTO B, SILVA RAD & FILIZOLA N. 2019. Variability in malaria cases and the association with rainfall and rivers water levels in Amazonas State, Brazil. Cad Saude Pública 35: e00020218. 2016). Currently, urbanization has critical importance for the emergence and maintenance of epidemics as well as the occurrence of zoonotic diseases. Increased interaction among humans from different places and the facilitated proliferation of vectors and pathogen reservoirs in the urban context explain, at least in part, how urbanization affects the spread of infectious diseases (Morse 1995, NeiderudMORENS DM, FOLKERS GK & FAUCI AS. 2004. The challenge of emerging and re-emerging infectious diseases. Nature 430: 242-249. 2015, Zahouli et al. 2017, Li et al. 2014, TianTATEM AJ, ROGERS DJ & HAY SI. 2006. Global transport networks and infectious disease spread. Adv Parasitol 62: 293-343. et al. 2018). Urbanization usually decreases forest cover and may increase the risk of infectious diseases. For example, reduced forest cover and urbanization were associated with higher rates of Zika virus infection and Zika-linked microcephaly cases in Brazil (Ali et al. 2017).

Urbanization represents a paradox concerning infectious diseases. Urban environments contribute to the spread of disease due to human agglomeration. On the other hand, urban areas provide better access to health services, which is a mitigating factor for the problems caused by infectious diseases, especially in high-income countries (Vlahov et al. 2005, Neiderud 2015, SeguradoSANCHEZ-RIBAS J, PARRA-HENAO G & GUIMARÃES AÉ. 2012. Impact of dams and irrigation schemes in Anopheline (Diptera: Culicidae) bionomics and malaria epidemiology. Rev Inst Med Trop Sao Paulo 54: 179-191. et al. 2016). This tug-of-war can remain in relative equilibrium in areas with predominantly urban characteristics but may slide to one side at city/forest interfaces. In these areas, deforestation processes in association with poor health services contribute synergistically to the emergence of infectious diseases, especially in low-income countries.

Degradation of sanitation services and the abandonment of urban areas by the government, a phenomenon known as “de-urbanization” (Eskew & Olival 2018), strongly contribute to the proliferation of vectors and other pests. De-urbanized areas are ideal for the dissemination of infectious diseases (PignattiPEREIRA EJAL, FERREIRA PJS, RIBEIRO LCS, CARVALHO TS & PEREIRA HBB. 2019. Policy in Brazil (2016–2019) threaten conservation of the Amazon rainforest. Environ Sci Policy 100: 8-12. 2004, Gulachenski et al. 2016, Eskew & Olival 2018). Urban slums are good examples of de-urbanized environments (CostaCOSTA KMM, ALMEIDA WAF, MAGALHÃES IB, MONTOYA R, MOURA MS & LACERDA MVG. 2010. Malária em Cruzeiro do Sul (Amazônia Ocidental brasileira): análise da série histórica de 1998 a 2008. Rev Panam Salud Publica 28: 353-360. et al. 2017), although it can be argued that these communities were never urbanized enough for a de-urbanization process to occur.

Urbanization, de-urbanization, poor sanitation, and deficient healthcare services are common phenomena in Amazonia (Silva 2006, GiattiGARDY JL & LOMAN NJ. 2018. Towards a genomics-informed, real-time, global pathogen surveillance system. Nat Rev Genet 19: 9-20. 2007, VianaVALLI M & BOLZANI VS. 2019. Natural products: perspectives and challenges for use of Brazilian plant species in the bioeconomy. An Acad Bras Cienc 91: e20190208. et al. 2007, 2016, Carvalho-CostaCONSTENLA DO, LINHARES AC, RHEINGANS RD, ANTIL LR, WALDMAN EA & DA SILVA LJ. 2008. Economic impact of a rotavirus vaccine in Brazil. J Health Popul Nutr 26: 388-396. et al. 2009, GomesGITHEKO AK, LINDSAY SW, CONFALONIERI UE & PATZ JA. 2000. Climate change and vector-borne diseases: a regional analysis. Bull World Health Organ 78: 1136-1147. et al. 2009, Gorayeb et al. 2009, Giatti & Cutolo 2012, Johansen & do Carmo 2012, Brierley et al. 2014, CardosoCARDOSO TAO & NAVARRO MBMA. 2007. Emerging and reemerging diseases in Brazil: data of a recent history of risks and uncertainties. Braz J Infect Dis 11: 430-434. et al. 2017). Taken together, these factors create the perfect storm for the occurrence of outbreaks and epidemics in the human population living or working in the Amazon region, especially in cities near forest areas and that have deforestation-associated activities.

Hydroelectric dams, waterways and irrigation systems

Amazon deforestation and other perturbations in the forest landscape are fundamental consequences of the construction of hydroelectric dams, waterways and irrigation systems (Sanchez-RibasRODRIGUES MT, HENZEL A, STAGGEMEIER R, DE QUEVEDO DM, RIGOTTO C, HEINZELMANN L, DO NASCIMENTO CA & SPILKI FR. 2015. Human adenovirus spread, rainfalls, and the occurrence of gastroenteritis cases in a Brazilian basin. Environ Monit Assess 187: 720. et al. 2012, TundisiTAYLOR LH, LATHAM SM & WOOLHOUSE MEJ. 2001. Risk factors for human disease emergence. Phil Trans R Soc Lond B 356: 983-989. et al. 2014, FearnsideFEARNSIDE PM. 2008. The roles and movements of actors in the deforestation of Brazilian Amazonia. Ecol Soc 13: 23. 2015). A good example is the Belo Monte hydroelectric power plant, which significantly changed the landscape of the Xingu River in the Brazilian Amazon, flooding an area of 516 km2 [228 km2 (44%) corresponding to the original riverbed and seasonally flooded area] (ANA 2019). However, this flooded area is likely to become very much larger, considering the 6140-km2 Babaquara (or Altamira) dam that, if built, would regulate the flow of the Xingu River to supply water to the Belo Monte hydroelectric power plant during the dry season (Fearnside 2017a). Two other examples of dams with large reservoir areas may be cited: The Marabá Dam, located on the Tocantins River, would have a total of 1115.4 km2 of flooded area, and the Simão-Alba Dam, located on the Juruena River, would have more than a 1000 km2 (Fearnside 2015).

The strongest effect of dam construction on the dynamics of infectious diseases concerns vector proliferation. Flooding of hitherto dry areas creates new breeding sites for disease vectors, especially mosquitoes, which contributes to the increase in the cases of various arboviral and parasitic infections (Sanchez-Ribas et al. 2012, Fearnside 2015, BritoBRITO B, BARRETO P, BRANDÃO JR A, BAIMA S & GOMES PH. 2019. Stimulus for land grabbing and deforestation in the Brazilian Amazon. Environ Res Lett 14: 064018. et al. 2018).

Construction of hydroelectric dams is often associated with the relocation of communities from areas that will be flooded or significantly impacted by the construction. Both the displaced population and the population migration attracted to areas near dam construction sites are exposed to substantial health risks, as in the case of the Belo Monte Dam (GrisottiGREGIANINI TS, RANIERI T, FAVRETO C, NUNES ZMA, TUMIOTO GIANNINI GL, SANBERG ND, DA ROSA MTM & DA VEIGA ABG. 2017. Emerging arboviruses in Rio Grande do Sul, Brazil: Chikungunya and Zika outbreaks, 2014-2016. Rev Med Virol 27: e1943. 2016). The new settlement areas may be sites of greater vector circulation or habitats of pathogen reservoirs. Also, the specific place where these communities will be relocated may influence the incidence of mosquito-borne diseases as a consequence of wind regimes and direction, which may facilitate or hinder mosquito bites (FearnsideFEARNSIDE PM. 1986. Human Carrying Capacity of the Brazilian Rainforest. New York, USA: Columbia University Press. 293 p. 1999). Since one of the mechanisms that mosquitoes use to locate humans is by detecting CO2 in the air, the location of houses with respect to wind directions and dispersion of CO2 can influence the number of malaria cases (MidegaMENDES A, GALVÃO P, DE SOUZA J, DA SILVA I & CARNEIRO RN. 2019. Relations of the groundwater quality and disorderly occupation in an Amazon low-income neighborhood developed over a former dump area, Santarém/PA, Brazil. Environ Dev Sustain 21: 353-368. et al. 2012, EndoELLWANGER JH, KAMINSKI VL & CHIES JAB. 2019. Emerging infectious disease prevention: Where should we invest our resources and efforts? J Infect Public Health 12: 313-316. and Eltahir 2018a, b, EllwangerELLWANGER JH & CHIES JAB. 2018b. Wind: a neglected factor in the spread of infectious diseases. Lancet Planet Health 2: e475. & Chies 2018b). Proximity to mosquito-breeding sites can also increase the risk of malaria transmission, an effect that depends on wind direction (Midega et al. 2012). It is likely that wind also impacts the incidence of other mosquito-borne diseases, as this factor influences the behavior of the mosquito itself and does not act directly on the pathogens. A recent study (Huestis et al. 2019) has shown that Anopheles mosquitoes can be carried over long distances (up to 300 km) by wind currents. The same study found that many of the wind-transported mosquitoes were female and had fed on blood before migration (Huestis et al. 2019). These findings indicate that modifications in mosquito populations in a given location may influence the dynamics of infectious diseases in very distant regions.

Just as dam construction facilitates the spread of infectious diseases, flooding of areas for irrigation purposes may contribute to the proliferation of disease vectors (Sanchez-Ribas et al. 2012). Although not directly related to the Amazon forest, the case of Panama Canal serves as another example of how water-related construction in a rainforest environment can have profound impacts on the spread of infectious diseases. The percentage of workers hospitalized due to malaria during the construction of the Panama Canal reached 9.6%. Yellow fever was another major problem during the canal construction. The spread of the diseases occurred due to human entry into areas where the mosquito vectors were present, as well as due to the proliferation of vectors with the increase of canal-induced breeding sites. An intense US-led mosquito control program in Panama has been very effective in significantly reducing cases of infection, but not completely eradicating the diseases (Stern & Markel 2004, CDC 2015). Finally, construction of dams, hydroelectric power plants, canals, and irrigation systems in forest areas are activities that enhance close contact of humans with wildlife and its associated pathogens, which is an additional risk factor for infectious disease dissemination.

Road construction and expansion of transportation facilities

Dramatic mortality from vector-borne diseases occurred during construction of the Madeira-Mamoré railway from 1907 to 1912 in what is now the Brazilian state of Rondônia (KatsuragawaJONES BA ET AL. 2013. Zoonosis emergence linked to agricultural intensification and environmental change. Proc Natl Acad Sci USA 110: 8399-8404. et al. 2008). The expansion of transportation facilities has continued in the Amazon region in the 1970s. The construction of the Trans-Amazonian Highway (also known as BR-230) represents a milestone in this expansion (FearnsideFAVORETTO SR ET AL. 2019. Zika virus in peridomestic neotropical primates, northeast Brazil. Ecohealth 16: 61-69. 1986). Construction began in 1970 and, by 1973, approximately 22,000 individuals had migrated to the highway region. This human flow to a forest region put many workers and migrants in contact with vectors of different diseases, including leptospirosis, leishmaniasis, Chagas disease, bacterial infections, malaria, Mayaro fever, yellow fever, and other arboviral diseases (Pinheiro et al. 1974, Smith 1982, Vasconcelos et al. 2001). Many legal and clandestine highways were and continue to be built in the Amazon region to facilitate transportation of workers and of the products from agriculture, ranching and logging.

Road construction improves infrastructure that is frequently associated with better health outcomes because it facilitates access to healthcare (Bauch et al. 2015, Wood et al. 2017). However, construction of roads and the expansion of transportation also contributes to deforestation, forest fires, hunting, and biodiversity loss, and it significantly increases human mobility in the region (BonaudoBONAUDO T, LE PENDU Y, FAURE JF & QUANZ D. 2005. The effects of deforestation on wildlife along the transamazon highway. Eur J Wildl Res 51: 199-206. et al. 2005, Laurance et al. 2009, Southworth et al. 2011, BarberBARBER CP, COCHRANE MA, SOUZA JR CM & LAURANCE WF. 2014. Roads, deforestation, and the mitigating effect of protected areas in the Amazon. Biol Conserv 177: 203-209. et al. 2014), with a direct impact on infectious-disease dynamics.

The extensive transit of people between multiple regions promotes the circulation of pathogens, thus facilitating the spread of infectious diseases. For example, the outflow of human immunodeficiency virus (HIV) from African forests to more populated regions at the beginning of the acquired immune deficiency syndrome (AIDS) epidemic was greatly facilitated by the extension of land transport and human mobility, which remain important factors in the spread of HIV and other pathogens (Lagarde et al. 2003, Eisenberg et al. 2006, Tatem et al. 2006, BarcellosBARCELLOS C, FEITOSA P, DAMACENA GN & ANDREAZZI MA. 2010. Highways and outposts: economic development and health threats in the central Brazilian Amazon region. Int J Health Geogr 9: 30. et al. 2010). This is also a concern in the Amazon region, as high mobility connects forest regions with urban areas, creating a “bridge” for infections to enter urban environments. Accordingly, the state of Amazonas has the second highest AIDS mortality rate in Brazil (7.8 deaths per 100,000 inhabitants) (Brazil 2018).

Regarding arboviral diseases, it is well-known that the Amazon forest harbors an enormous variety of species that may serve as vectors of such diseases; hence, in case a new pathogen is introduced in the region and encounters a suitable host, the infection is installed.

Human migration

Extreme weather events such as prolonged drought, excessive rainfall, and food shortages induce migration of human populations. Agricultural practices and search for land and rural properties can also stimulate migrations to forest areas. Infrastructure projects and price fluctuations on commodity markets can also contribute to the mobility of significant population contingents in the Amazon region. These demographic changes intensify deforestation (BarbieriBARBIERI AF & CARR DL. 2005. Gender-specific out-migration, deforestation and urbanization in the Ecuadorian Amazon. Glob Planet Change 47: 99-110. & Carr 2005, Garcia et al. 2007, FearnsideFEARNSIDE PM. 1999. Social impacts of Brazil’s Tucuruí Dam. Environ Manage 24: 483-495. 2008). Finally, climate-induced migration is a major challenge to health services worldwide (ReuvenyPONGSIRI MJ, ROMAN J, EZENWA WO, GOLDBERG TL, KOREN HS, NEWBOLD SC, OSTFELD RS, PATTANAYAK SK & SALKELD DJ. 2009. Biodiversity loss affects global disease ecology. BioScience 59: 945-954. 2007, Ridde et al. 2019).

Migratory events result in the exposure of populations to new pathogens since these populations eventually “invade” environments where pathogens or disease vectors circulate. This is most prominent when the environment in question is highly biodiverse, as in the case of the Amazon rainforest. This problem is aggravated when unvaccinated populations enter areas of vaccine-preventable endemic diseases. In addition to directly affecting the health of unvaccinated individuals, this phenomenon may impact the herd immunity of the vaccinated population. Moreover, migrants may introduce new pathogens in populations not originally affected by the disease (Confalonieri 2000, Coura et al. 2002, AguilarAGUILAR HM, ABAD-FRANCH F, DIAS JCP, JUNQUEIRA ACV & COURA JR. 2007. Chagas disease in the Amazon region. Mem Inst Oswaldo Cruz 102: 47-56. et al. 2007, Castelli & Sulis 2017, BartlowBARTLOW AW, MANORE C, XU C, KAUFELD KA, DEL VALLE S, ZIEMANN A, FAIRCHILD G & FAIR JM. 2019. Forecasting zoonotic infectious disease response to climate change: Mosquito vectors and a changing environment. Vet Sci 6: 40. et al. 2019, Grillet et al. 2019).

Migratory flows can overwhelm the public health system of the migrants’ destination, affecting prevention and treatment policies for infectious disease (Grillet et al. 2019, Paniz-Mondolfi et al. 2019). The recent sociopolitical crisis in Venezuela has caused an increase in non-autochthonous (imported) cases of malaria registered in Brazil, one of the main destinations of Venezuelan immigrants. Although this example is not directly related to deforestation, it illustrates how migratory movements can directly affect migrants’ health and at the same time have impacts on the health system (Grillet et al. 2019). The recent reintroduction of measles in Brazilian Amazonia by refugees from Venezuela is a recent example of how facilitated transportation, poverty and lack of adequate control measures may favor the spread of infectious diseases (Meneses et al. 2019).

It is clear that the triad “deforestation, migration and emerging infectious diseases” is an important issue when assessing the potential consequences of Amazon deforestation. Moreover, the economic impacts resulting from infectious disease-related overload of public health systems adds to the factors that make combating deforestation a major economic issue.

Hunting and consumption of bushmeat

Deforestation puts humans in close contact with wildlife and is linked with hunting in different ways. Hunting is a common practice in BrazilBRAZIL. 2000. Presidência da República, Casa Civil, Subchefia para Assuntos Jurídicos. 2000. Lei No 9.985, de 18 de julho de 2000. Available at: http://www.planalto.gov.br/ccivil_03/LEIS/L9985.htm Acessed on October 9, 2019.
http://www.planalto.gov.br/ccivil_03/LEI...
, with significant impacts on biodiversity. Although most forms of wildlife hunting are banned in the country, controlling this activity is extremely difficult, especially considering the vast extent of the Amazon region (BaíaBAÍA JÚNIOR PC, GUIMARÃES DA & LE PENDU Y. 2010. Non-legalized commerce in game meat in the Brazilian Amazon: a case study. Rev Biol Trop 58: 1079-1088. Júnior et al. 2010, Pantoja-LimaOLSON SH, GANGNON R, ELGUERO E, DURIEUX L, GUÉGAN JF, FOLEY JA & PATZ JA. 2009. Links between climate, malaria, and wetlands in the Amazon Basin. Emerg Infect Dis 15: 659-662. et al. 2014, Van Vliet et al. 2014, Chagas et al. 2015, BragagnoloBRAGAGNOLO C ET AL. 2019. Hunting in Brazil: What are the options? Perspect Ecol Conser 17: 71-79. et al. 2019, Souto et al. 2019). It is estimated that just in the triple frontier area of Amazonia shared by Colombia, Peru and Brazil 473 tons of meat from wild animals (“bushmeat”) are sold per year (Van Vliet et al. 2014). Human consumption of bushmeat, including meat from exotic animals, is traditional in the Amazonian countries (Milner-Gulland et al. 2003, Van Vliet et al. 2014). Also, hunting is often associated with logging operations, which bring workers into contact with disease vectors (Eve et al. 2000).

Wild animals host different known and unknown pathogens with a potential of infecting humans. Hunting and handling (butchering) meat of wild animals puts humans in direct contact with biological fluids of these animals and their pathogens. These practices therefore facilitate spillover events and the emergence of new infections in the human population (WolfeWERTH D & AVISSAR R. 2002. The local and global effects of Amazon deforestation. J Geophys Res Atmos 107: LBA55-1-LBA55-8. et al. 2004, 2005a, b, Leroy et al. 2009, UhartTERÇAS-TRETTEL ACP ET AL. 2019. Malaria and hantavirus pulmonary syndrome in gold mining in the Amazon region, Brazil. Int J Environ Res Public Health 16: E1852. et al. 2013, AstonASTON EJ, MAYOR P, BOWMAN DD, MOHAMMED HO, LIOTTA JL, KWOK O & DUBEY JP. 2014. Use of filter papers to determine seroprevalence of Toxoplasma gondii among hunted ungulates in remote Peruvian Amazon. Int J Parasitol Parasites Wildl 3: 15-19. et al. 2014, Pernet et al. 2014).

Tropical forests such as the Amazon rainforest harbor a wide variety of unknown pathogens. Due to this factor and other social, demographic, and environmental characteristics, Brazil is considered to be a hotspot for the emergence of infectious diseases (Keesing et al. 2010, AllenALLEN T, MURRAY KA, ZAMBRANA-TORRELIO C, MORSE SS, RONDININI C, DI MARCO M, BREIT N, OLIVAL KJ & DASZAK P. 2017. Global hotspots and correlates of emerging zoonotic diseases. Nat Commun 8: 1124. et al. 2017, Nava et al. 2017). The data mentioned above regarding hunting and bushmeat consumption make hunting-associated spillover events a serious (but still neglected) concern in Brazil.

Prostitution

Deforestation in remote areas such as the Amazon rainforest attracts a diversity of workers from various regions, not only for deforestation, but also for gold-digging and construction of dams and roads. This attraction of people to remote forest areas commonly occurs in socially vulnerable conditions and is associated with increased prostitution and unprotected sex (Parriault et al. 2015, FreireFOLEY JA ET AL. 2005. Global consequences of land use. Science 309: 570-574. et al. 2018, LopesLIANG L & GONG P. 2017. Climate change and human infectious diseases: A synthesis of research findings from global and spatio-temporal perspectives. Environ Int 103: 99-108. et al. 2019, MacielMACDONALD AJ & MORDECAI EA. 2019. Amazon deforestation drives malaria transmission, and malaria burden reduces forest clearing. Proc Natl Acad Sci USA 44: 22212-22218. et al. 2019). As a consequence, in multiple Amazonian regions there are increases in sexually transmitted infections, particularly syphilis and HIV (Zavaleta et al. 2007, BartlettBARTLETT EC, ZAVALETA C, FERNÁNDEZ C, RAZURI H, VILCARROMERO S, VERMUND SH & GOTUZZO E. 2008. Expansion of HIV and syphilis into the Peruvian Amazon: a survey of four communities of an indigenous Amazonian ethnic group. Int J Infect Dis 12: e89-e94. et al. 2008, Parriault et al. 2015, BenzakenBENZAKEN AS, SABIDÓ M, BRITO I, BERMÚDEZ XPD, BENZAKEN NS, GALBÁN E, PEELING RW & MABEY D. 2017. HIV and syphilis in the context of community vulnerability among indigenous people in the Brazilian Amazon. Int J Equity Health 16: 92. et al. 2017, Mosnier et al. 2018, Costa et al. 2019, Maciel et al. 2019, Neto et al. 2019NETO PLF ET AL. 2019. Syphilis among newly diagnosed therapy-naive HIV patients in Belém, Pará, Amazon region of Brazil. AIDS Res Hum Retroviruses 35: 511-512., Cavalcante et al. 2019).

One of the main factors contributing to the faster spread of HIV in the early 1920s in what is now the Democratic Republic of Congo was the increased number of sex workers in the region, especially in areas of forests that were being cleared for railroad construction (Faria et al. 2014). However, prostitution is often overlooked in studies evaluating the connections between deforestation and infectious diseases. This problem must receive more attention in programs of health promotion for Amazonian populations, with a special focus on sex workers, men who have sex with other men, and other vulnerable groups. The introduction and spread of sexually transmitted infections in indigenous populations in the Amazon region is of particular concern (Bartlett et al. 2008, Orellana et al. 2013, Benzaken et al. 2017).

Loss of animal and plant biodiversity

Environments with high biodiversity harbor many potential new pathogens. At the same time, preserving these environments and their rich biodiversity is, to a certain extent, a way to prevent emerging infectious diseases (Keesing et al. 2010). The relationship between biodiversity and infectious diseases is complex and may seem paradoxical at first, but some precepts are clear: preserved ecosystems act as health promoters, maintaining pathogens in the forest environment. From another perspective, disturbances in highly biodiverse ecosystems facilitate the emergence and spread of new human infections. These basic precepts need to be taken into account in future studies, development projects and political decision-making focused on the Amazon region.

Currently, the loss of animal biodiversity is a serious problem in the Amazon forest. The disappearance of predators can favor increases in the populations of species that act as reservoirs for pathogens. An increase in the population of a given animal species may favor the proliferation of blood-feeding vectors that feed on these animals. In addition, loss of plant biodiversity is linked to the fragmentation of habitats occupied by different animal species. Deforestation and habitat fragmentation threaten animal species and may even cause extinction. Together, the loss of animal and plant biodiversity diminishes and even extinguishes ecological niches occupied by predators, disease vectors, and pathogens. On the other hand, biodiversity loss creates new niches that may be occupied by alternative reservoir species, vectors, hosts, and pathogens (Morens et al. 2004, Pignatti 2004, AguirreAGUIRRE AA & TABOR GM. 2008. Global factors driving emerging infectious diseases. Ann NY Acad Sci 1149: 1-3. & Tabor 2008, Pongsiri et al. 2009, Ometto et al. 2011, Altizer et al. 2013). In brief, the loss of biodiversity profoundly alters the dynamics of the infections.

Deforestation and habitat loss decrease the quality of life of the human population, since environmental degradation is often accompanied by stress, malnutrition and increased contact with pollutants. These physiological aggressions can affect the immune system, causing immunosuppression and making both humans and other species more susceptible to pathogens, which facilitate the spread of infections between wildlife and humans (Aguirre and Tabor 2008, BeckerBECKER DJ, DOWNS CJ & MARTIN LB. 2019. Multi-scale drivers of immunological variation and consequences for infectious disease dynamics. Integr Comp Biol: icz138. et al. 2019). The combination of biodiversity loss, habitat fragmentation, and human contact with forest areas creates ideal conditions for the introduction of known and unknown pathogens into the human population.

HOW TO MITIGATE THE IMPACTS OF DEFORESTATION

Problems and activities associated with Amazon deforestation and impacts on infectious diseases are summarized in Figure 1. Brazil and other Amazonian countries have all of the main drivers for the emergence of infectious diseases: rich biodiversity and multiple social and ecological challenges. For these reasons, the emergence of infectious diseases in these countries cannot be completely prevented. However, there are many actions that should be implemented to prevent infectious diseases.

Vulnerability of human health to climate change can be evaluated and measured through different methods (Kovats et al. 2003, Ebi et al. 2006, Confalonieri et al. 2009). Various ways to identify climatic drivers of infectious disease also exist (Metcalf et al. 2017). Identifying the factors that stimulate the emergence of these diseases is therefore essential. Different regions present different challenges in addressing infectious diseases, thus requiring specific solutions.

Figure 1
Problems and activities associated with Amazon deforestation and impacts on infectious diseases. The problems and activities associated with the emergence of infectious diseases can result from Amazon deforestation (e.g., floods and water pollution). In other situations, they act as promoters of deforestation (e.g., road construction and mining). Some factors are both consequences and causes of deforestation, as in the case of human migrations and urbanization, as represented by bidirectional arrows. This figure was created using Mind the Graph illustrations (available at www.mindthegraph.com).

Inequality-related issues are at the core of several concerns discussed in this article. For example, inadequate patterns of land use and poor sanitation are directly related to deforestation, facilitating the spread of infectious diseases in multiple ways. Reducing social inequality is therefore essential to realistically addressing infectious diseases in Amazonian countries. To achieve this goal, investment in education, environmental sanitation, health facilities, and income generation are fundamental priorities, especially for the most vulnerable populations.

Prevention of infectious diseases also requires a robust monitoring system focused on the circulation of pathogens in the environment, humans, and non-human animals. In the environment, monitoring of pathogens in water, soil and sediments is needed for detection of health risks and for planning sanitation programs, especially in the Amazon region, where public health issues are very common (StaggemeierSOUTHWORTH J, MARSIK M, QIU Y, PERZ S, CUMMING G, STEVENS F, ROCHA K, DUCHELLE A & BARNES G. 2011. Roads as drivers of change: trajectories across the tri-national frontier in MAP, the southwestern Amazon. Remote Sens 3: 1047-1066. et al. 2011, PradoPIGNATTI MG. 2004. Saúde e ambiente: as doenças emergentes no Brasil. Ambient Soc 7: 133-147. & Miagostovich 2014, SpilkiSOUSA JÚNIOR AS, PALÁCIOS VRCM, MIRANDA CS, COSTA RJF, CATETE CP, CHAGASTELES EJ, PEREIRA ALRR & GONÇALVES NV. 2017. Space-temporal analysis of Chagas disease and its environmental and demographic risk factors in the municipality of Barcarena, Pará, Brazil. Rev Bras Epidemiol 20: 742-755. 2015). For monitoring in humans and animals, it is necessary to invest in low-cost diagnostic methods that are easy to apply in remote places. Genome-based technologies are emerging for diagnosis and surveillance of infectious diseases and for the study of emerging pathogens (Ellwanger et al. 2017, Gardy & Loman 2018, Gu et al. 2019, Gwinn et al. 2019). Selection of specific sentinel human and animal populations (blood donors, livestock, vectors, among others) helps to detect the emergence of new infectious diseases and of disease outbreaks, enabling actions to mitigate the spread of such events (Ellwanger et al. 2019).

It is also important to invest in laboratory facilities and in training personnel to identify new pathogens quickly, safely, and effectively. Regarding arboviruses, development of techniques with low cross-reactivity is essential. Outbreak-response networks need to be strengthened and expanded through national and regional surveillance systems. Two actions should be highlighted: vaccine development and vector control. Together with environmental sanitation, these two factors could bring robust advances in the control of infectious diseases in the Amazon forest and in other tropical regions (BarataBARATA RCB. 1997. O desafio das doenças emergentes e a revalorização da epidemiologia descritiva. Rev Saude Publica 31: 531-537. 1997, Waldman 2001, Lima-Camara 2016, Cardoso & Navarro 2007, Donalisio et al. 2017).

Brazil already has basic infrastructure and technical capacity for prevention and mitigation of infectious diseases. However, for these actions to be effectively applied, the government needs to supply resources to the agencies and to the professionals who are committed to these goals. Civil society should support the work of scientists and health professionals, and demand that the government appropriately allocate resources to agencies responsible for health promotion and environmental surveillance throughout the country, including the training of community health agents (Luna 2002). The vast territorial extent of Brazil is a challenge for epidemiological surveillance. Many activities of great social and environmental impact occur in conditions of geographical isolation or informal processes. Similarly, many public health emergencies occur in hard-to-reach places with little installed capacity for monitoring, prophylaxis, and treatment of diseases resulting from ecological disturbances. Investing in technologies for remote monitoring of environmental impacts and for remote health care can help overcome the challenges of epidemiological surveillance in Brazil.

The civil society needs to be more engaged with environmental issues, and it is the role of scientists and educators to encourage the population to be involved in actions focused on biodiversity preservation. Therefore, scientists must work to popularize science and raise awareness of the importance of preserving Amazon ecosystems from a broad perspective, including human health. Several new ways to promote this approach exist, including the use of mobile apps focused on environmental education, science podcasts, and platforms for promoting individuals’ engagement in science tasks (Palumbo et al. 2012, BagnoliniBAGNOLINI G, DA COSTA G, GERINO M, ROTH M & CÉCILE T. 2017. Multidisciplinarity for biodiversity management on campus through citizen sciences. In: 2nd Workshop on Smart and Sustainable City (WSSC 2017) in conjunction with 2017 IEEE Smart World Conference. San Francisco, United States. https://doi.org/10.1109/UIC-ATC.2017.8397397.
https://doi.org/10.1109/UIC-ATC.2017.839...
et al. 2017, von Konrat et al. 2018).

In addition to reducing deforestation, it is necessary to recuperate degraded areas. Reforestation, afforestation, and restoration of forest environments help mitigate climate change through carbon sequestration, and social, ecological and economic benefits are obtained through the recovery of degraded forest areas (Bonan 2008, BrancalionBRANCALION PHS ET AL. 2019. Global restoration opportunities in tropical rainforest landscapes. Sci Adv 5: eaav3223. et al. 2019, Bustamante et al. 2019, Prevedello et al. 2019). However, the carbon and biodiversity benefits of preventing Amazonian deforestation are much greater than those of forest recovery, both per hectare and per unit cost, making avoiding deforestation the current priority in the Amazon region (FearnsideFEARNSIDE PM. 2017a. Planned disinformation: the example of the Belo Monte Dam as a source of greenhouse gases, p. 125-142. In: Issberner L-R & Lena P (Eds), Brazil in the Anthropocene: Conflicts between Predatory Development and Environmental Policies. New York, USA: Routledge, 368 p. 2017b).

Any interference in nature has consequences. Increasing forestation and biodiversity may increase the burden of some infectious diseases since this can facilitate the contact of humans with pathogens. In addition, urbanization can have a favorable effect on the control of such diseases, as it provides the population greater access to health services and better sanitation (Bauch et al. 2015, Wood et al. 2017). Therefore, reforestation and actions to preserve biodiversity could have undesirable effects on human health if these actions are not coupled with the implementation of public health infrastructure, especially in cities and new settlements located in forest areas.

Beyond maintaining vegetation cover, it is necessary to limit and regulate human activity in the Amazon forest. Policies and inspection actions focused on the control of deforestation must be strengthened and expanded, limiting artisanal gold digging, industrial mining, agriculture, livestock and logging operations in Amazonia. Forest fires must be controlled more actively. Protected areas and indigenous lands (terras indígenas) must be respected. Besides preserving indigenous culture of ethnic groups, demarcation of indigenous lands contributes to the maintenance of forest areas with their original characteristics. Non-governmental organizations need to be recognized as important actors in the control of Amazon deforestation (BarlowBARLOW J ET AL. 2016. Anthropogenic disturbance in tropical forests can double biodiversity loss from deforestation. Nature 535: 144-147. et al. 2016, Nogueira et al. 2018, Artaxo 2019, Brito et al. 2019, Carvalho et al. 2019).

The Brazilian National System of Conservation Units (Sistema Nacional de Unidades de Conservação da Natureza - SNUC), which was created by law in 2000, establishes the criteria for the creation, implementation and management of protected areas (PAs). The SNUC classifies PAs into two main categories: “strictly protected areas,” which have as their primary objective the preservation of biodiversity and therefore can be used only for a few purposes (such as research), and “sustainable-use” PAs, which allow people to live within their borders and harvest forest products sustainably (Brazil 2000, Bauch et al. 2015). Besides contributing to biodiversity preservation, implementation of strictly protected areas has been associated with decreases in the incidence of diseases such as malaria, diarrhea and respiratory infection; sustainable-use PAs, on the other hand, have shown a positive correlation with malaria, probably due to greater exposure of people to mosquitoes (Bauch et al. 2015).

Historically, Brazil has a prominent role in the field of tropical medicine. The country should therefore be a protagonist in controlling deforestation and climate change and their impacts on infectious diseases. Since the country has the largest portion of the Amazon rainforest, Brazil should keep its leading role in health research in Latin America (Lacerda et al. 2019).

ADDITIONAL CONSIDERATIONS

Human pathogens represent only a tiny fraction of the world’s parasite diversity (BallouxBALLOUX F & VAN DORP L. 2017. Q&A: What are pathogens, and what have they done to and for us? BMC Biol 15: 91. & vanTESLA B, DEMAKOVSKY LR, MORDECAI EA, RYAN SJ, BONDS MH, NGONGHALA CN, BRINDLEY MA & MURDOCK CC. 2018. Temperature drives Zika virus transmission: evidence from empirical and mathematical models. Proc Biol Sci 285: 20180795. Dorp 2017). It is naive to imagine that infectious diseases can be totally controlled. The human population needs to learn how to live in a balance with pathogens, controlling and managing disease dissemination and taking measures to hinder the emergence of new infections (Bañuls et al. 2013). For example, many infectious diseases are endemic to the Amazon region as a result of the region’s natural landscape (ConfalonieriCONFALONIERI UEC, MARGONARI C & QUINTÃO AF. 2014. Environmental change and the dynamics of parasitic diseases in the Amazon. Acta Trop 129: 33-41. 2005). Almost all cases of malaria in Brazil occur in the Amazon region (Lacerda et al. 2019). A huge decrease in the human cases of these diseases would only be feasible through the absence of human contact with the forest, which is unrealistic and not beneficial for humans. Therefore, it is necessary to identify the regions with the highest risk for emerging infections, to invest in diagnostic technologies, and to develop better therapeutics.

Climate change and anthropogenic changes in forest environments can have varied effects on infectious diseases, including decreasing either vector populations or the number of disease cases in some situations, especially regarding malaria (Sanches-Ribas et al. 2012, Gottdenker et al. 2014, Laporta 2019). However, these cases in no way justify neglecting the impacts of deforestation on human health and biodiversity. The few potential “benefits” from climate change will be outweighed by a plethora of hazardous collateral effects. Based on the studies discussed in this article, it is evident that the decrease in the spread of some infectious diseases as a result of deforestation is very small and context-dependent compared to the large effect that deforestation has in promoting the spread of disease vectors and pathogens. Moreover, the Amazon region and other forest areas play multiple essential functions for the balance of life on Earth in ways that are not directly related to infectious diseases.

CONCLUSIONS

The influence of Amazon deforestation on the emergence of infectious diseases is supported by a large amount of consistent data. Deforestation and related human disturbances provide the link between a variety of factors involved in the emergence and spread of the infections. The complex interactions between proposed development projects and the respective burden of diseases in the Amazon region need to be considered.

Prevention and control of infectious diseases in the Amazon region are complex tasks and involve actions to mitigate all of the problems discussed in this article. Therefore, participation of different professionals and institutions is needed, including government agencies, universities, research institutions, non-governmental organizations, schools, and local communities. A One Health perspective should be applied, primarily to identify the factors contributing to the emergence and transmission of infectious diseases. Specific measures can be taken to address each specific problem, but these measures require integrated actions involving different spheres of the society. For example, the government may act with the help of non-governmental organizations to monitor deforestation in the Amazon region. Similarly, public health agencies, schools and scientists should work together to stimulate vaccination and other preventive and health promotion strategies.

Controlling deforestation means preserving biodiversity and protecting human health. Brazil has a great responsibility in this regard as the holder of the largest Amazon territory and must, therefore, actively and constantly ensure its preservation. From a broader perspective, the extent of Brazil’s commitment to the preservation of the Amazon region will be reflected in planetary health.

ACKNOWLEGMENTS

We thank the agencies that funded the authors of this article: JHE receives a postdoctoral fellowship from Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES, Brazil). BKL receives a masters scholarship from Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq, Brazil). VLK and LC receive doctoral scholarships from CAPES (Brazil). JMVV was supported by Labex EpiGenMed, an “Investissements d’avenir” program, ANR-10-LABX-12-01 postdoctoral fellowship (France). JABC, FRS and MRB receive research fellowships from CNPq (Brazil). PMF is funded by CNPq Proc. 311103/2015-4, 429795/2016-5; FAPEAM proc. 708565; INPA PRJ15.125, and Rede Clima (INPE) FINEP Proc. 01.13.0353-00. LLG receives support from the Fundação de Amparo à Pesquisa do Estado de São Paulo/São Paulo Research Foundation (FAPESP – proc.n. 2019/12804-3, Brazil) and from CNPq (Brazil) proc.n. 309840/2018-0. SEMA receives financing support from Fundação de Amparo à Pesquisa do Estado do Rio Grande do Sul (FAPERGS, Brazil).

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Publication Dates

  • Publication in this collection
    17 Apr 2020
  • Date of issue
    2020

History

  • Received
    8 Nov 2019
  • Accepted
    17 Feb 2020
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