Conservation Efforts and Malaria in the Brazilian Amazon

Micah B. Hahn Nelson Institute for Environmental Studies, Center for Sustainability and the Global Environment (SAGE), Department of Population Health Sciences, School of Medicine and Public Health, University of Wisconsin, Madison, Wisconsin; Wildlife Conservation Society—Canada, Nanaimo British Columbia, Canada; Division of Infectious Diseases, Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Department of Pathology, University of Texas, Galveston, Texas; Health Information Research Department, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil; Nicholas School of the Environment, Duke University, Durham, North Carolina

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Sarah H. Olson Nelson Institute for Environmental Studies, Center for Sustainability and the Global Environment (SAGE), Department of Population Health Sciences, School of Medicine and Public Health, University of Wisconsin, Madison, Wisconsin; Wildlife Conservation Society—Canada, Nanaimo British Columbia, Canada; Division of Infectious Diseases, Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Department of Pathology, University of Texas, Galveston, Texas; Health Information Research Department, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil; Nicholas School of the Environment, Duke University, Durham, North Carolina

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Amy Y. Vittor Nelson Institute for Environmental Studies, Center for Sustainability and the Global Environment (SAGE), Department of Population Health Sciences, School of Medicine and Public Health, University of Wisconsin, Madison, Wisconsin; Wildlife Conservation Society—Canada, Nanaimo British Columbia, Canada; Division of Infectious Diseases, Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Department of Pathology, University of Texas, Galveston, Texas; Health Information Research Department, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil; Nicholas School of the Environment, Duke University, Durham, North Carolina

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Christovam Barcellos Nelson Institute for Environmental Studies, Center for Sustainability and the Global Environment (SAGE), Department of Population Health Sciences, School of Medicine and Public Health, University of Wisconsin, Madison, Wisconsin; Wildlife Conservation Society—Canada, Nanaimo British Columbia, Canada; Division of Infectious Diseases, Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Department of Pathology, University of Texas, Galveston, Texas; Health Information Research Department, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil; Nicholas School of the Environment, Duke University, Durham, North Carolina

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Jonathan A. Patz Nelson Institute for Environmental Studies, Center for Sustainability and the Global Environment (SAGE), Department of Population Health Sciences, School of Medicine and Public Health, University of Wisconsin, Madison, Wisconsin; Wildlife Conservation Society—Canada, Nanaimo British Columbia, Canada; Division of Infectious Diseases, Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Department of Pathology, University of Texas, Galveston, Texas; Health Information Research Department, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil; Nicholas School of the Environment, Duke University, Durham, North Carolina

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William Pan Nelson Institute for Environmental Studies, Center for Sustainability and the Global Environment (SAGE), Department of Population Health Sciences, School of Medicine and Public Health, University of Wisconsin, Madison, Wisconsin; Wildlife Conservation Society—Canada, Nanaimo British Columbia, Canada; Division of Infectious Diseases, Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Department of Pathology, University of Texas, Galveston, Texas; Health Information Research Department, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil; Nicholas School of the Environment, Duke University, Durham, North Carolina

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We respond to Valle and Clark,1 who assert that “conservation efforts may increase malaria burden in the Brazilian Amazon,” because the relationship between forest cover and malaria incidence was stronger than the effect of the deforestation rate.1 We contend that their conclusion is flawed because of limitations in their methodology that we discuss in detail. Most important are the exclusion of one-half the original data without a discussion of selection bias, the lack of model adjustment for either population growth or migration, and the crude classifications of land cover and protected areas that lead to aggregation bias.1 Of greater significance, we stress the need for caution in the interpretation of data that could have profound effects on regional land use decisions.

Author Notes

* Address correspondence to Micah B. Hahn or William Pan (Duke University), Nelson Institute, Center for Sustainability and the Global Environment (SAGE), Department of Population Health Sciences, School of Medicine and Public Health, University of Wisconsin, 1710 University Avenue, Madison, WI 53726. E-mails: mbhahn@wisc.edu, micah.hahn@gmail.com, or william.pan@duke.edu.

Authors' addresses: Micah B. Hahn and Jonathan A. Patz, Nelson Institute, Center for Sustainability and the Global Environment (SAGE), Department of Population Health Sciences, School of Medicine and Public Health, University of Wisconsin, Madison, WI, E-mails: mbhahn@wisc.edu and patz@wisc.edu. Sarah H. Olson, Wildlife Conservation Society—Canada, Nanaimo, British Columbia, Canada, E-mail: solson@wcs.org. Amy Y. Vittor, Division of Infectious Diseases, Department of Medicine, University of Pennsylvania, Philadelphia, PA, and Department of Pathology, University of Texas, Galveston, TX, E-mail: amy.vittor@uphs.upenn.edu. Christovam Barcellos, Health Information Research Department, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil, E-mail: xris@fiocruz.br. William Pan, Nicholas School of the Environment, Duke University, Durham, NC, E-mail: william.pan@duke.edu.

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