A version of this story appeared in Science, Vol 375, Issue 6585.
The reconnaissance trip in western Venezuela was going smoothly—until a gunman took aim at their windshield. It was March 2019, and two infectious disease specialists, Alberto Paniz Mondolfi and Carlos Hernandez, were driving back to their headquarters from villages in Venezuela’s disease-ridden Portuguesa state, where they hoped to set up a campaign to collect health data.
On a desolate stretch of highway, a young man leapt from the bushes and took up a shooting stance in their lane. “I even remember the song on the radio. Money for Nothing. Dire Straits,” Paniz Mondolfi says. “I said, ‘Carlos, put your head between your legs, I’m going to try to go around this guy.’” He swerved into the opposite lane and pushed hard on the gas pedal. A shot rang out. And then more shots. Luckily, the would-be carjacker missed.
Rebuilding public health in chaotic, poverty-stricken Venezuela is not for the faint of heart. The oil-rich country once supported a robust science establishment. But a yearslong economic crisis exacerbated by the COVID-19 pandemic has devastated Venezuela and its public health infrastructure, allowing infectious disease to flourish. Malaria cases, for instance, rose nearly 20-fold from 2001 to 2017, Paniz Mondolfi and colleagues reported in The Lancet Infectious Diseases in May 2019. Now, he is on a mission to fight disease in his native country, one harrowing step at a time.
In 2016, the deteriorating conditions in Venezuela prompted Paniz Mondolfi, who is the director of molecular microbiology at Mount Sinai Hospital in New York City, to launch the nonprofit Venezuelan Science Incubator (IVC), a national network of 60 young physicians, biologists, veterinarians, and others who are diagnosing and treating infections and educating the public on hygiene and sanitation. The incubator has also enlisted an army of citizen-scientists to serve as disease sentinels, collecting basic epidemiological data and alerting IVC to outbreaks that the Venezuelan government’s destitute health agencies now largely ignore. “They’re doing amazing things,” says Martin Llewellyn, a molecular ecologist at the University of Glasgow.
With help from the Rotary Foundation, IVC has just opened what co-leader Isis Mejías, an environmental consultant in Houston, bills as Venezuela’s “first state-of-the-art molecular diagnostics lab” in Barquisimeto, IVC’s home base. It will help detect pathogens responsible for everything from Chagas disease and leprosy to leishmaniasis, Zika, Mayaro, and malaria. “Venezuela has just a tremendous diversity of infectious diseases,” notes Emilia Sordillo, an infectious disease specialist at Mount Sinai.
That diagnostic firepower has allowed IVC to embark on its most ambitious project yet: a pilot for a nationwide program to distribute drugs in communities hard-hit by parasitic worms.
Along the way, IVC’s volunteer corps—many of whom are still earning their college degrees—battle daily deprivations and obstacles. They camp out with hundreds of others at gas stations, waiting for sporadic deliveries to buy rationed fuel, and endure shakedowns at traffic checkpoints. “These kids are so brave,” says Sordillo, who is not affiliated with IVC. They are animated by the mission Paniz Mondolfi has set for IVC: “We need to create and construct a new country, a new culture.”
A generation ago, science flourished in oilrich Venezuela. “There were never problems with the research budget,” Paniz Mondolfi says. But former Venezuelan strongman Hugo Chávez expressed a disdain for science soon after taking power in 1999 and railed against intellectuals on his Sunday talk show Aló Presidente. Many academics stuck it out—at least until after Chávez’s successor, Nicolás Maduro, took power in 2013. Soon afterward, oil prices cratered, collapsing Venezuela’s economic house of cards. Ever since, “There’s been an enormous brain drain,” says Llewellyn, who did his Ph.D. on Chagas disease at the Central University of Venezuela (UCV).
Scientists marooned in Venezuela are mostly idle. Labs have been stripped of anything of value. Criminals pillaged the Institute of Tropical Medicine more than 20 times in 2016 alone, says IVC Academic Coordinator Juan Carlos Gabaldón Figueira, who left Venezuela in 2019 and is now pursuing a Ph.D. in medical parasitology in Barcelona, Spain. “Basically, nothing is happening in science now,” says Ismardo Bonalde, a physicist at the Venezuela Institute for Scientific Research and president of the Venezuelan Academy of Physical, Mathematical and Natural Sciences. As one of the nation’s top scientists, Bonalde earns less than $20 per month—“a joke,” he says. “How can I live on that?”
Venezuela once had enviable health statistics. Now, “Venezuelans are in survival mode,” Mejías says. Most lack access to an uninterrupted water supply and basic sanitation services. On top of that, “They lose track of things they need to do to maintain health, like washing their hands and washing food.” Medicine is scarce, many hospitals are dysfunctional.
Meanwhile, the government has choked off data collection. In November 2014, the Ministry of Health stopped publishing Boletín Epidemiológico, its weekly and monthly epidemiological reports. In 2018, it abolished the Venezuelan Center for the Classification of Diseases, which for 63 years had provided disease data to the Pan American Health Organization and the World Health Organization (WHO). “Venezuela is a black box,” Llewellyn says. Against that dispiriting backdrop, “We’re trying to help reignite research in Venezuela,” Paniz Mondolfi says.
Paniz Mondolfi spent his childhood in Kenya, where his grandfather, a zoologist, served as Venezuela’s ambassador to the United Nations Environment Programme. “I was always dissecting animals with him.” He wanted to be a marine biologist or an astrophysicist, but after moving to Venezuela for college he earned a medical degree and joined UCV’s vaunted Institute of Biomedicine. There, Paniz Mondolfi studied the immunology of leishmaniasis, hoping to embark on a Ph.D. in immunology. But Venezuela’s universities were withering, and in January 2007, he got a terrifying phone call. A national guardsman claimed his wife’s car registration was forged, had detained her at a checkpoint, and was demanding a ransom of about $1000. “That was more than I’d make in a million years in public health in Venezuela,” Paniz Mondolfi says. His father came up with the cash, and his wife was freed.
Days later, the couple was on a plane to New York City. Paniz Mondolfi did a pathology residency at St. Luke’s–Roosevelt Hospital Center and a series of medical fellowships at U.S. universities. He and his family returned to Venezuela in 2014. He tried to make a go of it as a dermatopathologist in Barquisimeto, his wife’s hometown. His family stayed with his in-laws for what was meant to be a 6-month transition, but “we were so poor we never made it out of their house.”
Paniz Mondolfi negotiated a deal to house IVC in a private hospital whose elite clientele safeguards it from power and water outages. The “inventive” arrangement, Llewellyn says, “jibes with how things work in Venezuela.” At the outset, the institute’s primary focus was on Zika virus, which caused a massive epidemic in Latin America in 2015 and 2016. Reports from Brazil indicated pregnant women infected with Zika were giving birth to infants with abnormally small heads and underdeveloped brains. IVC saw the same in Venezuela and also reported neurological symptoms not previously linked to Zika, including rapid eye movements—ocular flutter—from damage to the brainstem and cerebellum, and Alice in Wonderland syndrome, in which people experience distorted visual perception of objects.
Fever line
Annual malaria cases in Venezuela have risen steeply since 2010. Other infectious diseases have surged as well, but the government has choked off data collection.
Such revelations haven’t sat well with the government. In early 2019, two health officials showed up at the private hospital and delivered a blunt warning: If Paniz Mondolfi continued to publish data without their consent, they’d set the country’s intelligence police on him. Soon afterward, he and his family left for New York City, taking some of the heat off IVC. “They assumed they’d severed the head of our organization,” he says. As an added safety measure, IVC personnel cite joint affiliations with Colombian institutions when publishing papers.
As IVC’s aspirations to tackle other diseases began to outstrip its technical capacity, assistance arrived from an unexpected source. In the summer of 2018, Mejías, who was born in Valencia, Venezuela, was hiking in the country’s rugged Canaima National Park with a group that included a cousin of Paniz Mondolfi, who bent her ear about the nascent science incubator. Mejías had a deep connection with the global network Rotary, which had funded her work to improve sanitation at primary schools in Uganda.
Mejias soon joined the IVC team, and in 2020 she helped secure $82,700 from Rotary and other sources for the new molecular diagnostics lab in Barquisimeto. U.S. economic sanctions on Venezuela deterred U.S. firms from selling them scientific equipment, which was “so heartbreaking,” Paniz Mondolfi says, but European dealers came through, and now the lab has a biosafety cabinet for handling risky pathogens, a benchtop DNA sequencer, and a miniature immunoassay reader for detecting peptides, antibodies, and other substances in blood samples. Llewellyn calls it “high-impact science on a shoestring.”
IVC is now targeting Chagas, a tropical malady resurging in Venezuela. The disease is caused by Trypanosoma cruzi, a protozoan transmitted by triatomine insects, known as kissing bugs for their vampiric penchant for biting the face and sucking blood. Chagas ravaged Venezuela in the 1960s and ’70s before nationwide campaigns to spray pesticides and build bug-resistant dwellings. “A lot of it is education. How close you build your chicken hutch to your house is quite crucial,” Llewellyn says. Those interventions faded under Chávez. Anecdotal reports suggest the rural scourge is making inroads in Venezuela’s urban slums. But with scant data, Llewellyn says, “we don’t quite know what’s happening.”
When IVC gets wind of a Chagas outbreak, it dispatches a team to collect kissing bugs, which are examined for T. cruzi. They educate people on measures to reduce exposure to the bugs. They also train people in hot spots to snap cellphone pictures of suspicious insects and upload them to a real-time geographic reference website called #TraeTuChipo, or “Bring Your Bug,” designed by Lourdes Delgado Noguera, a medical student who started volunteering for IVC in 2018 when she was 17 years old. Entomologists chime in to identify and flag risky species. “Citizen science like this is an effective way of addressing public health in failing states,” Llewellyn says.
Paniz Mondolfi huddles with IVC volunteers over Zoom every weekend, plotting out logistics and keeping the team up to speed on the science with an online journal club. When the team is in the field analyzing samples, he can access the software platforms in real time to confer with them on what they are finding. Late last month, he got “Mayday!” texts from team members who had encountered outside Barquisimeto a rash of leishmaniasis cases, including a rare outbreak of the disease in housecats.
Now, IVC is gearing up for Deworming Venezuela. The inspiration was the 2019 research campaign in Portuguesa, which the team launched a week after the attempted carjacking. When they got to the villages, they encountered rampant malnutrition and intestinal parasitosis. “Basically, every single kid was infected,” Paniz Mondolfi says. In a pilot project that kicked off in late January, IVC is studying the link between worm infections and poor sanitary conditions in Portuguesa and Lara and administering the antiparasitic drug ivermectin.
IVC hopes to scale up Deworming Venezuela into a national program, although that would require partnering with a major international organization such as WHO. Meanwhile it forges ahead on meager funding—and the dedication of its tight-knit cadre of volunteers. “It’s quite a feeling to know you have found a family. Friends willing to persevere on the same journey,” says Nina Pagani, who was born in Caracas and joined IVC as a high school junior in 2017. Thanks to Pagani and others of her generation, Paniz Mondolfi says, “we’re keeping the scientific spirit alive in the middle of devastation.”
Long-running aging study charts health impacts of Venezuela’s collapse
Times were good in Venezuela when Gladys Maestre and her colleagues set out to study memory disorders in Maracaibo, a coastal city near the border with Colombia. That was a quarter-century ago, when the country enjoyed a decent standard of living and universal health care. Since then, the long-running Maracaibo Aging Study (MAS) has acquired iconic status—and a tragic new role: charting the toll of social dysfunction, economic collapse, and hunger on the elderly.
Launched in 1997, the MAS went hunting for Alzheimer’s disease in a cohort of 2453 people ages 55 or older in Maracaibo’s Santa Lucia parish. Its goal was to test the notion that Alzheimer’s is largely a phenomenon of the developed world. “Back then, I’d go to scientific meetings and people would say, ‘We don’t need to worry about Latin America, Alzheimer’s is not there,’” says Maestre, a neuroscientist born in Maracaibo who directs the Alzheimer’s Disease Resource Center for Minority Aging Research at the University of Texas, Rio Grande Valley. “In my heart, I was really hoping that was true.” Her first visit to a nursing home in Santa Lucia dispelled that notion: “It was obvious that many people there were severely demented.”
Maestre’s team discovered that compared with U.S. studies, Alzheimer’s incidence in Santa Lucia was twice as high in the 55 to 65 age group and 50% higher in people over age 65. And they were among the first to probe the link between cardiovascular health and cognition. “Today, everybody says what’s good for the heart is good for the brain. But that wasn’t an obvious connection 25 years ago,” says Sudha Seshadri, a senior investigator with the famous Framingham Heart Study, now in its 74th year.
When Venezuelan government support for the MAS dried up in the late 2000s, the U.S. National Institutes of Health (NIH) stepped in. In 2011, NIH backed a major expansion of the MAS to probe the genetics of aging in some 2500 members of an extended family in Santa Rosa de Agua, an impoverished and isolated neighborhood on the shores of Lake Maracaibo. Intriguingly, dementia is less common in that community, says Columbia University geneticist Joseph Terwilliger, who spearheads the study. One factor, he says, is Santa Rosa de Agua’s high mortality rate: Violence and accidents cause many early deaths. “But those who make it to 40 tend to live long, healthy lives,” Terwilliger says.
A novel set of measurements led to an unexpected finding. Blood pressure readings during physical exams tend to be high because people are stressed during an examination, so Maestre’s group pioneered the use of 24-hour blood pressure monitoring in an aging study. “No other study in the world has that kind of data,” says Seshadri, director of the South Texas Alzheimer’s Disease Research Center. About 10 years ago, the MAS team found that about 30% of the Santa Rosa de Agua cohort—“an unbelievably high rate,” Maestre says—suffers from an eye condition named glaucomatous optic neuropathy that can cause blindness if left untreated. In 2018, they correlated the condition with extreme and still-unexplained dips in nighttime blood pressure.
The MAS entered a grim new phase when Venezuela’s economy nosedived in the mid-2010s. Food and drugs became scarce, frosty U.S.-Venezuelan relations bred distrust of the NIH-funded effort, and the team lost a handful of study subjects who feared being seen as “collaborating with the enemy,” Maestre says. Others left the country, as did several key MAS personnel. As power outages grew frequent and lengthy, Maestre scrambled to move frozen tissue samples out of Maracaibo to overseas labs. In 2018, hundreds of samples vanished when highway bandits seized a DHL truck en route to Caracas. They’ve since used a specialized courier service that flies samples out of Maracaibo.
Then the pandemic arrived, cutting a devastating swath through both the Santa Lucia and Santa Rosa de Agua cohorts, Maestre says. Many study subjects have developed clinical depression as they cope with the loss of loved ones to COVID-19 and separation from family or friends who emigrated, says Carlos Chávez, a physician at the University of Zulia who works with the project and lost his wife to the virus.
In September 2021, a National Survey of Living Conditions found 76.6% of Venezuelans live in “extreme poverty.” Exorbitant prices allow most families to buy only a few days’ worth of food every month, Maestre says. The MAS team has enlisted local shops to provide free meals during evaluations, for example, and commodities such as coffee and chickens when things were especially dire a couple years ago. It’s a balancing act, as such interventions can skew data. Still, “We have to step out of our comfort zone and impact lives as best as we can,” Maestre says.
This spring, her team is gearing up for another round of evaluations in Santa Rosa de Agua. They hope to learn whether the residents’ meager diets are reducing the incidence of diabetes, although Maestre notes that any health gains may be offset by insufficient protein and deficiencies of some vitamins and minerals. Seshadri sees Venezuela’s humanitarian crisis as “a horrible natural experiment” akin to the Dutch Hunger Winter study, which tracked the long-term health effects of a famine during the final months of World War II. By tracing the impacts of Venezuela’s plight, Seshadri says, the MAS “might tell us something important for the world.”
She adds that the study has already provided a lesson in resilience: “It’s amazing they’re able to keep it going.”