Why Play the World Cup in a Malaria Zone?

Teams venturing inland in Brazil may have more to contend with than the opposition

Vanderlei Almeida / AFP / Getty Images
Vanderlei Almeida / AFP / Getty Images

Malaria is one of the world’s biggest killers and soccer players are not immune. Even before the World Cup started, two of the players scheduled to participate fell ill upon returning to their home countries. So why are some matches being played in Brazil’s malaria zone, and how will the teams cope?

For people who’ve never been to a malaria-infested country, it may be hard to grasp how top athletes like Kenneth Omeruo, a Nigerian defender who finished up the English season on loan from Chelsea to Middlesbrough, could allow themselves to contract the disease. Liverpool’s Kolo Touré also came down with malaria — not for the first time, he said — after a sojourn in Ivory Coast. Didn’t these guys have the money and smarts to protect themselves?

The truth is that it’s not so easy. A single mosquito bite can be deadly, and players do a lot of their work outside. Sweat can wash away insect repellent, and prophylactic medications aren’t always 100 percent effective. Many people who live in malaria zones don’t take them, preferring to deal with the disease after the fact.

Fortunately, malaria is treatable if caught quickly. Going from infection to full fitness for an international soccer match is no sure thing, but both Omeruo and Touré are in Brazil and ready to play.

Touré and his teammates are especially in luck, as none of their matches in the group stage take them into Brazil’s enormous malaria zone. Omeruo’s Nigeria, on the other hand, has one of four matches in Cuiabá; there are four more in Manaus, in the heart of Amazonia. Visitors to Cuiabá need only avoid mosquitoes to stay safe, according to the Centers for Disease Control and Prevention, but those traveling to Manaus need to take drugs.

This is where things begin to get complicated. Malaria parasites in Brazil are resistant to chloroquine, which has relatively mild side effects and only needs to be taken once a week. Instead, players in Manaus should take atovaquone-proguanil, doxycycline, or mefloquine. Doxycycline increases risks from sun exposure — not so good for daily training — and mefloquine has side effects that were severe enough for the United States Army to ban its use last year. So atovaquone-proguanil it is. But players may still have to deal with side effects including headaches, vomiting, diarrhea, and dizziness.

Though FIFA and Brazil’s government may have wanted to hold the World Cup in as many parts of the country as possible, scheduling matches in the malaria zone is a puzzling decision. Not only are the flights long, the players may experience medical problems that could knock them out of a game or even the entire tournament. If there’s a price to be paid for spreading the wealth, they and their fans will be the ones paying it.

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