By: Manuel F. Lluberas MS IDHA, Public Health Entomologist, Río Grande, Puerto Rico (firstname.lastname@example.org)
Vector-borne diseases continue to inflict a heavy burden on human populations. Mosquitoes are the world’s deadliest animal, claiming a life about every minute. In addition to a taking the equivalent of four 747 Jumbo planes full of people daily, malaria is estimated to be responsible for an average annual reduction of 1.3% of economic growth of countries with the highest burden.1 Mosquitoes are also responsible for hundreds of millions of cases of Dengue, Zika, Chikungunya fevers, and the re-emergence of Yellow Fever in parts of the World. This situation calls for improved evidence-based mosquito control strategic plans that safeguard the few public health insecticides available.2
A cursory examination of vector control programs reveals that, with rare exceptions, there is a marked dearth of public health professionals, especially mid-level, and field managers familiar with the details of vector control operations. Complicating the picture, many agencies and organizations speak about Integrated Vector Management (IVM) as the correct approach yet focus their attention on passive methods like mosquito nets and, occasionally, indoor residual spraying. Active mosquito population suppression interventions like larval source management, larviciding, and environmental management, which can be easily implemented through community engagement programs, are relegated to supplementary tools.3,4,5 This is in spite of documented evidence provided in at least two WHO manuals that they are effective under almost every ecological zone.6,7
Moreover, some of the programs established by mineral extraction companies and large plantations have achieved significant successes deploying many of the methods depicted in those publications as part of corporate social responsibility investments. Almost without exception, they have seen tremendous reductions in absenteeism and increases in productivity and revenues less than three years after implementing IVM campaigns that deploy as many tools in the mosquito control toolbox as possible. Unfortunately, because of their nature, these projects have not been properly documented or duplicated in the public sector.
Another factor is lack of political will and commitment. There is no question that those involved in vector control are committed to reducing the global disease burden, but vector control programs are frequently designed as full-time problems addressed on a part-time basis. That is, many of them operate between four to seven months of the year and are virtually shut down the rest of the time. Besides being an ineffective and inefficient structure, it allows the vector population time to recover, affords no job security or career path for the few program managers and their assistants, and provides no long-term corporate knowledge; the main reason for the high staff turnover. Establishing a community education and engagement component during the “off-season” would be a force-multiplier that would improve acceptability of the interventions selected, and advance staff retention.
With properly structured, designed, and implemented IVM programs that follow a rational decision-making process to determine the most appropriate mix of interventions that draw from resources beyond health, both public and private sectors can reduce or eliminate mosquito-borne diseases from almost anywhere.8
Past victories in the Panama Canal, the United States, northern Brazil, Sicily and other countries have been properly documented, but there are more recent success stories associated with initiatives in South Africa, Ghana, Zambia, Zanzibar, Sudan, Ecuador, and a few other countries. Notably, the earlier victories were reached with none of today’s technology or environmentally-sound and target-specific materials. Regrettably, improvements on target-specificity, remote sensing, satellite imagery, wireless communications, and insecticide delivery systems have failed to result in the implementation of truly integrated mosquito control programs mainly because many funding agencies do not understand the concept.
We need to get serious about vector control and take a full-time approach to it. Vector control programs need to deploy active vector population suppression interventions that attack vectors on several fronts simultaneously – larvae, pupae, and adult – and operate continuously.
So, looking at vector control, are we doing the right thing? Are we doing things right? We have a lot of room for improvement.
Manuel Lluberas is public health entomologist with extensive experience in the control of insects of public health and veterinary importance obtained during the past three decades in as many continents. He is a member of the Vector Control Working Group of RBM, designed the framework for the PMI’s IRS campaign, has published extensively on IVM, including a column on Malaria World, contributed in the publication of four books and two operational pamphlets, and directed vector control activities in Banda Aceh, Indonesia in the wake of the tsunami and helped Haiti after the devastating earthquake of 2010. His contributions to public health entomology were recognized by the American Mosquito Control Association with the Meritorious Service Medal. He is the Executive Director for Public Health at H.D. Hudson Manufacturing Company, and participated in the recent CAMA- and GBCHealth-hosted webinar on Emerging Issues and New Tools to Fight Mosquito–Borne Diseases in Africa.
- Sachs JD. Macroeconomics and health: investing in health for economic development. Report of the Commission on Macroeconomics and Health. Geneva, World Health Organization, December 2001.
- Status of pesticide management in the practice of vector control: a global survey in countries at risk of malaria or other major vector-borne diseases. Henk van den Berg, Jeffrey Hii, Agnes Soares, Abraham Mnzava, Birkinesh Ameneshewa, Aditya P Dash, Mikhail Ejov, Soo Hian Tan, Graham Matthews, Rajpal S Yadav and Morteza Zaim. Malaria Journal 2011, 10:125
- Lluberas, M. F. (2014) Empowering Communities to Protect Themselves Against Mosquitoes in the Wake of Hurricane María, Wing Beats, Vol. 29, No. 2; pp 18 – 19 (Summer, Fall, Winter 2018)
- Lluberas, M. F. (2008): Nothing but Net Only Works in Basketball: Emphasizing Integrated Vector Management in Malaria Control; Wing Beats, Vol. 18, No. 4; pp 22-27 (Winter 2007).
- Lluberas M.F. (2018) Integrated Vector Control: Proven Methods or Miasmatic Vapors? A Call to Action. Malaria Control and Elimination Vol 7, No. 1, 163. doi:10.4172/2470-6965.1000163
- WHO Offset Publication No. 1. Manual on Larval Control Operations in Malaria Programmes, WHO, Geneva 1973
- WHO Offset Publication No. 66. Manual on Environmental Management for Mosquito Control with Special Emphasis on Malaria Vectors, WHO, Geneva 1982
- WHO Expert Committee on Vector Biology & Control, (1983)