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This Week in Global Development
Beyond malaria: Africa’s shift to integrated mosquito management
00:35:25
For decades, Africa's malaria strategy has focused almost exclusively on disease control through indoor mosquito management and personal protection — bed nets, indoor spraying, and individual-level interventions. But this approach alone isn’t working....
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- [00:04]
A
Hi everyone and welcome to this special edition of this week in global Development. I'm Kate Warren, executive Vice President and executive editor at devex. And today we're digging into how one of the smallest creatures on Earth is creating some of the biggest challenges for global health, and you probably guessed it, that is mosquitoes. Now, depending on where you live, mosquitoes might just feel like an annoying part of summer. But for much of the world, mosquitoes can carry diseases like malaria, dengue, Zika, diseases that affect millions of lives every year. And as our climate changes, as cities expand and as mosquitoes adapt, their impact is shifting and spreading. So this special episode is sponsored by Valiant biosciences, a global leader in public health solutions that go beyond the bite. The work spans mosquitoes and vector management, forest health and environmental stewardship, all grounded in science and sustainability. And I'm joined today by Jason Clark, Director of global public health and Forest Health at Valant Biosciences, Silas Majambere, who's the business manager at Valiant Biosciences, and Sindeh Chakate, who is advisor to the President of the Republic of Benin, where the government is pioneering new financing strategies and cross sector collaboration to combat malaria and other mosquito borne diseases. So thank you all for joining us for this special edition episode. So I am particularly interested in this topic and really looking forward to learning from you experts here. I live in Washington D.C. which is often affectionately or unaffectionately referred to as the swamp, which is a perfect breeding grounds for mosquitoes. And you know, they really can kind of take over our summers. My family does everything we can. We use bug spray, we try to get into screens, we try to remove any standing water from our, from our backyard. But the mosquitoes always seem to win. And you know, we live across the street from a national park, we're surrounded by neighbors and businesses. They'll all do or do not their own mitigation practices. And so it really feels like there's only so much an individual can do and that really has to be systemic, coordinated and done at a bigger level. And you know, for my family, again, it's just kind of annoyance dealing with itchy bug bites. But for much of the world, the consequences can really be deadly. And so, Jason, I'd like to start with you. You know, when you think about mosquito control, I think a lot of people think about, you know, bed nets and bug spray, maybe indoor spraying. These tools that have saved millions of lives, but really only protect people, maybe around the individual level, inside or just around their homes, have limited Reach. So when you think about, and think about defining mosquito management today, what can be done beyond these more traditional methods?
- [03:13]
B
Yeah, thanks. Thanks Kate for the invite. Definitely. Excited to join you and, and Cindy and, and Silas to talk about this topic. You know, the idea of, of one of the approaches, certainly personal protection and, and bed nets is really sequestered to the continent of Africa. So a lot of, a lot of the world, in terms of what we talk about mosquito management has used a more integrated approach, because that's what mosquito management is. It's really an integrated approach to minimizing the impact of all mosquitoes, not just from a human health perspective, but also economically and for the quality of life. Right. You know, we're eight and a half, you know, going on nine billion people worldwide. And so when we think about that, the, the idea of management is more of a broader, long term strategic approach that's integrated, whereas the concept of control is, is very tactical and often referred to, particularly in the case of Africa, a single disease and a particular genus of mosquito. So, you know, as we're beginning to think a little bit more broadly about how do we manage mosquitoes, really the conversation is shifting away from just talking about a disease and really opening up and saying how do we take those limited public health dollars and manage the mosquito so that we can manage multiple diseases for those dollars. So that's really this idea of kind of the difference between what I think of mosquito management versus maybe the idea of just controlling of a disease.
- [04:59]
A
Yeah, that's a really interesting distinction to be making there and see. Let's bring you in and really kind of digging into this integrated mosquito management approach. And as Jason said, it is very cost effective, particularly in regions like sub Saharan Africa, and resources are limited and burden of diseases high. You know, Valent Biosciences has really been at the forefront of developing biological and ecological tools to really support this approach. You know, what innovations do you see as most promising for mosquito control and how do they help make this IMM approach more affordable and more scalable, particularly when you think about contexts like sub Saharan Africa.
- [05:43]
C
Yeah, thanks, Kate.
- [05:45]
D
So it might be obvious to us on the panel, but maybe it's worth repeating that mosquitoes breed in water. So most people will see the mosquito and they are bitten and they are burdened by mosquitoes when they are flying. And the tendency will probably be to think about controlling mosquitoes when they are flying only, but they are actually more vulnerable when they are not flying. Usually when they are in the water somewhere you can access and do Something about it. So we have a lot of innovations, but the principle should actually be the one that should be understood first. That is very, very old. It's not new. It's controlling mosquitoes at source. So reducing the population of mosquitoes at source, that is in the water, so that the mosquitoes that fly are not so many and then you can control them when they are adults. So in the realm of what Venant Biosciences is doing, with a lot of research and development background, with a lot of work that they've been putting in here, they have focused on both. So controlling mosquitoes at source, meaning using biological larvicides to control mosquitoes when they are in the water. But also, more recently, you might have heard about the innovation award we got in terms of developing a mosquito adulticide. We can talk about that more. But there is that too. So in the concept of Africa, because you talked about Africa, there is less and less focus on mosquito control in the water at the source. This is the only reason you call it an innovation, because otherwise it's really not new. It's been there forever. But because the shift has been, as Jason has said earlier, on the control rather than on management of mosquitoes, it's always have been in Africa about personal protection, spraying indoors or using bed nets. And the concept of source reduction or controlling mosquitoes at the source has been forgotten. So it's more of a reawakening rather than an innovation in terms of where mosquito control is in Africa.
- [08:20]
A
Yeah. And so, Jason, maybe you can talk a little bit about what are some of the challenges and opportunities you see in being able to scale more this integrated approach and as Selah says, really hitting mosquitoes at the source. I mean, I know again, I mentioned in D.C. where we have a lot of mosquitoes. I've heard stories how just even a little bottle cap full of water can breed millions of mosquitoes. And so when you think about that, can feel like an overwhelming challenge. Right. So what are some of the approaches you're seeing working and then maybe some of the challenges you're looking to overcome to scaling them?
- [09:01]
B
Yeah, it's. It's interesting, you know, so I'm in the Chicago area and you're in Washington D.C. but we share the original ecology, which is swamp. Right. They reversed, they had to reverse the river, you know, in Chicago. And, and before the city was even founded, it was very swamp like. And in fact, from the Mississippi eastward, there's a great heat map mortality, malaria mortality heat map from the 1880s that shows malaria mortality all over the United States, Washington D.C. chicago, even up to New York City. And so when we say what's worked, you know, we kind of need to go back and say what countries have really eliminated mosquito diseases. Here in the United States, they didn't just eliminate malaria, but they were able to eliminate, you know, other diseases like yellow fever, you know, for example. And so fundamentally what's worked and what I see beginning to work, it all starts with the philosophy of where you start. And where you start is environmental management. We talk about a swamp. You know, many of these places, you know, in the early 1900s were draining swamps or redirecting water to Celis's point, because if there's no water, there's no mosquito. It's really that simple. And so if you can do that, you don't need these other measures, but you can't do that all the time. And so the next step in that pyramid, of course, is to manage or to treat those waters, you know, oftentimes, you know, with larvicides. And then of course you can't do that at mass and in scale. And so that's where you need to go after the adult with maybe insecticides and adulticides. And ultimately, you know, it does require some level of personal protection. So that's what works. That's what's worked for over 125 years here in the United States, when they really started in the 20th century, not just taking this idea of personal protection, but incorporating policy at the federal level in terms of environmental management, but in parallel decentralizing decision making for managing mosquitoes ecologically, because the ecology of mosquitoes is very different, you know, between two neighborhoods, let alone within a county or a state or a country. So what I've seen work is when countries have decided to move away from maybe just a commodity donor based federal decision making only to decentralizing the concept of mosquito management to the local level who understands the situation. So both of those things have to happen in those countries that are beginning to move in that direction are successful or, you know, there's certainly going to be a higher degree of success. So that's where I'm seeing some positive. The challenges of course, is over the last 25 years, particularly in the continent of Africa, it's been the reverse of that. It's been a commodities based indoor mosquito management, federally centralized at the national level. And so that's created good progress. But over the last 10 years, according to the WHO malaria report, we've flatlined in terms of our ability to continue to reduce Malaria mortality and morbidity. And so it's that switch, because it's not a more money switch, although we do need more resources. It's a philosophical switch. And so that, again, it's the opportunity, but it's also the challenge in that it's very difficult after 25, let's say, you know, the turn of the millennia in 2000, when the millennium Development Goals were rolled out by the United nations, to operate in one way and then to recognize that you need to shift what's positive there is that it's been done before. To see us point this idea of innovation is really more of a reawakening. I think it's really interesting if you, if you look, if you track Bill Gates on, on social media or LinkedIn just recently, I think within the last week or two weeks, he is highlighting this history of malaria control and then management in the United States. And of course, Bill Gates has a huge following, but it's interesting that he's just now beginning to flag that as something to look towards in terms of what do we need to do next in areas where mosquito management isn't incorporated or where we continue to flatline with malaria.
- [14:08]
A
Yeah. And I think your point that you all have brought up around how a lot of the interventions, particularly on the sub Saharan African continent, has been around bed nets and at the individual level. And I wonder how much of this has really been driven by the fact that it's been a lot of international donors who have been pouring a lot of money into bed nets and indoor spraying and these kinds of interventions. And as we see that donor support declining, how do you move away from that reliance on that donor aid, but two more sustainably locally driven solutions. And there may be being an opportunity here and rethinking how mosquito control is done in that context. And Cinde, I'd love to bring you in. You're in Benin, which I think is a really good example of a country that has taken this more integrated mosquito management approach. I'd love to hear kind of how you all are thinking about this and also thinking about innovative ways to finance this work. And, you know, I'd love to hear about some of the ways that you are linking mosquito control to tourism and economic development and not just health outcomes and what your experience is that other countries might be able to learn from.
- [15:24]
C
So thank you, Kate, and it's a pleasure to be with you on this, on this podcast with Jason and Silas. I like your question, you know, but I think the real thrill behind is that we never really started to have a mosquito control strategy in Africa, if we want to be honest, it was really focusing on malaria, the impact on malaria. And like Jason said, it was indoor management, no bed nets, indoor sprays. And clearly, I think Jason was kind of political or diplomatic, I would say a diplomat saying that it flattened. But the reality is that malaria case has been increasing and we didn't see any improvement, I would say, on the way we manage malaria or mosquitoes in Africa for the last 10, 20 years. I think Jason mentioned two points. He said shift, and it had been done before. And this is exactly what happened with us in Benin. We decided to have a shift here because clearly having mosquitoes in the country, you know, biting people, it doesn't really match well with the development of tourism, which is in Benin, the second pillar of growth that we want to leverage in the country after agriculture. So what we did is that at a high level of the country, with the president himself, we decided to work on this topic and to look at it on the holistic approach. And so that was the first part, the shift. And the second part was, since it has been done before, where can we learn from the best? And we started to do some different trips in the world. We went in the US we went to Asia and Vietnam and to Djibouti in Africa to learn from the best, to have best practices, and to understand what can we do to actually control, really, mosquitoes. So what we're trying to do here after those trips and the strong willingness that we have to tackle this problem was to look at it on three points. The first point for me is, like Jason said, the environment control. The second point I would say is education. And I would like to add to that competence because you need to have also a very competent staff. I fully agree. When we say that we need to understand the ecology of the whole thing, you know, the mosquitoes, it might be different from a different region, different county, different city within a country. It could be different. So we need to have that local ownership, you know, have that local knowledge. And this is what we're trying to do. And linking that with tourism for us made sense, because at the end of the day, it's all a question of budget. How much are you willing to invest in this fight? Because it costs money. And for us, we really see it as investment because we believe that investing in mosquito control will ultimately bring resources, will bring revenues, because we'll be able to, I mean, to welcome motorists, to have more people satisfied the stay in Benin and then, you know, reduce the overall cost of malaria and invest that money into developing more a strategy around Moscow controls in other areas in the country that are not touristic. I would say based areas, but to actually bring that level of, I would say, environment control to the whole country. So that's pretty much what we're trying to do. It's true that it's the beginning. We're starting to do this process with the creation of an agency that is dedicated to this and directly reporting to the presidency because we believe this is a national problem and we need to put all the resources that we have behind that. So I don't know if we are an example yet, but I believe in five years we'll have tangible result and probably before that as well.
- [19:41]
A
The world is facing a range of health threats, from an increase in disease outbreaks to the health impacts of climate change. I'm Jenny Leigh Ravelo, senior global health reporter for devex. Every Thursday, we bring you exclusive news and insights on how the health sector is finding solutions to these challenges in our free weekly newsletter, Devex checkout. Visit devex.comnewsletters to subscribe. You know, I think you have all brought up the importance of local ownership and developing, I guess, locally relevant solutions. But I also want to talk about more that kind of coordination piece. And Cindy, you mentioned traveling to other countries and learning from different experts and. And really seeing the role of regional collaborations. And there is this Pan African Mosquito Control association that c lists. I'd love to hear a little bit more about how you see the role of, you know, these regional collaborations helping to advance a more integrated mosquito control approach while also recognizing the need for local ownership, local solutions.
- [21:01]
D
Yeah. Thanks, Kate. A little bit timely to bring up the Pan African Mosquito Control Association. We are going through a phase where we need to wake up again and put on boots on the ground and do our job. But that's a conversation for another time. So partnership again here in Africa, we have one advantage. We are not having to reinvent the wheel. We're doing something that has been done before, done very excellently. The Pan African Mosquito Control association sort of takes an example from the American Mosquito Control association, again, where mosquito control has and is done excellently and with a lot of, yes, a lot of resources, a lot of knowledge. And so we thought that we needed something like that on the continent. So more or less 10 years ago, we got together different people from different countries on the continent. The continent of Africa is quite big, bigger than people actually appreciate on the map, but so this is 1 billion, 1.4 billion people. So trying to have an agency or an association that would look after issues of mosquito on the continent. So malaria, dengue, we have all sorts of arboviral diseases circulating on the continent here. The idea was to sort of get together and learn together best practices on how to control mosquitoes. Mosquitoes don't have borders. If one country has an issue, the other will have two. So we tried to put our heads together and try to get to a point where we can influence policy on the continent in terms of what is adopted as the best approach for mosquito management. The best tools, learning from the science, the constituency had, scientists had, industry, has policymakers, national programs. So the idea here is to, to be together, learn together, put together best practices, influence policy, learn from the outside and try to control mosquitoes on the ground in Africa. The other thing about partnership here is the world has really changed. This is a time where anything that happens in Chicago or Washington D.C. i'll know it instantly, I will know what's happening there and you know what's happening in Africa. Information circulation is very easy. Exchange of knowledge, of ideas, of innovation will go much faster today than it was 100 years ago. So basically we have everything that it takes to do a great job. Question is, are we going to be determined to just think differently, do things differently on the continent, in this case, I mean on continent of Africa, as Jason just put it and Cynda also mentioned the control of malaria has flattened. And I like also to come back to that publication in Gates note, it does show so well what was done in the us it just fails to say do the same in Africa. So it goes halfway, but it then proposes different things that can be done and those things could be okay and are worth considering. But I think there's a lesson to learn and there's an experience that has been lived. People are still alive and doing that. One parenthesis that I want to add here before I end on this point is I often find fellow Africans and we're chatting and they actually don't know some of them, that there is mosquito control going on today in the us, in Europe, but there is. So we, because we have this concept or there is no malaria in Europe or in the US and we assume mosquito control is only done when you have malaria. But this is a multimillion dollar programs and jobs happening in the us, in Europe and for us in Africa. We have been behind and I'm glad programs like Cinders putting together is starting to do things differently. And I hope that we can only just Learn and do. There's plenty experience out there, there's plenty success out there that we can replicate.
- [25:48]
A
Yeah, that's an excellent point. And Cindy, you had talked a bit about education being a really critical component of overall mosquito management. And I'd love to hear a little bit more about how you see the role of education and civic participation in helping to take mosquito control from just a top down intervention to a more sustainable community led effort. And what you're seeing work in practice when it comes to both educating local communities but also learning from them and what they might be doing that is working really well.
- [26:25]
C
Thank you, thank you for the question. I think education and having also the buying of the population is critical here. And this is what we actually learned when we did our different trips. You know, you cannot put a police guard or someone, you know, behind every citizen to make sure that they have the good practices. And we said, and Silas mentioned it, you know, mosquitoes are coming out of water, you know, so the way we manage, you know, those, those water containers that, the containers that they may have at home, that they may have in the village in the different locations is quite critical. The acceptance also of the different team coming into their areas and spreading products that will be of course more ecological for them. But explaining also the results and explaining what is with the achievement that we're looking for I think is critical. And there's another part of education which is also the competence and understanding how the mosquitoes are working. It's not only malaria related because like I said, the focus has been on malaria, but here we're talking about mosquitoes with all, you know, the vector disease related around those mosquitoes. So it could be malaria, but it could be also another disease. So how can we get that knowledge, you know, in the country with all the people, the different stakeholders that we have around this problem? For me it's part also about education and I think having those partnership with other countries that were successful in this, whether the US or Asia or other countries in Africa is very important and quite critical for us. So I think, you know, in a way having the buying of people is for me the most important thing. Actually it's the first thing, it's the first thing that you, it's the first topic point where we need to invest in terms of resources. Otherwise you will have objection and you won't have good results. I believe so.
- [28:32]
A
Jason, we, a lot of our listeners are global health practitioners that maybe work on even specifically malaria and think about mosquito control within that specific context. What would be your Advice to them on how to maybe rethink mosquito management beyond a single disease approach. And you know, how they can think about incorporating this into their work, even if they are working more in a global health context.
- [29:05]
B
Yeah, no, it's a great question, great answers. In terms of Cindy and Cilis, there's, there's a lot, you know, there's a lot there. Yeah, it's interesting. I do want to touch on what Cindy just, just said is, is, is the idea of buy in when you only focus on a disease, right? In the case of malaria, there's only a certain genus of mosquito that can transmit malaria. It's not all mosquitoes. And there's other mosquitoes, other genuses that only transmit dengue or filariasis or all these mosquito diseases. And so if you're only treating the mosquito that transmits malaria, but the community is continuing to be bit outside, then they're questioning is this working? Because they don't know the difference. They just know they're being bitten by a mosquito or even worse, they're getting sick. It may not be from malaria, it may be from dengue, may be from West Nile virus, Zika, filariasis, whatever. And so this idea of managing, going back to what we originally started talking about, which is the shift from just saying malaria control to mosquito management is so fundamental. And that's such a public health idea. And there is a difference between public health and what I'll call traditional medicine or kind of the medical approach. You know, oftentimes the medical approach is a reactive approach in the sense of someone's sick and they go to the hospital or they go to the clinic and we treat them for something that's happened already. And public health is very much the preventative aspects of that. And how do you go about doing that? And that's through policy oftentimes, but also education, Education is such a huge part of it. And that's why in public health, you know, when you're successful in public health, nothing happens. So how do you prove a negative? It's, it's to the point that Celis brought up where he's saying there's, they didn't realize that there was mosquito management and control in the US and in Europe because there's no malaria. So we're, we're in this constant battle in the public health arena and public health professionals in educating. And it gets harder when you're successful to get money in order to keep things, you know, at the stage that they're at. And so what I would Always, you know, to your question about there's lots of global health professionals listening onto this podcast and are part of this community and you know, I, I, I would just always stress one is absolutely this idea of buy in and how do you do that? And that really is through having a more holistic mosquito management approach. But it's also, you know, recognizing that that's what public health is. It is holistic. It's not a pill. You know, I'll use the bed net is the analogy to that. Right? Here's a net, take it or in that case, sleep under. It has been, you know, oftentimes the approach or, you know, community health workers knocking on the home and said, you know, please let me in so I can spray the inside of your house. That requires, you know, active, active type of behavior. The public health approach is going to be more holistic. It's doing that and right. Helping manage the larger problem that's outdoors. So it's moving away from this kind of reactive control approach where here's using the analogy of the pill and really opening it up and saying we really need to take a public health approach here where it's multidisciplinary. I think, you know, in 2020, 2021, eight and a half billion people finally realized what public health is. I mean, recall there was a vaccine that eventually came into the fold, but that didn't mean that solved the problem. It was a function of education. It was the broader public health disciplines that were required in order to progress. Right. The ability to combat, you know, a global pandemic. So what we're really saying now is we're gonna try and localize it to where most of the problem still remains in the case of malaria. But to open up and decentralize this idea of public health, and when you do that, and there's lots of historical examples, the best examples of public health, global public health, where those disciplines are taken into consideration and rolled out, are where we've seen the most successful public health advances that we've seen as human beings.
- [34:16]
A
So yeah, and I think as you all have made the point, you not only get the public health gains, but you get the economic development gains, you get the quality of life gains. And particularly in a resource constraint environment that most of the world seems to be facing right now, finding these creative solutions where you can get a lot of bang for your buck, if you want to use that analogy, is ever more important. So, Jason Zila, Sandbank, thank you so much for what was a really fascinating conversation. I got a lot to think about too, about my own community and how we could do better at mosquito control. I really appreciate you taking the time and also thank you to Valent Biosciences for sponsoring this discussion and really advancing sustainable science based solutions for global health for our listeners. Thank you for tuning in to this special edition of this week in Global Development and we'll see you next time.