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It’s time for a decisive win

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In the fight against our oldest foes — mosquitoes  

By Htin Kyaw Thu & Leo Braack  

The fight between mosquitoes and mankind is a tale as old as time. With the diseases they carry, mosquitoes have caused humanity devastating death and disability throughout history.

In 2018, there were over 228 million malaria cases throughout the world and a global death toll of 405,000. But let us not forget about the other diseases that mosquitoes carry; in 2017 according to the World Health Organisation, the following numbers were reported globally: Dengue 96 million cases, 9,110 deaths, and 1.8 million disability adjusted life years (DALYs), lymphatic filariasis 38 million cases and over 2 million DALYs, Chikungunya over 693,000 cases, and Zika over 500,000 cases. There are others such as West Nile virus, Japanese Encephalitis, and many more.

A mosquito larva. Photo: Courtesy of Kasetsart University

It is Sir Ronald Ross, who first discovered the causality of malaria and disproving the centuries-old miasma theory where malaria was believed to be caused by bad (mal) air (aria).

This discovery was the first decisive win in favour of mankind, unlocking the secrets in our enemies and honing our strategies against them. We are past the centennial commemoration of Ross’s ground breaking discovery, but the fight against malaria is far from over.

The mosquitoes may not have fancy laboratories or offices in Geneva, but their evolutionary processes to fight back are as sophisticated as our intelligence.

Asia Pacific is a somewhat unique battleground between humans and mosquitoes. It is a home to a great diversity of anopheline vector mosquitoes, with more Anopheles species complexes are found than in the rest of the world.

The Plasmodium parasite, resistant to Artemisinin-derivatives, emerging and spreading across the continent, makes the battleground unfavourable to humans. 

The discovery of synthetic pyrethroids, a safer, longer-lasting, cheap but effective, and potent insecticide which we now use in mighty tools called long lasting insecticide treated bed nets (LLINs) and indoor residual spray (IRS) were a major blow to mosquitoes.

However, these tools, just like their predecessors, have limitations. They provide indoor protection, from ‘dusk-to-dawn’.  

Unfortunately, our mosquito enemies did not read the rule-book. They responded with an adaptation process by changing their behaviour, biting habits, and vulnerability to our weapons, slowly and successfully escaping from our assault.

Now, we need to improve our understanding of our enemies, come up with new tools. This kind of new intelligence will keep us ahead of the game.  

No time to waste in the elimination agenda

The humiliating failure of Global Malaria Eradication Programme (GMEP) is a constant reminder for us that history can repeat itself anytime and we can’t afford to let it happen.

Countries in Asia Pacific now target to eliminate malaria by 2030 and it is a time-bound race. It’s only a decade from now that history will judge our efforts — will it be major celebratory milestone? Or another humiliating defeat?  No country can never be safe from malaria, unless the all the surrounding countries, in the region, are all free from malaria. 

A regional problem needs a regional solution

Although countries in Asia Pacific are slowly and finally graduating from poverty, many still face frail health systems. The region needs an accelerator, facilitator, a partnership, and a catalyst. The Asia Pacific Malaria Elimination Network (APMEN) is a network that supports Asia Pacific countries with their malaria elimination mission by galvanising cooperation, partnership, and togetherness for a common mission. Vector Control Working Group bringing in the collective strength to the fight against malaria.  

Know your enemy

Entomologists are the frontline, intelligence agents who can advise us on how to win this battle against the malaria mosquitoes.

They can tell us which mosquitoes are vectors for malaria, where and how they are distributed, what are the behaviours (breeding, biting), biology, and whether they are susceptible to our current vector control tools.

They can help us answer the important questions of how malaria is being transmitted in a particular area and how the transmission can be halted.

One of the flagship initiatives of APMEN VCWG is the Malaria Vector Surveillance for Elimination (MVSE) course,  a specialised training programme equipping the entomologists and vector control specialists with knowledge and skills to carry out robust vector surveillance in their countries.

Life-long career building of entomologists that gives career incentives for entomologists is much needed in the region. APMEN Fellowship Program is an unique opportunity for countries to groom the next generation leaders in the field of entomology. We all can benefit from both success and our failures if we learn equally from them.

For this purpose, APMEN launched a platform called the Online Resource Exchange Network for Entomology (ORENE)  to be able to effectively exchange information between the countries who are united in this fight. APMEN also facilitates learning through its programme called TechTalk, which are technical deep dive webinars, from time to time, inviting NMCP representatives, researchers, and experts to share their knowledge and facilitate the knowledge transfer process.

Malaria elimination in Asia Pacific is an enterprise that we cannot afford to fail. The shifting frontlines between humans or mosquitoes, and the contest between us developing new tools and mosquitoes finding ways to overcome those tools, will ultimately determine the outcome of this battle.

Join our mission in ending this war with a victory, if you want to support APMEN VCWG, please write to l.braack@malariaconsortium.org or h.thu@malariaconsortium.org

Malaria Consortium is one of the partner institutions of APMEN. Malaria Consortium currently host the Vector Control Working Group. Malaria Consortium uses its expertise to support APMEN the working group to carry out the mission.

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