Dear Miles,

Please read the attached article.

Good Luck

Many thanks, Arvind. This is what is on my mind:

https://malariaworld.org/blog/malaria-elimination-dilemma

I.e. the wider (than malaria) implications.

Thank all of you for this valuable infromation 

Disney World in Orlando Florida just decided to drain pools in their long-unused water park.  This was in the news today  Do you suppose that reducing potentially hazardous mosquito breeding could have been a consideration?  What might happen if the first case of Zika north of Miami, Florida would come from Disney World? 

In the field of Nuisance & disease Vectors, I do not believe in the "3 E's": Elimination; Extermination or Eradication. At best, we may be able to CONTROL Vectors and be able to prevent major outbreaks. For instance,the World Health Organization had a "Malaria Eradication" Program for several decades. It failed miserably... Then came the "Roll Back Malaria" Program,  with almost similar results...The results of the ITN Bednets Program, are also Questionable (delivery to the people in need & maintenance in good condition, etc.)...Most of these efforts were for nought, because it appears that the number of Human Malaria cases in the affected Countries have currently been on the Rise!

Scientists, Medical Entomologists and the like, are NOT the first answer to solving the Global Malaria problem. Generous donations of untold Millions of $$ by well-meaning citizens, have literally gone to waste.

As most of us in this profession are aware, Malaria flourishes in Poor, Underdeveloped Nations, where housing, sanitation, out-dated agricultural practices, open sewers, open drainages, swamplands, etc. contribute to the problem. The so-called "Consultants" advising these poverty-ridden people who live in these terrible conditions that "...Mosquitoes breed in standing waters, therefore, by "eliminating standing water..." can solve the mosquito problem..." Such "advise" is quite Ludicrous! The most important Priority of these Poor Folks is: Where are they going to get their next Bowl of Rice to Survive another miserable day...? Not "Eliminate Standing Water"! Especially when they are surrounded by Polluted Standing water everywhere!

The very first step towards attempting to "Control" malaria, is the responsibility of the Local Politicians. They would have to sanction very large sums of money to Improvising the above-mentioned Environmental conditions that exist: Building Closed Sewer Systems; Closed Drainage Systems; Improvising Housing facilities; Availability of Piped Water so people do Not have to store water in containers; Draining swamplands; Improvising Agricultural practices & Drip System Irrigation; Improving Health conditions; There is an Unending List of other existing conditions that should be taken into consideration (an almost Impossible task by any aspiring Politician) before moving-on to the next step.

It is only AFTER these Environmental & Living Conditions have been Reasonably Improved, then the Scientists, Medical Entomologists and other Related Professionals might be able to step-in and provide meaningful advise to "Control" this monumental problem. 

Much more can be written on this subject, but this topic could get controversial & "ruffle many feathers..."

Yes, David, Disney World would presumably not want a Zika case to be thought to have "originated" from Disney World. Hence, perhaps, the logic in reducing potential breeding sites of mosquitoes!

Thanks, Minoo, for commenting on these points. Certainly a complicated subject. 

Dear Miles,

We have worked extensively on engineering aspects of malaria control and they play a crucial role in mosquito control. For e.g. water stagnating around a community tape water supply can be directly channelized through a plastered covered drain to a pond and that will stop water stagnation and mosquito breeding. Similarly in rural areas lot of waste water gets collected in front of the houses and this can be avoided by constructing  a soakage pit through applying best engineering methods. Leveling of ditches through earth work on wasteland and thereafter tree plantation on such ground control mosquito breeding and proves to be eco-friendly method of malaria control.  Flushing of irrigation canals, lining of canals to stop water seepage and intermittent irrigation are all engineering methods of malaria control and we have successfully demonstrated it in Kheda district of central Gujarat in India.    

It is interesting to see that malaria control methods are applied on a large scale currently.  The sudden onslaught of Zika is a hemispheric health crisis.  Fortunately, some preventative local efforts are being applied, Disney World being a good example.   Meanwhile the U.S. Congress is sitting on its hands and sitting on the big money, while citizens take more risks.  This is a disgusting response to a serious crisis, where some families will bear lifelong burdens from Zika.  As a specialist in personal protection against mosquitoes using repellents, I am happy that there are some good tools,  if people will just use them.  This includes convincing people with Zika to wear repellents and prevent further spread from these sick people. 

Thank you for the question Miles. While I agree that poverty, bad housing and lack of sanitation and access to good healthcare are root problems that increase both the exposure and morbidity of vector-borne diseases they are not in itself the answer. West Nile virus (WNV), eastern equine encephalitis (EEE) and above all tick-borne Lyme disease sicken thousands of people in some of the US most developed and wealthier states. There have also been epidemics of dengue in Hawaii, Tokyo, Florida, Texas, Chikungunya in Italy and now Zika in Florida. While the impact of vector-borne diseases is highest in areas with poor sanitation/housing and lack of access to healthcare the risk is not zero in developed countries. An informed citizenry that knows how to not provide mosquito habitat in their own backyards by discarding, covering and/or treating stagnant water, pressures politicians to fund informed control programs to manage mosquitoes in shared sites (sewers, catchment basins, urban marshes), and fund research to develop strategies for mosquito AND tick-borne disease control, and knows to use protective measures when traveling to areas where exposure is inevitable (and like David said, continues those measures when coming back potentially infected) are key.

P.S. Thank you for your review article, Arvind Singh, I am reading it with great interest.

Yes, Ms. Fonesca, you are correct in pointing out that we have Disease Vector problems in the USA also; plus, it gets even more complicated due to increase in global travel with potentially infected travelers visit developed countries...but, in comparison to the tremendous problems that some of the underdeveloped countries have, for example, Malaria, then there is no comparison. This highlights a salient point, that IF we have Disease Vector problems in developed Nations even after major efforts are made to publicize via educational programs, higher standards of living, superior sanitation practices, etc., then one has to consider the magnitude of the problems that underdeveloped countries have on their hands! Unless the entire environmental  infrastructure and living conditions are improved first to alleviate these problems, which only the Local Politicians can address; scientists, consultants and major financial contributors alone, cannot provide any long-term solutions.

That was basically I was trying to place emphasis on.

P.S.: A few of my Academic colleagues "silently" were in agreement, but they were not willing to openly support my personal views (quite understandable) to discourage funding for further research.

Mr. Madon, I am constantly amazed about how little we know of the ecology, behavior and physiology of mosquitoes and ticks. Throwing our hands in the air and waiting until politicians develop top down solutions is not smart and will result in pain and suffering. Informed citizens need to connect with humble scientists (humble because they will have to say "I do not know" many many times) and develop solutions together. And yes, I am quite sure some of those will require research, i.e. develop experiments trying to figure out what works, learning from the results, and applying them to the original questions. That is "research". Mindless applications of strategies for mosquito control that do not work is not research.

I should add getting back to the original question that I very much enjoyed reading the review by Mokuolu Olubunmi of habitat modification strategies for malaria control (pdf provided by Arvind Singh) - targeting Anopheles larvae is an approach that has finally come of age in the developing word (it was done in the US and Europe almost a century ago - although not in an informed way leading to wholesale loss of wetlands) . The examples given in that ms clearly underscore the importance and need for local community education and collaboration so best management solutions, sustainable and minimum impact, can be achieved.

Ms Fonesca, if one were to undertake a review of all the many thousands of scientific publications on malaria (an almost impossible task) ; the combined efforts of countless individuals attempting to alleviate this problem in the poor countries; all the efforts by WHO; sincere efforts by other groups; and donations of many millions $$ for the past several decades...Human malaria cases are on the rise in many affected countries.

I am not advocating that we simply "...throw up our hands in the air, and wait for the politicians to take steps to improve the infrastructure of their respective countries..."

I am not being pessimistic about this, we need to be realistic about the existing situation.

This is from Mokuolu 2013 (which is conveniently provided as a PDF in the first reply to Miles question): "Malaria mortality rates have fallen by 47% globally since 2000; by 54% in the WHO African Region and by 58% in African Children". That is still 400,000 or so children dying from malaria each year after all this effort - still too many and why I so enthusiastically support community based education and empowerment. What is unfortunately on the rise is urban malaria primarily in Asia and primarily due to Plasmodium vivax, much less deadly but with high morbidity. Changes in local Anopheles populations appear to be behind that shift but more research needs to be done to fully understand what is going on.

WHO Reports for the year 2013, are as follows:  ~198 million cases of malaria globally; with ~584,000 fatalities (compared to Mokuolu 2013).

WHO Reports for 2015:  214 million cases of malaria globally; with ~438,000 fatalities.

Other Reports estimate that "...over 1 million humans die from malaria each year (mostly children under age 5). An estimated 90% of the malaria cases occur in the Sub-Saharan Region of Africa...

~3.2 Billion people (nearly half of the world's population) are at risk of malaria...The cost in loss of economic growth is many times more...

Although these figures are rough estimates, they obviously indicate increase in human cases of malaria...Therefore supporting "community-based education and empowerment..."; all the research and funding; etc., has not really been a major factor in alleviating this problem. The Root of the problem is still prevalent...

I would like to cite an example at this point, malaria was prevalent in the USA during the 1800's and possibly before that century. Fortunately, the situation in this country was very different. Environmental, Sanitation, Housing & Health conditions were greatly Improved at Significant Cost. This was achieved by the combined efforts of the Politicians approving these significant costs to help in improving their environmental conditions; as well as the resolve of the American citizens willing to improving their quality of life. This resulted in controlling and solving the malarial threat in the USA (I would like to add here that "further scientific research" was not a major contributing factor)!

During most of the 1800's noone knew mosquitoes transmitted malaria (or any parasites or disease agents, for that matter). That was ascertained on August 20 1897 - the culmination of detailed scientific research developed by Ronald Ross. Malaria was rampant in the US until the mid 1900's when a concerted effort by the National Malaria Eradication Program (NMEP) a US coalition of Public Health and Mosquito Control programs. I should point out that county mosquito control programs were the brain child of John Smith, a Rutgers professor, that in the early 1900's researched mosquito biology and ecology to develop mosquito control strategies. The NMEP started in 1946 and ended around 1951 when malaria transmission in the US was successfully interrupted. "It consisted primarily of DDT application to the interior surfaces of rural homes or entire premises in counties where malaria was reported to have been prevalent in recent years." (from CDC's webpage). That strategy had been shown to be effective during WWII by the military and then emulated by the NMEP across the US. According to WHO (and many other sources) deaths in children due to malaria, particularly in sub-Sahara Africa, are significantly down: http://www.who.int/gho/malaria/epidemic/deaths/en/

Like I said in one of my former texts, there has been a recent increase in cases of urban malaria primarily in Asia and central and south America driven by Anopheles species that have become adapted to human-made water holding sites and a significant amount of organic matter. These P. vivax cases rarely lead to deaths but impose a significant burden on those infected, their families and their communities. Malaria epidemiology is changing and needs to be addressed differently also.

As per your question  "environmental engineering" in relation to Malaria?

Malaria is a mosquito borne disease. Mosquito egg laying in stable water. So preplaned water storage techniques, sewage water treatment plant, house infra structure, unused material etc. ultimately i will say best environment best human life.

There will always be changes in Vector-Borne Disease epidemiology as time goes on, that's a known fact.

The Bottom Line is:  Unless major improvements are implemented in the existing environmental infrastructure, health & housing conditions existing in poor countries... Vector-Borne Diseases will continue to flourish.

Thanks to all of you for your interesting comments on a wide range of matters. The reason why I asked the question was because of the biodiversity-associated and non-mosquito, conservation-related implications of vector control. The consequences would vary according to how and where this is carried out. See the original question (which referred to large bodies of water, etc.) in conjunction with what appears here:

https://malariaworld.org/blog/malaria-elimination-dilemma

I fully agree that new ideas need to keep coming in regard to malaria control, this so especially in Africa where most of the control mechanisms applied so far are not home grown but adaptations from other areas in the world. While acknowledging the success of the control mechanisms especially those directed towards the vector; mosquitoes, I need to also remind us that draining up or eliminating whole water bodies will have other environmental effects. Not to overstate that those water bodies are the sources of water to the African homes where piped water is still a dream in many homes. The water  bodies to home to other organisms and they too need to be considered as they have a role in the wider functioning of the ecosystem.

Still think solutions applicable to the local situation and considering all the other aspects of the environment.

hi see this attach 

Dr. Dina Fanseca's wise comments just now led me to Wikipedia, Ross, and more of the early pursuits of malaria, which killed my 4th great grandfather in the Canadian swamps.  

"Patrick Manson's clinical trial (ON HIMSELF, year 1900) showed that the practical solution to malaria infection was in:     1) avoiding the neighborhood of native houses where mosquitoes are abundant,  2) destroying the habitats of mosquitoes, 

3) protection from mosquito bite.[8]"   (Note this 3rd element, and subsequent Nobel Prizes to Ross and some others who battled against always-popular ignorance)

Successful anti-mosquito efforts by U.S. Army scientists led to the completion of the Panama Canal (1912-1915) using lessons learned from early Cuban scientists that are rarely appreciated. 

Efforts by the US Army in World War II to protect soldiers included a new U.S. Department of Agriculture laboratory to study chemical mosquito repellents and DDT.  I enjoyed my time working there.  It appears now that widespread resistance to DDT was not due to its use against malaria, but its widespread adaption of unwise and indiscriminate use in all kinds of agriculture.