E-Letter responses to:

p-forum: H. Varmus, R. Klausner, E. Zerhouni, T. Acharya, A. S. Daar, and P. A. Singer PUBLIC HEALTH: Enhanced: Grand Challenges in Global Health Science 2003; 302: 398-399 [Summary] [Full text] [PDF]

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Grand challenges in vector control roadblocked by narrow carriageway

Brian H Kay   (16 January 2004)

Grand challenges in vector control roadblocked by narrow carriageway 16 January 2004
Brian H Kay, Medical Research Queensland Institute of Medical Research, P.O. Royal Brisbane Hospital,Brisbane, Australia 4029 Respond to this E-Letter: Re: Grand challenges in vector control roadblocked by narrow carriageway	I applaud the Gates Foundation for their Grand Challenges initiative but suspect that for control of the major vector of dengue, Aedes aegypti (L.), GC7 (genetic control) and GC8 (chemical control) indicate a laneway mentality rather than one trying to build a superhighway. Of course, the panel was only given the job of selecting from submissions proferred. Given that the development of a pediatric vaccine is said to be at least 10 years away (1), even with the $55 million recent injection of Gates funding,it is imperative that culturally acceptable and affordable vector control strategies are developed, and soon. This is the grand challenge, and all means should be acceptable toward achieving this objective. The technical challenges of delivering transgenic Ae. aegypti are surpassed by the practical problems of containing this noted global traveller even at trial stage, public resistance to GM products, and memories of the forced withdrawal of WHO from Delhi, amid claims of Ae. aegypti as a biological warfare agent (2). For dengue vector control, chemical strategies such as temephos treatment of potable water and adulticiding have been scrutinized because of ongoing cost and poor efficacy, respectively. The modern impediments to successful Ae. aegypti control have been the promotion of the concept of container homogeneity implicit in larval surveillance indices once promoted by WHO (3), the inability of competitive health budgets to afford the paramilitary style programs originally done so well by Gorgas and Soper, loss of political will through failure to achieve prioritized outputs and to justify costs against economic burden, and lack of alternate cost-effective tools. Given that dengue hemorrhagic fever has increased exponentially in Asia since 1953-54, and more people remain unserved by water supply than anywhere else in the world (4), the real challenge is to deliver a cost-effective strategy to eliminate the risk created by the need to store water. Large water storages produce many more mosquitoes than the smaller containers. Fortunately, for 400,000 (the current figure) people in rural and urban Vietnam, a quantitative strategy of breeding site prioritization, contemporary leadership training, and community-driven biological control has resulted in elimination of Ae. aegypti and dengue (5). The grand and immediate challenge is to apply this strategy as widely as is applicable. 1. D. J. Gubler, Trends Microbiol. 10, 100 (2002). 2. Anon, Nature 256, 355 (1975). 3. World Health Organization, Weekly Epidemiological Record 47, 73 (1972). 4. United Nations.The United Nations World Water Development Report (UNESCO Publishing and Berghahn Books, 2003). 5. B. H. Kay et al., Am. J. Trop. Med. Hygiene 66, 40 (2002). The author declares no conflicts of interest.