We're losing pyrethroids due to massive resistance. Are new chemicals the solution?

Yes - we need new public health insecticides

29% (5 votes)

No - new chemicals will give us more of the same - resistance

71% (12 votes)

Total votes: 17

Comments

Environmental measures are permanent

The addiction to drugs and biocides is fueled by corporate pressures on physicians who don't know that there are better, simpler and longer-lasting methods, such as improved irrigation and drainage. Or simple ditching of swamps and other mosquito breeding sites. Or improved housing with screens and insect-proof roofs and eaves. There are also a multitude of anti-larval measures which have been in use ever since the mosquito connection with malaria was established over a century ago. Unfortunately the glamor and advertising pressure of the new chemical and drug age overcomes the average physician who has risen to a position of leadership in national and global health agencies. Because of their personal satisfaction with providing a quick-acting drug for their individual patients, they have little interest nor derive little personal satisfaction from organizing improved housing or drainage works in affected areas, despite the decades of experience with such measures for permanently reducing malaria transmission. So let the rest of us non-physicians work on simple, permanent measures. Clearly the drug and biocide approach of the pediatricians and other physicans has repeatedly collapsed, and will again. In fact, if you carefully read the WHO reports for 2010 and 2011, it is already failing.

William Jobin Director of Blue Nile Associates

build drainage canals but stay out of the trenches

Hi Bill, I dont think that the attitude "whatever comes out of the other camp is wrong" is helpful. Some of chemical solutions, IRS, LLIN are clearly helpful in providing a fast intervention and personal protection. Drugs for those who are sick is a given. If my kid was sick and someone offered to dig a drainage canal along the road outside in place of drugs, he d find his shovel broken on his head in a sec. Fast and personal protection methods are also more than relief for those at immediate risk, they are also great advocacy tools and support, local and abroad, is a prerequisite for any campaign. I also think that you are not correct in diagnosing the silver bullet approach of the past decade as a "new chemical drug age". If you look at the advocacy campaigns, the headlines have been dominated by the word "net". If you as a donor can imagine your 10bucks being converted into a safety barrier around a sleeping child, making the donation is easy and likely. That s however, where our disagreement ends. As expressed many times, I believe a sustainable effort is based on a multitude of interventions, among them engineering, larvicide and home improvement (none of which are "permanent" though). These type of interventions require more local adaption and so far it s been policy to only pursue "one shoe fits all" type solutions, irrespective of the successrate of this philosophy for any type of intervention, anywhere. If only the sustainable and locally adapted solution would be added to the mass campaigns, we d save money and the steps forward would not be followed by the slide back you predict. The larvicide and breeding site reduction (engineering) type campaigns need not be more expensive in terms of cost pr household pr year and they certainly provide overall greater value as they also improve on other aspects, such as sanitation, infrastructure and nusiance from mosquitoes that bite at dusk or day time. If you have the time and opportunity, please read our latest article Cost of Integrated Vector Control With Improved Sanitation and Road Infrastructure Coupled With the Use of Slow-Release Bacillus sphaericus Granules in a Tropical Urban Setting that s jr of medical entomology. We re not selling any of products mentioned in the article and this is not an attempt to fwd any commercial interest. br Rune

Rune Bosselmann

Director

Tananetting

Part of NRS International

Physicians personal approach is not wrong, but is inadequate

Hi Rune, I apologize if I gave the impression that I thought that the physicians running WHO were wrong in their approach. I meant to say that their approach, while understandable to me because it is obviously satisfying to them because of their training and professional experience, is not adequate for a global fight against malaria. It is the curative approach, as opposed to the preventive or public health approach. To be successful in the fight against malaria, we need to add the preventive approach as well. If the physician gives your kid a drug, it cures him for only a month. What about next month? But you are completely correct in your examples about curative needs for individuals. That is why we honor physicians, and why they have always been so important to our personal health. But to illustrate again what you probably already know, let us take the case of lung cancer caused by industrially polluted air. The physician would immediately look for a method such as powerful chemotherapy or irradiation or surgery to save the individual. I would go into that industry and make them clean up their stack emissions, and establish and enforce environmental regulations on industrial air pollution. Likewise, in our fight against malaria, we need both the curative and the preventive approach, as in most public health endeavors. Thank you for your report on integrated vector control and the all the work it involved. I will chase it down. Incidentally I have seen two other promising reports currently in MW which I am studying: one by Kweka et al from Kenya on predators of An gambiae, and another by Imbahale et al from Wageningen and Kenya on environmental tools for larval control. You might know these folks. It is heartening to think we are getting a balanced approach in our research. Bill

William Jobin Director of Blue Nile Associates

sustainable mosquito control

Hi Bill, It appears that we agree that the disease should be both treated, prevented and eradicated "at the source". We paid to make a pdf of our article for free. http://esa.publisher.ingentaconnect.com/content/esa/jme/2011/00000048/00000004/art00012 should take you there. It s the final of a line of articles from the same study. This one is on the feasibility.

real solution

If you make new and more sensitive solution they will again become resistance. The real way to slove the problem is study mosquitos and find out the assay which will catch that p450 enzyme. There is a enzyme which is destroying insectisite.This will help to make chemical.The assay should be very simple very cheap and in all ther world people can use just like pregnancy test. Some body need to suggest this topic to DOD SBIR.