Let’s take a moment and discuss some key precepts that relate strongly to Public Health and more narrowly, to vector-borne disease management: a proactive vs. reactive approach; cause and effect; the need to measure in order to manage. One might say these easy-to-understand ideas form the backbone of a successful Public Health program.
We’d be remiss if we did not inject another layer of realism to our discussion, however, and include other, unavoidable considerations: money, politics, and the complexity of meeting the needs of a wide range of stakeholder groups at the global, federal, state, and local level. For those who work in publicly administered public health programs, the latter group doesn’t often sync well with the former.
A case in point – VectorSurv, an online platform built by a forward-thinking team of researchers and programmers at the Barker Lab, part of the School of Veterinary Medicine at the University of California, Davis. Originally dubbed CalSurv, VectorSurv was born in 2015 through a grant partially funded by NASA. It is a sophisticated yet elegant tool that combines the power of geo-stationary satellite imaging with ground-level surveillance and intervention activities in a data repository mosquito abatement professionals can use to monitor and respond to potential vector-borne disease outbreaks quickly and effectively. The application was readily adopted by California vector control districts and has since expanded to include other states such as Arizona, New Jersey, Colorado, Washington, Wyoming, Idaho, Utah, Louisiana, Tennessee, North Carolina, and the Dakotas.
What’s Wrong with this Picture?
The value of such a tool seems self-evident. Continually updated by all participating districts, the system allows managers to assess mosquito activity at the macro level and stay ahead of the indicators that warn of a potential outbreak of mosquito-borne illness, including West Nile Virus (WNV), dengue, Zika, chikungunya, and others. In addition to surveillance data, districts log their intervention activities including the location, rates, and timing of both larvicide and adulticide applications. The expansion of the application beyond California provided districts with the added benefit of being able to monitor activity in bordering states and counties. This interstate intelligence proved valuable in 2019, for example, when a district in Southern California was able to react quickly based on a high volume of positive WNV samples emerging in Arizona, while the rest of California remained relatively calm.
VectorSurv also affords interesting possibilities for the future. With an adequately populated data set, researchers can investigate the impact of vector-borne disease interventions in a real-world setting. In theory, combining trap counts, positive pool data, brood locations, and subsequent response activities, biostatisticians should be able to evaluate the effectiveness of mosquito control interventions – and their resultant impact on the spread of vector-borne disease – as never before. This work is still in its infancy but has incredible potential for the purposes of future planning, operations, and ultimately human health.
Herein lies the crux of the ongoing battle vector control officials have to wage: in matters of Public Health, governments and societies tend to be painfully reactive.
Putting this tool in place nationwide seems like a no-brainer, right? Not so fast. That’s where money and politics and competing demands come in. The American Mosquito Control Association (AMCA) fully supports expansion of VectorSurv into a nationwide program. No one seems to deny the value of scaling the application, the question simply becomes who’s going to pay for it.
Despite its obvious benefits and financial support from local California districts, the state, and the Mosquito and Vector Control Association of California, operational funding for VectorSurv has been an ongoing challenge. In the vector control industry, funding levels and sources can be notoriously temporal and unpredictable. And herein lies the crux of the ongoing battle vector control officials have to wage: in matters of Public Health, governments and societies tend to be painfully reactive.
The 1999 introduction of WNV into the US is one example. The outbreak brought awareness of the importance of vector control to an all-time high, resulting in an influx of new federal monies for vector control. As the specter of WNV waned, however, that level of funding continued to dwindle. In 2016, the Zika outbreak resulted in hundreds of millions in response funding administered through the Centers of Disease Control and Prevention. CDC put those monies to good use including forward-looking improvements such as increased epidemiological laboratory capacity and the establishment of five new Vector-Borne Disease Regional Centers of Excellence across the country. But again, the funding was wholly reactive and most of it, temporary. A significant increase in long-term, proactive, federal support for local vector control programs failed to materialize.
If a shift toward a more proactive approach to vector-borne disease is indeed a federal objective, permanent federal funding for VectorSurv would seem to be low-hanging fruit. The heavy lifting is already done. What remains is to promote its adoption at the national level through CDC, the National Association of County and City Health Officials (NACCHO), AMCA, and state associations. In addition to some federal monies to support ongoing administration of the program, the commitment would also require resources to conduct the prerequisite training and to provide some level of ongoing support for State Departments of Health (including US Territories and Freely Associated States) where vector control funding is already lacking.
It seems like a wise investment.
~ Public Health Landscape