Vector-borne diseases (VBDs) – infections transmitted to humans by the bite of infected arthropods such as mosquitoes, ticks, and sandflies –significantly increased in the U.S. in recent decades. VBDs like West Nile Virus, Dengue fever, Lyme disease, and Malaria are major contributors to disease in the U.S. The threat of VBDs in the future is expected to intensify due to climate change, greater human exposure to vector habitats, and growing globalization.
The Centers for Disease Control and Prevention’s (CDC) National Public Health Framework for the Prevention and Control of Vector-Borne Diseases (VBDs) in Humans outlines the strategic priorities and importance of effective strategies in the U.S. for the mitigation of VBDs. Maximus responded to the Department of Health and Human Services (HHS) request for information on how to strengthen and improve our national response, highlighting the urgent need to further expand and improve our approach to combatting VBDs. We recommend focusing on five critical priorities to effectively support detection, reporting, and mitigation efforts:
1. Increasing public awareness of VBDs
Creating awareness in the general public around prevention, early recognition, and appropriate treatment-seeking behaviors is extremely important. The national strategy will be more effective by incorporating public awareness campaigns to promote awareness, improve understanding, and enable behavior change. Primary care providers play a critical role in informing patients about reducing exposure to vectors and vector-borne pathogens (e.g., utilizing personal protective measures and performing routine body checks after visiting high-risk areas). More aware communities can better participate in VBD control by limiting breeding sites. Veterinarians can also play vital roles as messengers in public health education and awareness efforts.
2. Improving VBD surveillance through modernized data reporting and visualization
An efficient surveillance system plays a vital role in supporting mission-critical surveillance efforts, as we experience in our public health work. Timely and complete data collection of incidence, prevalence, distribution, and trends is the foundation of any such efforts. Despite ongoing efforts to establish, reinforce, and expand surveillance systems, numerous gaps hinder the effective reporting and management of VBDs. Ideally, to create real-time and rich data sets, systems should develop standardized data formats, facilitate data transformation and restructuring, allow for seamless data sharing across administrative borders and jurisdictions, and ingest automatic data feeds. As the COVID-19 pandemic shows, timely reporting is essential to support decision-making that effectively mitigates outbreaks. Likewise, enhanced VBD detection methods are required to effectively control VBDs.
The national strategy for VBD mitigation should include improving the nation’s public health systems by leveraging data science tools, the latest database and data architecture infrastructure, and geospatial technologies. Modernization efforts are necessary to update critical infrastructure, improve interoperability, and ensure timely data collection so that decision-makers have situational awareness and near real-time public health information.
3. Spurring innovation through funding, optimizing regulatory considerations, and economic incentives
Vaccines against VBDs are the most effective way to mitigate infections and outbreaks. Despite this recognition, one of the major hurdles in developing vaccines and therapeutics for VBDs is the lack of financial incentives for scientists and manufacturers. These are expensive, extended, and arduous undertakings and are not workable without financial support. As a result, pharmaceutical companies are reluctant, unwilling, or unable to invest in the research and development of such drugs.
The national strategy should consider a range of economic incentives that fund early-stage research and development efforts and incentives that seek to ensure fair compensation for pioneer products as they enter the market. We recently witnessed how such support resulted in the record-time development of COVID-19 vaccines and therapeutics (such as monoclonal antibodies).
The national strategy should also carefully consider the lessons learned and models tested by the pandemic, such as how they may help bring innovative products for vector-borne diseases to market, broadly distribute, communicate about, and encourage acceptance of vaccines and therapeutics. Finally, partnerships between the private and public sectors should be expanded to reduce regulatory hurdles that often delay the introduction of new mitigation measures.
4. Expanding, improving, and training the medical workforce
In the past two decades, students enrolling in the field of medical entomology – the study of insects and arthropods that impact human health – have declined. In addition, veterinary schools continue to revamp their curricula to meet the demands of increasing specialization in the profession. Because arthropod course content is largely outside of these specialty areas, currently very few medical school curricula feature it. Researchers are more likely to gravitate toward cutting-edge disciplines such as genetics, cancer immunology, and proteomics (large-scale study of proteins), creating a vacuum in the expertise and staffing needed to mitigate VBDs. This decline also translates into decreasing public awareness, inaccurate or missed clinical diagnosis, and ineffective public health interventions and outbreak management.
The national strategy must consider how to close important workforce and research gaps. For example, additional research funding should be directed to universities to entice more entomology courses across all levels of competency, from introductory courses in the undergraduate curriculum to post-graduate and continuing education courses. In addition, public organizations, including the CDC, should revamp apprenticeship programs at all levels to ensure that VBDs are highlighted in existing flagship programs such as the Epidemic Intelligence Service (EIS). At the same time, NIH and USDA should dedicate research funding in flagship programs towards VBDs.
5. Enhance diagnostics through developing reagents, vaccines, and countermeasures
Diagnosing VBDs can be difficult for a number of reasons, mainly that patients usually present with non-specific clinical signs and symptoms, and current diagnostic methods are often unreliable, resulting in misdiagnoses or missed diagnoses. These challenges have broad implications. Clinicians rely on sophisticated and widely available diagnostics to diagnose and treat health conditions so the availability of enhanced diagnostic capacity such as whole-genome sequencing, widely utilized during the COVID-19 pandemic, holds great promise for overcoming these long-standing challenges for VBDs. Effective control through reliable screening and confirmatory diagnostics requires strategic and appropriate allocation of funding for the development of novel approaches for testing. Greater lab capacity and more reliable testing methods would mean more infections are caught early which would generate better surveillance data and improve treatment outcomes by commencing appropriate therapies more quickly. The national strategy should explore how innovative strategies utilized during the pandemic can be applied to VBD diagnostics.
Now is the time to significantly invest in the tools and infrastructure to detect, measure, and control or even eradicate VBDs. Strong collaboration with stakeholders, including public-private partnerships can be one of the best approaches to achieve desired and successful outcomes. Barring rapid, significant investments in all the strategies mentioned above, the impact of VBDs in the United States is likely to take an increasingly serious toll on the health of our population.