Members can sign in here.

About the Author

Bart Knols
Medical Entomologist (Dodewaard, Netherlands)

Bart G.J. Knols (1965) is the Managing Director of MalariaWorld, the world's first scientific and social network for malaria professionals. He is a malariologist with a Masters degree in Biology and a PhD in Medical Entomology from Wageningen University, the Netherlands. He also obtained an MBA degree from the Open University (UK) in 2006, for which he won the prestigious international ‘MBA Student of the Year 2007 Award’ as well as the Alumnus of the Year Award from the Open University. With 11 years of working experience in Africa he has managed large-scale research and vector control programmes on malaria for ministries, international or national research institutions. He has worked for the UN (IAEA) as a programme manager for three years, has served as a consultant for the World Health Organization, and is currently a Board Member of the UBS Optimus Foundation, the second largest charity in Switzerland. He has published over 130 peer-reviewed research articles, has written 16 book chapters, and has served as senior editor on a WHO/IAEA sponsored book on implementation research. In 2007 he co-edited a best-selling book titled 'Emerging Pests and Vector-Borne Diseases in Europe'. He received an Ig Nobel Prize (2006), an IAEA Special Service Award (2006), and in 2007 he became a laureate of the Eijkman medal (the highest award in the field of tropical medicine in the Netherlands). He has been a member of the Royal Dutch Academy of Arts and Sciences since 2004. Bart held an Assistant Professorship at Wageningen University until April '09 with projects across Africa. He currently directs K&S Consulting, a firm he founded in the beginning of 2007.

Post

When a killer disease strikes, what do you do?

Published 15th April 2010 - 4 comments - 3221 views -

The West Nile virus originates from Central Africa and was first detected in the jungle of Uganda in 1937 in a young woman suffering terribly on the floor of her mud-walled house with grass thatch roof. If this reminds you of the opening scenes of blockbuster movie 'Outbreak' with Dustin Hoffman you get the picture.

The virus escaped from the African continent, and it may have been an infected mosquito on board of an airliner that brought the virus to the USA. If it strikes, it causes flu-like symptoms but also encephalitis and can be fatal. It hit New York in August 1999 after the stowaway mosquito fled the cargo compartment at JFK airport. Not long afterwards, some sixty New York citizens became seriously ill. Nobody knew what they suffered from. Six died. By that time birds had been infected and started spreading the virus. Today the disease is present in the entire USA, causing thousands of cases, and killing tens to hundreds of US citizens, each year. It is spreading into Mexico and further south into Central America as I write this story. There is no vaccine, there are no drugs. The African virus has a firm grip on the USA and is there to stay.

To many this may sound like fiction. It’s not. Once it became publicly known that it was an African virus that hit the metropole, police forces were needed to calm the public that feared a terrorist attack with a biological weapon. A big concert in Central Park was cancelled by mayor Juliani when it became known that mosquitoes were the culprit. 
Globalisation is leading to the spread of tropical diseases. Diseases of the developing world are conquering the developed world.
It’s the way we respond to these threats that is striking in the following two videos where the response to the West Nile virus threat in California is compared with that of malaria in Tanzania’s capital, Dar es Salaam…
verflow-y: hidden;">San Joaquim, California, USA
0px; width: 1px; height: 1px; overflow-x: hidden; overflow-y: hidden;">
So this is how the USA deals with an African virus transmitted by mosquitoes:
gt;
“An air attack will stop the spread of the West Nile virus…”
“Spraying by air and ground to fight these mosquitoes here […] after a recent explosion of the mosquito population…”
“The San Joaquim County calls their efforts very aggressive to reduce the mosquito population here…”
“Officials say the fine mist is harmless to humans…”
“We have a lot of mosquitoes infected with West Nile Virus…”
“We want to knock down these populations to reduce the risk to the public…”
: 1px; overflow-x: hidden; overflow-y: hidden;">Dar es Salaam, Tanzania 
[voice-over] “Larvicides could be back on the malaria control agenda…”
“So the industrial area was completely not included in the map…”

To many this may sound like fiction. It’s not. Once it became publicly known that it was an African virus that hit the metropole, police forces were needed to calm the public that feared a terrorist attack with a biological weapon. A big concert in Central Park was cancelled by mayor Juliani when it became known that mosquitoes were the culprit. 

Globalisation is leading to the spread of tropical diseases. Diseases of the developing world are conquering the developed world.

It’s the way we respond to these threats that is striking in the following two videos. First we see the response to the West Nile virus threat in California, then the response to malaria in Tanzania’s capital, Dar es Salaam…

San Joaquim, California, USA

 

Some comments directly copied from the video:

“An air attack will stop the spread of the West Nile virus…”

“Spraying by air and ground to fight these mosquitoes here […] after a recent explosion of the mosquito population…”

“The San Joaquim County calls their efforts very aggressive to reduce the mosquito population here…”

“Officials say the fine mist is harmless to humans…”

“We have a lot of mosquitoes infected with West Nile Virus…”

“We want to knock down these populations to reduce the risk to the public…”

Malaria in Dar es Salaam, Tanzania

The city of Dar es Salaam was once malaria-free. During the colonial days it was prohibited to practice agriculture near or within the city. For fear of breeding sites that would bring mosquitoes and malaria. The massive growth of the capital and uncontrolled expansion has changed this situation. Malaria is now back in urban Dar es Salaam. Unlike West Nile in California, where it has only been present for five years, malaria is of course an ancient scourge in East Africa.

Some comments from the video:

[voice-over] “Larvicides could be back on the malaria control agenda…”

“So the industrial area was completely not included in the map…”

“The coverage is not complete. Even we can not go larviciding properly…”

In San Joaquim resides a well funded and well equipped vector control force, that is capable of flying and spraying large areas. And blanket all breeding sites with larvicides that kill the immature mosquitoes. Postal codes are available, making the organization of the campaign meticulous. Streets have names, houses have numbers.

In Dar es Salaam, the Urban Malaria Control Project treats breeding sites on foot, and a recent report showed that many are missed. The programme relies on volunteers from the community (community-owned resource persons, COPRs) rather than well payed professional staff as in San Joaquim. This brings its own challenges. 

So spotting the differences is not difficult and it won’t take much guessing in which of these two settings mosquito control is most effective in curbing disease transmission.

But the big question becomes: If we know how to do it in our own backyard, why isn’t it done in the same way over there? Development in this case would be to take the big man from San Joaquim and put him in Dar es Salaam for a few months. Reciprocally, the Tanzanians should get the experience in California... right? Both parties would have a lot to learn from each other, with the aim to build sufficient capacity and capability in both settings to ward off deadly disease.

How would you tackle malaria in Africa?


Category: Health | Tags: tanzania, usa, mosquito, disease control,


Comments

  • Iris Cecilia Gonzales on 16th April 2010:

    Yes Bart, what can be done? In the Philippines, we’ve also had to deal with the spread of harmful disease such as the influenza (AH1N1) virus.


  • Bart Knols on 16th April 2010:

    @Iris. A lot can be done. The Philippines have a lot of malaria, I’ll get to that in a future blog. Island after island can be freed of the disease without rocket science and aerial spraying. More soon…


  • Peter Ward on 19th April 2010:

    hello again Bart,

    You continue to post interesting comments. Thanks!

    It’s odd, isn’t it. Africans continue to do what they’ve always done and it delivers the same as it always has. Why don’t we just go in there and force them to see sense?

    I write that ironically. In fact, there are many in Africa who are definitely trying to do something different. They’re hampered by a range of things, of which resources is a key one: both money and trained people.

    But if we were to turn up with the kit and say “we’ll do it for you” it wouldn’t help much, or for long. We would be at great risk of failing to understand the environment. We have to work with these people, not around them. Only with their participation and their knowledge do we have the possibility to achieve long-term gains.

    I think therefore we must seek out those with the vision to make a difference and then support them. It’s interesting that you choose Tanzania as your example. I’ve been working the NMCP in Tanzania for the last year and I see people there who really want to make a difference, led by the excellent Dr Alex Mwita. But faced with the reality of a huge impoverished country—that is already recognised as having taken major steps against malaria—I think it’s sometimes hard even for them to keep up the fight. There are so many other problems facing the country that sometimes even malaria isn’t at the top of the list.

    So don’t doubt these people. They want to do the right thing, but doing it takes longer than both we and they would like. Work with them, provide information on best practice without bringing a “this is the right way because it’s our way” mentality, and amazing things can be achieved. Step by step…

    Peter Ward


  • Bart Knols on 19th April 2010:

    @Peter. Thanks for your comment. Allow me to put one thing straight up front. There is, in my view, no ‘Us and Them’. We’re in this business together - so no need to criticise or blame anyone. As a matter of fact, I suffered malaria 9 times in the 11 years that I spent in East and Southern Africa. Therefore I consider malaria as much a problem of my own as for people residing and living in Africa.

    The point I am trying to bring up here can best be explained by someone else’s words: “When it gets to malaria, there is no partial success. It is either glorious success or dismal failure”. These words were written by Fred Soper in 1943. The message has not changed in the 67 years that followed.

    Although I have much respect for the project in Dar es Salaam, it will be dismal failure once the funds dry up. Therefore I am not arguing that the willingness, enthusiasm, and passion to do something against malaria by people like Dr. Mwita is not sufficient. I am arguing that the approach should be one geared towards total removal of the disease.

    If Dar would get rid of malaria, not only 10% of Tanzania’s population would live without it, but it would also be a possible step to rid Zanzibar of it once and for all, wouldn’t you agree?


Post your comment

  • Remember my personal information

    Notify me of follow-up comments?

    --- Let's see if you are human ---

    A human creature that practices the art of "blogging" is called a... Add a questionmark to your answer. (8 character(s) required)