Bold Thinking at Abt: Global Health Security

Bradford Lucas

Director for the PMI AIRS Project
Vice President, International Health

Resources to Fight Vector-Borne Diseases | Bio

“Global health security threats really are a race to the starting line,” Lucas says. “We have to be ready to respond, whether the vector-borne disease is malaria or Zika.”
Abt Associates’ Brad Lucas is applying his expertise and lessons learned from malaria control to help shape the course of action against Zika. As Project Director of the President’s Malaria Initiative Africa Indoor Spraying (PMI AIRS ) project, Lucas understands not only the programmatic and technical requirements to fight vector-borne diseases, but the high degree of adaptation necessary to mount and sustain an effective response.

“Vector-borne diseases make up nearly 20 percent of all infectious disease,” says Lucas. “People are infected with some of the most debilitating diseases that we face in public health, both in terms of mortality and morbidity. If you’re going to eliminate the disease, you have to eliminate the vector.”

Preparing a Public Health Army

The evidence for Lucas’s assertion is shown in PMI AIRS. Since 2011, Lucas has been managing the planning, implementation and monitoring of indoor residual spray (IRS) programs in 16 African countries. The resource-intensive process requires “an army of people,” including thousands of spray workers, supervisors, warehouse keepers, washers, drivers, and many others.
“So much of IRS is having everything ready. We set up dozens of operation sites across several districts,” says Lucas. “Each of these must have a store room, warehouse, toilets, showers, and a washing area for cleaning the equipment.” 
Hundreds or thousands of workers are hired seasonally and help the project cover from 100,000 to 500,000 households in a given country program. Lucas stresses the need for strong procurement and logistics for these IRS campaigns to make sure that all insecticide, protective equipment and supplies are ready and distributed to operation sites in time for the campaign start date.  The PMI AIRS team provides training, supervision and management to ensure everything runs according to plan.
“When you actually start the spray campaign, which may only take 30-45 days to actually complete, you probably spent six months getting ready,” he explains. “Most of the sprayers and other seasonal workers are hired from those local communities because they know the communities and are trusted by the communities.”

Monitoring to Assess Impact

But spraying is only one part of the work. Entomological monitoring is required to determine if the IRS is having the intended effect on killing the mosquitoes, and how long the residual effect of the insecticide is lasting.  Entomological monitoring is also used to determine if mosquitos have developed resistance to a given insecticide.
“One of the biggest challenges of IRS is that you have to cover nearly every single house in the geographical area you are trying to protect,” he says. “Ninety percent of the homes in a particular village need to be protected with IRS in order to protect the entire community.” The following year, you have to spray the same houses again to keep suppressing the mosquito population before the next peak malaria transmission season.
This is true for other vector-borne diseases like Zika. Efforts to eliminate the Zika mosquito, Aedes aegypti, have proven successful in previous campaigns. However when vector control efforts stop, Lucas says, the species quickly rebounds. Moreover, since the Aedes aegypti are day biters and bite both outdoors and indoors, the vector control strategies for Zika are different than malaria in Africa and will need to be adapted.
“Nobody can say at this point that ‘This is the best approach to be used in vector control for preventing Zika transmission’” says Lucas. “The global and country public health authorities who are addressing Zika will be piloting and evaluating different approaches to see which of the vector control strategies is most effective.”

Areas of Expertise

  • International health
  • Indoor residual spraying