Building Out Vector-borne diseases in sub-Saharan Africa: the BOVA Network

In the past, many infectious diseases in Europe and North America were addressed by installing clean water, good sanitation and housing. Today global health focuses on water and sanitation, but there is comparatively little research done on housing and health. This is a missed opportunity, since many important diseases transmitted by insects, occur indoors or around the home. The goal of this Network is to make communities in sub-Saharan Africa more resilient to the threat from insect-transmitted diseases; chiefly malaria, a rural disease, and diseases carried by Aedes species mosquitoes, like Zika and dengue, which are primarily urban diseases. To achieve this goal we need to find new solutions to stop mosquitoes entering houses and, for Aedes-borne diseases, to reduce the aquatic habitats in towns and cities. Whilst this may sound common sense, despite repeated attempts, we have been singularly unsuccessful in bring together experts in insect-transmitted diseases and the built environment over the past 50 years. There is an even greater necessity to break down these silos today since the World Health Organisation will launch its global strategy on the control of insect-transmitted diseases in May 2017 which advocates for the need to control vector-borne diseases by experts in vector-borne diseases working alongside those in the built environment. The BOVA Network, if funded, would be in the vanguard of this new strategy helping to protect communities in sub-Saharan Africa from these major insect-borne diseases. The Management Board that will run the Network is an extremely diverse group with experts on insect-transmitted diseases, architecture, civil engineering, town planning, development, product development, industry, health economics and community participation; from sub-Saharan Africa and developed countries. This exceptional pool of talent will allow us to link-up with larger groups of experts and the Network grant will provide the springboard for us to grow a new scientific discipline. Specifically the Network will: 1) facilitate the exchange of information about insect-transmitted diseases and the built environment between disciplines, 2) fund basic and applied research to develop and scale-up products and novel approaches to reducing the threat from insect-transmitted diseases in the built environment, 3) help build the next generation of scientists, architects, engineers and planners developing approaches to the control of these diseases and 4) to reach out to funders and those engaged in development projects, like United Nations organisations and the Development Banks to invest in the control of vector-borne diseases through the built environment. This Network is designed to help protect the citizens of sub-Saharan Africa from the threat of insect-transmitted diseases and has the potential to change the lives of millions.

Despite major reductions in malaria in sub-Saharan Africa (SSA) in the past 15 years, malaria continues to be a major burden on health with 114 million people infected, 191 million clinical malaria cases and 394,000 deaths in the region in 2015. The scale of the rise in Aedes-borne diseases in SSA is uncertain, not least because until relatively recently most febrile illnesses were considered to be malaria. Today there is a growing recognition of the threat from Aedes-borne diseases including yellow fever, dengue, Zika and chikungunya. Since over 80% of malaria transmission in SSA occurs indoors, and Aedes-borne diseases are transmitted in and around the house by vectors that lay their eggs in water bodies indoors and outdoors, the focus of the Network will be on developing ways of screening houses from mosquitoes and building environments inimical to vectors. To achieve this we will bring together two disparate communities: experts on vector-borne diseases and the built environment. Our Management Board is unique in having a broad range of experts from both disciplines, and from SSA and developed countries. This Board will oversee a range of activities namely: (1) information exchange, (2) pump-priming research in the control of vector-borne diseases and the built environment, (3) capacity building in this area and (4) advocacy to reach out and expand the network in order to build a new scientific discipline and ensure its sustainability. There has never been a better time to develop this Network since it is essential to support the World Health Organisation's (WHO) new global strategy on vector control that has building inter-sectoral collaboration between the health sector and other sectors as one of its four central action pillars. In this strategy the need for strengthening collaboration between these sectors is key. Thus, if funded, the Network would be at the forefront of WHO's Global Vector Control Response and will help protect the health of millions.

There are many potential beneficiaries of the BOVA Network including the citizens of sub-Saharan Africa, politicians, NGOs, UN organisations, researchers and manufacturers within and outside sub-Saharan Africa. Our work will focus on reducing malaria, principally a disease of rural areas, and Aedes-borne diseases (yellow fever, dengue, Zika and chikungunya), principally focused in urban areas, in sub-Saharan Africa. Collectively these diseases affect the health of millions and restrain economic development. The BOVA Network will provide a number of deliverables that will contribute to a reduction in malaria and Aedes-borne diseases through improvements in the built environment including:

1. Multi-sectoral action in vector-borne diseases. Multisectoral action is considered a central pillar of effective and sustainable global vector control but there have been few success stories due to the challenges of working across silos. The rich and diverse membership of BOVA's Management Board provides an opportunity to integrate both the vector-borne disease and built environment research communities acting as a flagship for multisectoral action in the field of vector-borne disease control. Thus the Network has the potential to influence international decision making at the highest level.

2. Information exchange. In order to develop a new discipline of vector-borne diseases and the built environment we will expand the network by reaching out to potential stake holders using: (a) a BOVA Network website describing the work being undertaken and providing a platform by which new members can join, (b) an annual meeting where stake holders can share information about their research and develop new ideas, (c) by members of the Network presenting talks at international conferences and to local-decision makers, (d) at annual meetings of the Roll Back Malaria work stream on vector-borne diseases and the built environment and (e) the publication of scientific articles in high impact peer-reviewed journals.

3. Evidence-based decision making. The World Health Organisation will only make policy recommendations for new tools and approaches provided there is sufficient supporting evidence. We will use the BOVA Network to strengthen the case for recommending house screening as an intervention against malaria by submitting a portfolio of evidence to the Vector Control Advisory Group of WHO, who will review this information. If successful, Member States would encourage screening against malaria, which would reduce malaria transmission. In addition, research findings that result from pump priming funds dispersed to grantees will add further evidence to support the uptake of building interventions as protection against vector-borne diseases.

4. Development of new products and approaches.
The Management Board has numerous members with expertise in improving health in developing countries through innovative product design, novel architectural designs, and changes in the built environment. These individuals will help facilitate the development of research proposals submitted for funding and will be allowed to submit their own research proposals for funding.

5. Sustainability
The 3-year project period is relatively short for establishing a fully functional pathway of new vector control interventions focused on the built environment, so it is important to seek further funding during the project period in order to maintain momentum. It is for this reason that we have allocated funding for members of the Network to hold small workshops to develop ideas for further funding. We will also provide funds for the collection of baseline data that will help individuals develop strong proposals.

We view the BOVA Network as the catalyst for launching a new discipline for reducing the impact of vector-borne diseases by changes to the built environment. The potential for impact is huge.