Dengue prevention update from the AIDF Asia Summit in Bangkok

A new vaccine against dengue was licensed for the first time in December of last year and is now in the market in five countries in the world, namely Mexico, Brazil, El Salvador, Costa Rica and The Philippines. Nevertheless, the shots against the virus will not be sufficient enough to beat the disease infecting about 390 million people around the world every year, according to experts.

“This vaccine is not a magic bullet. It has to be integrated with a holistic approach where community engagement its center alongside vector control”, Jean- Antoine Zinsou, Senior Director, Public Affairs and Advocacy at Sanofi- Pasteur, the vaccine manufacturer that developed the Dengvaxia.

Dengue is the fastest growing mosquito-borne disease in the world, mainly due to increasing urbanization in tropical and sub-tropical climates where the Aedes aegypti, the mosquito that carries the dengue virus, lives.

“Community engagement is the key to successful dengue prevention and to get rid of the mosquito breeding sites”

Due to the rapid spread of the virus, the World Health Organization accelerated its procedure for evaluating new vaccines and, last April, the Organization released a recommendation to adopt the vaccine and a definitive position paper is expected to be released on July 29.

The Aedes aegypti depends on stagnant water to lay its eggs and reproduce. Natural water containers, like puddles, or artificial recipients, such as flower pots, forgotten buckets or even coconut shells, make ideal breeding grounds. “Community engagement is the key to successful dengue prevention and to get rid of the mosquito breeding sites”, explains Zinsou.

Southeast Asia, the region with the highest dengue incidence in the world, is well aware of the importance of communities in the fight against dengue and, six years ago, the Association of Southeast Asian Nations (ASEAN) launched the ASEAN Dengue Day. This information day is celebrated every June 15 to raise awareness about the risk of the disease.

“Dengue prevention and control is a shared responsibility which needs collective action from all stakeholders to work together and enhance cooperation as one community “, says the Bangkok Call for Action released on the occasion of the 6^th ASEAN Dengue Day, held under the theme, ‘Community Empowerment: A Sustainable Success to Fight Dengue’.

For this approach to be effective, identifying the key actors in the communities is essential. “This is very context specific. Some may believe more in religious figures. For other, the village chief is more acceptable to them,” says Muhammad Shafique, Regional Behaviour Change Communication Specialist at the Malaria Consortium.

One key ingredient that could improve dengue-vaccine effectiveness is community.

Nevertheless, research shows that the most trusted figures are community healthcare workers (CHW). In India, for instance, CHW help to strengthen the immunization programs and reduce the burden of vaccine-preventable diseases, according to a study from the University of Pittsburgh.

Experts also stress the indirect benefits that communities can get from vaccination since it reduces the odds of the mosquito biting an already infected person and transmitting the disease to a healthy individual. In the case of dengue, this indirect benefit is even more important because the vaccine is only approved for use in people nine to 45 years old.

The vital ingredients to a recipe for a successful of a dengue vaccination program

Implementing a vaccination program is usually not an easy task with many variables coming into play. According to a literature review carried out by researchers from Sanofi-Pasteur and Kingston University, the non-socio-demographic determinants to vaccination adoption can be organized into five main dimensions: access, or easiness to get the vaccine; affordability, or cost related to it; awareness of the existence of the vaccine and its benefits; acceptance of the vaccine; and activation or a motivation that brings people into the vaccination centers.

Find out more about the global cost of dengue

Even when governments adopt the vaccine into their Expanded Programs on Immunization, such as The Philippines which launched the first public dengue vaccination program last March, communities are still key in breaking some of these barriers. “If we understand that in order for the vaccine to be effective, you need all three shots (six months apart), it is critical that the persons who start their vaccine complete all three,” said Indeok Oak, Independent consultant on development.

“In order to facilitate this, the process of obtaining the vaccine shots must be readily accessible. Providing vaccine shots at schools, workplaces, or already existing facilitate where people go regularly would make it easier to get the shots rather than having to physically go to a designated clinic or hospitals.” These community places are also important in monitoring and implementing surveillance systems on the effectiveness of the vaccine in the communities where it has been administrated.

Sharing these community-based experiences is also essential to build knowledge on how to fight the rapid spread of dengue. For this reason, Break Dengue has organized the €10,000 Prize, a competition that aims to find the best initiatives and campaigns that help to combat dengue fever by integrating the new vaccine into the anti-dengue arsenal.

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