For any company developing new vector control tools, receiving an Experimental Use Permit (EUP) from the US Environmental Protection Agency (EPA) is a significant milestone. For Oxitec, it opens the way for field testing its genetically modified Aedes aegypti mosquitoes in Florida and Texas. Oxitec’s second-generation ‘Friendly mosquitoes’ have shown great promise for reducing mosquito populations and combatting the spread of mosquito-borne diseases such as dengue and Zika.

We spoke with Oxitec CEO Grey Frandsen about its implications, the impact of the current pandemic, why lockdowns could be fertile ground for dengue outbreaks – and why we need to view COVID-19 and dengue as interrelated.

Why is this EUP so important for Oxitec?

We’re thrilled that the EPA granted us this approval. The EUP will allow us to deploy pilot projects in the US to demonstrate the effectiveness of our new Friendly™ Aedes aegypti technology. Aedes aegypti continues to spread in the US, meaning the risk of dengue and other vector-borne diseases that this mosquito transmits continues to go up. With current tools like insecticides losing their effectiveness, and with a growing demand for safe technologies that do not have an impact on biodiversity, we think Friendly™ mosquitoes can play an important role in the US.

In addition, regulators around the world consider the US EPA a stringent regulatory authority. The amount of scientific effort that the EPA and other agencies such as the US Centers for Disease Control (CDC) put into reviewing our technology throughout the 18-month process was incredible. This adds to the body of scientific evidence and rationale for our technology, adding yet another layer of credibility as we engage with additional countries around the world.

What challenges did you face along the way?

Oxitec is developing first-in-class technology, and our EUP is the first time a genetically modified mosquito has been granted a EUP in the US. In most countries where we’ve operated, we’re the first technology of its kind for regulators, which means that our efforts are equal parts about Oxitec’s technology and the broader need for paths to market for a new generation of tools.

It can be difficult, but we have shown that when we focus on building a trusting and science-based working relationship with regulators and our stakeholders, we can shape a pathway to regulatory approval.

What next steps do you have planned?

Our field trials aim to demonstrate just how well our technology works. We’re going to be generating data in line with EPA requirements to ultimately gain full commercial approval.

In the case of Florida, we’re now seeking approval from Florida’s regulators, then will go to our local partners to seek their final approval of the trial. And once we have all of those lined up, we look forward to releasing our Friendly™ mosquitoes in a small field trial.

How is COVID-19 impacting dengue interventions?

Thankfully, Oxitec is relatively unaffected. All of our programs continue on track with only a few certain operational adjustments. We’re prioritising the safety of our staff and stakeholders, and our programs continue to advance.

As your readers know, COVID-19 is taking up most of the oxygen in the room on the global health front. But we can’t ignore the fact that COVID-19 is confounding already-challenging issues for those countries facing the challenges of dengue.

Aedes aegypti continues to expand its presence into new territories. Our warming climate, rapid urbanisation and limited vector control capacities in many countries remain major challenges to the dengue fight.

Dengue is a global epidemic, and it is making COVID-19 responses more difficult. Dengue patients – up to 200 million each year – are taking up precious hospital beds and medical resources that fragile public health systems need for COVID-19 patients. The reverse is true too, of course. COVID-19 is overwhelming public health systems, preventing the care that dengue patients need. In both cases, the result is more suffering.

Could the pandemic be a turning point in the fight against dengue?

So, from one vantage point, we have an opportunity now. We can slog through this and get back to what we were doing before: a relatively anaemic fight against dengue globally. Or we can re-think our approach entirely; learning from what we’ve seen is possible when the international community collaborates (or not in some instances) to respond to a pandemic.

How can we harness what is being done for COVID-19 into a renewed effort to eliminate dengue?

We need to view COVID-19 and dengue – and malaria and other vector-borne diseases and health challenges – as interrelated. Progress on one front helps us make progress on others. We have to use this as an opportunity to make the global fight against dengue stronger and smarter, because it relates directly to how our public health systems are capable of managing the next big shock.

And that’s where I believe technologies such as ours can play a significant role. We will accelerate efforts in what, no doubt, will be a very different era where we will have to fight harder for resources, energy and attention.

Are dengue outbreaks increasing with COVID-19?

We know that Aedes aegypti mosquitoes thrive in domestic environments. One could imagine that dengue rates could rise as a result of lockdowns, particularly in dense urban areas, but we have yet to see data. Many cities are struggling to sustain vector control operations, and in some, vector control operations aren’t a thing.

We know anecdotally from our partners in Brazil, for example, that COVID-19 is overburdening cities and they need to ensure dengue outbreaks do not tax the health system further. They are attempting to expand efforts to fight dengue and are eager for us to finalise our 2^nd generation Friendly™ solution to deploy at scale. Stay tuned on that front!

How critical will new technologies be as we fight against dengue against the backdrop of COVID-19? We’d love to hear your thoughts.