Empowering rural communities for effective larval source management: A small-scale field evaluation of a community-led larviciding approach to control malaria in south-eastern Tanzania.

Introduction: Larval source management, particularly larviciding, is mainly implemented in urban settings to control malaria and other mosquito-borne diseases. In Tanzania, the government has recently expanded larviciding to rural settings across the country, but implementation faces multiple challenges, notably inadequate resources and limited know-how by technical staff. This study evaluated the potential of training community members to identify, characterize and target larval habitats of Anopheles funestus mosquitoes, the dominant vector of malaria transmission in south-eastern Tanzania. Methods: A mixed-methods study was used. First, interviewer-administered questionnaires were employed to assess knowledge, awareness, and perceptions of community members towards larviciding (N = 300). Secondly community-based volunteers were trained to identify and characterize aquatic habitats of dominant malaria vector species, after which they treated the most productive habitats with a locally-manufactured formulation of the biolarvicide, Bacillus thuringiensis var. israelensis. Longitudinal surveys of mosquito adults and larvae were used to assess impacts of the community-led larviciding programme in two villages in rural south-eastern Tanzania. Results: At the beginning of the program, the majority of village residents were unaware of larviciding as a potential malaria prevention method, and about 20 % thought that larvicides could be harmful to the environment and other insects. The trained community volunteers identified and characterized 360 aquatic habitats, of which 45.6 % had Anopheles funestus, the dominant malaria vector in the area. The preferred larval habitats for An. funestus were deep and had either slow- or fast-moving waters. Application of biolarvicides reduced the abundance of adult An. funestus and Culex spp. species inside human houses in the same villages, by 46.3 % and 35.4 % respectively. Abundance of late-stage instar larvae of the same taxa was also reduced by 74 % and 42 %, respectively. Conclusion: This study demonstrates that training community members to identify, characterize, and target larval habitats of the dominant malaria vectors can be effective for larval source management in rural Tanzania. Community-led larviciding reduced the densities of adult and late-stage instar larvae of An. funestus and Culex spp. inside houses, suggesting that this approach may have potential for malaria control in rural settings. However, efforts are still needed to increase awareness of larviciding in the relevant communities.

Broaden Research on Ocean Alkalinity Enhancement to Better Characterize Social Impacts.

Ocean alkalinity enhancement (OAE) is being considered as a way of achieving large-scale removals of carbon dioxide from the atmosphere. Research on the risks and benefits of different OAE approaches is expanding apace, but it remains difficult to anticipate and appraise the potential impacts to human communities that OAE might generate. These impacts, however, will be critical to evaluating the viability of specific OAE projects. This paper draws on the authors' involvement in interdisciplinary assessment of OAE (1) to identify the factors that currently limit characterization of potential social impacts and (2) to propose ways of reconfiguring OAE research to better consider these.

The needs and opportunities for housing improvement for malaria control in southern Tanzania.

BACKGROUND: Malaria disproportionately affects low-income households in rural communities where poor housing is common. Despite evidence that well-constructed and mosquito-proofed houses can reduce malaria risk, housing improvement is rarely included in malaria control toolboxes. This study assessed the need, magnitude, and opportunities for housing improvement to control malaria in rural Tanzania. METHODS: A mixed-methods study was conducted in 19 villages across four district councils in southern Tanzania. A structured survey was administered to 1292 community members to assess need, perceptions, and opportunities for housing improvement for malaria control. Direct observations of 802 houses and surrounding environments were done to identify the actual needs and opportunities, and to validate the survey findings. A market survey was done to assess availability and cost of resources and services necessary for mosquito-proofing homes. Focus group discussions were conducted with key stakeholders to explore insights on the potential and challenges of housing improvement as a malaria intervention. RESULTS: Compared to other methods for malaria control, housing improvement was among the best understood and most preferred by community members. Of the 735 survey respondents who needed housing improvements, a majority needed window screening (91.1%), repairs of holes in walls (79.4%), door covers (41.6%), closing of eave spaces (31.2%) and better roofs (19.0%). Community members invested significant efforts to improve their own homes against malaria and other dangers, but these efforts were often slow and delayed due to high costs and limited household incomes. Study participants suggested several mechanisms of support to improve their homes, including government loans and subsidies. CONCLUSION: Addressing the need for housing improvement is a critical component of malaria control efforts in southern Tanzania. In this study, a majority of the community members surveyed needed modest modifications and had plans to work on those modifications. Without additional support, their efforts were however generally slow; households would take years to sufficiently mosquito-proof their houses. It is, therefore, crucial to bring together the key players across sectors to reduce barriers in malaria-proofing housing in endemic settings. These may include government subsidies or partnerships with businesses to make housing improvement more accessible and affordable to residents.

Lessons of the Israeli-Palestinian Conflict for Public Health: The Case of the COVID-19 Vaccination Gap.

In early 2020, the COVID-19 pandemic revealed a faceless, non-adversarial threat that endangered Israelis and Palestinians with the same ferocity. However, the capacities of the health systems to address it were not equal, with Israel more equipped for the outbreak with infrastructure, resources, manpower and later, vaccines. The pandemic demonstrated the life-saving benefits of cooperation and the self-defeating harms brought by non-cooperation. These trends are explored here by an international team of public health and environmental scholars, including those from different sides of the Israeli-Palestinian conflict. This article explores the importance of recognizing the Israeli and Palestinian jurisdictions as a single epidemiological unit, and illustrates how doing so is a pragmatic positioning that can serve self-interest. We demonstrate how despite political shocks precipitating non-cooperation, there has been a recurrent tendency towards limited cooperation. The paper concludes with lessons over the need for reframing public health as a potential bridge, the need for structural changes creating sustainable platforms for accelerated transboundary cooperation to enable the steady management of current and future public and environmental health crises regardless of dynamic political crises, and the importance of civil society and international organizations in forging collaboration in advance of governmental engagement.

Imperfect diagnosis: The truncated legacies of Zika testing.

When the Zika virus burst onto the international scene in the second half of 2015, the development of diagnostic tools was seen as an urgent global health priority. Diagnostic capacity was restricted to a small number of reference laboratories, and none of the few available molecular or serological tests had been validated for extensive use in an outbreak setting. In the early weeks of the crisis, key funders stepped in to accelerate research and development efforts, and the WHO took responsibility for steering diagnostic standardization, a role it had successfully played during the West Africa Ebola virus outbreak. Yet when the WHO declared the end of the Zika Public Health Emergency of International Concern in November 2016, diagnostic capacity remained patchy, and few tools were available at the scale required in the countries that bore the brunt of the epidemic, particularly Brazil. This article analyses the limited impact of global R&D efforts on the availability of Zika diagnostic options where they were most needed and for those most vulnerable: women who might have been exposed to the virus during their pregnancy and children born with suspected congenital Zika syndrome. The truncated legacies of testing during the Zika crisis reveal some of the fault lines in the global health enterprise, particularly the limits of 'emergency R&D' to operate in geopolitical contexts that do not conform to the ideal type of a humanitarian crisis, or to tackle technical issues that are inextricably linked to domestic struggles over the scope and distribution of biological citizenship. Diagnostic shortcomings, we argue, lie at the heart of the stunning transformation, in less than two years, in the status of Zika: from international public health emergency to neglected disease.

Addressing key gaps in implementation of mosquito larviciding to accelerate malaria vector control in southern Tanzania: results of a stakeholder engagement process in local district councils.

BACKGROUND: Larval source management was historically one of the most effective malaria control methods but is now widely deprioritized in Africa, where insecticide-treated nets (ITNs) and indoor residual spraying (IRS) are preferred. However, in Tanzania, following initial successes in urban Dar-es-Salaam starting early-2000s, the government now encourages larviciding in both rural and urban councils nationwide to complement other efforts; and a biolarvicide production-plant has been established outside the commercial capital. This study investigated key obstacles and opportunities relevant to effective rollout of larviciding for malaria control, with a focus on the meso-endemic region of Morogoro, southern Tanzania. METHODS: Key-informants were interviewed to assess awareness and perceptions regarding larviciding among designated health officials (malaria focal persons, vector surveillance officers and ward health officers) in nine administrative councils (n = 27). Interviewer-administered questionnaires were used to assess awareness and perceptions of community members in selected areas regarding larviciding (n = 490). Thematic content analysis was done and descriptive statistics used to summarize the findings. RESULTS: A majority of malaria control officials had participated in larviciding at least once over the previous three years. A majority of community members had neutral perceptions towards positive aspects of larviciding, but overall support for larviciding was high, although several challenges were expressed, notably: (i) insufficient knowledge for identifying relevant aquatic habitats of malaria vectors and applying larvicides, (ii) inadequate monitoring of programme effectiveness, (iii) limited financing, and (iv) lack of personal protective equipment. Although the key-informants reported sensitizing local communities, most community members were still unaware of larviciding and its potential. CONCLUSIONS: The larviciding programme was widely supported by both communities and malaria control officials, but there were gaps in technical knowledge, implementation and public engagement. To improve overall impact, it is important to: (i) intensify training efforts, particularly for identifying habitats of important vectors, (ii) adopt standard technical principles for applying larvicides or larval source management, (iii) improve financing for local implementation and (iv) improve public engagement to boost community awareness and participation. These lessons could also be valuable for other malaria endemic areas wishing to deploy larviciding for malaria control or elimination.

Hybrid mosquitoes? Evidence from rural Tanzania on how local communities conceptualize and respond to modified mosquitoes as a tool for malaria control.

BACKGROUND: Different forms of mosquito modifications are being considered as potential high-impact and low-cost tools for future malaria control in Africa. Although still under evaluation, the eventual success of these technologies will require high-level public acceptance. Understanding prevailing community perceptions of mosquito modification is, therefore, crucial for effective design and implementation of these interventions. This study investigated community perceptions regarding genetically-modified mosquitoes (GMMs) and their potential for malaria control in Tanzanian villages where no research or campaign for such technologies has yet been undertaken. METHODS: A mixed-methods design was used, involving: (i) focus group discussions (FGD) with community leaders to get insights on how they frame and would respond to GMMs, and (ii) structured questionnaires administered to 490 community members to assess awareness, perceptions and support for GMMs for malaria control. Descriptive statistics were used to summarize the findings and thematic content analysis was used to identify key concepts and interpret the findings. RESULTS: Nearly all survey respondents were unaware of mosquito modification technologies for malaria control (94.3%), and reported no knowledge of their specific characteristics (97.3%). However, community leaders participating in FGDs offered a set of distinctive interpretive frames to conceptualize interventions relying on GMMs for malaria control. The participants commonly referenced their experiences of cross-breeding for selecting preferred traits in domestic plants and animals. Preferred GMMs attributes included the expected reductions in insecticide use and human labour. Population suppression approaches, requiring as few releases as possible, were favoured. Common concerns included whether the GMMs would look or behave differently than wild mosquitoes, and how the technology would be integrated into current malaria control policies. The participants emphasised the importance and the challenge of educating and engaging communities during the technology development. CONCLUSIONS: Understanding how communities perceive and interpret novel technologies is crucial to the design and effective implementation of new vector control programmes. This study offers vital clues on how communities with no prior experience of modified mosquitoes might conceptualize or respond to such technologies when deployed in the context of malaria control programmes. Drawing upon existing interpretive frames and locally-resonant analogies when deploying such technologies may provide a basis for more durable public support in the future.

Setting the standard: multidisciplinary hallmarks for structural, equitable and tracked antibiotic policy.

There is increasing concern globally about the enormity of the threats posed by antimicrobial resistance (AMR) to human, animal, plant and environmental health. A proliferation of international, national and institutional reports on the problems posed by AMR and the need for antibiotic stewardship have galvanised attention on the global stage. However, the AMR community increasingly laments a lack of action, often identified as an 'implementation gap'. At a policy level, the design of internationally salient solutions that are able to address AMR's interconnected biological and social (historical, political, economic and cultural) dimensions is not straightforward. This multidisciplinary paper responds by asking two basic questions: (A) Is a universal approach to AMR policy and antibiotic stewardship possible? (B) If yes, what hallmarks characterise 'good' antibiotic policy? Our multistage analysis revealed four central challenges facing current international antibiotic policy: metrics, prioritisation, implementation and inequality. In response to this diagnosis, we propose three hallmarks that can support robust international antibiotic policy. Emerging hallmarks for good antibiotic policies are: Structural, Equitable and Tracked. We describe these hallmarks and propose their consideration should aid the design and evaluation of international antibiotic policies with maximal benefit at both local and international scales.

Motivations and expectations driving community participation in entomological research projects: Target Malaria as a case study in Bana, Western Burkina Faso.

BACKGROUND: Most field entomology research projects require active participation by local community members. Since 2012, Target Malaria, a not-for-profit research consortium, has been working with residents in the village of Bana, in Western Burkina Faso, in various studies involving mosquito collections, releases and recaptures. The long-term goal of this work is to develop innovative solutions to combat malaria in Africa with the help of mosquito modification technologies. Since the start of the project, Bana residents have played an important role in research activities, yet the motivations and expectations that drive their participation remain under-investigated. This study examines the factors that motivate some members of the local community to contribute to the implementation of Target Malaria's activities, and, more broadly, explores the reasons that animate citizen participation in entomological research work in malaria-endemic regions. METHODS: A qualitative approach was used to survey the factors motivating members of the local community to assist in the implementation of Target Malaria's entomological research activities in Bana. Eighty-five individual in-depth and semi-structured interviews were conducted, followed by three focus groups, one with youths who had participated in mosquito collections, and two with adult men and women from the village. All data collected were fully transcribed, processed, and subjected to thematic content analysis. RESULTS: Data showed that the willingness of local community members to participate in entomological research activities was informed by a wide range of motivational factors. Although interviewees expressed their motivations under different semantic registers, the data showed a degree of consistency around five categories of motivation: (a) enhance domestic protection from mosquitoes and malaria, (b) contribute to a future world free of the disease, (c) acquire knowledge and skills, (d) earn financial compensation, and (e) gain social prestige for the village. CONCLUSION: These varying motivations reflect a set of differing personal and collective perceptions about the participation process, combining short and long-term, individual and collective motivations. Beyond the specific circumstances of this case, the study highlights the complex reasons that drive collective participation in entomological research and vector control activities. Detailed knowledge of community expectations should underpin any effort to mobilize local participation in field research activities.

Opinions of key stakeholders on alternative interventions for malaria control and elimination in Tanzania.

BACKGROUND: Malaria control in Tanzania currently relies primarily on long-lasting insecticidal nets and indoor residual spraying, alongside effective case management and behaviour change communication. This study explored opinions of key stakeholders on the national progress towards malaria elimination, the potential of currently available vector control interventions in helping achieve elimination by 2030, and the need for alternative interventions that could be used to supplement malaria elimination efforts in Tanzania. METHODS: In this exploratory qualitative study, Focus group discussions were held with policy-makers, regulators, research scientists and community members. Malaria control interventions discussed were: (a) improved housing, (b) larval source management, (c) mass drug administration (MDA) with ivermectin to reduce vector densities, (d) release of modified mosquitoes, including genetically modified or irradiated mosquitoes, (e) targeted spraying of mosquito swarms, and (f) spatial repellents. RESULTS: Larval source management and spatial repellents were widely supported across all stakeholder groups, while insecticide-spraying of mosquito swarms was the least preferred. Support for MDA with ivermectin was high among policy makers, regulators and research scientists, but encountered opposition among community members, who instead expressed strong support for programmes to improve housing for poor people in high transmission areas. Policy makers, however, challenged the idea of government-supported housing improvement due to its perceived high costs. Techniques of mosquito modification, specifically those involving gene drives, were viewed positively by community members, policy makers and regulators, but encountered a high degree of scepticism among scientists. Overall, policy-makers, regulators and community members trusted scientists to provide appropriate advice for decision-making. CONCLUSION: Stakeholder opinions regarding alternative malaria interventions were divergent except for larval source management and spatial repellents, for which there was universal support. MDA with ivermectin, housing improvement and modified mosquitoes were also widely supported, though each faced concerns from at least one stakeholder group. While policy-makers, regulators and community members all noted their reliance on scientists to make informed decisions, their reasoning on the benefits and disadvantages of specific interventions included factors beyond technical efficiency. This study suggests the need to encourage and strengthen dialogue between research scientists, policy makers, regulators and communities regarding new interventions.

Uncertainty in times of medical emergency: Knowledge gaps and structural ignorance during the Brazilian Zika crisis.

Uncertainty was a defining feature of the Brazilian Zika crisis of 2015-2016. The cluster of cases of neonatal microcephaly detected in the country's northeast in the second half of 2015, and the possibility that a new virus transmitted by Aedes mosquitoes was responsible for this new syndrome, created a deep sense of shock and confusion in Brazil and around the world. When in February 2016 the WHO declared a Public Health Emergency of International Concern (PHEIC), it noted that it did so on the basis of what was not known about the virus and its pathogenic potential. To better understand the role that non-knowledge played in the unfolding of the Brazilian Zika crisis we differentiate between three different kinds of uncertainty: global health uncertainty, public health uncertainty, and clinical uncertainty. While these three forms of uncertainty were difficult to disentangle in the early weeks of the crisis, very soon each one began to trace a distinct trajectory. Global health uncertainty centered on the question of the causative link between Zika virus infection and congenital malformations, and was declared resolved by the time the PHEIC was lifted in November 2016. Public health and clinical uncertainty, in contrast, persisted over a longer period of time and did, in some important ways, become entrenched. This taxonomy of uncertainties allows us to explore the systematic nonproduction of knowledge in times of medical emergency, and suggests structural limitations in the framework of "emergency research" that global health institutions have developed to deal with unexpected threats.

Correction: Economic sanctions and academia: Overlooked impact and long-term consequences.

[This corrects the article DOI: 10.1371/journal.pone.0222669.].

Economic sanctions and academia: Overlooked impact and long-term consequences.

Financial sanctions are often thought of as the "soft alternative" to armed conflict and are widely used in the 21st century. Nonetheless, sanctions are often criticized for being non-specific in their action, and having impact beyond their intended remit. One often-overlooked area affected by sanctions are academic systems of research and education. Sanctions place "invisible barriers" for research in these countries by limiting access to necessary resources and curtailing their effective use. In this paper we present a national survey of Sudanese academics focused on the impact of 20 years of economic sanctions on their work. It identifies key areas of academic research and education that have been impacted by international sanctions. Moreover, these data highlight how the impact of sanctions on academia is likely to persist long after they are formally lifted. The paper concludes by problematising the current interpretation of jus post bellum, or moral behaviour after conflict. It suggests that the responsibility to make reparations in the form of support for academic systems applies to countries who impose economic sanctions.

Perceptions of bioenergy with carbon capture and storage in different policy scenarios.

There is growing interest in bioenergy with carbon capture and storage (BECCS) as a possible technology for removing CO2 from the atmosphere. In the first study of its kind, we investigate whether and how different forms of incentivisation impact on public perceptions of this technology. We develop a new experimental method to triangulate perceptions of BECCS in different policy scenarios through quantitative measurement and qualitative elicitation. Here we show that the type of policy instrument used to incentivise BECCS significantly affects perceptions of the technology itself. While we find approval of coercive and persuasion-based policy scenarios for incentivisation, supportive instruments proved polarising. Payments based on the amount of CO2 removed from the atmosphere were approved, but guarantees of higher prices for producers selling energy derived from BECCS were strongly opposed. We conclude that public support for BECCS is inextricably linked to attitudes towards the policies through which it is incentivised.

Crafting a public for geoengineering.

In a short period of time, climate 'geoengineering' has been added to the list of technoscientific issues subject to deliberative public engagement. Here, we analyse this rapid trajectory of publicization and explore the particular manner in which the possibility of intentionally altering the Earth's climate system to curb global warming has been incorporated into the field of 'public engagement with science'. We describe the initial framing of geoengineering as a singular object of debate and subsequent attempts to 'unframe' the issue by placing it within broader discursive fields. The tension implicit in these processes of structured debate - how to turn geoengineering into a workable object of deliberation without implying a commitment to its reality as a policy option - raises significant questions about the role of 'public engagement with science' scholars and methods in facilitating public debate on speculative technological futures.