Transforming Bangladesh’s Dengue Control with Wolbachia: A Tailored Strategy

Prof. Dr. Sharmeen Yasmeen, Dr. Maliha Mannan Ahmed
Case Study, Dengue, ICU Management, Pandemic

25

Aug 25

Dengue has been terrorizing Bangladesh in the most horrifying epidemic for the last three years. Ever since it’s first major outbreak since 2000, it remained a seasonal fever the first decade and half, confined mostly in Dhaka city but now the outbreak has spread all over the country without following a specific time frame. Despite the authorities employing regular fogging with pesticide, management of breeding sites, generating public awareness, and health care facilities’ stockpiling remedial supplies, when an outbreak happens, the spread accelerates at such a pace that it soon overwhelms the entire healthcare system. It would be smart if cost calculation, budget analysis is drawn based on the existing data and compare it to generating a science based long-term Aedes extermination strategy is undertaken. Brazil is another country fighting a dengue battle for decades now. They have used Wolbachia-infected Aedes aegypti mosquitoes to dramatically cut dengue transmission in Niterói a city in Brazil with the population of around half a million. Drawing inspiration from the success of Niteroi, Bangladesh has the opportunity to adopt a proven, sustainable method to save lives and healthcare costs.

1. Dengue Burden Overview: Niterói vs. Bangladesh (2018–2023)

Niterói, Brazil (Population ~500,000)

  • Wolbachia mosquito releases began in 2015. By 2021, dengue cases were 60% lower than in neighbouring Rio de Janeiro. 1
  • In 2024, Niterói recorded just 403 dengue cases (~69 per 100,000), compared to Rio’s much higher incidence. 2
  • A study showed sustained Wolbachia establishment in >97% of local mosquitoes, paired with long-term low dengue incidence. 3

Bangladesh (Population ~170 million)

Year   Cases   Deaths        CFR
2018     10,148    26        0.26% 4,12
2019     101,354    164–179        0.16% 4–6,13
2020     1,405    7        0.50% 4
2021     28,429    105        0.37% 4,5,12
2022     62,382    281        0.45% 5,8,12
2023     321,179    1,705        0.53% 9,15
  • 2023 was the deadliest dengue year ever, with cases exceeding the previous 23 years combined (2000–2022) and twice as many deaths. 9
  • Hospitals were overwhelmed; >1,000 dengue fatalities were reported before October 2023. 11, 15

2. Why Wolbachia Works: Insights from Niterói’s Success

  1. Biological Blocking: Infecting Aedes aegypti mosquitoes with the bacteria Wolbachia (wMel strain) reduces their capacity to transmit dengue, Zika, chikungunya, and yellow fever viruses.1
  2. Stable Local Establishment: Releases in 2015 resulted in >97% Wolbachia prevalence, maintained for years.3
  3. Impact on Dengue:
    • Niterói saw >60% reduction in dengue and chikungunya cases in early 2020s .1,2
    • Neighboring regions without Wolbachia saw far higher incidence.2
  4. Community Support: Over 90% of residents backed the program, aiding monitoring and vector control efforts.2
  5. Scalable Infrastructure: Brazil announced plans for a large-scale mosquito-rearing facility capable of producing 100 million eggs/week. 2

3. Tailored Rollout Plan for Bangladesh

3.1 Phase I: Pilot in High-Burden Urban Zones

  • Target populations in Dhaka—especially Mirpur, Mohammadpur, Uttara (~1–2 million total).
  • Mosquito releases over 18 months across 4–6 zones.
  • Monitor introduction of Wolbachia (>80‑90%) and track dengue incidence month‑by‑month.
  • Baseline and ongoing entomological and epidemiological surveillance are essential.

3.2 Technical Capabilities

  • Establish a local mosquito-rearing lab, capable of producing ~100 million wMel eggs weekly.
  • Equip teams of 100–200 community release agents per zone to ensure thorough coverage.
  • Collaborate with icddr,b, DGHS, and universities for entomological quality control.

3.3 Community & Public Engagement

  • Launch awareness campaigns via mosques, local media, social platforms, tribal consultations—informing that mosquitoes are “bacterially infected,” not genetically modified.
  • Seek >80% household participation, aided by trusted community figures.
  • Maintain concurrent traditional vector-control: remove standing water, clean breeding sites, use larvicides as needed.

3.4 Health System Strengthening & Policy Integration

  • Establish a “Arbovirus Control Cell” within MoHFW with DGHS, icddr,b, and WHO involvement.
  • Enhance surveillance systems: geotag dengue cases, integrate dashboards.
  • Train clinical staff in triage and early dengue management protocols.
  • Simplify regulatory approvals via DGDA; develop national standard operating procedures.
  • Integrate Wolbachia costs into yearly public health budgets and explore external funding.

4. Cost Estimates & Economic Justification

Per-Capita Cost

  • Laboratory development reduces costs to US $1.50–3 per person, based on scaled-efficiencies in low-income settings.1

Pilot Investment

  • For ~2 million people: US $3–6 million over 18 months.

National Scale

  • Urban population ~50 million → US $75–150 million over 5 years (~US $15–30 million annually).

Treatment Savings

  • Bangladesh 2023 saw ~203,000 hospitalizations at approx. US $50 per case (~US $10 million).
  • Wolbachia could reduce cases by 77‑90%, saving both lives and treatment costs within 2–3 years.1

Funding Strategy

  • Seek international grants (Gavi, Gates Foundation, WB, ADB).
  • Partner with CSR arms of national businesses.
  • Collaborate with WHO/UN for technical & pilot support.

5. Health Infrastructure Needs

  • Surveillance: Strengthen DGHS and IEDCR labs; deploy real-time GIS-enabled dashboards.
  • Clinical Capacity: Expand critical care training for dengue, improve triage protocols for severe cases.
  • Human Resources: Train community release teams; entomologists; local NGOs.
  • Regulatory Setup: MoUs among MoHFW, WMP, icddr,b; clear import/bio-release SOPs.
  • Monitoring & Evaluation: Coordinate zone-by-zone control comparisons; quarterly reports; adaptive release schedule.

6. Implementation Timeline

PhaseDurationKey Activities
Planning & Setup6 monthsRecruit staff, build facility, baseline data, community outreach
Pilot Release18 monthsMosquito deployment, surveillance, community feedback
Mid-Term Evaluation6 monthsAnalyze outcomes, refine scalable model
National Scale-Up24–36 monthsExpand to all major urban centers
Sustained SurveillanceOngoingAssess efficacy, perform periodic evaluations

7. Expected Outcomes

  • Dengue Incidence: Anticipate 80–90% reduction; cases could fall from ~200,000 to under 40,000 annually.
  • Mortality Reduction: From ~1,700 to ~170–340 saving approximately 1,360–1,530 lives per year.
  • Healthcare Relief: Less hospital congestion during monsoon outbreaks; better patient outcomes.
  • Economic Benefits: Reduced hospital bills, fewer lost workdays, improved social wellbeing.
  • System Resilience: Stronger institutional capabilities for future vector-borne diseases.

8. Risk Management & Mitigation

  1. Public Misinformation: Preemptively counter GM or “biohazard” rumors with transparent community outreach.
  2. Urban Density Barriers: Deploy releases in high-rise apartments and informal settlements using trained local volunteers.
  3. Seasonal Challenges: Continue releases through monsoon; adapt schedule to weather patterns.
  4. Technical Dependence: Strengthen local labs; partner with global academic entomology experts.
  5. Funding Uncertainty: Diversify revenue sources and secure multi-year governmental grant commitments.

9. Regional Leadership Potential

  • With success, Bangladesh can become a regional model (South Asia) like Brazil, Vietnam, Indonesia.
  • Supports SAARC/WHO collaborations, leveraging shared strategies and research.
  • Enhances validity for future dengue vaccines and integrated disease control measures.

10. Conclusion & Next Steps

Bangladesh stands at a decisive moment. The Wolbachia approach backed by strong scientific evidence, demonstrated cost-effectiveness, and proven community acceptance offers an achievable pathway to drastically cut dengue cases and save lives.

By committing to an initial US $3–6 million pilot, investing in the necessary human capacity, and embedding Wolbachia into health policy, Bangladesh can avert 80–90% of dengue, significantly reduce deaths, and build a more resilient public health system.

The global health community the government, NGOs, donors must unite now to turn this vision into reality.

Authors of this article

Prof.Dr. Sharmeen Yasmeen, Head of the dept. of Community Medicine and Public Health, Bangladesh Medical College and Chairperson, Public Health Foundation, Bangladesh Email: sharmeenphfbd@gmail.com

Dr. Maliha Mannan Ahmed, MBBS (BMC), MBA (ULAB), Masters in Healthcare Leadership (Brown University, USA) and Level 1 Certification on Precision Nutrition.  The Executive Editor of The Coronal.

References

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  2. AP News. In Rio, rife with dengue, bacteria-infected mosquitoes are making a difference. Published Mar 2, 2024.
  3. Gesto JSM, Pinto SB, Dias FBS, et al. Large-scale deployment and establishment of Wolbachia into the Aedes aegypti population in Rio de Janeiro, Brazil. Front Microbiol. 2021;12:711107.
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  11. Al Jazeera. Bangladesh dengue deaths cross 1,000 in worst outbreak on record. Oct 2, 2023.
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  13. Das A. 2019 Dengue outbreak in Bangladesh; confirmed via DGHS. Wikipedia.
  14. Reuters. As temperatures rise, Brazil ramps up efforts to combat dengue outbreaks. Mar 12, 2024.
  15. The Guardian. Deadliest outbreak ever seen: climate crisis fuels Bangladesh’s worst dengue epidemic. Jan 18, 2024.