This document proposes a collaborative, integrated approach to preventing, controlling, and eliminating vector-borne diseases in the Eastern Mediterranean region. It notes the increasing burden of these diseases, driven by factors like climate change, conflict, and urbanization. It advocates addressing the three main vector-borne disease groups - caused by Anopheles, Aedes, and other vectors - together rather than separately. This integrated approach would leverage existing programmatic strengths while consolidating resources for more efficient and effective surveillance, control, and response efforts against all vector-borne diseases in the region.

1. A sustainable, integrated approach
to the prevention, control and
elimination of vector-borne
diseases
Proposal for collaborative action
Dr Yvan Hutin, Director, Division of Communicable Disease Control
Distribution of long-lasting
insecticidal nets in Yemen

2. The 2022 floods
emergency in Pakistan:
A major malaria outbreak
with long lasting
consequences

3. Vector-borne diseases are expanding over time in
the Eastern Mediterranean Region, causing
morbidity, mortality and economic loss
Higher endemic burden, more outbreaks
Causes: Insufficient programme investment, climate change,
conflict, displacement, migration and urbanization

4. Three main groups of vector-borne diseases
Anopheles
(malaria)
The silent killer  majority of the
burden
• More rural
• More mortality
• Programme
platform
Aedes
(yellow fever, dengue, chikungunya,
Zika virus disease outbreaks)
• More urban
• More morbidity and
economic impact
(e.g. tourism)
• Emergency
response
Others
• Leishmaniasis
• Zoonoses, some of
them highly lethal
• Onchocerciasis
• Lymphatic filariasis
- Crimean-Congo
haemorrhagic fever
- Rift Valley fever
- Zoonotic leishmaniasis
- Schistosomiasis
Should we address these
together or separately?

5. 1369 million healthy life years lost to vector-borne
diseases in the Eastern Mediterranean Region in 2019
Onchocerciasis Lymphatic filariasis Yellow fever
Trachoma Dengue Schistosomiasis
Leishmaniasis Malaria
Severe visceral
leishmaniasis in a child,
Khartoum, Sudan
Bleeding manifestations
of Crimean-Congo
haemorrhagic fever

6. The malaria situation is unstable
because of insufficient
programme response, climate
change and biological threats
Malaria-free countries
High-burden countries targeting control
Focal transmission targeting elimination

7. Aedes leads to outbreaks of dengue, chikungunya
and yellow fever
Malaria-free countries
High-burden countries targeting control
Focal transmission targeting elimination
D
D
D
D
`
C
,
Y
D
C
C
Presence of Aedes aegypti
C Chikungunya
D Dengue outbreaks
Y Yellow fever
D
Presence of Aedes albopictus
?

8. Vector-borne diseases are on the increase
0
50,000
100,000
150,000
200,000
250,000
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
2016
2017
2018
2019
2020
2021
2022
Number
of
cases
reported
Year
Reported cases of cutaneous leishmaniasis,
Eastern Mediterranean Region, 19982022
Reported number of outbreaks of dengue,
Eastern Mediterranean Region,
2009April 2023
0
1
2
3
4
5
6
7
2017 2018 2019 2020 2021 2022 2023
Number
of
reported
outbreaks
April 2023

9. We know how
to handle this,
we just
need to join
forces
Strong programme
base for malaria?
 Expand to all
vector-borne diseases
Strong emergency
response capacity?
 Consolidate to address
all threats
Malaria programme
and dengue response?
 Optimize response with a
single vector-borne disease
programmatic approach

10. We shaped the strategy from the challenges we face
Prevention, detection, diagnosis, management
Vectors and environment
 Eco-epidemiology,
biological threats
Integrated vector surveillance and control
Coordinated programmatic approach
Cadre
Integrated disease surveillance
Resources insufficient?
Let’s consolidate all investments around a vision!
Context
 Emergencies, migrations,
fragmentations
Capacities
 Entomology, pesticide
management
Information gap
 Weak surveillance

11. Building blocks of an integrated programmatic approach:
Cost-effectiveness – Sustainability – Resilience
Vector
surveillance
and control
Diagnosis Surveillance
Case
management
Outbreak
preparedness
and response
Monitoring
and
evaluation
Multisectoral
coordination:
engaging
communities,
agriculture
sector

12. In 2023, Pakistan is
moving forward with
integrated vector
surveillance and
control on a pilot
basis with WHO
support

13. How can we build on the experience of malaria
programmes, the response to COVID-19, and emerging
diseases, with contributions from all relevant WHO
departments?
We want to hear from you:
What is the best way to ensure a country-owned, integrated
programmatic approach to malaria and other vector-borne diseases?
How can WHO help you reach this goal?