Indonesia’s Health Ministry confronts dengue crisis with Wolbachia mosquitoes amid misconception challenges

INDONESIA: The utilization of Wolbachia mosquitoes as a control measure for managing dengue hemorrhagic fever (DHF) has garnered significant attention, albeit accompanied by lingering concerns about its effectiveness.

This scrutiny was particularly evident in Denpasar and Buleleng, where the scheduled distribution of Wolbachia mosquito eggs faced obstacles, leading to their eventual destruction.

The eggs, intended for dispersal in Denpasar on Monday (13 Nov) and Buleleng on Sunday (12 Nov), succumbed to a time-sensitive fate due to unforeseen delays, as highlighted by Erwin Simangunsong, Chief of Partnership, Strategic Program, and Operation at Save the Children Indonesia.

The logistical challenges resulted in the loss of these Wolbachia mosquito eggs, originally designated for distribution to 22 thousand households in Denpasar and Buleleng over a period of 12-20 weeks.

The implications of this setback extend beyond operational setbacks, touching upon broader concerns and misconceptions surrounding the Wolbachia mosquito initiative.

Erwin Simangunsong pointed out that a considerable portion of these apprehensions stems from disinformation circulating among various parties.

Contrary to prevailing concerns, Wolbachia is characterized as a natural bacterium that has coexisted with insect populations for an extended duration.

Importantly, there is a lack of evidence-based support indicating any adverse effects of Wolbachia mosquito proliferation on humans, animals, or the environment.

Erwin Simangunsong emphasized that the Wolbachia mosquito strategy does not involve genetic engineering, dispelling fears of alterations to the mosquito’s genes or DNA.

Consequently, there is no transformation in the mosquito’s physical characteristics, nature, or size resulting from this approach.

Ministry of Health response

The Indonesian Ministry of Health has voiced its support for the initiative to propagate Wolbachia mosquitoes as a means of dengue hemorrhagic fever (DHF) control.

Maxi Rein Rondonuwu, the Director General of Disease Prevention and Control (P2P) at the Indonesian Ministry of Health, highlighted that this strategic approach has received backing from the World Health Organization (WHO).

The Ministry’s confidence in this method is rooted in research findings and WHO recommendations, as articulated by Maxi on Tuesday (14 Nov).

This Wolbachia mosquito initiative was initially explored through research in the Special Region of Yogyakarta (DIY), where it was observed that incidents of DHF significantly decreased.

The research, conducted by WMP in collaboration with the Tahija Foundation, spanned a limited scale over four years until 2015.

The crux of the initiative lies in Wolbachia’s ability to weaken the dengue virus within the Aedes aegypti mosquito’s body.

The Ministry of Health underscores the mechanism, elucidating that when a male Aedes aegypti with Wolbachia mates with a female Aedes aegypti, the dengue virus in the female mosquito becomes blocked.

Furthermore, if a female mosquito with Wolbachia mates with a male mosquito lacking Wolbachia, all the resulting eggs will contain Wolbachia.

This biological process, as outlined in an official statement from the Ministry of Health on Tuesday (14 Nov), ensures that the dengue virus is not transmissible to the human body.

Building on the success observed in Yogyakarta, where DHF cases were reduced by 77 per cent in 2022 following the Wolbachia mosquito deployment, the Ministry of Health emphasizes the tangible benefits of this approach in effectively curbing the spread of dengue fever.

Wolbachia’s effective innovation in reducing dengue fever cases

The Ministry of Health in Indonesia has adopted Wolbachia technological innovation as a proactive measure to curtail the spread of Dengue Hemorrhagic Fever (DHF) across the country.

This cutting-edge technology has not only been implemented in Indonesia but has also demonstrated effectiveness in nine other countries, including Brazil, Australia, Vietnam, Fiji, Vanuatu, Mexico, Kiribati, New Caledonia, and Sri Lanka.

The integration of Wolbachia technology is a crucial component of the comprehensive control strategy, the details of which have been submitted to the National Strategy (Strannas).

In Indonesia, this innovative approach was initiated as a pilot project in five cities: Semarang City, West Jakarta City, Bandung City, Kupang City, and Bontang City, in accordance with the Minister of Health’s Decree Number 1341, focusing on the implementation of the Wolbachia Implementation Pilot Project for dengue prevention.

The effectiveness of Wolbachia has been under scrutiny since 2011, with research conducted by WMP in Yogyakarta, supported by the Tahija Foundation.

The research spanned the preparation and release phases of Aedes aegypti carrying Wolbachia on a limited scale from 2011 to 2015.

Trials conducted in Yogyakarta City and Bantul Regency in 2022 revealed promising outcomes.

In locations where Wolbachia was introduced, there was a documented reduction of up to 77% in dengue fever cases, accompanied by an 86% decrease in the proportion of hospitalizations.

The Head of Yogyakarta City Health Service, Emma Rahmi Aryani, emphasized the significant reduction in Dengue spread following Wolbachia implementation, citing data that showed cases in Yogyakarta City from January to May 2023 below the minimum line when compared to the patterns of the previous seven years (2015-2022).

Despite the positive impact of Wolbachia technology, it does not render existing dengue prevention and control methods obsolete.

The public is encouraged to continue adhering to the 3M Plus movements, comprising draining, closing, and recycling, and maintaining personal and environmental cleanliness.

Semarang is the first city to start implementing innovations to control dengue using Wolbachia technology

Semarang spearheads the implementation of innovative measures to control dengue, introducing Wolbachia technology as a groundbreaking approach.

Following Semarang, the next four districts and cities—West Jakarta, Bandung, Kupang, and Bontang—are slated to adopt this cutting-edge strategy.

Wolbachia, a groundbreaking innovation, possesses the unique ability to paralyze the dengue virus within the Aedes aegypti mosquito, the vector responsible for Dengue Hemorrhagic Fever (DHF), thereby preventing transmission to humans.

Despite being positioned in the middle concerning dengue cases among the selected cities, Semarang has been identified as more progressive and is hence the inaugural city to embark on the Wolbachia pilot project.

Indonesian Minister of Health Budi Gunadi Sadikin made this announcement during the launch of the “Implementation of the Wolbachia Pilot Project” in Semarang on 30 May 2023.

Dengue fever prevention adopts a dual-pronged approach: administering vaccines to the community and implementing Wolbachia technology to render mosquitoes incapable of transmitting the Aedes aegypti virus.

Minister Budi Gunadi Sadikin emphasized the need for a comprehensive strategy that goes beyond treatment and focuses on prevention.

Vaccination and Wolbachia-induced mosquito sterilization are identified as the two pivotal preventive measures.

Minister Budi Gunadi Sadikin acknowledged the patience required for the six-month mosquito-spreading process, emphasizing that results would manifest in 2-4 months.

The goal is to reach an 80% Wolbachia mosquito population within one year, contingent on successful mating and multiplication.

Semarang’s residents are encouraged to pray for the swift proliferation of Wolbachia mosquitoes to expedite the transformative impact on Aedes aegypti mosquito populations.

Cases of dengue hemorrhagic fever in Indonesia

The surge in Dengue Hemorrhagic Fever (DHF) cases in Indonesia has become an urgent and escalating concern.

In 2021, the country recorded 73,518 cases, resulting in a death toll of 705 individuals.

The severity of the situation intensified in 2022, with reported cases surging to 131,265 and a death toll of 1,183.

This alarming trend underscores the critical need for comprehensive strategies to address and mitigate the impact of the DHF crisis in Indonesia.

The Ministry of Health has vigilantly monitored this unfolding scenario, revealing that, in the first 22 weeks of 2023 (January to May), Indonesia recorded 35,694 cases of dengue hemorrhagic fever (DBD).

Imran Pambudi, the Director of Prevention and Control of Infectious Diseases at the Ministry of Health, shared these figures during an online press conference commemorating ASEAN Dengue Day on 12 June.

Within the January to May 2023 period, West Java emerged as the province with the highest incidence of dengue fever cases in Indonesia, reporting 6,398 cases.

Bali followed closely with 3,678 cases, while Central Java and East Java reported 3,068 and 2,551 cases, respectively.

Regrettably, the Ministry of Health also reported a significant number of deaths attributed to dengue fever during the same period.

Imran Pambudi highlighted that the total number of dengue fever-related deaths reached 270 cases by the 22nd week of 2023.

The provinces of Central Java, West Java, East Java, NTB, and East Kalimantan experienced the highest incidence of fatalities, underscoring the need for targeted interventions and heightened public awareness.

The dengue virus, classified within the arthropod-borne virus (arbovirus) group, encompasses four distinct serotypes: DEN-1, DEN-2, DEN-3, and DEN-4.

In Indonesia, the most prevalent serotype is DEN-3, associated with severe dengue fever cases and widespread distribution.

In response to the escalating DHF crisis, the Ministry of Health has taken proactive measures by initiating a Pilot Project for Dengue Control through Wolbachia in five cities. .

The project is being implemented in Semarang, West Jakarta, Bandung, Kupang, and Bontang, with the goal of exploring new avenues for effective DHF prevention and control.