The incidence of dengue hemorrhagic fever (DHF) continues to increase in Indonesia with a peak in 2016 (incidence rate almost 80/100,000 population, national strategic plan target < 10/100,000 population). The absolute number of deaths in the last 4 years has been above 500 people per year (highest in 2022: 1,236 people per year). From humanitarian ethics, of course we are not justified in saying that the number of lives lost is small.
The government has carried out various dengue prevention interventions since the beginning of the dengue prevention program in 1970, such as larvicidation, fogging, the 3 M mosquito net movement, the mosquito nest eradication movement (PSN), and the one house one jumantik movement (G1R1J). However, these efforts have not been able to slow the rate of this disease nationally.
Dengue hemorrhagic fever is caused by the dengue virus which is carried by the Aedes aegypti and Aedes albopictus mosquitoes. Data from the World Mosquito Program (WMP) Yogyakarta shows that the Aedes aegypti population is always present throughout the year. Wolbachia itself is an obligate intracellular bacterium that naturally infects insects and is inherited maternally.
Transfection of Aedes aegypti with several Wolbachia strains provides resistance to dengue virus infection (dengue virus cannot develop in the body of the Aedes aegypti mosquito which has Wolbachia, so the Aedes aegypti mosquito cannot transmit the dengue virus to humans). The main mechanism of action is through food competition between viruses and bacteria. Wolbachia bacteria do not infect humans or other vertebrates, and do not cause disease in humans or animals. Thus, introducing Wolbachia into the body of Aedes aegypti is a method for controlling dengue hemorrhagic fever that can be developed.
When a male mosquito with Wolbachia mates with a female mosquito without Wolbachia, the eggs will not hatch, but if a female mosquito with Wolbachia mates with a male without Wolbachia, all the eggs will hatch producing mosquitoes with Wolbachia too and if the female mosquito has Wolbachia If you mate with a male mosquito that has Wolbachia, all of its offspring will hatch and contain Wolbachia.
The Aedes aegypti mosquito with wolbachia is not a genetically modified organism, considering that the wolbachia bacteria introduced into the body of Aedes aegypti are identical to the wolbachia in its original host, namely Drosophila melanogaster (fruit fly). It’s just a natural strategy in the form of biological control.
For 12 years (starting in 2011), the Center for Tropical Medicine, Faculty of Public Health Medicine and Nursing, UGM, supported by the philanthropy of the Tahija Foundation (a foundation owned by the Indonesian nation itself) has conducted research on the application of wolbachia mosquito technology to reduce the incidence of dengue fever in Yogyakarta.
The four research phases include: safety and feasibility (2011-2012), limited-scale release of wolbachia-infected mosquitoes (2013-2015), cluster randomized controlled research (CRCT) large-scale release of wolbachia-infected mosquitoes/clinical trials (2016-2020), and implementation model (2021-2023). In this study, male and female Wolbachia-bearing mosquitoes were released over a period of around 6 months so that the majority of mosquitoes in the population had Wolbachia and it was hoped this could reduce the transmission of the dengue virus.
Safety tests conducted by Gadjah Mada University showed that there was no wolbachia infection from Aedes aegypti mosquitoes to humans, the release of Aedes aegypti mosquitoes with wolbachia did not change the mosquito population and Aedes aegypti mosquitoes with wolbachia had the same characteristics as those in nature, including in terms of resistance. insecticide.
Thus, there is no natural imbalance that occurs after the release of Wolbachia mosquitoes. The Ministry of Research, Technology and Higher Education and the Ministry of Health’s Research and Development Agency also took the initiative to assess the environmental risks of implementing this method by appointing 24 independent experts from various professions. The conclusion of the risk assessment of the release of wolbachia in Yogyakarta is that the release of Aedes aegypti mosquitoes containing wolbachia is at a very low risk.
In the next 30 years, the chance of increasing harm (cause more harm) will be negligible, Wolbachia will not infect humans, horizontal transmission will not occur to other species and will not pollute the biotic and abiotic environment, and an increase in the number of Aedes aegypti mosquitoes in the release area will only occur. during the release period (there was no difference in the number of Aedes aegypti mosquitoes before and after Wolbachia was released).
The world’s first efficacy test of the application of this technology was carried out in Yogyakarta by Indonesian researchers with the highest standard research design in the academic world (CRTT)! As a result, the Wolbachia-bearing Aedes aegypti mosquito was able to reduce dengue cases by 77.1 percent and reduce hospitalization due to dengue by 86 percent, a significant result for reducing the incidence and severity of dengue disease in the community.
Furthermore, after the research, the number of dengue fever case notifications in 2021-2023 turned out to be much lower than the average of the previous 30 years. DHF cases in Yogyakarta City decreased by 83 percent in the period when Wolbachia had settled compared to the period before Wolbachia had settled. Research conducted in Indonesia was then also carried out in Brazil, Vietnam and Australia with results that were consistent with those in Indonesia.
Based on these results, the Indonesian Academy of Sciences (AIPI) recommends that Wolbachia technology become a policy for the Ministry of Health to be used by the public in treating dengue in Indonesia. Not only that, at the world level this success made the Vector Control Advisory Group (VCAG) recommend to WHO to start developing intervention guidelines for the release of Aedes mosquitoes carrying Wolbachia in the context of controlling dengue fever.
We should be proud that this is the first time that VGAC has provided a positive assessment of the public health impact of a new vector control intervention (reduction of pathogen transmission due to wolbachia intervention).
What is currently underway is the implementation phase of the research results. After being successful in Yogyakarta, this pilot project program will then be carried out in 5 cities: Semarang, West Jakarta, Bandung, Kupang and Bontang based on the Decree of the Minister of Health of the Republic of Indonesia No. 1341. For this reason, government leadership, strong support from stakeholders and community acceptance are needed. .
It is time for society to give positive acceptance to this technology created by our nation’s own children. Don’t be trapped by various hoaxes that lead opinions to be antipathetic towards the implementation of this program. In fact, the neighboring country, Malaysia, has adopted this technology. Even other countries in the world such as Brazil, Colombia, Singapore, Thailand, China, Vietnam, Tahiti, Fiji, Vanuatu, Mexico, Kiribati, Sri Lanka and Australia. If many other countries in the world “take” the results of this Indonesian research to apply in their countries, how come we are just spectators in our own country?
If the world health institutions (WHO and VGAC) only acknowledged the success of this technological discovery by our own nation’s children, why would we be suspicious? What the public also needs to underline is that this technology does not mean eliminating various existing control methods, but rather it complements other control efforts whose files have been included in the national strategy.
It is true that education and outreach are the first steps that must be taken to build trust and eliminate concerns in society. However, the broad umbrella of communication regarding this matter cannot only be imposed on one party, the government or program implementers.
The public itself must also explore official and valid information channels to obtain accurate data to avoid misperceptions which often occur in today’s post-truth era. Especially for figures who actually have a medical background, so they don’t make the wrong move when giving their opinion. And so as not to harm the work of the nation’s children in their own country.***
2024-02-16 15:00:44
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