"Basically a PR exercise…": a qualitative study of expert perspectives on 'performative versus evidence-informed' dengue vector control in the Asia-Pacific region

Abstract

Background: Dengue cases are increasing despite continued efforts to control its vectors, with the Asia-Pacific region projected to bear a substantial proportion of the global burden. However, literature on dengue vector control methods and evidence use in national control programmes in the region is limited. We thus aimed to explore expert perspectives on current methods and how to improve dengue vector control programmes across the region.

Methods: We conducted remote semi-structured interviews with a purposive sample of 23 dengue vector control experts with experience in the Asia-Pacific region, analysing data using an abductive thematic approach.

Findings: Participants indicated that monitoring, evaluation and operational research related to dengue vector control methods was deprioritised in many countries across the region and that national vector control resources were often directed to relatively inefficient yet highly visible insecticide-based methods such as adulticide fogging. They suggested additional investment in other forms of vector control, including Wolbachia-based technologies that show potential and should be tested in larger urban settings. They also noted that traditional environmental control methods such as source reduction and biocontrol were potentially the most sustainable Aedes vector control methods if conducted through better-resourced and better-evidenced community engagement approaches.

Conclusions: The focus on visible and familiar methods evinces political concern for performative vector control. While understandable, refocusing national dengue vector control priorities on monitoring and evaluation/research evidence and mobilising communities can help Asia-Pacific countries improve Aedes mosquito management and therefore health outcomes.

Keywords: Dengue; Global Health; Health systems; Medical entomology; Qualitative study.