The Mosquitoes Are Winning

from New York Times I'm Michael abaro. this is a daily. [Music]. for decades the world seemed to be. winning the war against mosquitoes and. the deadly diseases that they carry now. we're once again losing that battle. today my colleague Stephanie Nolan. explains why.

[Music]. it's Thursday October 5th. [Music]. Stephanie you have embarked on an entire. line of coverage for the times about. mosquitoes why why mosquitoes and why. now so I went into this really thinking. about Solutions I was going to do some.

nerdy geeky stories because I knew there. was some great new technology coming to. fight mosquitoes and you know they're. our biggest enemy right they're the. deadliest animal well just explain that. they're the deadliest animal so they. kill more humans than anything else than. any other living creature because of the. diseases that they carry because of the. diseases they carry exactly there's West. Nile there's Dengue there's malaria so I. went into this planning to look at. Solutions and really quickly I realized.

that I hadn't really kept up with the. scale of the problem that yes we have. new tools but we need them because the. problem has really gotten away from us. and I. I covered Public Health Global public. health for a living but I hadn't. realized how much the kind of tide in. this battle had shifted that the. mosquitoes were winning and winning how. they're winning in terms of our ability. to control mosquito-borne disease and.

the place where you see that the most. strikingly I think is with malaria with. malaria in Africa we were doing a really. good job of bringing down Malaria deaths. and that progress has stopped. that is genuinely surprising to me. because I think of malaria as a disease. that we have mostly gotten under control. so lay out for us exactly what happened. and why that progress has stopped. so if you go back like 20 years almost a.

million people were dying in malaria. every year almost all of them in Africa. so just to remind you the way that. malaria spreads right is you have a. mosquito who bites a person who has a. parasite the parasite reproduces in the. gut of the mosquito and then when it. bites the next person that person gets. infected and you have these cycles of. sickness that go through families and it. can be deadly of course especially for. small children but it's not just about.

death right it's it's horrible you get. fevers that can be so severe you get. hallucinations you get vomiting you get. this absolutely debilitating fatigue and. you don't get it once right you can get. it four or five times in a really season. kids are getting 10 cases in a year and. that takes like a huge toll on their. families they're spending their money on. medical bills and people can't go to. work because they're taking care of them. there's a huge economic and so for all. of these reasons in the late 1990s.

there's a decision by African. governments by some philanthropists and. Global public health organizations to. really make an effort to wipe malaria. out in Africa. we are first of all reaching out to. other partners making an alliance for. rollback malaria and what does that look. like it's a big investment Microsoft. founder Bill Gates is giving up daily. control of his company to concentrate on. his foundation which funds health and.

education projects worldwide a lot of. that money comes from philanthropy from. the Bill and Melinda Gates Foundation in. particular who make eradicating malaria. a huge priority the fact that it kills. over a million children a year and yet. has almost no money given to it you know. that struck us as as very strange but it. became and the decision is to try three. strategies we'll take the diseases of. the poor where there's no market and. we'll get the best scientists working on. those diseases one is better drugs so.

there are new and better treatments for. malaria and there's a real effort to get. those into Primary Health Care Clinics. across rural Africa there were also new. and better insecticides so in places. with a heavy malaria burden they would. spray insecticides inside people's homes. and they're long acting right and so. that would provide you with protection. for a while and then last one bed nets. the thinking was that the main. mosquitoes that transmit malaria in. Africa they bite indoors and at night. when people are asleep and that's when.

people are getting infected and so you. had this huge campaign to get an. insecticide treated bed net in every. household on every family mothers were. sent home from clinics with them with. their new babies trucks would roll into. Villages and give them out and so as. these elements come together. I'm quite optimistic that we will be. able to eradicate malaria. [Music]. and how.

three. Solutions including this quite low-tech. bednet solution actually work well it. works really well deaths come way down. cases come way down by about 25 15. deaths bottom out at about 550 000. people which obviously is still like a. horrifying number of people but you've. got deaths in half right wow and people. have really seen the difference in their. lives and the economic impact on their. families and so for a while there as.

you're watching that curve of infections. come down there's a belief that like. okay if we keep investing in this and we. keep going maybe we're going to get to. elimination so how do we get instead to. where you say we are which is not. elimination but instead mosquitoes and. malaria resurgent and winning well so. here's what I have found in my reporting. after talking to dozens and dozens of. malariologists parasitologists.

entomologists all kinds of people who. were working in this all over Africa. the short answer is the mosquitoes. adapted their lifespan might only be six. or seven weeks and they evolve really. really quickly so you get a lot of. mutations within a mosquito which means. that there's lots of opportunities for a. mosquito to develop a way that it can. survive what we're throwing against it. [Music]. foreign.

mosquitoes have outmaneuvered the. solutions that we had in place. and one of the big changes ties directly. to bed nets so. if mosquitoes were not able to feed at. night they weren't able to feed on. sleepers who were under Nets some of. those mosquitoes died out. and there was an evolutionary Advantage. for those who started feeding at other. times in other places and so now you. have mosquitoes that are feeding. Outdoors feeding during the daytime and.

obviously people are not wandering. around all day long wrapped in a bed net. right so if you're not protected anymore. at the time when those mosquitoes are. biting suddenly you have cases starting. to go back up. and you know that same evolutionary. Advantage issue comes up with the. treatments and it comes up with the. insecticides mosquitoes are resistant at. this point to almost all of the. chemicals all of the insecticides that.

are being used across Africa they just. don't kill them the way they did 20. years ago. foreign. very effective Solutions you mentioned. that really brought down death from. malaria across Africa. they create the conditions in which. these mosquitoes adapt and adapt in ways. that outsmart all three of these. Solutions yeah exactly and brace. yourself for this Michael it gets worse. so I'm reporting on all of this and I.

call up a scientist at the CDC who runs. their entomology program and she tells. me yes these daytime biters these. insecticide resistant mosquitoes it's. all a really big problem but also she. says that I've missed something huge. which is what. well while the public health world has. been focused on mosquitoes and the way. that they're adapting and how to respond. to malaria in rural Africa there's a.

whole new mosquito. and it's an urban mosquito it's highly. adapted to live and thrive in cities so. suddenly there's a kind of double whammy. nightmare scenario being presented to. you yeah not only are mosquitoes out. adapting all the tools that we had for. Rural malaria now you have a mosquito. that's bringing the disease into urban. areas and they're totally unprepared to. respond. foreign.

[Music]. tell us more about this second threat. this mosquito that's now posing a risk. to Africa's cities. so it's a mosquito called anopheles well. here's where it gets tricky it's called. anopheles Stevens eye or anopheles. defensive and the entomologists I've. interviewed are kind of split right down. the middle about how to pronounce it and. so in fact a lot of them now just refer. to her as Steve it turns out these folks.

have a pretty good sense of humor in the. face of some pretty awful information. is of course the ones that bite us are. all the females who are in search of. blood for the protein to lay eggs. so Steve is. she's kind of the superhero of. mosquitoes. she's unbelievably adaptable she's great.

at high temperatures she likes it when. it's wet but she's also fine when it's. dry. she'll breed all year round so you're. not talking about having a malaria. season anymore like in a rainy season. wow and on top of all of that she's what. in the entomology World they call a very. confident Vector which means she's. really good at spreading the malaria. parasite it lives well inside her and. it's very easy for her to pass it on to.

the next person she bites. so perhaps not a superhero but instead. like a villain yeah. is this one of the mosquitoes Stephanie. that we think evolved across rural. Africa during this period when bed nets. and insecticides were being used and. just has found her way into cities great. question but no Steve is an immigrant. she originates in South Asia in India. and Pakistan unknown in Africa until way.

back in 2012. so in 2012 it was found in. the tiny little country of Djibouti on. the Horn of Africa and the theory is. that she was imported on container ships. maybe in old car tires and you know. initially nobody was overly concerned. about this until all of a sudden in. Djibouti City malaria cases started to. creep up and remember malaria is not. known as an urban disease right like.

we're talking about a rural disease when. we talk about malaria and Africa so it. caused a lot of confusion like what. exactly is going on in Djibouti and then. in 2022 you get an outbreak of malaria. in Ethiopia's second largest city which. is a place called duradawa and it's got. about a half a million people. and what happens is that a duradawa. university which ends up being the.

center of this outbreak half of the. students who live in the male. dormitories fall ill the student clinic. is overflowing with cases at first they. don't know what's wrong with these. people and then they start to realize. that they've got malaria and eventually. more than 10 000 people are diagnosed. with malaria in a city where like a half. dozen people might get malaria in the. course of the Year normally like they've. just not seen anything like this before. fascinating so it's very clearly the.

beginning of a new phase of Africa's. relationship to malaria and it sounds. like that is because of Steve yeah. exactly and I wanted to see what does it. look like when Steven's eye invades a. city why is that potentially such a. problem and then I also wanted to see. what cities what health systems are able. to do if anything when they're trying to. respond and you know the Ethiopian. government is not receptive to foreign.

journalists and it took me many many. months but finally back in May I got to. diradoa and I went to spend time with a. couple of scientists a molecular. biologist named fitzsim tedesi and an. entomologist named Jenny gatashu and. they've been studying Steven's eye and. this outbreak since the moment it. started well tell us more about this. trip. so I got to ghirardella and it's a very. very very arid City in a river valley.

it's it's very close to the border with. Djibouti and Somalia. it's a very vibrant place especially at. night it really comes alive at night. because of the Heat. it has lots of little narrow streets and. the houses are behind High walls it's. very dense housing actually little blue. Auto rickshaws zip around in the street. and you get women who are wearing really. brightly colored hijab and robes. foreign. and when I get there basically the very.

first thing we do is we go to the place. where these scientists fits them in De. Jane first found Steven's eye which is. where okay you've got the gear I'm ready. well it's along the banks in little. pools that have been left along the. sides of the bank of the river that runs. through ghirardella I'm ready to meet my. first stupid guy. I love a little stagnant water. so we're standing in the shallow water.

on the edge of the river. can I see this one yeah you can see them. yeah and degeny is scooping up water. from these pools and puddles and looking. at the larvae you would say the chances. are very high Stephen very very highly. and what he's trying to do when they. collect samples in a place like this is. figure out how much of the mosquito. population is actually Steve and they. started doing this next to the river. when the malaria outbreak began because.

a lot of the initial cases that were. reported were in families who lived near. here near the river right so we had 100. meter radius for the largest area 100. meter radius of everywhere you found a. case and what they do is they go to the. home of everyone who's diagnosed with. malaria and they trap the mosquitoes in. and around the house so lo and behold 97. of the mosquitoes they catch are an. awfully students eye. wow so this mosquito is clearly.

thriving but is it mostly contained to. the river no so in fact they found Steve. in a lot of other places that are a lot. less predictable than a river the places. this mosquito is turning up are really. surprising if you think about the ways. that we traditionally think of. mosquitoes in Africa behaving Steve is. so adaptable that sure she'll breed in. these pools next to the river but she'll.

also breed in water tanks and she can. breed in the amount of water that you. might find in an old bottle cap she will. feed on humans yes but she'll also feed. on livestock and that's why actually the. next place that de Jenny wanted to take. me was into a goat shed so lots of. families in duradoa have these little. outbuildings in their homes where they. keep a couple of goats or a couple of. sheep maybe a cow. and it turns out that the mosquito will. rest in there because it's cool and it's.

dark and it's moist during the daytime. when it's really hot and there's also of. course a very accessible source of food. which is the goats the goats so I'm. following along behind a Jenny down. these narrow alleyways. an animal shed with a low roof yeah and. the next thing you know he's down on his. hands and knees crawling into these. little buildings they're maybe like. three or four feet tall they're just. crammed full of goats and he goes and.

you know he wants to show me how this. works so in I go too okay I am crawling. in. shed here we go I can see nothing I'm. gonna. generally not made to be an entomologist. there are one two four yeah seven goats. and he gets on his phone and he uses the. flashlight to run it sort of really. quickly over the walls and there were.

mosquitoes what did we find fed mosquito. you can tell from out here. okay all right to Jenny is able in the. dark in the Gloom with the goats to. identify which mosquitoes they are I can. barely see them oh. sorry goats sorry. he's like totally unfazed by the goats.

and when he sees the mosquitoes what he. does is he's got what's called an. aspirator. which is like a little glass tube with a. piece of rubber piping on the end and he. puts the rubber pipe in his mouth and he. holds the end of a glass tube up against. the wall where he's seen a mosquito and. he gently sucks it in. got him. so that it's alive but trapped and what. they do is again like take them back to. the lab where they can sort them. properly and identify which species it.

is and then know whether he's finding. Steve in these places this is an amazing. thing to Envision well it's particularly. amazing if you think about doing it with. like a large herd of goats who are also. very interested in what's happening and. are fully attempting to participate. these goats are spitting in me. excuse me pardon me.

okay. so when did Jenny had sucked all the. visible mosquitoes off the walls we. crawled back out of the shed and walking. through more of these narrow streets I. gotta tell you like I'm looking at the. place in a whole new way now right and. I'm just thinking there are so many. places where Steve could be. if you think that like she only needs.

small amounts of water to breed and. she's happy with artificial sources of. water she's happy in containers in Old. plastic containers I'm looking around. and I'm seeing puddles under cisterns. and I'm seeing water storage containers. in front of people's houses. Municipal Water only runs a couple of. days a week so when it turns on. everybody fills up some barrels some. Jerry cans in front of their house and. keeps them nearby and they don't have. reliable trash collections so you'll get.

lots of these little bits of plastic. around that are a place for it to breed. and when we talk about Steven's eye. being a threat across Africa like that's. one of the reasons why right because. these erratic Municipal Services it's a. very common problem. so I'm looking around duradawa and I'm. thinking Steve could be everywhere here. and I'm thinking like the public health. system is absolutely not in a state to. respond to this.

[Music]. well what exactly is the public health. infrastructure in a city like this that. is now dealing with Steve and with so. much malaria. so Ethiopia has really been investing in. Primary Care in public health but they. don't have Urban malaria response right. remember it hasn't been an urban disease. so there's no muscle memory in the city.

for responding people don't have. immunity they get very ill and Clinics. don't know what they're looking at I. talked to a woman a nurse who was. pregnant when she got malaria she got. incredibly sick but it was 10 days and. you know a half dozen malaria tests. before she got a confirmed diagnosis. because nobody was looking for it and. this is a nurse who presumably has a lot. of strong ties to the medical community. yeah when you get a sudden severe.

malaria outbreak in a place that's not. expecting it it can really quickly start. to derail things right and if you think. that there are 600 million people who. live in cities in Africa then that's so. many people who were potentially. vulnerable to this mosquito. so if when you start to put all of those. things together you get the scenario. that keeps Ethiopian scientists awake at. night that's really terrifying that CDC.

scientist who first told me about this. and somewhat counterintuitively we think. of cities as places that represent. progress and where Health Care is going. to be better than in rural Africa you're. saying that it's the opposite in this. case the treatment is worse and the. opportunities for the mosquitoes to grow. are even greater. hopeless right I I don't think that. there's a reason why cities can't learn. to respond to this why people can't.

develop this expertise but it doesn't. exist now. well let's turn to the question of. solutions which is definitely the thing. you set out to report on. are there any and not just solutions to. Steve in African cities but to the. adaptations that are presenting such. problems in rural Africa as well what. can African governments do about this. beyond what they've already done so. there are some new Solutions and each.

one of them comes with some challenges. first of all there are improvements on. the things we have there are new classes. of insecticides being brought to Market. and those will hopefully kill mosquitoes. more effectively there's also some. really interesting new Innovative. Technologies I went to Kenya to see a. clinical trial of something called a. spatial repellent which is this sheet of. clear plastic it's about the size of a. piece of loose leaf and it's soaked in a. repellent that confuses the mosquitoes.

keeps them from being able to bite so. the early indications are that both of. these things are working really well but. are mosquitoes all the time are adapting. right and So eventually you're going to. run into this question of resistance. again right all these things sound like. they ultimately have a shelf life they. can't last all that long given just how. quickly mosquitoes evolve and adapt yeah. so that's why you need to come at this. from a couple of different directions. right and that's one of the places where. I would say there's a lot of Hope right.

now there's a new malaria vaccine that's. being rolled out in sub-Saharan Africa. you give it to small children and it. should be able to provide them with a. lot of protection throughout their lives. but you know vaccines like we saw with. covid they're challenging to deliver and. they can be expensive they're coming in. at about ten dollars per child which. maybe doesn't sound like so much but if. you think about the fact that for. example Tanzania their Whole Health. budget is two dollars per person per. year so stacked against that these.

vaccines are really going to cost a lot. so if a solution situation is not where. anyone wants it to be as you've been. talking Stephanie it's occurred to me. that we've spent this whole conversation. talking about Africa but. Steve seemed to come from outside of. Africa to Africa and now it's Africa's. problem I have to assume that a fear. might be that as malaria becomes a. bigger and bigger crisis in Africa for. all the reasons we're talking about here. Africa could export its malaria problem.

to somewhere else in the world is that. what the scientists you talk to fear you. know I think I would say it's not so. much about export it's not about. something that comes on a boat it's. actually it's about something much. bigger than that what we've been seeing. with mosquito-borne disease in the last. few years is a really big impact from. climate change lots of places are. becoming a better environment for. mosquitoes that carry a lot of different. diseases not just malaria I think what.

we're seeing is that in a very quickly. changing World mosquitoes do better move. faster than we do and for me that's the. lesson from Steve that I saw in Ethiopia. hmm not that Steve's going to leave. Africa and come to other parts of the. world invade other continents but that. the environmental issues that are. present in a place like Africa are. present elsewhere that's the problem. that as humans we create lots of.

situations where mosquitoes can flourish. they look different in different places. cities and towns Africa versus Latin. America but what those places have in. common is that mosquitoes are thriving. and posing a threat that we're not. nearly quick enough in providing. solutions for. or it sounds like from the case of. Africa. prepared to deal with in real time no. not yet. I think for me the lesson of what I saw.

in duradawa what's happened with Steve. is really just how quickly things can go. south right you can think that you don't. have the problem or you can think that. you have the problem managed or that you. have the tools you need and the way. mosquitoes work incredibly quickly you. can find yourself with a Public Health. crisis and I think as we think about the. spread of mosquitoes and the threat they.

pose I think that should be alarming for. everybody. [Music]. Stephanie thank you very much we. appreciate it it's a pleasure. [Music].

we'll be right back. here's what else you need to know day. when I ran for president I vowed to fix. our broken Student Loan program because. while a college degree is still the. ticket to a better life that ticket has. become excessively expensive. on Wednesday President Biden canceled. nine billion more in student loan debt. just as requirements to repay those.

loans which have been paused for three. years have resumed. Biden's previous attempts to forgive a. far larger amount of student loans were. struck down by the Supreme Court but the. latest effort is a workaround that. relies on a different law as I said at. the time I believe the Court's decision. to strike down my student debt relief. program is wrong. but I promised I wouldn't give up. and. more than 75 000 employees of the health.

care company Kaiser Permanente began a. three-day strike on Wednesday becoming. the latest group of unionized workers to. walk off the job in the past few months. the workers are demanding higher wages. which they say are necessary to end. labor shortages that have plagued the. company for years the strike is being. closely watched because Kaiser. permanente's health care plans cover 13.

million Americans across eight states. today's episode was produced by Alex. Stern will Reed Rob zipko and Sydney. Harbor it was edited by MJ Davis Lynn. contains original music by rowani misto. Marion Lozano and Dan Powell and was. engineered by Alyssa Moxley our theme. music is by Jim brunberg and Ben. Landsberg of Wonderland.

thank you. that's it for the daily I'm Michael. abaro see you tomorrow. [Music].