ByteBack: Using digital innovation against arboviral disease outbreaks

Launch integrated platform for vector-borne diseases and vector control.  

Identify knowledge gaps and generate recommendations, disseminate via mobile phone technology. 

Professor James G Logan

Over 80% of the world’s population is at risk from at least one vector-borne disease (VBD), such as malaria, Zika or dengue, and over 700,000 deaths are caused by VBDs each year. In Africa, 830 million people are at risk of at least one arboviral disease transmitted by mosquitos.

Changing climate, urbanisation and international travel increase the likelihood of outbreaks of arboviral diseases, as exemplified by the recent Zika pandemic in 2015/16, and outbreaks of dengue in Ethiopia and yellow fever in Angola.

Of particular concern is the rising number of dengue cases: over 3.9 billion people in 129 countries are at risk of dengue, and each year, approximately 400 million people become infected, 100 million get sick, and 22,000-40,000 die. 

When trying to address these challenges, public health professionals face three major shortcomings: 

• A lack of accurate and current data. Which disease vectors and which pathogens are present in which area at any given time?  

• A lack of clear guidelines and evidence-based recommendations. Which measures should be taken against which vector? 

• A lack of clear communication among stakeholders and with affected populations. Who does what? And how can we include local populations in our efforts? 

1. Health Workers – The Global Vector Hub will provide simple and free access to summary documents, reference material and guidelines to those working in public health. 
2. Humanitarian Aid Workers – Country profiles provide information on the vectors and pathogens present, as well as in-country organisations engaged in vector control and resources.
3. Vector Control Programme Operators – We seek to support these individuals through the provision of written resources, guidelines, standard operating procedures and resource links. 
4. Researchers – The data repository will aid researchers in studying vector distribution and monitoring resistance, and the networking feature will promote collaboration
5. General Public – Those with an interest in vectors, a concern about VBDs, or who have become engaged in community activities for vector control will be able to access basic information, while also uploading their own observations via CitizenScience-based apps. In addition, populations at risk will receive dedicated alerts through Viamo’s established 3-2-1 system. 

We have been in continuous exchange with key representatives of all stakeholder groups while developing our platform (in person and via online webinars, tutorials and social media). Moreover, an online forum will form part of the Global Vector Hub to allow for interaction and discussion between users. 

The objective of the Global Vector Hub is to address the public health burden of vector-borne diseases. Through data, guidelines and recommendations, we aim to improve knowledge and the capacity to respond to disease outbreaks, and ultimately to control vectors such that they do not present a health risk to human populations. 

Whilst much of the material and data hosted on the GVH will be for professionals engaged in vector-control activities, the GVH is a resource that is free to anyone with internet access. The information and data are presented in a clear, concise and accessible way, and translated into several languages. 

In including content and surveys on the 3-2-1 Service, a sustainable service, we will also ensure that the public has actionable information to make informed health decisions and their voices are heard. Once content is hosted on the 3-2-1 Service, it is accessible by all at no cost. Should we find messages are popular and helpful to people who listen to them on the 3-2-1 Service in any of these countries, we can replicate them in any of the 16 countries the 3-2-1 Service exists and ensure that the common good is utilized by an even larger audience.

By making guidelines and standard operating procedures easily accessible, we can promote the effective use of tools against disease vectors. By sharing data globally, we can better inform new strategies and assist vector control programmes; and through developing networks and information exchange we can build a community of practice, thus improving epidemic preparedness. A future expansion of the GVH platform into other types of diseases would further enhance our capacity to prevent and respond to outbreaks.

By providing assistance and guidance in controlling VBDs, we are actively contributing to achieving the Sustainable Development Goals (SDGs) 3 (Good Health and Well-being), 11 (Sustainable Cities and Communities), and 17 (Partnerships for the Goals).

To give an example of our previous activities in this field: when Hurricane Dorian struck the Bahamas in 2019, the GVH team produced a situation report that outlined the threat of VBDs in the country. This described the vectors and their habitats, identified possible outbreaks, and provided a list of vector control organisations in the area that might provide assistance. This was shared widely with emergency response organisations and ensured they had the information they needed to mitigate against VBD outbreaks amongst communities already left vulnerable by the storm. 

The Global Vector Hub has an initial focus on diseases transmitted by Aedes mosquitos, such as dengue, chikungunya and Zika. In the first year, we plan to implement dedicated local stakeholder engagement programs in Uganda and Nigeria, chosen because:

• They suffer from high arboviral disease burden, especially dengue.
• We have already established strong connections with local stakeholders, who are aware of and keen to tackle the issue of VBDs, and arboviral diseases in particular. This is crucial for any long-term success of our program.
• Viamo’s local offices have long-established working relationships with local communities and health officials.
• Both countries have high coverage of mobile phone networks, thus enabling the implementation of a 3-2-1 approach.

Following the successful implementation of the ByteBack program in Uganda and Nigeria, we plan to expand our program in three dimensions, incorporating lessons learned from our pilot phase:

1. Expand to neighbouring countries that are similarly affected.
2. Widen the scope of ByteBack to include other VBDs, such as malaria and leishmaniasis.
3. Integrate further data sources, such as genomic surveillance or weather data, and improve the predictive power of our platform through AI-driven data processing.

We will continue to monitor our current metrics on the uptake of the Global Vector Hub:

• Increase number of registered users by 100-200 per month, especially from our initial target areas Uganda and Nigeria
• Increase number of added datasets, again initially focusing on vector data from Uganda and Nigeria
• Increase number of viewed and downloaded documents and resources by 1,000-1,500 per month

 In the longer-term, we will also monitor for these outcomes:

• Increased engagement with local communities, as indicated by feedback to our local teams, and by participation in CitizenScience aspect (uploaded observations)  
• Clear signs of uptake by local stakeholders, such as implementation of recommended control strategies.
• Reduced disease burden and reduced incidence of VBDs as final outcome.
• Improved awareness of diseases and vectors by communities, using questionnaires and surveys to quantify this impact.
• New research projects using GVH data (indicated by citing GVH as source)

We will also monitor the uptake of the 3-2-1 system, which integrates the option for dedicated feedback.

The main barriers to overcome for the Global Vector Hub are (i) access to data, especially from national surveillance programs; (ii) reaching local stakeholders, as the COVID-19 pandemic has curtailed most of our international outreach activities since 2020; (iii) the need to secure long-term funding to maintain the platform and its content, as well as engaging with the global vector control community; and (iv) building long-lasting connections with health officials who are constrained by political and budgetary hurdles, lack awareness of the urgency of VBD control, or do not have access to accurate and up-to-date information to make evidence-based decisions, especially while all their attention and resources are taken up by responding to the COVID-19 pandemic.

We will address these barriers by:

(i) forming data-sharing agreements with other data sources, and continue to work with national surveillance programs and other stakeholders to build mutual trust;

(ii) continuing to reach out to stakeholders, especially through online workshops and webinars;

(iii) exploring further sources of long-term maintenance funds;

(iv) using the pilot projects in Uganda and Nigeria described here to highlight the benefits of supporting the GVH to health officials in other countries. 

London School of Hygiene & Tropical Medicine (LSHTM): The Global Vector Hub is based at LSHTM, using their infrastructure and support. Both Vecotech and ARCTEC are spin-off companies founded at LSHTM.

With its technology-based and data-driven approach, the Trinity Challenge offers a great opportunity for our ByteBack project to overcome some of the challenges we have encountered while creating the beta version of the Global Vector Hub. While it is undeniable that the additional funds of the prize money would indeed be very welcome, we are also very keen to partner up and receive support from several of the Trinity Challenge members. In particular, we would like to receive further mentoring and introductions to stakeholders, such as government officials (eg. by BMGF or CHAI); we would be keen to discuss with Microsoft, BMGF, IHME and Facebook how to better integrate further data sources into our platform, and we would indeed be interested in discussing long-term funding to ensure the sustainability of our platform.

We are already in contact with numerous stakeholders in Uganda and Nigeria; these include the African Union-Africa CDC, the Pan-African Mosquito Control Association (PAMCA), the Eliminate Yellow Fever Initiative (EYE), the Uganda Virus Research Institute (UVRI), the Nigerian Centers for Disease Control (NCDC), plus relevant contacts at the Ministries of Health, Education, and Agriculture responsible for vector control in their respective areas. We will continue to deepen our connections with these stakeholders, as well as developing further connections through our local staff.

We have previously been in contact already with numerous teams at Trinity Challenge member organisations, and would be very keen to discuss with them further collaborations for this project. These include: 

• Facebook – Data for Good (Alex Pompe & team: we would like to integrate their Facebook Disease Prevention Maps data on human movement and population distribution into our risk predictions) 
• Microsoft

1. Their recently opened Microsoft Africa Development Centre, based in Nigeria and Kenya, would prove an invaluable connection.
2. Ethan Jackson & Premonition team: we would be very interested in integrating their automated mosquito traps and generated data) 

• Clinton Health Access Initiative (Tara Seethaler; stakeholder engagement Latin America) 
• BMGF (Helen Jamet & Jennifer Gardy; malaria control and data).