What role for insecticides in vector control programs?

Vector-borne diseases including dengue, yellow fever, Japanese encephalitis, malaria, leishmaniasis, and filariasis remain severe public health problems in most of the countries in which they are endemic. In some cases, their incidence is increasing and they are spreading to new geographic areas. For a number of the infections, the most effective manner of controlling their transmission is through control of their vectors. However, in some instances, such as dengue and Chagas' disease, there is no alternative. Most countries that are endemic for vector-borne diseases maintain vector control services, and most large tropical and semitropical cities also have pest control programs, mainly against pest mosquitoes. Virtually all of the vector and pest control programs depend on the use of insecticides formulated as larvicides, adulticides, baits, or insecticide impregnated bed nets. For many years, the development of new insecticides for use in public health programs was encouraged and supported by multilateral and bilateral health agencies, including the implementation of field trials in endemic areas. Due to the development of insecticide resistance, toxicologic and environmental considerations, and the cost of development and of registration, the number of compounds available for use has declined while the number of new insecticides submitted for laboratory and field trials to the World Health Organization has dwindled even more. The recrudescence of vector-borne diseases, the rapid pace of urbanization, lagging development of environmental services in many tropical cities, and difficulties encountered in ensuring the community's cooperation in its own protection through environmental measures make imperative the continued availability of pesticides for public health use. Since only the pesticide manufacturing industry has the combination of technical and financial resources to promulgate the research and development of new pesticides and pesticide groups, it is suggested that governments, bilateral, and multilateral organizations explore the manner in which they can assist industry in the development of new compounds and guarantee the continued availability of effective and safe pesticides for vector-control programs.