Scaling Health Interventions for Effective Long-term Dengue control (SHIELD): Implementation and policy research for scaling up Wolbachia in Indonesia

  This four-year research program addresses the challenges of scaling and integrating Wolbachia replacement technology-a proven method for controlling dengue and other arboviral diseases-into national dengue control programs. With dengue presenting an increasing global health threat and Indonesia facing one of the highest global dengue burdens, this work aims to increase the reach and impact of Wolbachia-based dengue control in Indonesia and generate insights for broader global adoption. Dengue threatens over four billion people worldwide, costing an estimated $9 billion annually. Conventional control measures like insecticide fogging have failed to curb surging dengue transmission, exacerbated by urbanization, climate change, and global mobility. In 2024, a record 14.4 million dengue cases and 11,000 deaths were reported globally, including 257,000 hospitalized dengue cases and 1,461 deaths in Indonesia. Innovative tools such as Wolbachia and Takeda's QDENGA® dengue vaccine offer new hope for controlling arboviral diseases, and there is an urgent need to accelerate uptake into disease control programs. Wolbachia is a naturally occurring bacterium that, when introduced into Aedes aegypti mosquitoes, reduces their ability to transmit dengue and other arboviruses. Previous global trials by our project team, including the pivotal efficacy study (2017-2020) in Yogyakarta, Indonesia, have demonstrated significant and sustained reductions in dengue incidence following Wolbachia mosquito releases. Based on this evidence, Indonesia's National Dengue Control Strategy (2021-2025) identified Wolbachia as a key innovation requiring further pilot deployment, research, and policy development, and the Indonesian Ministry of Health is piloting its programmatic delivery in five cities in 2022-2025. The overarching goal of this research is to derive lessons from Indonesia's '5 Cities Project', a pilot Wolbachia implementation initiative, to inform strategies for national and global scale-up. Specific objectives include: Evaluating the feasibility, acceptability, and effectiveness of Wolbachia deployment under programmatic conditions. Identifying critical intervention components and required adaptations for maintaining effectiveness during scaling. Addressing knowledge gaps on long-term entomological and epidemiological outcomes. Engaging stakeholders in co-design of sustainable and scalable operational models. Informing strategic decision-making on integrating Wolbachia and vaccination into dengue control programs in Indonesia Leveraging Indonesia's experience to inform global policy and practice for evidence-based arboviral disease control. The program comprises four interrelated work packages: Implementation Research: Systematic assessment of resources, capabilities, barriers and enablers for effective scale-up of Wolbachia. Entomological Studies: Investigation of operational and ecological factors affecting Wolbachia establishment, and the field resilience of the intervention to heatwave conditions. Public Health Impact: Analysis of dengue case reductions using routine surveillance data and prospective clinic-based studies, coupled with seroprevalence surveys, to evaluate Wolbachia's impact and inform Wolbachia and vaccine targeting. Economic and Disease Modelling: Assessment of the cost-benefit and budget impact of Wolbachia deployment under programmatic conditions and exploration of optimal integration with dengue vaccination campaigns. This research will inform a feasible and effective model for scaling up Wolbachia deployment in Indonesia, directly contributing to the national strategic goal of incorporating innovations into evidence-based policy and practice, and facilitating nationwide scale-up to reduce dengue morbidity and mortality. Globally, it will provide critical evidence for decision-making and operational planning on integrated arboviral disease control, including cost-effective and equitable targeting of Wolbachia and vaccination programs.  This program builds on our team's decade-long translational research collaboration, to bridge the evidence-to-action gap and maximise the reach and impact of new tools for the pressing global health challenge of epidemic arboviral disease.