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Electoral incentives to combat mosquito-borne illnesses: Experimental evidence from Brazil.

ABSTRACT: Mosquito-borne illnesses present significant health challenges to the developing world. If citizens are informed about their government's efforts to combat these diseases, will they reward incumbents who have performed well and punish those who have done poorly at this task? Electoral sanctioning requires that combatting disease be a sufficiently salient concern, which, in turn, is likely to depend upon subjective perceptions of the risks posed by particular illnesses. Epidemics typically prompt stronger risk perceptions than endemic diseases, but where both types circulate jointly, the more familiar endemic disease may determine public reactions. The salience of health threats also varies among individuals; those with a self-interest in prevention or a personal connection to the effects of mosquito-borne illnesses may react more strongly. This study presents the results of a face-to-face survey experiment in Pernambuco, Brazil, informing subjects about their mayor's use of federal funds to combat mosquito-borne illnesses such as dengue (an endemic disease) and Zika and chikungunya (both epidemics). We examine the effect of this information on intended vote for the mayor's reelection. For the full sample, the treatment has no significant effect. However, we find a large and significant punishment effect among voters who know someone affected by microcephaly or the Zika virus. Drawing on survey and focus group evidence, we argue that most voters fail to act upon our treatment information because mosquito control is a low-salience concern primarily associated with endemic rather than epidemic diseases. Our study constitutes the first experimental evidence as to whether informing citizens about government public health efforts affects voting behavior. Our results suggests that, where similar epidemic and endemic diseases circulate together, informational campaigns aiming to induce electoral accountability should also seek to boost the salience of the information by educating the public about the difference between familiar and newer threats.

SUBMITTER: Boas TC

PROVIDER: S-EPMC7126885 | biostudies-literature | 2019 Jan

REPOSITORIES: biostudies-literature

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Electoral incentives to combat mosquito-borne illnesses: Experimental evidence from Brazil.

Boas Taylor C TC Hidalgo F Daniel FD

World development 20180908

Mosquito-borne illnesses present significant health challenges to the developing world. If citizens are informed about their government's efforts to combat these diseases, will they reward incumbents who have performed well and punish those who have done poorly at this task? Electoral sanctioning requires that combatting disease be a sufficiently salient concern, which, in turn, is likely to depend upon subjective perceptions of the risks posed by particular illnesses. Epidemics typically prompt ...[more]

PMID: 32287930

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Project description:BackgroundThe introduction of the bacterium Wolbachia (wMel strain) into Aedes aegypti mosquitoes reduces their capacity to transmit dengue and other arboviruses. Evidence of a reduction in dengue case incidence following field releases of wMel-infected Ae. aegypti has been reported previously from a cluster randomised controlled trial in Indonesia, and quasi-experimental studies in Indonesia and northern Australia.Methodology/principal findingsFollowing pilot releases in 2015-2016 and a period of intensive community engagement, deployments of adult wMel-infected Ae. aegypti mosquitoes were conducted in Niterói, Brazil during 2017-2019. Deployments were phased across four release zones, with a total area of 83 km2 and a residential population of approximately 373,000. A quasi-experimental design was used to evaluate the effectiveness of wMel deployments in reducing dengue, chikungunya and Zika incidence. An untreated control zone was pre-defined, which was comparable to the intervention area in historical dengue trends. The wMel intervention effect was estimated by controlled interrupted time series analysis of monthly dengue, chikungunya and Zika case notifications to the public health surveillance system before, during and after releases, from release zones and the control zone. Three years after commencement of releases, wMel introgression into local Ae. aegypti populations was heterogeneous throughout Niterói, reaching a high prevalence (>80%) in the earliest release zone, and more moderate levels (prevalence 40-70%) elsewhere. Despite this spatial heterogeneity in entomological outcomes, the wMel intervention was associated with a 69% reduction in dengue incidence (95% confidence interval 54%, 79%), a 56% reduction in chikungunya incidence (95%CI 16%, 77%) and a 37% reduction in Zika incidence (95%CI 1%, 60%), in the aggregate release area compared with the pre-defined control area. This significant intervention effect on dengue was replicated across all four release zones, and in three of four zones for chikungunya, though not in individual release zones for Zika.Conclusions/significanceWe demonstrate that wMel Wolbachia can be successfully introgressed into Ae. aegypti populations in a large and complex urban setting, and that a significant public health benefit from reduced incidence of Aedes-borne disease accrues even where the prevalence of wMel in local mosquito populations is moderate and spatially heterogeneous. These findings are consistent with the results of randomised and non-randomised field trials in Indonesia and northern Australia, and are supportive of the Wolbachia biocontrol method as a multivalent intervention against dengue, chikungunya and Zika.

Dataset Information

Electoral incentives to combat mosquito-borne illnesses: Experimental evidence from Brazil.

Publications

Electoral incentives to combat mosquito-borne illnesses: Experimental evidence from Brazil.

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