It’s High Time for Operation ‘Tick Speed’

The CDC was founded 80 years ago with a single mission: to eradicate malaria from the U.S. By 1946, the year of the CDC’s inception, malaria had devastated the nation, causing significant morbidity and mortality for more than 150 years. By 1951, within roughly 50 years of the discovery that mosquitoes transmitted the malaria parasite, the disease had been eliminated from the continental U.S., including the Deep South.

While malaria was the vector-borne scourge of the 19th century, another vector-borne illness took up the mantle in the 20th. A mysterious illness affecting people in Lyme, Connecticut, in the 1970s turned out to be a new tick-borne infection, later named Lyme disease after its place of discovery. Within a few years, Lyme disease cases were identified across the Northeast and Midwest, and a new vector-borne epidemic was well underway.

Whereas malaria progressed from disease understanding to elimination within 50 years, Lyme disease has expanded dramatically in incidence and geographic reach over a similar period. Moreover, other tick-borne diseases have emerged and expanded alongside Lyme: babesiosis, anaplasmosis, ehrlichiosis, and a growing number of other pathogens.

The public health burden of the tick-borne disease epidemic has become substantial, with incidence rates exceeding 100 per 100,000 population in some endemic areas in the U.S. Allergic reactions to tick bites, specifically alpha-gal syndrome (“red meat” allergy), have also emerged as a major public health concern, with tens of thousands of suspected cases identified in the U.S. in recent years. Taken together, these trends make ticks and tick-borne diseases a major public health emergency across large swaths of the country.

How did we get here, and what can be done about it? Why could the U.S. defeat malaria and yet it has been unable to cope with Lyme and other tick-borne infections despite tremendous technological advances over the last 100 years?

The answers might be complex, but the bottom line is fairly clear. The fight against malaria took place at the geographic scale of malaria transmission: first through vast public works projects draining mosquito habitats over millions of hectares, followed by widespread dichloro-diphenyl-trichloroethane (DDT) applications to more than 4.5 million houses in 13 southern states. The federal government assumed leadership in funding and carrying out antimalarial measures across the endemic region. In contrast, the main responsibility for tick-borne disease control and prevention has been delegated to individuals, who are expected to protect themselves and their property as best they can. The results are clear. Decades of reliance on personal protection and public education have failed to reduce, or even slow, the expansion of tick-borne diseases.

If the current approach has proven to be a failure, does a path to success even exist? There is a sense of despair among many public health professionals — epidemiologists, medical entomologists, primary care physicians, infectious diseases specialists, allergists, and other clinicians confronting the tick-borne disease epidemic. However, all is not lost, and there is a way forward if the political will, support, and sufficient resources are applied in a targeted and sustained manner.

Treat the underlying disease, not the symptoms. Burgeoning tick populations are a symptom of overabundance of a particular host species, white-tailed deer. A single deer harboring 100 female ticks can produce hundreds of thousands of tick larvae. Deer densities in many areas greatly exceed environmental carrying capacity, facilitating tick reproduction and driving tick population explosions. There will be no effective control of tick-borne diseases without significant changes in deer management. State agencies need to stop treating deer solely as valuable wildlife and start applying a “farm-to-table” approach similar to commercial fisheries management. Deer should be harvested at levels sufficient to maintain long-term, ecologically appropriate deer densities that do not support excessive tick populations.

Pivot to control and prevention. The current paradigm of pathogen surveillance and public education has failed to produce measurable outcomes. The focus of investment should shift toward vector control and prevention, specifically deer management and an expanded arsenal of tools for personal protection. Rigorous testing and evaluation of control and prevention methodologies should identify effective approaches, while clear, evidence-based guidelines should be developed for both the general public and professional audiences.

Develop novel products. None of the existing control or prevention methods are adequate. There is an urgent need to invest in and develop new tick-control products with reduced environmental impact, repellents, treated clothing, and acaricidal personal hygiene products, as well as novel approaches to tick control.

Promote medical innovation. Accelerate development of vaccines, treatments, and diagnostics.

Employ artificial intelligence (AI). Support AI-driven development of novel methodologies, from modeling ecological impacts to designing novel products and treatments. AI can help address the highly complex relationships among ticks, hosts, pathogens, and environmental factors, facilitate brainstorming and testing of new ideas, and aid in designing novel tick control products and therapeutics.

Integrate expertise. Only collaborative efforts among public health practitioners, basic scientists, and clinicians can translate discoveries into effective commercial products.

Most importantly, the federal government has to reclaim the leadership role in dealing with the epidemic. CDC is located in Atlanta because the epicenter of the malaria epidemic was in the South. The time has come to consider locating appropriate federal programs and expertise closer to the northeastern U.S. to coordinate efforts and channel the necessary resources to where they are needed most.

The road ahead will not be smooth; it will require difficult political decisions and reallocation of scarce resources. However, all is not lost. With determination and perseverance, Operation “Tick Speed” can succeed in curtailing the epidemic of tick-borne diseases.