Prevalence (sero prevalence) of human neurocysticercosis in Africa. Only 2002-2012 articles were considered.
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He completed his thesis in electromechanics in September 1991 and received his third cycle degree. Dr. Lamchich received his Ph.D. from the same university in July 2001. His main activity is based on short-circuit mechanical effects in substation structures, control of different types of machine drives, static converters, active power filters. In the last decennia, his research interests have included renewable energies, particularly the control and supervision of hybrid and multiple source systems for decentralized energy production, and intelligent management of energy. He has published more than fifty technical papers in reviews and international conferences. With IntechOpen, he has published two chapters and was editor of the books “Torque Control” and “Harmonic Analysis”. 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Venkateswarlu",coverURL:"https://cdn.intechopen.com/books/images_new/371.jpg",editedByType:"Edited by",editors:[{id:"58592",title:"Dr.",name:"Arun",surname:"Shanker",slug:"arun-shanker",fullName:"Arun Shanker"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"878",title:"Phytochemicals",subtitle:"A Global Perspective of Their Role in Nutrition and Health",isOpenForSubmission:!1,hash:"ec77671f63975ef2d16192897deb6835",slug:"phytochemicals-a-global-perspective-of-their-role-in-nutrition-and-health",bookSignature:"Venketeshwer Rao",coverURL:"https://cdn.intechopen.com/books/images_new/878.jpg",editedByType:"Edited by",editors:[{id:"82663",title:"Dr.",name:"Venketeshwer",surname:"Rao",slug:"venketeshwer-rao",fullName:"Venketeshwer Rao"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}}]},chapter:{item:{type:"chapter",id:"42388",title:"Control of Taenia Solium Transmission of Taeniosis and Cysticercosis in Endemic Countries: The Roles of Continental Networks of Specialists and of Local Health Authorities",doi:"10.5772/51286",slug:"control-of-taenia-solium-transmission-of-taeniosis-and-cysticercosis-in-endemic-countries-the-roles-",body:'Neurocysticercosis (NCC) is still an endemic disease in most of the countries of Asia, Africa and Latin America, despite the important progress made in the development of effective tools for its prevention, diagnosis and treatment. Although the infection disappeared in many European countries during the nineteenth century, in some Eastern European countries control was not achieved until the beginning of the twentieth century, mainly due to the improvement of their political, social and economic status. Alarming recent reports show the persistence of the endemia in Africa [1-3] (Table 1), as well as in the Americas [25] (Table 2) and in Asia (Table 3). None of the endemic countries has been able to eradicate Taenia solium´s Taeniosis/Cysticercosis (T/C). Similarly, the frequency of human cases of NCC is increasing in some industrialized countries, such as the United States, Canada and Spain, due mostly to migrant workers, although some autochthonous cases have also occurred [92-97].
In this paper, we will try to understand the reasons behind such failures and propose strategies that can improve the control of the T/C.
It is clear that there are efficient tools for diagnosis and treatment, although investigations must surely go on and progress will be made.
Country | Reference | Type of study | Subject included | Diagnosis based on | Seroprevalence Cysticercosis | Prevalence NCC |
Burkina Faso | [4] | Population- based | 763 | Ag-ELISA | 10,3%; 1.4%; 0% | |
[5] | Population-based | 734 | Ag-ELISA | 4.5% | ||
Burundi | [6] | Case-control | 324 PWE 648 controls | Ab-ELISA | 59.6 % PWE 31,5% controls | |
[7] | PWE | 250 | Ab-ELISA | 61% | ||
[8] | Case-control | 303 PWE 606 Controls | Ab/Ag -ELISA | Ab 58,7% ; Ag 38,3 PWE Ab 31, 4% Ag 20 % controls | ||
[9, 10] | Population-based | 168 | Ab-ELISA | 1,2% | ||
[11] | Population-based | 500 | EITB | 25,8% | ||
Cameroon | [12] | Population- based | 137 Butchers 198 Controls | Ag-ELISA | Butchers 3,6% Controls: 4,5% | |
[13] | Population- based | 504 PWE | Ab/Ag ELISA | 1,2% Ag 44,6% Ab | ||
[14] | Population- based | 4993 | Ag-ELISA CT scan | 0,4% 1,0 % 3,0% | 59.1% of sero+ | |
[15] | Population- based | 93 PWE 81Controls | Ab-ELISA | 18,3% PWE 14,8% Controls | ||
Democratic Republic of Congo | [16] | Population-based | 943 | Ag-ELISA | 21.6% | |
Madagascar | [17] | Population-based | 4375 | Ab-ELISA EITB | 7-21% | |
[18] | US Peace Corps | 73 | EITB | 8,2% | ||
Mozambique | [19] | Urban children | 269 | Abs | 20,8% | |
Senegal | [20] | Population-based | 403 | Ag-ELISA EITB CT scan | 11,9% | 23,3% of sero+ |
South Africa | [21] | PWE (Hospital) | 92 | CT scan | 37% | |
Tanzania | [22, 23] | Hospital-based | 212 PWE | CT scan | 16.5% | |
Zambia | [24] | Population-based | 708 | Ag-ELISA | 5,8% |
Prevalence (sero prevalence) of human neurocysticercosis in Africa. Only 2002-2012 articles were considered.
Improvement of neuroimaging techniques permits a sensitive and accurate diagnosis of NCC in the great majority of cases, the problem being its limited accessibility to the principal rural population. Immunodiagnosis based on serum antibody detection is an efficient marker of contact with the parasite, permitting the identification of endemic areas in which control and preventive measures must be intensified. Detection of parasite antigens in serum and cerebrospinal fluid permits a confident diagnosis of severe neurocysticercosis forms, allowing opportune and adequate treatment and reducing the morbidity [98]. Regarding NCC treatment, two cestocidal drugs (Praziquantel and Albendazole) have been used for at least 30 years. Although different studies evaluating their efficacy have shown that these drugs are not efficient in all patients, they also revealed that they eliminate the parasites and diminish the symptomatology significantly more than placebo [99-101]. As a consequence, investigation in this area must continue.
Country | Reference | Type of study | Subject included | Diagnosis based on | Seroprevalence Cysticercosis (%) | Prevalence NCC |
Bolivia | [26] | Population-based | 10124 (124 PWE) | EITB CT-scan | 27.4% PWE | |
Brazil | [27] | Blood donors | 1133 | Ab-ELISA | 5.6 | |
[28] | Population-based | 694 | EITB | 1.6 | ||
[29] | Hospital-based | 36379 | CT-scan | 0.20% | ||
[30] | Population-based | 110 PWE | EITB, Ag-ELISA | 8.2 (EITB) 3.6 (ELISA) | ||
[31] | Hospital-based | 5 105 259 | Admission | 0.01% | ||
[32] | Population-based | 354 | Ab-ELISA, EITB | 11.3 | ||
[33] | Population-based | 84 | Ab-ELISA | 5.9 | ||
[34] | Population-based | Deaths Sao Paulo state | Death certificate | 0.55/1000,000** | ||
[35] | Hospital-based | 1501 | Autopsies | 4.80** | ||
[36] | Hospital-based | 1009 | CT-scan | 9.02 | ||
[37] | Hospital- based | 6500 | Autopsies | 0.80 | ||
Colombia | [38] | Hospital based | Psychiatric patients with neurological signs (98) Primary psychiatric patients (153) Controls (246) | EITB | Group 1: 5.1 Group 2: 2.6 Group 3: 2 | |
[39] | Population-based | 399 | Ab- ELISA | 52.9 | ||
[40] | Patients with neurological symptoms | 1890 sera 989 CSF 52 sera + CSF | Ab-ELISA CTscan/MRI | 14.9 | 82.2 | |
[41] | Population-based | 157 | Ab-ELISA | 28.7 | ||
[42] | Pig-breeders | 46 | EITB | 8,7 | ||
[43] | Population-based | 665 | Ab-ELISA | 28.4 | ||
[44] | PWE | 111 | Ab- ELISA | 17,1 | ||
[45] | PWE | 223 | Ab-ELISA | 35,9 | ||
[46] | Population-based | 29360 | Ab-ELISA | 8.55 | ||
Ecuador | [47] | Population-based | 4306 | Ag-ELISA | 4.99 | |
[48] | Population-based | 2415 (24 PWE) | CT scan | 33% PWE | ||
[49] | Population-based | 800 | Ag-ELISA, EITB | 2.25 | ||
[50] | Hospital-based | 194 PWE (late-onset) | CT scan/MRI | 19.6* | ||
Haiti | [51] | Medical visits | 216 | EITB | 2.8 | |
Honduras | [52] | Population-based | 6473 (151 PWE) | EITB CT scan | 37 (PWE) | |
[53] | Population-based | 5609 (33 PWE) | EITB CT scan | 13.9 (PWE) | ||
Mexico | [54] | Population-based | 154 | CT scan | 9.1 | |
[55] | Population-based | 649 | CT scan | 9.1 | ||
[56] | Psychiatric patients | 105 | Ab-ELISA EITB | 7.6 (ELISA) 0.9 (EITB) | ||
[57] | PWE (late-onset) | 455 | CT scan | 21.1 | ||
[58] | All NC patients diagnosed at INNN in 2004 | 4706 | CT scan/ MRI | 2.5 | ||
Nicaragua | [59] | PWE | 88 | Ab-ELISA EITB | 8.0 (ELISA) 14.8 (EITB) | |
Peru | [60] | Population-based | 2583 | EITB | 13.9 | |
[61] | Population-based | 316 | EITB | 21 | ||
[62] | Population-based | 903 | EITB (825) CTscan (150) | 24.2 | 27.3 | |
[63] | Housemaids | 1178 | EITB CT-scan | 14.6 | 50 (of sero+) | |
[64] | Population-based | 803 | EITB CT-scan | 24.4 | 3 | |
[65] | Population-based | 817 (8 PWE) | EITB CT-scan | 50 (PWE) | ||
[66] | Population-based | 368 | Ab-ELISA, EITB | 3.3 | ||
Venezuela | [67] | Population-based | 68 | Ag/Ab ELISA | Ag: 64.7, Ab: 79 | |
[68] | Population-based (3) | 1254 | Ag/Ab ELISA | Ag: 9.1; 6.1; 5.7 Ab: 36.5;36.5; 4 | ||
[69] | Hospital-based | 158 psychiatric patients 127 controls | EITB | Patients:18.3 Controls:1.6 | ||
EITB: Electro immune transfer blot; PWE: people with epilepsy. Ag: Circulating antigens of T. solium metacestodes, Ab: Antibodies anti-cysticercal. * Only patients diagnosed between 2000 and 2009 were included. ** Cases of cysticercosis in general were reported |
Prevalence (sero prevalence) of human neurocysticercosis in Latin America. Only 2002-2012 articles were considered.
Country | Reference | Type of Study | Subject included | Diagnosis Based on | seroprevalence | Prevalence NCC |
China | [70] | Population-based | 202 | Ab-ELISA | 2.97%. | |
India | [71] | Population-based | 72 | CT-scan | 26% | |
[72] | Hospital study | 1026 PWE | CT-scan | 34.6% | ||
[73] | Population-based | 1063 | EITB | 15.9% | ||
[74] | Population-based | 450 | Ab-ELISA | 22.4% | ||
[75] | Population-based | 595 | CT-scan | 15.1% | ||
[76] | Population-based | 141 PWE | CT-scan | 24.8% | ||
[77] | Population-based | 1064 (sera) | Ab / Ag-ELISA CT-scan | 15.9% (Ac) / 4.5% (Ag) | ||
[78] | Neurological patients | 103 | Ac-ELISA | 33 (32%) | ||
[79] | Population-based | 1442 controls 91 suspected cases of NCC 100 healthy students | Indirect haemagglutination (IHA) | 6.1% controls 21.97% suspected cases 0% healthy students | ||
[80] | Blood donors | 216 | Ab-ELISA / Ag-Co-agglutination | 14 (6.48 %) | ||
Indonésia | [81] | Population-based (1539 people) | 1120 cases of burns, 293 PWE (Papua) / 74 PWE, 746 controls (Bali) | Ab-ELISA | 67% PWE, 65% SCN (Papua) 13.5% PWE 12.5% controls (Bali) | |
[82] | Population-based | 17 PWE 32 SCN 47 control | Ab-ELISA | 70.6% PWE 62.5% SCN 25.5% control | ||
[83] | Population-based | 96 | Ab-ELISA | 45.8% | ||
[84] | Population-based | 311 | Ab-ELISA | 0.3% | ||
Korea | [85] | Population-based | 74,448 | Ab-ELISA | 8.3% (1993) 2.2% (2006) | |
Malasya | [86] | Population-based | 135 | Ab-ELISA | 2.2%. | |
Nepal | [87] | Hospital study | 300 PWE | MRI | 47% | |
Philippines | [88] | Population-based | 497 | Ab-ELISA | 24.6% | |
Thailand | [89] | Population-based | 159 | Ab-ELISA | 5.70% | |
Viet Nam | [90] | Population-based | 210 | Ag-ELISA | 5.7% | |
[91] | Population-based | 707 (303 mountain, 175 coast 229 urban) | Ag-ELISA, CT scan | 5.3% (mountain) 0.6% (coast) 0% (urban) | ||
PWE: people with epilepsy / SCN: subcutaneous nodules |
Prevalence (seroprevalence) of human neurocysticercosis in Asiaonly 2002-2012 articles were considered.
Regarding porcine cysticercosis, diagnosis based on tongue inspection has been conventionally used, but does not detect all affected pigs. Serology permits, although not with ideal sensibility and specificity, identification of the areas where the life-cycle of the parasite persists. Echography (ultrasound) has recently been introduced as a sensitive (95%) and specific (97%) method of diagnosis (Kappa coefficient of 90%) [102]. Treatment of cysticercotic pigs with oxfendazole has shown a good efficiency [103].
Diagnosis of the adult form of T. solium is perhaps the topic where more efforts must be made. Although a species-specific coproantigen ELISA was developed, reaching very good performance [104], further studies are required to evaluate it in field conditions. And this is not so easy, as prevalence of taeniosis seems to be much lower than that of cysticercosis, a fact understandable as one tapeworm carrier can infect hundreds of people and thousands of pigs. Treatment of taeniosis with niclosamide or praziquantel has shown to be very efficient [105].
In conclusion, although efforts must continue in some areas, today we have tools that allow the detection of endemic areas and the effective diagnosis and treatment of patients in most circumstances. This situation, adding to the existence of specific tools for prevention (vaccine), allows the design of extensive and effective preventive and control programs.
Cysticercosis is considered a neglected “tools-ready disease” according to WHO [106] and as a potentially eradicable disease since 1993 [107].This is feasible because there are no animal reservoirs besides humans and pigs, the only source of T. solium infection for pigs being humans (the definitive host), interrupting the parasite´s life cycle seems an easy task by intervention strategies acting upon different stages of the parasite´s development.
Different strategies have been proposed and tested, generally experimental and at small scale, to eradicate the (T/C) complex, the most notable being:
Massive cestocidal treatment to humans in order to reduce the number of tapeworm carriers [108-110].
Health education programs aiming to promote the understanding of the mechanisms of transmission of the parasite and to improve hygienic behavior, pig-management and sanitary conditions which fosters transmission [111-113].
Vaccination of rural pigs: different vaccines have been tested in field conditions and have demonstrated their efficacy in preventing swine cysticercosis [117-120].
Combinations of different strategies: pig vaccination and treatment [121], massive human cestocidal treatment associated with pig vaccination and treatment [122,123].
Almost all these strategies have shown some degree of efficacy, this fact contrasting with the persistence of the parasite in all the endemic countries in the 1950’s. It should be noted that, to our knowledge, programs promoting letrinization of rural communities and construction of pig housing have not been tested (probably due to economic and logistic costs) although it seems to be a very efficient strategy for many parasitic and infectious disease transmitted by faeces.
This is a truly kafkian situation: we are in the presence of a parasite that causes a potentially severe human disease, as well as important economic losses; paradoxically, it is clear that the disease is potentially eradicable and, in fact, scientists and health authorities know how to eradicate it and have strategies to reach this goal. Despite all these resources, and their demonstrated effectiveness, the signs of a decrease of the transmission rate in the endemic countries are inconclusive or doubtful and, worse yet, in some non-endemic countries, an increase in the number of neurocysticercosis cases is occurring.
Faced with this perspective, it becomes evident that we will not attain the eradication of T. solium without:
International initiatives have been concerned with the problem of cysticercosis for many years and several meetings were organised, the most important being: WHO Technical Consultation (Geneva, 1983), Pan American Health Organization (PAHO) Informal Consultation on Taeniasis/Cysticercosis (Porto Allegre, 1990), International Task Force for Disease Eradication (ITFDE, Atlanta, 1993), PAHO/WHO Informal Consultation on the Taeniasis/Cysticercosis Complex (Brasilia, 1995), North Atlantic Treaty Organization (NATO) Seminar on Emergent Helminth Zoonoses, (Pozna, 2000), Fifty-Fifth World Health Assembly, (Geneva, 2002), ITFDE II (Atlanta, 2003), WHO Expert Consultation on Foodborne Trematode Infections (Ventiane, 2009). In most of them, strategies for prevention and control of T/C were analyzed and recommendations were made. Since 2008, the WHO has included T/C in its Global Plan to combat Neglected Tropical diseases [124].
Regarding national health authorities, not much has been done. In very few countries, specific norms have been recommended. Such is the case of Latin America where only Mexico has an official norm for the vigilance, the prevention and the control of T/C in the first level of attention which was published in 1994 (modified in 2004) [125]. The Mexican norm includes the implementation of education and information programs, the identification and treatment of tapeworm carriers, the referral of subjects with suspected of NCC to a second level of attention, the confiscation of infected pigs, and the obligation to notify the diagnosed cases of NCC, taeniosis and swine cysticercosis to the corresponding authorities. The effort must be applauded, and has surely contributed to the awareness of the general population and of the medical personnel about the problem. Unfortunately, still, 15 years after its promulgation, cases of swine and human cysticercosis are still being diagnosed and not notified in Mexico. Probably, this is due to the fact that this norm did not reach the rural zones where the life-cycle of T. solium is still active and notification is not equally honored by all professionals (or because there are no health facilities in these areas).
It is important to promote the confiscation of infected pigs, but who is going to pay the owners, and who will go to the endemic communities (for example >2500 municipalities in Mexico) and make the diagnosis in more than six million rural pigs that get renewed every year? Clearly, pig owners must be included in a control program, for the obvious reason that they are the most interested in not having infected pigs.
It is highly relevant to promote the notification of infected individuals, but who will make this notification? Hospitals with an efficient epidemiologic department are scarce and medical doctors in public institutions are generally over loaded by the clinical workload. The comparison of the official statistics and the statistics published from only one hospital center can demonstrate the problem: in 2004, in the Instituto Nacional de Neurología y Neurocirugía, located in Mexico City, an institution that treats only patients lacking social security, 120 new cases of NCC were diagnosed [58], while in the official statistics, in this same year, approximately 400 new NCC cases were reported throughout Mexico [126]. It is very improbable that a sole institution accounts for a quarter of all the Mexican NCC cases, and probably this is due to a significant under-reporting of cases. Faced with this undesirable practice, what actions can the governments take? It is probably necessary: 1) to maintain a continuing health education program available to the population and the medical personnel, insisting on their obligation to notify the cases and promoting the establishment of epidemiological departments and surveillance system in all the hospitals, 2) to actively lobby for the implementation of a National Control Program that could be started as a priority in the areas from where most cases are referred. In relation to this point, the critical question is, who can organize a preventive program? The scientists probably not, as the logistics of such programs require an established structure supported by a recognized local authority. Since 2009, in Mexico, an extensive pilot control program is under way, in certain areas of the poorest states, based on health and sanitary education and associated with vaccination of pigs. Local authorities are part of the efforts, helping with the identification of the endemic areas, by furnishing sera collected from the pigs, and by funding the program. The results so far are encouraging. People in the remote areas accept suggestions for improvement in their pig raising methods and for their personal hygiene, including the indispensable installation of latrines [127]. What has become clear is that programs must be of long duration, at least 5 years. It is of little use to visit communities, give talks, vaccinate pigs and leave. People in theses “forgotten” areas need long-lasting help, advice and supervision. Therefore, without the active participation of the governments, failure of any control program is predictable because scientists cannot apply it at large enough scales and sufficient time. Finally, the presence of cysticercosis is an objective indicator of unacceptable conditions in a rural community, and their improvement will not only contribute to the eradication of cysticercosis, but will also bring collateral benefits, such as the control of other soil transmitted diseases and increased public awareness of respect for adequate simple public health measures.
As T. solium does not respect frontiers, it is necessary to organize multidisciplinary regional networks of specialists that must be the interlocutors of the local government and international organizations, and that must participate in the decision of where the preventive measures must be applied, and what type of measures are the most adequate regarding the individual characteristics of the country affected. Such efforts are currently established:
In Asia, the Regional Network for Asian Schistosomiasis and other important zoonoses (RNAS+) was created in 2006 (extension of the RNA created in 2000) and since this date has published several papers and has maintained discussions on preventive measures to be applied to effectively combat zoonoses.
In Africa: the Cysticercosis Working Group in Eastern and Southern Africa (CWGESA) was established in 2002 to promote communication, collaboration and coordination of integrated research and control activities to combat cysticercosis.
In Europe, The European Cysticercosis Working Group, inaugurated in 2008 and receiving organizational support from the World Health Organization (WHO)/Food and Agricultural Organization of the United Nations (FAO) Collaborating Centre for Parasitic Zoonoses in Denmark and the University of Edinburgh, Scotland, and aimed at finding ways to achieve a more effective, concerted approach to combat cysticercosis in Europe, as well as in the main cysticercosis-endemic areas of Africa, Asia, and Latin America [128].
In Latin America, since 1987, the Cysticercosis Working Group in Peru has made several epidemiological, diagnostic and control studies in this country [129] and recently a new Ibero-Latinamerican network was created to promote the investigation and the implementation of preventive measures in the entire continent.
At the moment, although some objectives have been reached, their scope is still limited. To improve the situation, it is necessary: 1) to expand exchanges between the different networks; 2) to open ways of communication between these networks and the national and international authorities.
In conclusion, to reach the control of T.solium infections it is very important to open new ways of communication between the scientists, grouped in networks, and with the international and the national health authorities. Agreements must be made in which the role and responsibilities of each of them are clearly defined. If one of these conditions fails, we are afraid that in 50 years, today’s T/C epidemiological situation will persist.
The authors acknowledge the CYTED program (Ibero-American Programme for Science, Technology and Development) that has founded partially the network.
Substantial changes in urban mobility systems are required across the globe in order to reach sustainable development goals (SDGs) and climate change objectives. Indeed, sustainable urban transport is essential to achieve SDG targets related to urban access, reduced health impacts from air pollution and road traffic crashes, clean energy, inefficiency of fossil fuel subsidies, resilient infrastructure, climate change measures and sustainable cities and communities [1].
\nExposure to ambient air pollution results in 4.2 million deaths annually [2], and 9 out of 10 urban dwellers breathe air that does not comply with the WHO standards. The transport sector is the largest contributor to PM2.5 pollution [3], with, for example, the economic cost of air pollution from road transport in OECD countries estimated at close to USD 1 trillion per year, measured in terms of the value of lives lost and ill health [4]. In addition, physical inactivity is responsible for 3.2 million deaths annually [5]. Data on noise impacts are limited; however, the health effects from exposure to noise are substantial. In the European Union, 65% of the urban population is exposed to noise above 55 dB, leading to an estimated 1–2 million DALYs annually [6]. Other concerns related to urban transport include increasing congestion and lack of accessibility, social equity and transport justice [7], urban liveability, habitat fragmentation [8] and energy security or oil price vulnerability [9].
\nAt the global level, urban (passenger) transport contributed about 2 billion tonnes of CO2 in 2015 or one-quarter of total transport emissions (including international aviation and maritime transport) [4]. In order to meet the Paris Agreement climate change targets of staying well below 2° and aiming for 1.5°, total transport emissions have to be limited to 2–3 billion tonnes in 2050 from approximately 8 billion tonnes today [10]. As transport is where emissions are rising the most rapidly among all sectors, this is a major challenge.
\nTraditionally, transport planning has been focussing on providing infrastructure to meet a projected future demand for transport. As Banister argued in his seminal article, ‘The Sustainable Mobility Paradigm’ [11], addressing the above-mentioned challenges requires fundamental shifts in transport planning. This new paradigm involves, among others, focussing on accessibility of opportunities in the urban space rather than mobility and vehicular travel per se, management of travel demand, considering street as a ‘space’ rather than a road and including environmental and social concerns in transport project evaluation.
\nMost literature on sustainable mobility considers modal shift away from cars to more environmentally benign modes. Within this, there is a significant and growing amount of research on cycling, with bicycles also enjoying a good reputation with policymakers in most countries. Motorcycles, on the other hand, are, by and large, ignored in sustainable transport research, as well as in policy discussions and climate change literature, although some researches are acknowledging its importance in meeting climate change objectives [12]. Since 2010, more literatures have been published on electric two-wheelers, such as e-bikes and electric scooters, which assess their potential impacts on the mobility systems and the environment, user motivations and aspects such as safety and driver behaviour [13].
\nThis chapter aims to add to existing literature by (1) assessing qualitatively how electric two-wheelers (E2W) can contribute to sustainable urban mobility and (2) reviewing policy options to enhance the role of E2W.
\nIn this chapter, we adopt the following approach. The e-bike is a relatively new vehicle and in fact represents ‘the most rapid uptake of alternative fuelled vehicles in the history of motorisation’ [13]. E2W thereby change urban mobility ecosystems or regimes, including the vehicle fleet composition, mobility options and urban planning. As a new mobility option for both passenger and freight (e-cargobikes), it has the potential to replace trips by other modes, notably bicycles, motorcycles, public transport and cars but also small trucks and vans. In addition, E2W may support other modes such as public transport by providing convenient first and last mile mobility. We particularly look at shifting from motorcycles to E2W as a way to maintain space-efficient (passenger) mobility on two wheels, yet in a cleaner fashion; however, shifting away from other modes may also be significant.
\nTwo-wheelers powered by a combustion engine, including mopeds, scooters and motorcycles, play a key role in transport in many parts of the world. In South and Southeast Asia, the share of two-wheelers in the passenger vehicle population is particularly high, for example, 72% in India [14], 87% in Indonesia and 95% in Vietnam (95%) [15]. The fleet is growing by up to 10% annually in several Asian countries. In Europe, 12% of all registered vehicles are powered two-wheelers, though almost half of these are >250 cc [14] and often used for touring and sports purposes rather than utility mobility. In Brazil, 26% of the vehicle population are motorcycles and in North America, only 3% [14]. In China and Southeast Asia, two-wheelers account for more than a quarter of total passenger transport activity (measured in passenger-km) in 2015, more than any other mode [12].
\nA motorcycle uses seven times less space compared to a car [16] and is more energy-efficient, even when accounting for a higher average occupancy of cars. Nevertheless, motorcycles are significant sources of air pollution, noise and CO2 emissions and are involved in a large share of road crashes.
\nIn many cities in Asia, motorcycles are the preferred mode of transport by a large share of the population [17]. In dense cities, for example, Hanoi, accessibility to jobs by motorcycle is higher than by any other modes [18]. It enjoys higher status than a bicycle and is considered more convenient, particularly for hot and humid weather conditions. Motorcycles are relatively affordable and can be acquired by most households, thereby making it an equitable mode of transport.
\nIn European cities, motorcycle mode share is often low, however rising in recent years. Amsterdam is a case in point, with about 2% of trips in 2016 by mopeds and scooters, which is a doubling compared to 2008. Moreover, such two-wheelers are involved in 16% of road crashes [19]. Although there are plans and strong public support to ban mopeds and scooters from using bicycle lanes, as of mid-2018, these are still allowed on all bike lanes and are not required to wear helmets. The users are relatively diverse, that is, they include all age and income groups.
\nAt the same time, electric two-wheelers are gaining importance and already take a significant modal share in some countries in 2015, notably China (7%) and 2–4% in Denmark, the Netherlands and Japan [20]. China dominates E2W sales with about 30 million and a stock of about 250 million [17], followed in sales by Europe with 2.3 million, while the rest of the world accounts for about 1 million in 2015 [13].
\nThese are predominantly e-bikes, which fall roughly in two categories: pedal-assisted bicycles (also called pedelecs) or throttle-controlled electric mopeds with the option of pedal power (often for regulatory purposes). The former are the most common in Europe, while in China and some Southeast Asian countries, e-bikes of the latter types are dominant. The speeds are up to 20–25 km/h for pedelecs and up to 45 km/h for e-mopeds, and the weight ranges from 20 to 45 kg. Electric scooters are capable of higher speeds and often fall in a different vehicle category than e-bikes.
\nTo explore the characteristics of different E2W markets and their role in the mobility system, we examine—briefly and in broad terms—developments in China, Vietnam and the Netherlands.
\nIn China, petrol-fuelled motorcycle bans in many cities in the early 2000s—starting with a sales ban in Shanghai in 1996 [21]—have resulted in a large and fast uptake of especially scooter-style e-bikes, with a 15–25% trip mode share in major cities [22]. They have become popular as well in cities where conventional motorcycles are still allowed (Figure 1). E-bikes have pedals and are classified as nonmotorised vehicles, thereby there is no requirement to wear helmet nor for licencing, and they can use bicycle lanes. E-bikes are used by a wide range of user groups, in small, medium and large cities, also as access mode for public transport. However, in general two-wheelers are used more by lower-income groups [23].
\nGuilin, China: both conventional and electric motorcycles are used.
Within Southeast Asia, Vietnam has the highest share of motorcycles in the vehicle fleet [15]; however, e-bikes are not yet popular. The main users are those that do not have access to motorcycles. A key user group is students, who find these more convenient than the bicycle while it does not require a licence, registration or helmet, as is the case for motorcycles. E-bikes (Figure 2) are often of type that could be considered a hybrid between scooter-style and bicycle-style e-bikes. They have pedals, yet these are rarely used. There are two-wheeler lanes in some cities; however, in general they have to mix with other traffic. There are no specific policies to promote electric two-wheelers. A ban on motorcycles is planned in the city centre of Hanoi in 2030; however, whether this will cover e-bikes is not clear.
\nHanoi, Vietnam: two-wheelers in mixed traffic, although on some roads space is allocated by mode.
In Europe, most e-bikes are of the bicycle style. Weather is less of a barrier to cycling compared to Asian countries; however, e-bike extends the range of trips that can be covered by bicycle, in distance and user groups. Looking at the Netherlands, e-bikes sales are increasing rapidly and in 2017 account for about one-third of bicycle sales [24]. Although in the early days of e-bikes it was mostly the elderly buying E2W, in recent years, its popularity is spreading to many other groups, including students, commuters and parents of young children. Approximately half of the km travelled is for recreational purposes [24]. E-bikes, just as mopeds, are allowed on the bicycle lanes (Figure 3); however, as of July 2018, speed pedelecs need to use the main road in urban areas.
\nAmsterdam, the Netherlands: bike lanes are used by bicycles, mopeds and electric bikes.
In this section, we review how E2W fits in a sustainable urban mobility system. Based on Banister [11], we focus on aspects of accessibility, as well as social and environmental sustainability.
\nMost trips in cities across the globe are less than 10 km, and many are shorter than 5 km. In the Netherlands, over 50% of car trips are shorter than 7.5 km [24], and in medium-sized cities such as Rajkot and Visakhapatnam (1–2 million population) in India, nearly 80% of all trips are below 5 km [25]. Even in the United States, known for their relatively low density and sprawl, 35% of all car trips are less than 5 km and 60% are below 8 km [20]. Trips up to 5 km are generally considered to be suitable for cycling. E-bikes can extend the range of trips currently or potentially undertaken by bicycle [24, 26] by reducing barriers such as hilly terrain, weather, low speed, physical strain and bad air quality [13]. At the same time, e-bikes can replace trips by motorised modes such as motorcycle, car and public transport.
\nMode shift impacts vary, as shown in emerging literature. In Chinese cities where petrol-fuelled motorcycles are not allowed, e-bikes are displacing bus trips, yet also a significant share of trips by car/taxi and bicycle [13]. Some of the factors that impede use of bicycles are also barriers to using e-bike, for instance, heat, rain and air quality [26]. In Sweden, more than 50% of e-bike users in both urban and rural areas report replacing car trips, across different trip purposes [27]. An analysis of studies in Europe shows that the proportion of e-bike trips that replace car trips ranges from 16 to 76% [28].
\nTwo-wheelers provide accessibility benefits over cars and public transport. Especially in dense cities in Asia and Europe, bicycles and motorcycles are more affordable, flexible, reliable and often faster than cars. In addition to reduced space require for parking, motorcycles use 3.4 times less road space than cars in Hanoi [29]. Two-wheelers are thereby much more space-efficient than other private vehicles, even when considering a slightly higher average occupancy rate for cars. In the longer term, mobility based on two wheels thus has an impact on land use and urban development and enables denser and liveable cities as opposed to ‘sprawling car-dominated cities’ [20]. Therefore, mobility modes and transport planning are strongly related to more fundamental questions around urban development and the future of cities.
\nOther positive impacts of e-bikes—compared to car or motorcycle travel—for individuals and society include health due to physical activity [13] and social interaction in the public space [30], although both these effects are less strong than for bicycle travel. In the economic realm, electrification of transport is a key strategy to reduce oil consumption and improve energy supply security.
\nEnvironmental benefits are substantial as well, in particular for climate change, air quality and noise. Compared to conventional motorcycles, electric two-wheelers emit substantially less CO2 emissions per km (on a life cycle basis), even when powered by coal-based electricity [31]. Indeed, over 80% of the 29 million tonnes of CO2 savings in 2017 by all types of electric vehicles globally are due to e-bikes in China [17]. For Vietnam, e-bikes are identified as the option with the second-largest CO2 abatement potential in the transport sector [32]. Kerdlap and Gheewala [33] show that in Thailand, deploying a fleet of 13.6 million electric motorcycles to replace an equivalent fleet of conventional petrol-powered motorcycles between 2015 and 2030 could reduce two-wheeler life cycle CO2-eq emissions by approximately 42–46%. Globally, it is estimated that in 2050, 22% of urban passenger travel can be by (e)bike, compared to 6% in the base case. This results in 300 MtCO2 reductions in 2050 and USD 1 trillion in savings from vehicle purchase and operation and construction and maintenance of infrastructure [20]. Moreover, meeting the Paris Agreement targets requires 70% of global two-wheelers to be electric [17]. It should be noted that in peer-reviewed literature on climate change mitigation, however, there is limited attention for the role of electric two-wheelers.
\nUrban air pollution impacts are significant as well. The health impact of particulate matter on a person-km basis is lower than other modes that include petrol-powered cars, even for a coal-based electricity grid [34]. Finally, e-bike can reduce noise significantly [35], as conventional motorcycles and cars are key sources of urban traffic noise.
\nTable 1 presents a qualitative assessment of the sustainability aspects of electric two-wheelers discussed above, in comparison with other modes. It should be noted that this comparison is for illustration purposes only, as the modes cover different trip distances and impacts may differ considerably depending on local circumstances, particularly transport planning and environmental standards. Public transport modes are bus, tram and metro. Paratransit covers a variety of more informally organised transport such as motorcycle taxis, three-wheelers and minibuses, which are sometimes used as feeder mode for high-capacity public transport. Equity assessment is based on typical costs of travel, including ticket prices for public transport and total costs of ownership for private vehicles. In space efficiency, both parking and road space are considered. Lower CO2 emissions also imply improved energy efficiency (i.e. reduced resource consumption) as well as energy security. Public transport first and last mile trips often involve ‘active’ modes such as walking or cycling. Other environmental impacts, such as pollution from battery production, are not explicitly considered here.
\nMode | \nTypical trip distance | \nEquity | \nSpace efficiency | \nAir pollution | \nCO2 emissions/energy use | \nNoise | \nPhysical activity | \n
---|---|---|---|---|---|---|---|
Walking | \n<1.5 | \n+++ | \n+++ | \n+++ | \n+++ | \n+++ | \n+++ | \n
Cycling | \n1–5 | \n+++ | \n+++ | \n+++ | \n+++ | \n+++ | \n+++ | \n
E2W | \n1–15 | \n++ | \n++ | \n+++ | \n+++ | \n+++ | \n+ | \n
Motorcycle | \n1–15 | \n++ | \n++ | \n+ | \n+ | \n0 | \n0 | \n
PT + NMT | \n1–20+ | \n++ | \n+++ | \n++ | \n++ | \n++ | \n++ | \n
PT + paratransit | \n1–20+ | \n++ | \n+++ | \n+ | \n+ | \n+ | \n+ | \n
Paratransit | \n1–5 | \n++ | \n++ | \n0 | \n+ | \n+ | \n0 | \n
Car | \n1–20+ | \n+ | \n0 | \n+ | \n0 | \n+ | \n0 | \n
Environmental and social sustainability impacts of urban transport modes.
Notes: PT, public transport; NMT, nonmotorised transport; 0, lowest rating; +, low rating; ++, medium rating; +++, high rating.
In the above assessment, road safety has not been taken into account. A meaningful comparison between modes is not possible as often multiple modes are involved in one road crash. In addition, among countries, road crash rates and fatalities for all modes differ by more than an order of magnitude. That said, motorcycles are often associated with safety concerns, and globally 23% of the 1.3 million road deaths were drivers or passengers of motorised two- and three-wheelers [36]. In the Netherlands, an increase in road deaths in 2017 was associated with the rising use of e-bikes among the elderly, as these are more difficult to handle than bicycles [37], with e-bikes taking 30% of total bike fatalities [24]. Unruly driving behaviour, for example, jumping red lights at intersections, is a key concern with e-bike riders as well as bicyclists and motorcycles in various countries [13].
\nIn Figure 4, the sustainability impacts as included in Table 1 are added and compared with accessibility benefits for urban trips of 2–10 km length in a dense city that has a balanced approach to transport planning for the different modes. Accessibility, or the ease of reaching opportunities, covers travel time, flexibility, reliability and ease of parking. The width of the ovals indicates how strongly accessibility depends on local conditions such as congestion, parking options, public transport service quality and urban planning. For example, in some cases a car may be as fast as a motorcycle, whereas in heavy congestion and limited parking availability, a car provides low accessibility.
\nIndicative qualitative assessment of sustainability impacts and accessibility benefits of urban transport modes for trips 2–10 km, on a person-km basis. Accessibility covers travel time including parking and reliability. Sustainability aspects here include equity, road and parking space efficiency, air pollution, CO2 emissions and fuel consumption, noise and physical activity (see Table 1). Larger ovals indicate larger spread in accessibility/sustainability benefits depending on local conditions. All vehicles except E2W are powered by internal combustion engines.
A key observation from this figure is that E2Ws increase range and comfort of bicycles and improve sustainability performance of motorcycles while preserving accessibility benefits.
\nIn various countries, a limited number of policy initiatives are taken to promote electric mobility on two wheels. Yet in general, it can be stated there is a lack of policy attention, particularly in comparison to policy and research on other electric vehicles such as cars and buses.
\nThere is a large potential in different regions to expand the use of electric two-wheelers, so what can be done do to harness this potential? Policymakers have a range of instruments that can be deployed [17]. In general, these can be organised by regulatory, economic and informative instruments [38], while for transport, often planning instruments are considered as well [39]. Table 2 presents a brief overview, after which these options are discussed.
\nInstrument type | \nPolicy measure | \n
---|---|
Regulatory instruments | \nPhase-out conventional motorcycles | \n
Low-emission zones in cities | \n|
Speed limit 30 km/h on shared roads | \n|
Vehicle standards and registration requirement | \n|
Planning instruments | \nDedicated lanes for E2W (and bicycles) | \n
Travel demand management, including traffic calming and parking management | \n|
Dedicated waiting boxes at intersections, optionally with shading | \n|
Electric bike-sharing facilities | \n|
Economic instruments | \nIncentives such as subsidies, tax breaks for purchase or registration of E2W | \n
Taxation of fuels (petrol and diesel) | \n|
Information/communication instruments | \nCampaigns | \n
Behaviour change programmes | \n
Overview of policy options to promote E2W.
In the realm of regulatory instruments, the strongest policy measure is to ban motorcycles powered by fossil fuels, as implemented in Chinese cities. A phase out of conventional motorcycles and moped sales is considered in the Netherlands [40]. Similarly, a low-emission zone in a city can be designed such that conventional motorcycles will not be able to comply with the required emission standard to be allowed to circulate in the zone. Further, to improve safety for two-wheelers, speed limits for shared roads can be an effective tool, e.g. 30 km/h in urban areas where no dedicated lanes exist. At the same time, helmet use can be made compulsory for vehicles capable of travelling faster than a certain speed, for example, 25 km/h. Finally, electric two-wheelers need an appropriate legal framework in national vehicle legislation. Malaysia, for example, has adopted standards for electric mopeds with speeds in the range of 25–50 km/h, covering safety, performance and national compliance issues [41].
\nPlanning instruments are key as well, for example, allocating dedicated road space for two-wheelers, together with quality standards for existing and new road surface that improves safety [14]. E2W then co-exist with either conventional motorcycles or bicycles, depending on the desired speed range and design of the two-wheeler lanes. For example, in China, e-bikes are often allowed on bike lanes. In addition, two-wheeler mobility can be made more attractive, for example, by advanced stop boxes for two-wheelers at intersections (see Figure 1, right-hand side), which can be shaded in tropical regions to protect drivers from heat and rain. Travel demand management, to make car travel less attractive, is required as well. Measures include traffic calming (e.g. speed bumps), reducing parking supply, fuel taxation and restricting access to roads while allowing two-wheelers, ensuring a lower ‘detour’ factor for the latter. Finally, electric bikes can be included in bike-sharing schemes.
\nFinancial incentives are another important instrument to promote E2W purchase and use. These can be designed, for example, as purchase subsidies, as done in some provinces in China [21], sales tax breaks [42] or an increase in petrol tax. In countries where motorcycle taxis are common, specific programmes to convert motorcycle fleets in a city to electric two-wheelers can be designed. In the Netherlands, a tax-deduction scheme for employees to buy a bicycle or e-bike exists. For behaviour change policies, incentives are often used in tandem with information instruments. It is argued that key life-changing events, such as moving to a new city or the birth of a child, are often powerful catalysts for behaviour change. Policy instruments can mimic such disruptive change [43], e.g. by pilot programmes with free e-bikes in exchange for car keys, as done in a promotion programme in Switzerland [44] or other incentives and campaigns. At the same time, information and training on road safety are needed for drivers of two-wheelers and other road users, e.g. as part of driver training curricula [14].
\nElectric two-wheelers can play an important role in sustainable urban mobility systems and addressing climate change. However, two-wheelers, including electric, suffer from a bad reputation and a lack of attention from policymakers in many countries. This chapter gives an overview of developments in China, Vietnam and the Netherlands, each with their own mobility system characteristics. Other than China, e-bikes and electric scooters are still in an early stage of development.
\nYet there is a large potential: electric two-wheelers can on the one hand address negative impacts of fossil-fuelled motorcycles and cars on air quality, climate and noise while on the other hand extend the distance range of bicycles, by reducing the physical effort needed, which is especially attractive in hilly and tropical environments. In general, compared to other modes, electric two-wheelers score high on key criteria for sustainable mobility in terms of accessibility (flexibility, reliability, and speed), road space use, equity and environmental externalities, although road safety remains a concern.
\nFinally, this chapter proposes a range of policy measures—regulatory, planning, economic and communicative instruments—that can be used to promote purchase and use of electric two-wheelers. These include for example implementing low-emission zones, phasing out of conventional motorcycles, improving the legal framework, urban planning to increase attractive and safety of two-wheelers and conducting behaviour change programmes that cover both incentives and information for individual users or motorcycle taxi fleets.
\nComments and feedback from the book editor, Kathleen Dematera and Todd Litman, on a draft version of this chapter are greatly appreciated.
\nIntechOpen publishes different types of publications
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\n\nREVIEW CHAPTER – A review chapter analyzes or examines research previously published by other scientists, rather than reporting new findings thus summarizing the current state of understanding on a topic.
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\n\nSingle or multiple author manuscript
\n\nCompacts provide a mid-length publishing format that bridges the gap between journal articles, book chapters, and monographs, and cover content across all scientific disciplines.
\n\nCompacts are the preferred publishing option for brief research reports on new topics, in-depth case studies, dissertations, or essays exploring new ideas, issues, or broader topics on the research subject. Compacts usually have between 50 and 130 pages.
\n\nCollection of papers presented at conferences, workshops, symposiums, or scientific courses, published in book format
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