By Melinda Hadi, Head of Market Access – Public Health, Vestergaard
As a manufacturer of long-lasting insecticidal nets (LLINs), Vestergaard is deeply committed to ensuring that effective and high-quality malaria prevention tools are available to malaria endemic countries and populations at risk. The annual World Health Organization (WHO) World Malaria Report describes both the progress and the continuing malaria burden: despite significant reductions in malaria incidence since 2000, there were an estimated 228 million cases of malaria and 405,000 deaths from malaria worldwide in 2018. The WHO Africa Region accounted for approximately 95 percent of the cases and deaths. While we know that additional tools and strategies will be required, continued innovation into core interventions like LLINs is also needed to ensure that effective LLINs are available to protect families and communities against rapidly evolving malaria mosquitoes. As with many insects, mosquitoes have become resistant to many of the insecticides that we rely on for control.
In a report on overall malaria research and development (R&D) funding, an estimated USD 600 million per year has been invested into R&D since 2010, with approximately five percent allocated for vector control products. This is a small share of the funding envelope, given the substantial contribution of vector control tools, such as LLINs and indoor residual spraying, to preventing malaria.
Developing new tools from good ideas is not enough. Innovative companies are acutely aware of the investments and risks required to move from basic research to product development. What has proven to be a greater challenge is progressing from product prequalification to full-scale implementation for impact. For example, the pyrethroid-PBO LLIN, PermaNet® 3.0, was prequalified by WHO Prequalification (formerly a WHO Pesticide Evaluation Scheme interim recommendation) in 2008. It took nearly 10 years to scale up an effective tool against pyrethroid resistant mosquitoes. In 2017, the large-scale deployment of PermaNet® 3.0 and Olyset® Plus in Uganda was also the setting for a second cluster randomized control trial that confirmed PBO LLINs offer greater protection against pyrethroid resistant mosquitoes than standard pyrethroid LLINs. When faced with limited R&D funding, procurement commitments and adoption at scale are essential to support rollout of current effective tools and to incentivize future innovations.
As one of the industry partners working with the Innovative Vector Control Consortium (IVCC), we are encouraged by the collaborations in both product development and market access strategies. Through the New Nets Project led by IVCC, dual insecticide LLINs are entering the market and are being deployed in pilots in a number of countries in Africa.
Meanwhile, the High Burden High Impact response of WHO and the RBM Partnership to End Malaria is showing us that a country-led approach not only prioritizes malaria control efforts, but also makes use of epidemiological and entomological information for tailored targeting of malaria prevention interventions such as LLINs.
It is clear that innovation requires partnerships, not only in product development, but in ways that ensure effective tools reach the people who need them.
As a member of CAMA, Vestergaard can bring its technology in insecticide treated materials to partners to jointly explore the types and characteristics of other vector control tools needed; for instance, products that can reduce outdoor biting malaria vectors. This is an opportunity for public and private sector partners to work together to develop and target tools where mosquito biting, and therefore potential disease transmission, is taking place.
In addition to the burden of malaria, the increasing burden of other mosquito borne diseases such as dengue is extremely worrying. The WHO reports over 96 million symptomatic cases of dengue and an estimated 400,000 deaths each year – not to the mention other viral diseases such as Chikungunya, Rift Valley fever, West Nile fever, Yellow fever, and Zika virus. Vestergaard is currently exploring the use of insecticide treated materials for window screening, perimeter barriers, and other uses to target indoor and outdoor biting mosquitoes.
Maintaining progress and achieving further reduction of the malaria burden will require innovative LLINs and other vector control tools that are effective against the mosquito populations in malaria endemic areas. Current tools and those to come must be implemented at scale to offer the greatest malaria protection and fully achieve the intended impact.
Melinda Hadi is the Head of Market Access, Public Health at Vestergaard, and was a panelist on the GBCHealth & CAMA webinar on Emerging Issues and New Tools to Fight Mosquito-Borne Diseases