New Nets Prevent 13 Million Malaria Cases in Sub-Saharan Africa

Compared to standard nets, the introduction of 56 million state-of-the-art mosquito nets in 17 countries across sub-Saharan Africa averted an estimated 13 million malaria cases and 24,600 deaths.

17 April 2024

GENEVA/LIVERPOOL – The New Nets Project, an initiative funded by Unitaid and the Global Fund and led by the Innovative Vector Control Consortium (IVCC), piloted the use of dual-insecticide nets in malaria-endemic countries between 2019 and 2022 to address the growing threat of insecticide resistance.

Anopheles mosquitoes are increasingly resistant to the pyrethroid insecticides used on standard insecticide-treated nets (ITNs). This may reduce the nets’ ability to protect people from malaria, so we must continue to develop and test new tools.

The BASF Interceptor® G2 ITNs are coated with chlorfenapyr, a new generation pyrrole insecticide, in combination with the standard pyrethroid insecticide. DCT’s Royal Guard® net incorporates a combination of pyriproxyfen and pyrethroid into the yarn of the net. Both ITNs are more effective against mosquitoes with pyrethroid resistance than standard nets are.

Between 2019 and 2022, the New Nets Project supported the deployment of 38.4 million nets across sub-Saharan Africa. In parallel, the Global Fund and PMI supported the deployment of millions of additional nets under an internal initiative (NTI). As a result, a total of 56 million mosquito nets were introduced in 17 countries across sub-Saharan Africa.

Two clinical trials and five pilot studies, delivered through the New Nets Project as well as through partner funding, found the new ITNs to improve malaria control by approximately 20-50% in countries reporting insecticide resistance in sub-Saharan Africa, compared to standard nets.

The epidemiological evidence built throughout the project led the World Health Organization (WHO) to publish new recommendations supporting the use of pyrethroid-chlorfenapyr nets instead of pyrethroid-only nets in countries facing pyrethroid resistance. WHO also issued a conditional recommendation for the deployment of pyrethroid-pyriproxyfen nets instead of pyrethroid-only nets to prevent malaria in adults and children in areas with pyrethroid resistance.

Dr. Philippe Duneton, Executive Director of Unitaid, said: “The New Nets Project has made a massive contribution to malaria control efforts, helping to accelerate introduction of next-generation bed nets – a critically important tool for reducing malaria cases and deaths. The success of this project was not guaranteed from the outset, but our collective efforts to tackle multiple access barriers simultaneously helped ensure that new nets could reach communities as quickly as possible. These partnerships will serve us well as we continue to seek out promising innovations to address challenges in the fight against malaria.”  

The additional cost per case of malaria averted using the Interceptor® G2 nets compared to a standard net ranged from $0.66–$3.56* The reduction in malaria cases and deaths from using the Interceptor® G2 nets, compared to a standard net, equated to a potential US$28.9 million in financial savings to health systems.

As the number of dual active ingredient ITNs being used increases year on year, the subsequent financial savings to the health system will also increase, underlining the long-term financial and public health benefits of this additional investment.

In addition, the operational pilots also produced a set of guidelines for how to effectively incorporate these new nets into multi-product campaigns and continuous distribution.

Peter Sands, Executive Director of the Global Fund, said: “We are delighted to see that the dual active ingredient insecticide-treated nets have demonstrated exceptional impact against malaria. The success of the New Nets Project is proof that, by fostering collaboration across global health partners, harnessing innovation, and using market-shaping approaches, we can fight insecticide resistance, make our interventions highly cost-effective and accelerate progress against malaria. Together with our partners, we will continue to invest in the insecticide-treated net innovation pipeline to avert more cases, save more lives, and get back on track towards the global malaria goals.”

Catalytic market-shaping work under the New Nets Project increased supply and demand of dual active ingredient nets, ensuring equitable and affordable access to novel vector control products for country level control programs and vulnerable populations.

UK-based social finance company MedAccess and the Bill & Melinda Gates Foundation supported access to Interceptor® G2 nets in 20+ countries by providing a volume guarantee that enabled BASF to reduce the price procurers pay for the nets. This, combined with continued efforts by partners to scale the introduction of all dual active ingredient nets as they receive WHO prequalification, will help to ensure sustainability beyond the completion of the project.

David McGuire, Director Access and Market Shaping at IVCC, said: “The catalytic market-shaping work under the New Nets Project to increase supply and demand for dual-insecticide nets laid the foundation for ensuring equitable and affordable access to these novel vector control products. The NNP has demonstrated, along with the NgenIRS project, the importance and potential impact of market interventions to ensure that the most vulnerable have access to the best vector control. Similar approaches will be critical for novel products emerging from IVCC’s development pipeline.”

The evidence built through the New Nets Project for the use of the dual active ingredient ITNs is testament to the importance of product-development and catalytic market-shaping interventions to deliver and scale up high-impact, cost-effective prevention tools that meet the needs of malaria-endemic countries.

Dr. Michael Charles, CEO of the RBM Partnership to End Malaria, said: “The findings of the New Nets Project demonstrate the value of investments into state-of-the-art tools in the fight against malaria. We always say that there is no silver bullet to eliminating malaria and we cannot rely on single interventions, but rather invest in a suite of tools, which when combined, will have the biggest impact on defeating this disease. The dual-insecticide nets are a shining example of one of these tools and the results, coupled with the savings for health systems, make the case for their continued rollout globally.”

* These calculated savings are based on end-of-project pricing and differ between locations depending on local factors including local infrastructure and scale of procurement.

For further information, please contact:

Laura Roberts, Communications Manager

laura.roberts@ivcc.com

(+44) 07849 700582

Project and product information

The New Nets Project (NNP)
The Global Fund and Unitaid are each investing US$33 million between 2018 to 2022 to introduce new insecticide-treated nets to fight malaria-carrying mosquitoes. The New Nets Project is working to build the evidence base around, and prime the market for, the next generation of nets, which are treated with two different types of insecticide to help improve control of mosquitoes.

The project will generate evidence on the efficacy and cost-effectiveness of the new dual insecticide nets to inform a WHO policy decision on dual-AI nets and guide decision-making around product procurement at the country level. It is expected that the New Nets Project – with its unique design of parallel collection of epidemiological data and cost-effectiveness studies – will significantly reduce the timeline for entry of the new nets into the market.

The U.S. President’s Malaria Initiative and the Bill & Melinda Gates Foundation are key operational and financial partners. A coalition led by IVCC is implementing the project which includes The Alliance for Malaria Prevention, Imperial College London, The Liverpool School of Tropical Medicine, PATH, PSI and Tulane University.

About IVCC

IVCC is the only Product Development Partnership (PDP) focused on solutions for vector control. IVCC was established in 2005, through an initial grant to the Liverpool School of Tropical Medicine (LSTM) from the Bill & Melinda Gates Foundation. As a registered charity in the UK, IVCC receives grant funding from the Bill & Melinda Gates Foundation, UK Aid, USAID, The Swiss Agency for Development and Cooperation and the Australian Department of Foreign Affairs and Trade to partner with different stakeholders across industry, scientific institutions and endemic countries to facilitate the development and availability of novel and improved public health insecticides and formulations which can combat the rapidly growing. problem of insecticide resistance. In addition, IVCC has received funding from Unitaid and the Global Fund to implement catalytic market access projects, such as NgenIRS and the New Nets Project which support the rapid and scaled deployment of vector control tools. IVCC has three core values of partnership, innovation and respect, and strives to live these values in our dealings with all partners.

Website: ivcc.com
X (Twitter):  @invectorcontrol
LinkedIn: IVCC (Innovative Vector Control Consortium)

About Unitaid

Unitaid saves lives by making new health products available and affordable for people in low- and middle-income countries. Unitaid works with partners to identify innovative treatments, tests and tools, helps tackle the market barriers that are holding them back, and gets them to the people who need them most – fast. Since it was created in 2006, Unitaid has unlocked access to more than 100 groundbreaking health products to help address the world’s greatest health challenges, including HIV, TB, and malaria; women’s and children’s health; and pandemic prevention, preparedness and response. Every year, these products benefit more than 170 million people. Unitaid is a hosted partnership of the World Health Organization.

About the Global Fund to Fight AIDS, Tuberculosis and Malaria

The Global Fund is a worldwide partnership to defeat HIV, TB and malaria and ensure a healthier, safer, more equitable future for all. We raise and invest more than US$5 billion a year to fight the deadliest infectious diseases, challenge the injustice that fuels them, and strengthen health systems and pandemic preparedness in more than 100 of the hardest hit countries. We unite world leaders, communities, civil society, health workers and the private sector to find solutions that have the most impact, and we take them to scale worldwide. Since 2002, the Global Fund partnership has saved 59 million lives.

For more information, please visit: www.theglobalfund.org

Information on the work of the Global Fund is available at www.theglobalfund.org

Follow the Global Fund on X: http://twitter.com/globalfund

Join the Global Fund on Facebook: http://www.facebook.com/theglobalfund

Interceptor® G2
Interceptor® G2 is a second-generation ITN developed by BASF with a combination of chlorfenapyr and alpha-cypermethrin to control insecticide resistant mosquitoes. This novel mode of action in vector control exploits mosquito enzymatic systems against themselves and shows no cross-resistance to other insecticide classes. Unlike pyrethroids, the chlorfenapyr target site of activity is not the insect nervous system. Instead, chlorfenapyr acts, after being metabolized by P450 enzymes at the cellular level, by disrupting respiratory pathways and proton gradients through the uncoupling of oxidative phosphorylation within the mitochondria. The Interceptor® G2 net has a WHO prequalification listing.

Royal Guard®
Royal Guard® is an ITN developed by Disease Control Technologies to provide vector control through both the personal protection of traditional mosquito knockdown and mortality, as well as a reduction in fecundity of any mosquitoes that manage to survive exposure to the products pyrethroid active ingredient. The intended benefit of the insect growth regulator, pyriproxyfen, is to reduce the fecundity of adult female mosquitoes and, therefore, yield an overall reduction in the vector population by inhibiting egg laying, larval-pupal transformation and the emergence of functioning young adult mosquitos. The Royal Guard® net has a WHO prequalification listing.

Image credit: PSI Mali

Duke University and US Government relations firm DC Legislative and Regulatory Services co-sponsored a Vector Expedited Review Voucher (VERV) stakeholder event in Washington DC on 28^th February, 2024.  The purpose of the meeting was to explain and discuss the December 2023 Pesticide Registration (PR) notice published by the Environmental Protection Agency (EPA) regarding the VERV program.

Held at the Duke University’s “Duke in DC” office on Pennsylvania Avenue, the event was attended by the EPA, the Innovative Vector Control Consortium (IVCC), the agrochemical industry and other private and public sector organisations, including the American Mosquito Control Association (AMCA).  All are stakeholders in the development of innovative vector control tools to support malaria eradication.

Jeff Moe, adjunct professor at the Duke Global Health Institute, and a co-author of the 2017 Health Affairs article which proposed VERV, opened the event by reflecting on the successful introduction of the US Food and Drug Administration’s Priority Review Voucher (PRV) programme in 2007: “PRV had a positive impact on the development of treatments with limited profitability for neglected tropical diseases. The VERV programme can, like PRV, stimulate the development of innovative vector control solutions to help us better control, and hopefully eradicate, diseases such as malaria.”

Chris Larkin, Director of Operations and Communications at IVCC, who took part in a panel session, added: “Incentives like the VERV program are needed to ensure that innovative vector control tools are developed and made available with new modes of action to help address the threat of insecticide resistance which is critical for the fight against diseases such as malaria which still claim over 600,000 lives every year.”

Participants heard from EPA representatives including Susan Jennings (Senior Advisor for Public Health, Office of Pesticide Programs), Stephen Scheibel (Pesticide Registration Improvement Act (PRIA) Coordinator,) and Billy Smith (Director, Registration Division, Office of Pesticide Programs).  They described the operation of the VERV program including the eligibility criteria to receive a VERV award.  Jennings explained that to be eligible for a voucher, active ingredients must demonstrate efficacy against insecticide-resistant mosquitos (per efficacy guidelines), have a novel or unique mechanism different from other insecticides already registered by the agency for mosquito control, and target mosquitos which transmit disease.

Jennings added that, whilst active ingredients must not be contained in any EPA registered pesticide product, a registrant may petition the EPA to issue a voucher for a repurposed agricultural insecticide by demonstrating a significant public health benefit.

Jennings also highlighted that any novel mode of action will be assessed on case by basis by the Office of Pesticide Program (OPP) through the consideration of factors such as:

• The mechanism targets new or different receptors
• The pesticide is in a new or different chemical class classification by the Insecticide Resistance Action Committee
• The mechanism uses special approach such as interrupting behaviour, targeting different life stages, or prohibiting reproduction.

Full details of the EPA VERV program can be found at: https://www.epa.gov/mosquitocontrol/vector-expedited-review-voucher-verv-program

www.ivcc.com/vector-control/vector-expedited-review-voucher-verv/

www.vectorvoucher.info

IVCC is delighted to confirm that the Australian Government, has awarded IVCC a five-year, 17 million Australian dollar grant to advance the control of malaria in Papua New Guinea (PNG) and other Indo-Pacific countries.

Funded through the Australian Government’s Partnerships for a Healthy Region initiative, IVCC will continue the expansion of a vector control toolbox tailored to regional contexts which will better equip countries to prevent, control and work towards eliminating malaria and other vector-borne diseases.

The new grant which runs until January 2029, builds upon the programme of work IVCC initiated in 2018 under its first grant.  The workstreams developed under the new grant will support capacity-strengthening for the evaluation and adoption of new vector control tools in PNG and the further evaluation and uptake of spatial emanators in the Greater Mekong Subregion.  As a new area of focus, IVCC will also support improving the tools and approaches available for the control on Aedes-borne diseases in the region, including dengue and chikungunya.

Under its first grant, IVCC worked with its partners to demonstrate the efficacy of bite prevention tools deployed to forest-exposed populations in Cambodia at risk of malaria. In PNG, national capacity to evaluate and scale-up novel vector control tools was strengthened by developing new entomological facilities, a range of new product trials and establishing a national-led stakeholder network.

IVCC CEO, Justin McBeath said: “We are extremely grateful to the Australian Government for again entrusting IVCC to undertake this important vector control work across Papua New Guinea and the Indo-Pacific region.  In delivering our objectives, IVCC will work with local partners to support capacity development to ensure that local benefits are realised from the project and that the focus areas of the activities address the issues that are important to local communities and the region.”

Minister for Foreign Affairs, Senator the Hon Penny Wong said: “We cannot have the peaceful stable and prosperous region we want without improving the health and well-being of our region’s communities.  As close neighbours, friends and equals, Australia will continue to work with Papua New Guinea and Indo-Pacific partners to meet current and future health challenges.”

Image credit: Graham Small / IVCC

During British Science Week (8th to 17th March, 2024), IVCC proudly participated in a UK parliamentary reception, showcasing the groundbreaking New Nets Project (NNP).

Hosted by STOPAIDS, the All-Party Parliamentary Group (APPG) on HIV & AIDS, the APPG for life sciences, and the Parliamentary & Scientific Committee, the event celebrated the crucial role of UK-based science and innovation in advancing progress towards health-related Sustainable Development Goals (SDGs) by 2030.

The evening spotlighted collaborative efforts between UK-led research and innovation institutions, and multilateral institutions, such as Unitaid, in accelerating global health responses through innovative new health products. Tenu Avafia, Deputy Director of Unitaid, spoke of the interconnected roles of Unitaid and The Global Fund in global health responses. The NNP, led by IVCC and funded by Unitaid and The Global Fund, piloted the use of new dual-insecticide nets in areas of moderate to high malaria transmission throughout sub-Saharan Africa. The project underscores the importance of product development and catalytic market-shaping interventions to deliver and scale up high-impact, cost-effective prevention tools that meet the needs of endemic countries.

While addressing the audience, Shadow Minister for Science, Research, and Innovation, Chi Onwurah, emphasized the pivotal role of partnerships in fostering innovation. The success and profound impact of the NNP are largely attributed to a geographically diverse consortium of partners. Their collaborative efforts encompassed trials, pilot studies, cost-effectiveness research, impact modelling, and implementation endeavours.

Chi also called for a commitment from governments to long-term stable funding, vital to deliver on global health goals.

Download the New Nets Project poster presented at the reception here.

L to R: Tenu Avafia (Deputy Director of Unitaid), Laura Roberts (IVCC Communications Manager) and Justin McBeath (IVCC CEO). Image Credit: Martha Varney / Malaria and Neglected Tropical Diseases APPG.

Our Africa Regional Coordinator, Andrew Saibu, contributed an editorial in the latest edition of the South African Pest Control Association’s (SAPCA), Pest News.

In the piece, Andrew makes the case for the role of the private sector, and mining companies in particular, in supporting malaria control throughout sub-Saharan Africa.

The Pest News February 2024* instalment is available via this download. Andrew’s editorial is available from page nine onward: Mines against malaria.

*with thanks to SAPCA.