Why the words we use and the way we understand them matters

What do you understand by the term “commodity”?  To most people in the global health world it means a consumable product essential to delivering health care, like a drug or diagnostic kit.  And when we read reports or grant applications we see the word commodity used all the time in this way.

But in the world of economics or business, or in our everyday lives, “commodity” has another meaning.  It refers to products that are not distinguished from one supplier to another, for example electricity or petrol.  When you buy electricity you don’t expect the electricity from one supplier to be better than another and there is no such thing as a premium quality option.

So, we get tricked by the language into a false conclusion.  Because we call all our consumables in public health commodities, we get misled into thinking that there is no differentiation between them.  Nowhere has this been more apparent than in the market for long lasting insecticide treated nets.  They are treated as pretty much pure commodities, and this has an alarming consequence.

For a true commodity there is no differentiation between one product and another, so there is no reason to look for anything other than the lowest price.  There is no need for product innovation and the simple economics of supply and demand determine the price.    There is a process called commoditisation which is what happens when a product that used to be new and innovative becomes widely manufactured to similar performance.  Think of flat screen TVs and we are all familiar with the key outcome of that; the price falls dramatically!   So if you want products to get cheaper and more uniform then commoditisation is a good thing.

But what if it turns out that having all the products be the same is a bad thing ?  There is an inherent danger in commoditisation that we create monocultures at risk of catastrophic failure. Well that is exactly where we are with insecticide resistance today.  Because they are so effective, safe and cheap, we have become totally reliant on one kind of insecticide, the pyrethroids, and, in our drive to push down costs, we have commoditised the market for products based on that insecticide.   And guess what; we ended up with resistance.  We should not be surprised.

Others elsewhere will talk about the heroic struggle to create new chemistry that will dig us out of the hole of insecticide resistance, but I want to talk about the economics of those new products.

First of all they will become the differentiated non-commodity par excellence.  Not only will they differ from pyrethroid based products and each other but those differences will not be the same for every situation.  Some people will see dramatic differences as they move away from pyrethroids whilst others may barely notice.  Worse still these differentials will vary with time as resistance waxes and wains under varying ecological pressure.

So the day of the vector control product as commodity is soon reaching an end and that calls for a whole new way of thinking about those products and their performance and price.  We are all quite happy with the concept of paying a higher price for a high performance product (let us not touch on that other abused word “quality”) ,  but that’s because we have a view about what high performance means.  We are just going to have to get used to deciding what high performance resistance breaking insecticides are worth and get used to paying it.

Perhaps we could start by calling them something other than commodities. How about differentiated goods?

(Next time I will put the record straight on the difference between quality and performance)

Pesticide regulation.  Two words, separately or together, that send shivers down the spines of those on the left and right of the political spectrum.  The words conjure up lengthy risk assessments, decisions written in the language of regulation, and long product labels with lots of small print.

Who grows up wanting to be a pesticide regulator?  It’s unlikely to be a career competing for the top slot among school children.  I have been a government pesticide regulator for my entire career.  Completing a 30 plus year career with the United States Environmental Protection Agency (EPA) in September 2014.

What kept me interested for so long? It was a perfect fit for an academically trained zoologist and biostatistician/epidemiologist with a desire to change the world.

Protecting public health and the environment was the criteria for every single pesticide product decision. At the same time, recognizing the value of pesticide products that allow farmers to produce a diverse, plentiful, affordable food supply, protect houses from being destroying by termites, and protect people from vector borne diseases.

Every single decision made on a pesticide product had an immediate impact on society in some way, nationally and sometimes globally. Every decision made a difference.

The bar is high. To gain and maintain trust and confidence regulation must protect, but not stifle innovation.  In the case of pesticides, a sound regulatory process must also encourage the innovation of safe, effective pesticides to deal with constantly changing pest problems.

Immediately upon retiring from EPA I accepted a position with IVCC to manage the regulatory process for three new insecticide active ingredients with different modes of action.  The goal of the work is to help eradicate malaria!  Pretty much a dream job—to move directly into managing the approval process for insecticides targeted at controlling this global vector borne disease. What better way to put my experience to use—helping to save lives, and really making a difference to the lives of millions of people.

At IVCC I will be working with companies developing new insecticides, to get products available for use in the shortest time possible without sacrificing the quality and thoroughness of the regulatory review. I will help with the development of high quality, complete data packages supporting the safe, effective use of the new products for submission to national regulatory authorities and international review bodies.

Regulation of insecticides is absolutely necessary. It protects people and the environment from unintended adverse effects from their use.  At the same, because public health insecticides play such a vital role in saving lives and improving life chances for millions, regulation must also facilitate development of these essential new chemistries that protect people from vector borne diseases. It’s all an integral part of this great mission to eradicate malaria and change the world.

IVCC joined Syngenta Crop Protection AG today in a joint media release announcing that Syngenta are progressing a novel insecticide ‘active ingredient,’ into early development.

The breakthrough is a result of four years of intensive research by Syngenta supported by IVCC and our funding partners, the Bill & Melinda Gates Foundation, the UK Agency for International Development (UKAID), the US Agency for International Development (USAID) and the Swiss Agency for Development and Cooperation (SDC)

IVCC CEO Nick Hamon emphasised in the media release that this is a significant breakthrough in the battle against malaria that shouldn’t be underestimated. ‘Together with other solutions in the IVCC pipeline, this new insecticide has the potential to substantially reduce the risk of future insecticide resistance and lay a foundation for the eventual eradication of malaria,’ he said.

The announcement by Syngenta heralds the first of several new active ingredients that IVCC partners will enter into full development this year.

It is a timely announcement for World Malaria Day, which takes place on 25th April this year, with its emphasis on sustaining commitment to building on the successes achieved since the turn of the millenium in reducing malaria. In advance of World Malaria Day United Nations Secretary-General Ban Ki-Moon said that malaria control was one of his priorities; ‘Malaria control has proven to be one of the smartest investments in health we can make,’ he said. ‘When we target our funds in proven malaria control interventions, we create healthier communities and more robust economies’. Read the Secretary-General’s full comments here

Dr Fatoumata Nafo-Traoré, Executive Director of the Roll Back Malaria Partnership also emphasised the importance of tackling insecticide resistance.’We have come half the distance with half the funds,’ she said.’To beat growing threats like insecticide and drug resistance, we must re-commit ourselves and raise our ambitions’.

Syngenta is one of the world’s leading companies with more than 28,000 employees in over 90 countries dedicated to its purpose: Bringing plant potential to life. For more information about Syngenta please go to www.syngenta.com.

Reports in Time magazine today (Jan 13, 2015) about Insecticide Resistance in Mali shouldn’t really come under the heading of news. We’ve known about insecticide resistance in mosquitoes for a long time. In fact, that’s one of the reasons IVCC was set up in 2005—to develop new and effective vector control tools to challenge insecticide resistance.

But what is more serious is the comment in the article that resistance has ‘reached a level at some localities in Africa where it is resulting in the failure of the nets to provide meaningful control’. This is not only inaccurate, it is positively harmful.  Even if insecticides on bednets shows limited efficacy in some cases, the physical barrier of the bednet still provides a meaningful level of protection—over 50% according to WHO.  The article also fails to point out that the impact of growing insecticide resistance is not yet fully understood, nor is it distributed evenly across sub-Saharan Africa.

Long-lasting Insecticidal Treated bednets (LLINs), and Indoor Residual Spraying (IRS) have been remarkably successful over the past 15 years in reducing deaths and sickness from malaria across sub-Saharan Africa. In the World Malaria report 2015, the WHO reports that malaria mortality rates have decreased by 54% in the region during this period and that 44% of the population at risk is now sleeping under a LLIN. They estimate that 670 million fewer case and 4.3 million fewer malaria deaths occurred between 2001 and 2013 than would have occurred if incidence and mortality rates had remained unchanged.

Undoubtedly, some of this is due to better drug therapies and more effective diagnostics and health systems and that is also good news. But a large portion of it is also down to effective protection of the people at risk, especially the most vulnerable groups of pregnant women and young children. There is substantial evidence that LLINs and IRS have been remarkably efficient. The massive distribution of bednets has been a major lifesaver.

Ironically, the success of bednets and IRS one of the reasons why resistance has been developing. It’s a natural response from an insect population under stress. (See our video ‘The Tipping Point’) And it’s why we’re developing new anti-malarial insecticides that are safe for people and the environment that could bring to an end this never ceasing circle of solution-resistance-solution. (See our video ‘Why 3 new Ais’)

Working with the world’s leading agro-chemical companies, and top scientific experts in entomology and chemistry, we have already isolated 9 new chemical classes of anti-malarial insecticide with completely new (and different from each other)  modes of action. This year we will select 3 of these to go into full development. If funding is adequate and the extensive regulatory processes are passed, these new insecticides will be in operation in the field by 2022.

In the meantime we have developed new formulations of existing insecticides for IRS, and have some novel approaches to bednets that are currently undergoing evaluation.

Time reports scientists are urging ‘the development of new and effective malaria vector control strategies’. Right, we’re on the case and the finishing line is in sight.

I was inspired today by learning about the indirect and somewhat hidden value creation of IVCC capacity building amongst African scientists working in vector control.

I spent the day with the Pan-African Malaria Vector Research Consortium (PAMVERC) team based here at the Kilimanjaro Christian Medical University College in Moshi, Tanzania. IVCC works closely with Professor Mark Roland (LSTMH), Professor Frank Mosha (Director of Research at KCMCo), Dr. Matt Kirby (Program Manager) and the local Moshi scientists to test novel malaria insecticide interventions in the laboratory and field. We are also working, with the support of Alex Wright, to create a unique GLP-like accreditation process to strengthen and improve the efficiency and robustness of field evaluation.

This close IVCC/PAMVERC partnership has indirectly, but very effectively, helped train a new generation of MS and PhD students in entomology and vector biology who can take a lead in the eradication of malaria and other neglected tropical diseases. Over the past few years, some twelve MS students as well as a number of PhD students have worked on IVCC trials for their theses. To name just two, Dr Jovin Kitau, a medical entomologist and Dr Johnson Matowo, a molecular biologist specialising on insecticide resistance.

This often unrecognised approach to capacity building means that innovation funders get a significant return on their investments. It’s a double return, too—in the short term, outstanding trials data that lead to better prevention of malaria transmission, and in the longer term, building a foundation of local expertise and talent. This foundation of experts in malaria and vector control is essential to our hopes of eventually eradicating malaria from Africa.

I wonder if we can do more formally to promote the training and development of local scientists?