Public-Private Partnership in Action

The Mulanje Mission Hospital (MMH) works closely with the National Malaria Control Programme (NMCP) of Malawi, ensuring quality delivery of vector control interventions to fight malaria in the district. The catchment population in Mulanje is approximately 85,000 people living in 72 villages.

The MMH vector control programme is implemented and managed by the hospital and is privately funded by the Good Little Company, Fane Valley Co-operative Society Ltd, Ardbarron Trust and Global Affairs Canada through Presbyterian World Service and Development. MMH has invested in indoor residual spraying (IRS) since 2012, when they began using alphacypermethrin, a pyrethroid insecticide, at an average cost of $3 a sachet.  The malaria season dovetails with the rainy season, which starts in November and tapers off towards the end of April the following year. Households are sprayed before the peak of the transmission season to minimize contact between infective mosquitoes and people living in these communities.

After expanding IRS operations from 4 villages in 2012 to 22 villages in 2013, a marked decline in the number of u5 deaths was noted at the hospital – a trend that has been sustained over time, as IRS capacity has expanded even further and more effective products are being utilized.

Pyrethroid resistance was first detected by the University of Malawi, Chancellor College, in 2015, prompting the vector control programme to switch IRS active ingredients and adopt a 3rd generation IRS (3GIRS) product. Though the new 3GIRS product, Actellic® 300CS, is long-lasting and effective against pyrethroid resistance mosquitoes, it was also significantly more expensive. Maintaining coverage became a challenge: coverage dropped from 55 villages (47,000 people) in 2015 to 35 villages (30,000 people) in 2016.

MMH first approached IVCC regarding a potential partnership with NgenIRS in 2017, and with the support of NgenIRS the programme was able to procure Actellic® 300CS at a reduced price, less than $20 a bottle, that year. In 2018 the project was able to provide an additional co-payment, and the price dropped even further to $15 a bottle and the programme was able to cover 52 villages and protect an additional 12,000 people, a 28% increase over 2016.

In 2019, the programme will switch to SumiShield® 50WG, the second 3GIRS product out of 3 currently available, and an insecticide with a different mode of action. Annual rotation fulfills a vital part of vector control programmes’ insecticide resistance management plans and is in line with the WHO’s Global plan for insecticide resistance management in malaria vectors (GPIRM).

The successful public-private partnership between the NMCP, MMH and private funders with the assistance of a market shaping initiative NgenIRS (funded by Unitaid), showed great value in accelerating access to effective new vector control products, sustaining coverage and impacting lives in these malaria risk communities in Malawi.

An additional success story from Malawi comes from the NgenIRS partnership with the US President’s Malaria Initiative (PMI), which supports the NMCP with IRS through its VectorLink project in Nkhotakota District. Though the PMI/NMCP IRS program had stopped in 2012, the programme was restarted in 2018 and was able to protect more than 500,000 additional people.

To read more about the MPI VectorLink project in Malawi, click here.

IVCC had a strong presence at this years’ Pan African Mosquito Control Association (PAMCA) conference held in Yaoundé, Cameroon in September.  Derric Nimmo, Technical Manager IVCC, Allison Tatarsky, University of California, San Francisco, Malaria Elimination Initiative and RBM VCWG New Tools, New Challenges and Fredros Okumu from the Ifakara Health Institute, Tanzania, co-organised a symposium entitled ‘Vector Control Innovations to drive progress in malaria and other mosquito borne disease control’ with an outstanding list of speakers to support the symposium.

The symposium delivered the latest research on an ever-expanding toolbox of vector control tools and approaches and disseminated important findings to the PAMCA membership and wider malaria community to inform future research and implementation of vector control across the African continent.  It also made visible to national malaria programmes the diverse and high impact tools that can be integrated into countries’ vector control response now or in the future.  Topics covered in this symposium were of significant importance to malaria burden reduction and elimination efforts and the control of other mosquito-borne diseases.

IVCC was a sponsor of PAMCAs 6^th annual conference and exhibition

The session was co-chaired by Allison Tatarsky and Mercy Opiyo, Manica Health Research Centre, Mozambique, and ISGlobal, University of Barcelona.

Speakers at the symposium were:

Derric Nimmo, IVCC – Overview of the vector control pipeline and rational for an integrated vector management (IVM) response.

Ingrid Etoke, IVCC – The New New Nets project – project scale up and progress to date

Andrew Saibu, IVCC NgenIRS programme, and Richard Oxborough, Abt Associates– early results from PMI VectorLink rollout of 3^rd generation IRS insecticides, Fludora Fusion and SumiShield.

Silas Majambere, Mosquito Consulting – Precision larviciding with drone technology and new longer lasting larvicides for Aedes and Anopheles control

Eric Ochomo, KEMRI/CDC – Ivermectin: results from IVERMAL in Kenya

Lina Finda, IHI – Spatial repellents: community-wide effect of transfluthrin-treated eave ribbons

Under the conference theme, ‘Partnering for Impact’, IVCC hosted its first stakeholder conference in three years in its home town of Liverpool on 19^th September.   Ahead of the full day conference at Liverpool’s Town Hall, 150 guests were invited a very special pre-conference dinner at Liverpool’s iconic Anglican Cathedral where they were able to meet and network over dinner whilst being treated to a stunning performance from mezzo soprano Jennifer Johnston, artist in residence at Liverpool’s philharmonic orchestra.

IVCC was delighted to welcome Dr Ruth Shakespeare, former medical director of the Mulanjee Mission hospital in Malawi, as the keynote speaker.  Dr Ruth’s honest and very real testimony to the challenges of dealing with malaria on the ground grabbed everyone’s attention.  Dr Ruth spoke passionately how her hospital ward can become overrun with malaria cases if there is no adequate vector control support in the local area, often with more than seventy percent of hospital beds being filled with children suffering from serious cases of malaria.  However, Dr Ruth’s message was also one of real hope.  Following the introduction of next generation IRS in the area, malaria cases have fallen dramatically.  Moreover, Dr Ruth has shown how the mission hospital approach can be a model for how future IRS and other vector control initiatives can be efficiently and effectively rolled out across local community settings.   (A full copy of Dr Ruth’s speech can be found here)

IVCC’s programme for the day was filled with a series of panel discussions and presentations from a range of distinguished guests drawn from all corners of the malaria community, including funders, industry, academia and regulators.  As well as valuable networking time, attendees were also able to view an extensive scientific poster programme as well as see a demonstration of new ‘smart-lite’ IRS spray technology from Goizper.

A series of inspiring and thought-provoking sessions ensured that key challenges were discussed and debated and and where achievements had been made, they were appropriately recognised.  IVCC would like to thank all participants for making our Stakeholder conference a highly engaging and successful event.

IVCC is pleased to announce that it has received its third and largest grant from the Bill & Melinda Gates Foundation, with an additional $75million over the next five years. The grant will continue to support IVCC’s work in vector control, especially preserving and expanding gains against malaria by developing innovative vector control products that prevent transmission of malaria from mosquitos to vulnerable populations. In particular, the grant will contribute to development costs of three new insecticides currently in pre-development and other related tools and solutions, the total costs shared with industry and other funders.

Sir Mark Moody Stuart, Chairman of the IVCC Board of Trustees, said, ‘This is a remarkable time for IVCC in its 10th year of discovering and developing new vector control tools. This substantial grant is evidence of the successful journey so far travelled, and we are grateful for the continued support from the Bill & Melinda Gates Foundation and all our partners. Vector control has been shown to have played a major role in the rolling back of malaria over the past 15 years and this grant will help to maintain that momentum through the new public health insecticides that are about to go into full development.’

Dr Nick Hamon, IVCC’s CEO said, ‘We are very pleased to have received this award from the Bill & Melinda Gates Foundation, coming as it does at a crucial point in IVCC’s strategy to provide malaria control programmes with the vector control tools they need to continue the battle to eradicate malaria. We have a full pipeline of novel vector control products, and next year several innovative compounds will go into final development. We are also working with new partners, and new funders to ensure these insecticide resistance-breaking products are delivered cost effectively and speedily to the market.’

IVCC is also supported by funding from UKAID, USAID, the Swiss Agency for Development and Cooperation, and UNITAID.

Possibly the most important malaria-transmitting mosquito in Africa is Anopheles gambiae, which likes to bite people indoors between dusk and dawn. This highly specialised behaviour has enabled vector control interventions such as indoor residual sprays and insecticide treated bednets to greatly impact malaria transmission in many regions of Africa.

But other species of mosquito mustn’t be overlooked if elimination and eradication of malaria is to be possible:

Anopheles arabiensis plays an important role in malaria transmission in many parts of Africa. Being more weakly endophilic (ie: likes biting indoors), it is impacted to a lesser extent by indoor focussed vector control tools.

Anopheles funestus is the predominant vector in many parts of Africa,too. Like An. gambiae it mainly bites at night, indoors.

Anopheles nili and Anopheles moucheti play an important role in malaria transmission in humid savannahs, degraded forests and forested areas of equatorial Africa. These mosquitoes are often found near streams and rivers where their immature stages are associated with floating vegetation and other debris.

These two understudied but locally important species, while often found bloodfeeding indoors at night, have a broader range of behaviours and will seek other hosts as well as people.

The variety of mosquito behaviour in Africa alone demands a better understanding that can lead to the development of vector control interventions that target these diverse species and the diversity in their habitat and behaviour.

And beyond Africa, the range of malaria vectors becomes even more complex. Here, there is not only a need for better understanding of the impact of existing vector control tools, but also a clear picture of the novel vector control tools that are needed, especially in low disease transmission settings.

Demonstrating the link between a particular intervention, and disease transmission is a challenging task. But it is a worthwhile and necessary investment for those serious about reducing the burden of malaria.