IVCC’s stakeholder event in 2013 took place at MIM in Durban, when key individuals and organisations from all over the world gathered to share information and strategies for fighting malaria.

One of IVCC’s key objectives for stakeholder events is to engage with people working in country control programmes. The MIM Pan-African Malaria Conference 2013 in Durban provided a perfect opportunity to make contact and learn from people in the front line of malaria vector control.

The IVCC stand provided a visual summary of key achievements since the launch of IVCC in 2005 and a time frame for delivery of new vector control tools.

There were many visitors to the stand. Most were seeking  information about the progress of IVCC’s collaboration with industry partners to develop the three new active ingredients that will form the basis of a new generation of public health insecticides. A frequent question was, ‘how long before you can deliver?’, indicative of growing concerns about insecticide resistance.

Information about IVCC’s portfolio and details about insecticide resistance were presented to delegates in an IVCC symposium on new tools for the management of insecticide resistance.

Professor Hilary Ranson from LSTM started the IVCC symposium with an overview of insecticide resistance in vector control. Dr Charles Wondji looked at the mechanisms of insecticide resistance and Professor Diabate Abdoulaye considered current strategies and future challenges for malaria vector control in Africa. An industry perspective was provided by Frederic Baur, who outlined the development of new products for insecticide resistance management.

During an evening reception later in the week, the new IVCC CEO, Dr Nick Hamon, outlined the IVCC mission and objectives for the next few years. Tribute was paid to the founders of IVCC and thanks recorded to the committed industry partners and funders who make the work of IVCC possible.
IVCC also took part in a demonstration of the new  Insecticide Quantification Kits (IQKs), which are designed to help spray programmes monitor the effectiveness of indoor residual spraying.

One of the keys to IVCC’s success over the past few years has been the bringing together of public and private expertise. IVCC’s Expert Scientific Advisory Committees (ESACs) have been a key element in our successful development of innovative vector control products over the past eight years. Each ESAC brings together scientists from across the globe to ensure our industrial partners are provided with guidance from conception to roll out, something our partners say has been crucial to applying their considerable skills towards developing new insecticides targeted at public health

The long process of developing new anti-malarial insecticides began (it feels now like the mists of time, but it was only about 8 years ago) with the production of a detailed description of the vector control product we were looking for. This technical description, called a Target Product Profile (TPP), lists all the essential and desirable characteristics of a product. For insecticides this will include public health attributes, ecological impact, fitness for purpose and costs. Effects on humans and the environment is central, and the new insecticides will be much better than has previously been available, partly because of the precise targeting.

The Public Health ESAC were responsible for drawing up the TPP for IVCC’s active ingredient project­—a cornerstone of our mission. This TPP covered a wide range of requirements, from toxicity for humans and insects to end user requirements tailored for health products in developing countries.

But it doesn’t stop there—ESACs continually advise IVCC on new project submissions, project design, project continuance, termination and extension. However, their work doesn’t end there; they continue to provide a review of all current projects and product data to ensure we keep on target to deliver on our mission.

ESAC members are chosen for their professional skills and knowledge, developed over a lifetime of product development. Add this to the skills and expertise of our industrial partners, and their commercial experience and ‘muscle’, and you have the recipe for success that has brought us very close to achieving our initial objectives—the first new public health insecticides in over 30  years. That’s something to celebrate.

There’s a lot of work goes into a good experimental hut trial, and you can’t tell that just by looking at charts of data. Graphs and numbers never adequately express just how much work has gone in to generating the facts.

A single study, for example, will demand not only careful preparation of the site, but also the relentless commitment and skill of field technicians working consistently in hot, humid environments. Carefully collecting mosquitoes, recording and preserving them often for weeks or months on end is a testing occupation.

A key part of our mission is generating excellent and reliable data to demonstrate conclusively that the products under development by our industry partners work in the place where they will be used, like Africa. If you’ve ever been to sub-Saharan Africa you’ll know that the conditions there are very different from ‘at home’ in Europe or the Americas.

The field trials we run have to be rigorously controlled if they are to produce data we can rely on. For this reason we follow WHO published guidelines to make the data relevant not just to our partners but to others also.

It’s also why we’ve put an enormous effort over the past few years into supporting our trial site partners by training them in the principles of Good Laboratory Practice/Good Experimental Practice to the highest commercial standard. Ultimately the daily performance of the products being delivered depend on the accuracy of every data point that comes in from the field. And every bit of data takes us closer to a world where we can stop mosquitoes, and other insects, from killing people.

Currently we’re working with four African institutions, who join our project teams to run new product evaluations. These are spread across sub-Saharan Africa in Tanzania, Benin, Cote d’Ivoire and Burkina Faso. It’s here, in countries where malaria is still a big problem that IVCC projects come close to the reality of helping fight growing pyrethroid resistance, which is a real threat in the battle against malaria.

The people who we work with are leaders in their field, and do excellent work for us, and we’re always open to expanding our collaborations in Africa and finding new sites at which to work. Having access to a range of different environment types helps have a better understanding of a product’s performance. Products under development may take a long time to get to the field, but its only here when used in local conditions against local malaria vectors that they can be truly tested for performance. We want to make sure that when they finally get to where they’re needed, they work well.

One of the things I value about IVCC is our commitment to delivering this mission we started—developing the essential new vector control products needed to stop malaria in Africa and other parts of the world. At the end of the day that’s how we’ll be judged.

Over the past few years it’s been a privilege to work with industry to develop new active ingredients for Vector Control. I’ve worked with some of the best scientists from Bayer, Sumitomo and Syngenta.

Eight years ago when IVCC was formed we didn’t know whether we could interest industrial companies in this venture. There’s not much of a commercial nature in it for them, and there are always risks and unforeseen costs. Of course, there’s also the potential of unforeseen gains whenever you’re creating new chemistry.

We now know that they are both interested and willing to allow some of the best and most dedicated scientists in their companies to look for the new insecticides we so desperately need.

Each of the companies we work with is very different — with different cultures and approaches to the challenge. They rightly use their own tried and tested methods that have proved so effective in commercial applications. But the three things that the scientists in all these teams have in common is their professionalism, their enthusiasm, and their commitment to the goal.  It is, after all, a matter of life and death for millions of people. How many jobs offer that as a challenge?

It has been encouraging to discover how each of the companies are very open to IVCC and their co-operation with the ESAC. They have openly shared all the information we need to help steer the projects, though for obvious reasons there is strict secrecy between them.

This is a unique co-operative programme that will deliver the future products for vector control, and ultimately will have an enormous impact on the lives of people in areas where malaria is such a scourge.

The current control paradigm for malaria is not sustainable in the long term from both a biologic and political perspective, said Dr Alan Magill, addressing the IVCC Stakeholder Day conference in Liverpool.

Dr Magill is a Director of the Bill and Melinda Gates Foundation charged with overseeing the development and implementation of strategies for the foundation’s ultimate goal of the eradication of malaria. He was addressing an audience of vector control and public health experts from across the world, who had gathered together to consider the latest developments in IVCC’s vector control programme. If malaria resurgence is to be avoided, Dr Magill said, eradication is the only strategy that makes sense moving forward.

He outlined five key principles in the malaria eradication strategy. Beginning with the first, precise definitions, he said, ‘the definition of malaria eradication is actually getting parasites out of people.’ The second and third principles involve complete clinical cure including removal of the ‘vast human reservoir of malaria parasites’ in asymptomatic people.

The fourth principle he outlined concerns the fundamental precepts of evolutionary medicine and correct ecologic thinking. ‘Malaria is a very big complex system.  It’s got the biology, the ecology, the political, and the social pieces,’ he said. It is important to understanding it as a system and then ensure that product development and policies are ‘evolutionarily correct’ going forward.

Dr Magill’s final principle was think globally and impact locally,  ‘there is no one size fits all, no one single solution that’s going to magically lead us to eradication,’ he said.

Talking about the role of vector control product development he said that it was important to accelerate the delivery of new vector control products through the current system and get them out to impact just as soon as possible.

‘Let’s finish the job,’ he said in conclusion. ‘We don’t like to get distracted by discussions about elimination and eradication.  This is all about saving lives.  It’s saving lives now in sick people and it’s saving lives for ever going forward because we’re going to avert all those deaths by elimination.  It’s a pure simple equation.  We know that this is biologically and technically feasible and we think the new tools that will be developed in the next few years will make a lot of the things we’re talking about much more operational and feasible.’

Turning to IVCC and the stakeholders in the room he said that the next decade would be an intense period of experimentation—’using current tools and new ways, and really thinking about that long term goal of eradication’.

‘IVCC is a hub in the eradication eco system, and through that hub we can reach out to all the talent in the room.  I would say that if there’s a problem out there in the vector space world, well this is the group of people to solve it.  You own it; if you don’t like it it’s up to you to change it.’