Sitting snugly in the shadow of Mount Kilimanjaro in Tanzania sits the Kilimanjaro Christian Medical University College. Based at the college is PAMVERC, where a team of scientists works collaboratively across a number of organisations, such as London School of Hygiene and Tropical Medicine and IVCC, to test new innovations in vector control, mostly malaria-focussed.

Even though we know how to prevent malaria, it still kills over 600,000 people each year. The vast majority of these are children under the age of five, and pregnant women.  Insecticide treated bed nets and indoor residual spraying of insecticides have and will continue to save thousands of lives every year; however, as with any monotherapy (only one class of chemistry is available for use in bed nets), resistance is starting to seriously take its toll.  We are seeing resistance to pyrethroid insecticides and other classes of chemistry almost everywhere we look for it, and in some locations in Africa complete failure has been observed. This is not a new story but it is an increasingly frightening one. Insecticide resistance is now reaching the tipping point. (Watch the IVCC video here for more information)

The good news, however, is that even when insecticides fail, the physical barrier of a net continues to provide some level of protection from malaria transmission, so continued net use is important.  IVCC’s mission and focus since its inception in 2005 has been to work across multiple stakeholders, especially industry, to catalyse innovation in vector control and bring new classes of insecticides to market.  New products are starting to become available or are in the product development pipeline at a well-advanced stage. Watch this space!

However, our focus is beginning to shift from managing innovation to managing time from discovery to impact.  I recently asked two different highly respected scientists in the field of malaria and neglected tropical disease research what a complete failure of pyrethroids in bed nets would represent in terms of lives lost and the estimates were staggering—somewhere between 70,000 and 150,000 per year.  Any number of preventable deaths is completely unacceptable, but these types of numbers defy belief and really raise the level of urgency and responsibility.  Today, from discovery to impact for a new insecticide takes about 12 years.  We have a number of new chemistries just entering the development phase, which means that, if we take a normal course to market we will not see an impact until 2024/2025.

What if all the different players in the value chain agreed to do something creative and disruptive so that we can make new life-saving public health insecticides available by 2020—just five years?  This is feasible, and could save many thousands of lives.

We know how to accelerate the development of experimental products when lives are at stake—the Ebola crisis has demonstrated this.  So, we in the malaria community need to take full responsibility and apply the same principles and urgency to solving the malaria problem.

Novel drugs and vaccines are in the research pipeline, but vector control is and will continue to be the foundation of malaria management for the foreseeable future. Can we rise to the challenge of maintaining or improving on the performance of long-lasting insecticide treated nets and indoor residual sprays and getting them into the hands of those that desperately need them in five years or less?

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.

The UK has played a significant role globally in the fight against malaria, according to a new report by the All Party Parliamentary Group on Malaria and Neglected tropical Diseases (APPMG).

Launching the report in the House of Commons, Former Secretary of State for International Development, the Rt Hon Andrew Mitchell MP, praised the UK for helping drive the remarkable progress in preventing malaria, which has halved child deaths from the disease since 2000. He went on, however, to stress the importance of maintaining support, investment and innovation in the struggle against malaria, noting that resurgence is a very real threat.

According to the report, ‘the recent dramatic improvements in malaria control give no cause for complacency: history has repeatedly shown that when efforts and funds to control malaria are relaxed, it comes roaring back. Reducing malaria control efforts at this point risks failing to capitalise on the strategic advantage we are developing – jeopardising millions of lives and billions of dollars’.

The report suggests that the  next five years will be particularly critical in malaria prevention as innovative approaches to developing new insecticides, drugs and vaccines show healthy pipelines of potential new products. ‘We are now at a tipping point in the fight against this disease: sustained investment will drive down the number of malaria cases and deaths still further’.

Insecticide resistance is highlighted as a growing threat especially as  ‘the corner stone of prevention is vector control’.

The economic return on malaria investment is also highlighted in the report, which suggests a net economic return on malaria investment of over $200 billion by 2035. ‘Healthier communities will be more economically productive, and educational outcomes will be enhanced.’

Download the full report by following the link on this page.

A personal view of the Stakeholder Day 2014, by journalist Stephen Regan

Early in the stakeholder forum Rear Admiral Tim Ziemer set a challenge for all delegates: “What can you do?  What can I do?  What needs to be done to focus on outcomes, to set our identities aside, to embrace the strategic plan for product development.”

In an upbeat opening speech, the ex US Navy man, who heads the President’s Malaria Initiative said: “We’re not going to be able to achieve on malaria control, sustainability and eradication without a mechanism like IVCC to facilitate developments of new tools and products needed to continue the fight, then eventually get us to elimination, so I hope it’s clear that we’re all in.”

His remarks gave resonance to a growing feeling in the malaria community – very evident during the forum – that now is the time for a focusing of efforts and a coming together.

Observing the audience at the Museum of Liverpool, Tim Ziemer said it was clear that a “unique blend of scientists, researchers, investors and programme specialists” had come together to review, renew, affirm how important it was to rethink.

He told delegates: “It’s not only about product development but also looking at ways of improving the delivery of mechanisms. It’s a difficult task – and you know what’s sobering …? Well, it’s kind of up to us; it’s up to the people in this room to actually deliver on the mission.”

Tim also told delegates: “Product development partners like IVCC have resulted in accelerating new technology development. We’re seeing more promising products in the pipeline than we ever have before.  For an investor that represents an exciting deliverable. …

“The potential to provide more value for money in a high risk, high gain and highly technical field, by leveraging funding to gain support for continued development of critical commodities to combat a disease of poverty like malaria – that reflects an effective research investment.

“We, the United States Government, look at this IVCC as an investment opportunity to leverage some of our research money for the future and we’re very pleased to be a partner.”

Tim added: “We stand within the reach of achieving the goals that we once thought were unimaginable; ending deaths from malaria and then eliminating it from the globe. The goal over the next 20 years will be to sustain and build on this effort that we’ve achieved today – and face challenges such as resistance, mosquito resistant, parasite resistance and the uncertainties around donor and national funding for malaria control.

“We’re all in this together, it’s really up to us as critical partners in the fight to do something about it.”

IVCC receives £12 million from the UK Department for International Development (DfID) to develop the next generation of public health vector control tools.

IVCC has been awarded £12 million over the next five years by the UK Department for International Development (DfID) to support the development of new insecticides to combat malaria.
This is part of the UK Government’s commitment to combating diseases that place an enormous burden on the world’s poor. £138 million will go to nine product development partnerships for the development of new tools to treat, control and ultimately eliminate some of the world’s deadliest diseases, including malaria.

International Development Secretary, Justine Greening, said, “The development of new technologies is vital if we are to improve the health of the poorest people through better treatment and prevention, and avoid the unnecessary deaths of children. Working together in product development partnerships, the public and private sectors have a chance to bring together their expertise for the benefit of millions of the world’s poorest and most vulnerable people.”

The CEO of IVCC, Dr Nick Hamon commended DfID for its investment in saving lives amongst the poorest people. ‘This support from the UK government is vital to sustaining the enormous gains that have been made over the past 10 years in preventing malaria through effective vector control tools. Insecticide treated bednets and indoor residual spraying have proved to be very effective at reducing deaths and illness from malaria, but increasing resistance to existing insecticides puts these gains at risk.

With this support from DfID and other major partners such as the Bill and Melinda Gates Foundation, IVCC will move to the next phase in our development of the first new public health insecticides in 30 years. This novel chemistry will play a major part in bringing to an end this entirely preventable deadly disease which kills hundreds of thousands of children annually, devastates families and keeps countries poor.’

Since it was formed in 2005 IVCC has worked with some of the world’s leading agrochemical companies to identify new active ingredients that will form the basis of totally new insecticides for malaria prevention, and ultimately help to bring about the eradication of the disease. Companies partnering with IVCC have recently introduced two new insecticide formulations that prolong the effective life of current interventions and are proving to be valuable additional tools for malaria prevention.