7 November 2019, Hanoi, Vietnam.
IVCC has published the results of three landscape studies it commissioned as part of its 5-year $18.75 million grant from the Indo-Pacific Centre for Health Security through Australia’s Department of Foreign Affairs and Trade (DFAT).
The reports, which will provide the platform for a series of bespoke product intervention strategies, aim to address the growing threat of vector-borne diseases in the region by providing a comprehensive analysis of the technical, regulatory and market access environment for vector control in the region.
The studies found that while there is a wide range of malaria and other disease transmission ecologies – stretching from South Asia through to the Pacific Islands – several common themes emerged including:
- Outdoor transmission is a key challenge necessitating innovation and access to vector control tools for outdoor protection.
- Despite a lack of insecticide resistance data in many parts of the region, insecticide resistance among dominant Anopheles vectors is widespread in South Asia, and there are indications that pyrethroid resistance is increasing in the Greater Mekong Subregion (GMS), an area also confronting multi-drug-resistant parasites. Limited testing in PNG indicates that pyrethroid susceptibility remains high.
- Most national programmes rely almost exclusively on the mass distribution of long-lasting insecticide treated nets (LLINs), apart from Pakistan and India, which implement wide-scale indoor residual spraying (IRS).
- Aedes-borne diseases are on the rise as Ae. aegypti and Ae. albopictus populations continue to proliferate with increasing occurrences of dengue outbreaks and often inadequate diagnostic capacity to detect chikungunya and Zika viruses.
- There are some countries with relatively strong Aedes control programmes, but most lack capacity, accessible and effective surveillance and control options.
Insecticide resistance among Aedes, both pyrethroid adulticides and temephos (organophosphate) larvicide, is very severe in some countries. - Capacity for emergency response and implementation of International Health Regulations (IHR) for health security varies significantly, with most countries lacking adequate tools and resources.
IVCC is uniquely positioned to address these challenges in collaboration with national programmes and research, implementation and industry partners. Potential solutions fit into IVCC’s integrated vector management (IVM) portfolio of work, because rather than a single product, it is likely to be an integrated package of tools and approaches that, driven by improved, high-quality data and implementation, can sustainably reduce mosquito-borne diseases in the region.
Robin Davies, Head of Australia’s Indo-Pacific Centre for Health Security, said: “Vector control interventions have proven to be highly effective in reducing malaria and other mosquito-borne illnesses. Continued innovation in vector control, led by IVCC, will be critical to further driving down the burden of vector-borne disease across our region and globally.”
Nick Hamon, CEO of IVCC added; “IVCC has a wealth of experience and expertise in delivering impactful innovative vector control solutions across sub-Saharan Africa. By tapping into this knowledge and expertise we are well placed to transfer our knowledge and learning to deliver a toolbox of relevant vector control solutions fit for the Indo-Pacific region.”
Notes
The reports were launched during a workshop of regulators from across Asia-Pacific focused on best practices and challenges related to the registration and regulation of vector control products. The workshop was convened as part of the Vector Control Platform in Asia Pacific (VCAP), an initiative led by the Asia Pacific Leaders Malaria Alliance (APLMA) and Unitaid to address policy barriers to vector control.
The technical landscape was undertaken by the University of California, San Francisco (UCSF) Malaria
Elimination Initiative, the regulatory landscape by the consultant John Paul Vasanthan and the Market Access Landscape by FutureBridge.
Conducted between September 2018 and May 2019, the studies comprised of a desk review of 19 countries and in-depth consultations and interviews with governments and partners in the focus countries of Cambodia, Indonesia, Malaysia, Myanmar, Papua New Guinea (PNG) and Vietnam.
Fighting Insecticide Resistance in Ghana 25th May 2018Ghana shares their story using SumiShield® 50WG
Ministry officials highlighted the successes over the past few years and emphasized the challenges faced in the country, in particular, the growing threat insecticide resistance.
The timely availability and launch of SumiShield® 50WG in Ghana, now provides the country with an alternative insecticide for indoor residual spraying (IRS) in a region in Ghana where entomological monitoring flagged up resistance to all other available insecticides. It has a new mode of action, and was prequalified by the World Health Organization (WHO) for indoor residual spraying in October 2017. The National Malaria Control Programme(link is external)(NMCP) in Ghana is now able to implement sub-national rotation in the country with 2, third generation insecticides SumiShield® 50WG and Actellic® 300CS.
Indoor residual spraying is one of several tools supporting the NMCP’s goal of reducing malaria morbidity and mortality by 75 percent in Ghana between 2012 and 2020. The two IRS implementation partners in Ghana working closely in partnership with the NMCP are AGAMal malaria control programme(link is external), supported by the Global Fund, and the President’s Malaria Initiative (link is external)(PMI) VectorLink(link is external) project.
Ghana has been a NgenIRS country partner since 2017, procuring 3GIRS insecticides at reduced prices as a result of participation in consolidated forecasting, followed by manufacturer discounts and a co-pay mechanism to reduce prices further. The NgenIRS project has enabled the country to expand its coverage compared to the 2016 campaign, with the inclusion of Karaga District.
During 2017, thirteen districts were sprayed by the AGAMal and seven by PMI VectorLink respectively, protecting an estimated 1.9 million people.
The Malaria Programme Manager, Dr. Kezia Malm, stated that malaria is still the number one cause of death in children under 5 in the country and the programme and partners are working tirelessly to reduce these numbers. The areas most affected by insecticide resistance is the Ashanti Region. Districts targeted for IRS in this region during 2018 would have been excluded due to resistance levels, if a new insecticide was not available at the time of spraying.
After the press briefing and a visit to the Noguchi Memorial Institute for Medical Research Institute, the press delegation went to Ashanti region where they were introduced to the AGAMal malaria control programme and the operational implementation of IRS using the new insecticide SumiShield® 50WG.
Village leaders, community members and spray operators were given the opportunity to directly tell their story to journalists.
Journalists talking to village leaders and community members in a village in the Ashanti region, Ghana.
Press event in Accra, from left, Samuel Asiedu (Project Director, AGAMAL), David McGuire (NgenIRS Project Director, IVCC) Atsuko Hirooka (Executive Officer, Sumitomo Chemical Co., Ltd.), HE Tsutomu Himeno (Ambassador, Japan), Tina Mensah (Deputy Minister of Health), Dr Gloria J Quansah Asare (Deputy Director General, Ghana Health Services), Alexandra Cameron (Technical Manager, Unitaid) and at the podium Dr. Keziah Malm (National Malaria Programme Manager).
Links to Unitaid’s Video & Photo Story
https://www.youtube.com/watch?v=QycIfcllEsk(link is external)
https://unitaid.eu/news-blog/inside-ghanas-mosquito-squad-a-photo-story/#en(link is external)
Links to related press releases, stories and articles
https://unitaid.eu/news-blog/new-boost-to-ghanas-malaria-control-programme/(link is external)
https://spark.adobe.com/page/AUlSyLWZj2pmE/(link is external)
https://elpais.com/elpais/2018/05/09/planeta_futuro/1525853136_438091.html(link is external)
Rotation of 3GIRS insecticides in full swing
Unitaid, IVCC and Sumitomo Chemical Company announced the inclusion of the new insecticide SumiShield® 50WG, as part of the NgenIRS project. This announcement followed the prequalification listing by WHO in October 2017.
With two long-lasting IRS (3GIRS) products now available, SumiShield® 50WG and Actellic® 300CS, the pre-emptive annual rotation goal outlined in the Global Plan for Insecticide Resistance
Management in malaria vectors (GPIRM) is achievable. Bayer’s 3GIRS product, Fludora® Fusion is currently undergoing final stage trials required for WHO prequalification and we hope this 3rd long lasting product can join the NgenIRS programme in 2019. BASF´s Sylando® 240SC is under WHO-evaluation.
Funders and procurers now have the opportunity to simultaneously prevent resistance build up and affect the cost-effectiveness of IRS by adopting pre-emptive, subnational rotation strategies where appropriate. Rotating all effective and available insecticides is key as a wholesale shift from one effective long-lasting IRS product to another within the market would undermine the goals of increasing competition, reducing product cost, and the market volatility of IRS products. Experts have proposed a new strategic approach based on pre-emptive rotation of multiple 3GIRS products within a country to:
- support resistance prevention best practices;
- support stable, multi-year forecasts and
- support reduced price through competition.
Half of the NgenIRS partner countries adopted a sub-national rotation strategy for 2018, as part of their national insecticide resistance management plan. Tanzania has completed their IRS sub-national rotation campaign for 2018, Ghana and Burkina Faso are in the process of adopting this strategy and the remaining four countries will follow.
Related links:
http://www.who.int/pq-vector-control/prequalified-lists/sumishield50wg/en/(link is external)
Mozambique Randomized Control Trial
At the 7th Conference of the Multilateral Initiative on Malaria in April members of the NgenIRS project, along with colleagues from around the world, met during a windy week in Dakar, Senegal to discuss the most recent malaria research, control, and elimination findings. Some of the key results presented by members of the NgenIRS project were included in a symposium on the cluster randomized trial taking place in Mozambique to determine the public health impact and cost-effectiveness of indoor residual spraying (IRS) with Actellic®300 CS.
PATH has been partnering with the National Malaria Control Program (NMCP), Centro de Investigação em Saúde de Manhiça (CISM), and the US PMI AIRS project since 2016 to conduct the trial in Mopeia District, Zambezia Province. The study team presented preliminary results describing the epidemiologic and entomologic impact of the 2016 IRS campaign. The trial, which is taking place in an area where parasite prevalence is significantly above 50% in children under five years of age, is broken into two study arms: one arm where households used LLINs, the standard malaria vector control tool in Mopeia (LLINs only), and one arm where households received IRS with Actellic® in addition to LLINs (IRS + LLINs).
Preliminary results to date have shown that in the first six months after the 2016 IRS campaign, RDT-confirmed malaria case incidence at district health facilities was 20% lower in children from villages with IRS + LLINs than from villages with LLINs only. After adjusting for health care utilization rates (around 56% in Zambezia), the analysis shows that an estimated 4,000 cases of childhood (under 5-year old) malaria were averted in Mopeia district during the 12 months after IRS. Entomological surveillance also revealed that the density of An. Funestus mosquitoes collected by CDC light traps during that same time period was 50% lower in IRS versus non-IRS clusters. Further analyses on complete passive case detection, active case detection, and cross-sectional survey data will be forthcoming, along with a comprehensive costing analysis that will shed light on the health system and societal costs of malaria and the cost-effectiveness of 3GIRS interventions in Mozambique.
Working Together with Partners to Expand the Evidence Base 26th June 2018The Mali story
In the last two years, NgenIRS has been working in close collaboration with a number of stakeholders in Mali to study the impact of IRS. The team’s first trip was conducted in September 2016 to introduce the NgenIRS evidence team, discuss current vector control/malaria landscape, review data sources and availability, prioritize research questions, and discuss study designs. The key partners in Mali include the National Malaria Control Program (NMCP), the US President’s Malaria Initiative (funds IRS implementation in Mali), Africa Indoor Residual Spray Project (implements IRS in Mali), and the MEASURE Evaluation project (supporting NMCP on health information systems management and monitoring and evaluation activities). From the outset, all stakeholders were enthusiastic about the collaboration and expressed interest in conducting the IRS impact evaluations. Ideas, approaches, and data sets—including implementation and routine malaria surveillance data— were shared and the analysis process began. Two additional trips took place in 2018 to present preliminary analysis, review data gaps, and discuss future plans. During these visits, the NgenIRS team received feedback from NMCP, PMI, and MEASURE Evaluation and the analysis was refined and additional research questions posed.
Engaging country-level partners and providing frequent status updates on the analytic process has proven successful in building sustained and productive partnerships in Mali. As a result of this successful collaboration, the evidence base demonstrating that IRS is a cost-effective malaria control intervention has grown: a manuscript recently co-authored by study partners was published in early 2018 and its results have been discussed at length by multiple stakeholders during several presentations at ASTMH 2017, ASTMH West Africa 2018, and at MIM 2018.
As further NgenIRS analyses of more recent spray campaigns get underway, it’s clear that enthusiasm of in-country partners remains strong. MEASURE Evaluation, NMCP, and PMI have promptly validated and shared the latest malaria surveillance data and provided feedback on the data challenges and caveats to consider in the analysis as well as providing inputs for integrating the latest entomological surveillance data.