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?

As I discovered recently, while visiting Forde Abbey, a 12^th century monastery in Dorset, the word about malaria seems to be getting out.

When asked about what I do for a living, I used to expect to start every response with a short explanation of malaria, mosquitoes, insecticides, bed nets and vector control. But this is happening less frequently these days. The general public often knows the basics about malaria and there is an expectation that the challenge of malaria is being managed and a solution is just around the corner.

Just around the corner may be a little optimistic but it certainly it is in sight.  In 2000, <3% of the population at risk from malaria had access to an insecticide treated net; today that number is about 50%.  In the last fourteen years, there has been an estimated 50% global decline of mortality rates. This is something to celebrate, of course, but a staggering 580,000 people still died of malaria in 2013.

The World Health Organization’s new malaria targets are ambitious—to reduce malaria mortality rates and case incidence by ≥90% by 2030, to eliminate malaria from ≥ 35 countries by 2030, and to bring us ‘as close as possible to global eradication.

To achieve this, novel insecticides, drugs and vaccines are essential. IVCC’s mission is to build a toolbox of vector control solutions that can combat insecticide resistance. When IVCC was formed ten years ago, our biggest hurdle was to build partnerships with the major agrochemical industry companies and work with them to identify novel chemistry for public heath use.

Four and a half million compounds and 27 chemical classes later, that challenge has now been replaced with the need to find significant funding to take three new interventions ‘across the finish line’.

In 2013, $2.7 billion was spent on malaria through international and domestic funds. But an estimated $5.1 billion will be needed annually if we are to ensure that malaria ceases to have a devastating impact on people’s health and livelihoods around the world.

So what funding does IVCC need over the next ten years to complete its mission?

It takes much the same process to get a novel insecticide registered and into the right hands as a new drug; chemistry, efficacy, formulations, toxicology, environmental impact and chemistry, registration fees etc. are all needed to provide safe and effective products.

I am very optimistic about the life-saving potential of the IVCC product pipeline, thanks to the incredible support of funders such as the Bill and Melinda Gates Foundation, UKAID, USAID, Swiss Agency for Development and Cooperation, as well as our industry partners such as Syngenta, Bayer, Sumitomo and BASF.

If our current funders ‘stay the course’ until 2025, we need to find an additional $100m, 70% of this in the next four years. I think we can do this, but it will not be easy.

Today we work closely with committed and motivated funders, but there are other sources of funding that could play a part in eradicating malaria.  What about the private sector?   Companies with long-term growth strategies for sub-Saharan Africa, could make a contribution to saving lives and growing the African economy, and at the same time building their brands and repetitional capital.

Are there any senior industry executives out there with the vision to see the value of being a partner in this incredible and winnable fight to eradicate malaria?

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?