How post-market surveillance on insecticide resistant bednets will help end malaria

*Vestergaard says investment in assessing bio efficacy of LLINs can play critical role to close evidence gap, inform procurement, deployment decisions

As part of efforts to eliminate malaria, stakeholders have called for more investment in supporting post-market surveillance on insecticide resistance and assessing bio efficacy of bednets.

The stakeholders including global health company, Vestergaard, formed part of a trilogy of panel discussions, hosted by The Corporate Alliance on Malaria in Africa (CAMA) and its partners to discuss lessons and opportunities in the fight against malaria in Africa.

The concluding segment of the three-part webinar series focused on sustaining progress in the fight to end malaria. Like the previous two events, the conversation included high-level representation from the private sector such as Exxon Mobil, Access Bank and Heineken in addition to Vestergaard, as well as government organisations including the Ministries of Health in East and West Africa, and multilateral organisations such as Global Fund, World Health Organisation and Africa Centre for Disease Control (CDC). During the dialogue series, Vestergaard focused on how the malaria community and private sector can better partner to accelerate elimination of the disease, as well as the need for strategic procurements to bring product innovation faster and at scale to market. In addition, they highlighted the importance of a regulatory framework to support the evaluation of the in-country performance of vector control tools.

Chief Executive Office at Vestergaard, Michael Joos, reminded participants that achieving the 2025 and 2030 malaria goals, and ultimately eliminating the disease, would require renewed commitment and substantial increases in investment, so as to support the innovations that can help accelerate malaria innovation. He said the private sector can play a central role in these efforts provided a clear innovation pathway is defined to go from idea generation to market and enable investments in Research and Development (R&D) and manufacturing ramp-up.

“Insecticide resistance is challenging the already fragile gains. We must increase the pace of innovation through strategic partnerships, as it is becoming increasingly more complex to screen new active ingredients, bind them to textiles, and manufacture and scale them as rapidly as possible,” Joos advised.

Joos also pointed out that innovative companies are acutely aware of the investments and risks required to move from basic research to product development. What has proven to be a greater challenge is progressing from product prequalification to full-scale implementation. Strategic procurement contracts and supportive measures to for innovative products to be adopted at scale are essential to support the rollout of next generation nets.

“The speed at which we bring such innovative products to market is essential, but equally important is the rigorous evidence required to confirming their impact,” Joos said.

“Greater investment in vector surveillance data along with post-market surveillance, guides not only the selection of the most appropriate interventions to deploy, but also provides insight into their long-term efficacy and adoption by the population,” he continued.

Increased investments into product efficacy data should provide countries with substantiated data sets confirming where and when to deploy the most effective products for the greatest impact. In the case of pyrethroid- piperonyl butoxide (PBO) nets, it is even more important to evaluate the performance of the nets in the field, through a systematic post-market surveillance programme.

According to a research published in The Lancet, a new class of bed net that includes the chemical piperonyl butoxide (PBO) has been shown to significantly reduce malaria infection in children. World Health Organisation (WHO) recommendations on pyrethroid-PBO nets were revised in late 2017 based on the results of this study, among others.

Cluster randomised trials have confirmed that PBO Long Lasting Insecticide-treated Nets (LLINs) products, offer greater protection against pyrethroid resistant mosquitoes than standard pyrethroid LLINs, and they are becoming the new standard of care in Africa.

However, there are currently no long-term field studies confirming the insecticidal activity of low-content PBO nets, most recently introduced to the market. In addition, manufacturers have taken diverse approaches to formulate their products, leading to different PBO concentrations being used. As the PBO is incorporated inside the fabric, it must be slowly released to the fabric surface over the product lifetime to play its role to the full extent. In such a situation, investment in post-market surveillance activities can play a critical role to close the evidence gap and inform procurement and deployment decisions.

Finally, innovation requires partnerships, not only in product development, but also in ways that ensure the people who need them use effective tools. Joos highlighted how digital tools could help us interact with end-users and provide insights into how best to support the use and durability of bednets.

As the discussion came to a close, CAMA encouraged participants to state their pledge in the fight against malaria and their support for the End Malaria Project in Nigeria. As part of its commitment, Vestergaard pledged technical support in terms of establishing a systematic post-market surveillance framework for LLINs jointly with National Malaria Elimination Programme (NMEP). This support will include knowledge transfer on insecticide resistance testing protocols for vectors and for assessing the bio efficacy of bednets, from Vestergaard Noguchi Vector laboratory in Accra, Ghana. Additionally, Vestergaard said it is committed support towards expanding the number of vector surveillance sentinel sites in Nigeria.

“It is encouraging to see how the community has already stepped up to continue and accelerate efforts against malaria despite the obstacles. Vestergaard applauds the End Malaria Project initiative, which seeks to galvanise support towards reducing the incidence and prevalence of malaria in Nigeria,” Joos said.

Vestergaard manufactures innovative, high-quality tools to improve global health outcomes in mainly low- and middle-income countries. Known for their PermaNet LLINs to prevent malaria, the company has manufactured 800 million PermaNet protecting an estimated 1.6 billion lives in malaria-endemic countries. Additional company initiatives focus on fighting neglected tropical diseases, reducing food insecurity through Chombo and ZeroFly storage bags and utilising technology to drive data-driven decision making.

Founded in 1957, the company is headquartered in Switzerland, with an office in India, a research and development lab in Africa and a quality control and manufacturing lab in Vietnam.

CAMA is a GBCHealth-led initiative to drive partnerships for malaria control and elimination. The Alliance is a unique coalition of companies from various industries, all with business interests in Africa. CAMA channels the collective force and voice of the private sector to drive impact on malaria in Africa from workplaces to region-wide initiatives. CAMA is a platform for corporations working in Africa to share best practices, create new partnerships and gain visibility for malaria control efforts across the continent. CAMA companies both lead and support innovative malaria prevention, control and treatment activities and collectively deploy millions of dollars to programs that serve the needs of malaria-affected people and communities. CAMA also provides a forum for business to engage with and build relations with malaria-focused government and civil society stakeholders. CAMA is a membership-based Alliance currently comprised of companies and institutions.