An entomologist's advice in the fight against insecticide-resistant mosquitos
When I lived in Tanga on the northeast coast of Tanzania, I could feel the breeze from the nearby Indian Ocean as it flowed through my open windows. They were covered with screens, of course, and as an entomologist, I was only too aware of the importance of these screens as the first line of defense against malaria-carrying mosquitoes. I also knew the importance of spraying our walls with insecticide, sleeping under insecticide-treated mosquito nets and covering our bodies with insect repellent when we went outside at night.
Malaria was an insidious disease claiming way too many lives of people in the community where I lived in Muheza and Tanga. Despite our diligent efforts, by the time my son was 2, he’d contracted malaria twice, both times when sleeping over at a friend’s home where they didn’t use bed nets. We learned firsthand that a bed well-made in Africa always had a net over it. This lesson has become my life’s work, first as a researcher in infectious diseases and now as head of entomology at Vestergaard, where my mission is to keep our world safe from malaria through the introduction of bed nets and other tools designed by the company to fight malaria.
Over the past 15 years, the global community has made huge progress in reducing the impact of malaria. The World Health Organization estimates a 60 percent reduction in malaria-related deaths and 6.2 million lives saved. Much of this success is credited to the aggressive use of long-lasting insecticidal nets. Today, over half of Africa sleeps under a bed net, and they have contributed to an estimated 68 percent reduction in malaria deaths in Africa. As the world’s largest manufacturer of bed nets, Vestergaard has contributed significantly to the war against malaria, and it is very rewarding to have a job that enables me to make such an impact.
Sadly, there’s little time to bask in the glory of success, as my work, and that of my colleagues around the world, is far from over. Today, malaria still steals way too many lives — killing a child every 60 seconds and projected to take the lives of hundreds of thousands of people this year. To make matters worse, mosquitoes are becoming increasingly resistant to the insecticide used in LLINs. In 2015, 60 countries reported resistance to at least one insecticide used for control of malaria mosquitoes. The threat of resistance in malaria vectors is very real and has the potential to erase the great strides made so far.
As the malaria mosquito evolves, so have we through constant innovation. Us scientists on the front lines of this disease have created stronger defenses — from my company, a new type of bed net that has been evaluated and approved by the WHO to be more effective against certain types of insecticide-resistant mosquito. This net is an insecticide synergist combination net. The synergist, piperonyl butoxide, works to enhance the effect of the insecticide on the net by inhibiting the metabolic enzyme defense systems of the resistant mosquito.
Deployment of this net at scale has been delayed as countries and donors wait for guidance from WHO to determine where and when this bed net, called PermaNet 3.0, and other products that enter the new product class, will be used. Unfortunately the timing for developing this normative guidance is lagging very far behind the product recommendations that WHO gave to PermaNet 3.0 as a malaria control tool. The system is broken when the evaluation and guidance process takes longer than the innovation and development of the technology.
Several lessons we’ve learned about malaria control can guide the way forward:
1. For vector control products to be successful, they need to be scalable and tailored to the needs of local communities. Products that limit the need for repeat interventions and have the ability to continue working for years instead of days, weeks or months, tend to be the most effective.
2. Guidance for where and when new products should be used should be based on the specific products claims of that new product. Only products that have their claims reviewed and substantiated by WHO should be scaled up.
3. We must keep malaria high on the global agenda, with all stakeholders working with a sense of urgency: WHO providing guidance for quick deployment of the best tools; countries engaging with end users to ensure compliance, donor groups continuing to provide funding needed; and the private sector innovating the best tools possible.
I am able to watch my son grow up because he benefited from access to care, surviving malaria twice before the age of 2. For many families living in malaria zones without such access, their best hope is to never get bitten by a malaria-carrying mosquito. We must work together to cover their world with the best and most effective malaria prevention tools now.
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