In the 1990s, as momentum grew again for a concerted effort against malaria, the need for sustainable approaches to vector control became more important.

Sustainability requires that the potential impact of insecticide resistance be addressed. The impact of insecticide resistance on malaria vector control had been known about for a long time; it was after all one of the reasons the WHO’s Global Malaria Eradication Programme fell short of its ambitious target in the late 1960s.

RBM Partnership to End Malaria

In 1998 the WHO, UNICEF, UNDP, and the World Bank launched the RBM Partnership to End Malaria, originally called ‘Roll Back Malaria’, with the aim of creating a partnership to coordinate global action against malaria.

The RBM Partnership to End Malaria operates through a number of Working Groups, one of which, the Vector Control Working Group, or VCWG, has the purpose to align the RBM partners on best practices to reach and maintain universal coverage with effective vector control interventions. To achieve this requires effective stewardship of those interventions. Hence the VCWG has a great interest in Insecticide Resistance Management (IRM). In fact, the idea for this MOOC grew out of a VCWG meeting, and much of the material in the MOOC has been developed by the VCWG membership.

It was recognised that there was a lack of capacity for IRM across much of the malaria-endemic regions. So, under the auspices of the WHO, the African Network for Vector Resistance to insecticides, ANVR, was created in 2000. The ANVR acts as a platform for networking and capacity building, bringing together national vector control programmes, research institutions and the private sector.

Lessons from agriculture

As the focus turned to IRM, the agricultural experience of insecticide resistance and resistance management came into view. Insecticide resistance had been recognised as a major problem in many agricultural settings, and a large body of research had been undertaken to identify appropriate and effective Insecticide Resistance Management programmes. Such IRM strategies are widely deployed by farmers around the world. Whilst there is much that can be learnt from the agricultural experience, nearly all agricultural IRM strategies rely on the availability of insecticides from multiple mode of action classes. At the turn of the millennium, whilst the ANVR, and others, started to strengthen networks and build capacity for IRM, there was still a lack of tools to effectively implement these strategies.

An impasse broken

To help address this impasse, the Innovative Vector Control Consortium, IVCC, was formed in 2005. The IVCC is a Product Development Partnership (PDP) and was originally established through a grant from the Bill and Melinda Gates Foundation to the Liverpool School of Tropical Medicine. By bringing together partners from industry, academia, and the public sector, they facilitate, and accelerate, the development of novel and improved public health insecticides. With a number of notable successes, the IVCC has expanded its activities to further support, and build capacity for, the evaluation of new vector control insecticides, interventions, and paradigms.

In 2012, after consultation with many experts and stakeholders, the WHO published an authoritative document on IRM, the Global Plan for Insecticide Resistance Management in Malaria Vectors (GPIRM). The GPIRM was more than just a textbook – it was a call to action to recognise the real threat of insecticide resistance, and to take steps to address it.

Collaboration and partnership

The fight against malaria has come to be characterised by collaboration and partnership. Another good example of this is the Zero by 40 partnership. In collaboration with the IVCC and the Bill and Melinda Gates Foundation, some of the world’s leading agricultural companies have come together to collaborate toward the development of innovative vector control tools, with the aim of eradicating malaria by 2040. With a commitment to reaching zero malaria, and to the stewardship of insecticide-based interventions, the Zero by 40 partnership also strongly promotes IRM.

With these and numerous other groups and organisations supporting the development of malaria vector control tools, and actively promoting and addressing insecticide resistance management, one would think that the problem would be solved. Indeed, as a direct result of their funding, activities, and interventions, sustainable malaria vector control is in a far better position than it could have been. However, their vision for, and commitment to, sustainable malaria vector control, and ultimately malaria elimination, needs the vision, collaboration, and commitment of all of us to finally reach this goal.

Author: Mark Hoppé