Shaping Markets, Saving Lives
NgenIRS progress, achievements and outlook
More countries accessing lower priced 3GIRS leads to expanded coverage
Since 2016 NgenIRS has expanded the number of countries it supports from 4 to 14. As a result of co-payments and volume guarantees, malaria programmes in partner countries have been able to procure over 4 million units of 3GIRS at $15, a significant reduction from the $23.50 starting price in 2016. Over 1 million additional units have been procured by partners outside of the co-payment mechanism at a significant discount, in return for volume guarantees to manufacturers. As a result, implementing partners have been able to procure approximately 1.7 million additional units during 2016 and 2017 (1.3 million units in 2017) and protect an estimated 15 million more people than would have been possible if they had been paying full price.
Addition of new product allows for improved resistance management through rotation while increasing competition
SumiShield® 50WG, the second 3GIRS insecticide was added to the project, after WHO PQ listing in Oct 2017. The addition of SumiShield® 50WG created much needed competition in the marketplace. Competition leads to lower prices and makes it possible for countries to implement sub-national rotation with a new class of chemistry for vector control, in line with GPIRM and national IRM strategies. In 2018 half of NgenIRS partner countries will begin rotation with SumiShield® 50WG. In addition to the currently available products Bayer’s 3GIRS product, Fludora® Fusion is currently undergoing the final stage of trials required for WHO pre-qualification and is expected to enter the market early 2019. BASF’s Sylando is also under review for prequalification.
Demonstrating the impact and cost-effectiveness of 3GIRS
For products to be accepted by countries and implementation partners, evidence on their cost-effectiveness and impact is imperative. A cluster randomized control trial, co-funded by PMI, is underway in Zambezia province, Mozambique. In addition, retrospective evaluations of the impact of IRS are being supported in Zambia, Mali, Ghana, and Uganda and will shed more light on the incremental cost and impact of IRS in these settings. Results from Mali show that in 2014, 3GIRS with Actellic® 300CS was a good public health investment. In Barouéli District more than 250,000 people were protected and over 76,000 cases of malaria were prevented. In neighbouring Bla District, where both IRS and seasonal malaria chemoprevention interventions were rolled out simultaneously, preliminary analysis suggests a combined impact of these complementary strategies. After suspending IRS in 2015 in Bla District, an area with high access to LLINs, a 70% increase in under-5-years-old malaria incidence rates was observed from 2014-2015. This was significantly greater than the change reported from Barouéli District, where incidence rates remained the same.
Planning for transition and sustainability
The project is now in the process of planning with its partners for the transition of key NgenIRS-funded activities such as country-level and Africa-wide forecast consolidation, establishment of volume guarantees to manufacturers in exchange for reduced prices and the ongoing collection of data to evaluate the impact and cost-effectiveness of 3GIRS in order to ensure continued expansion of use within a competitive and sustainable market.