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?

Keeping people healthy and creating prosperous communities is not only ethically sound, but also makes good business sense, said Sir Mark Moody-Stuart, Chairman of the IVCC Board of Trustees, addressing nearly 500 company leaders and executives at the Third Global Forum for Business as an Agent of World Benefit.
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After half a working lifetime in the big business world of the Ag industry, Mathias Mondy, the latest addition to the tiny IVCC core team, tells why he’s excited at the prospects ahead.

I first heard of IVCC back at its very inception in 2005 when I worked for Bayer Environmental Science. I was in charge of the marketing of public health products for Europe and my colleagues from development were already singling IVCC out as one of the most exciting Product Development Partnerships.

Maintaining an innovation stream for vector control is not a simple issue for a large company like Bayer. When you think about it:

• this is a small market in comparison to corn, soy and wheat;
• it requires specific expertise to properly formulate active ingredients as bednets or indoor residual sprays;
• commercialisation of products fluctuates according to public tenders

Fortunately, more often than not, there are people in management who understand that the impact of vector control products go well beyond simply killing mosquitoes. They enable populations to access the tools they need to protect themselves against deadly and debilitating diseases such as malaria.

All in all, I spent 17 years in the Ag industry. The more experience I gained in development, marketing and stakeholder outreach the more I was fascinated by the actual impact of our products. My key driver was demonstrating their usefulness in sustaining agriculture—lowering its environmental footprint, increasing profitability for all stakeholders, and allowing societal development through securing food access.

By joining IVCC I am putting my expertise and my industry insight at the service of a great cause: eradicating malaria.

This is a very exciting time. I was blessed with the opportunity of attending the IVCC stakeholder forum in July where I witnessed the dedication of vector control people, the renewed support for IVCC’s work from the funding community, and the ongoing work of innovators.

My first responsibility at IVCC will be to create a framework to track the advancement of our partnerships and to report transparently to our funders. This is nothing less than fulfilling our moral duty to deliver innovative and sustainable solutions to women, men and children from endemic countries and thereby saving lives.

A personal view of the Stakeholder Day 2014, by Journalist Stephen Regan

In his keynote speech toward the end of the forum Dr Alan Magill – Director of the Bill and Melinda Gates Foundation – told delegates: “I have probably the world’s shortest job description. It is two words – Eradicate Malaria. Bill and Melinda are very clear and direct in their communication.”

Dr Magill also proved clear in his communication, making a cogent, detailed case for moving away from control strategies for malaria – to eradication. Control of malaria, as we’d come to understand it over recent years, was left with very few tools and very few strategies, he told delegates.  He named some of those tools and strategies – long-lasting insecticidal-treated nets, IRS with a few different compounds, first generation malaria rapid diagnostic test, ACTs to treat sick people and a few interventions within that preventive treatment.

He acknowledged that applying the limited sets of tools at scale over the last decade or so had led to some remarkable achievements.

But he added: “This control paradigm clearly has … weaknesses.  And one of those, of course, is that these interventions really need to be applied continuously and with great vigour for a long time”.

There was no apparent exit strategy, he observed, and applying the current set of tools for a very, very long time means we will to lose the tools to resistance. That was already happening.

Dr Magill said: “We’ve used the tools … and stratagems we have, in an evolutionary incorrect and ecologically incorrect way for quite some time.”
He predicted that that would be noticed in the funding round-up for replenishment next year, and added: “Every disease, every topic, has its moment in the sun.”

He asked delegates to recognise that eradication of malaria is actually the only pathway forward and to get behind the campaign to Accelerate to Zero. He defined malaria eradication as “actually getting parasites out of people”.

Principles

Dr Magill outlined five principles: the importance of precise definitions; complete cure (as opposed to what he called “clinical cure”); tackling the transmission reservoir in asymptomatic people; think global – act local; and approaching everything we do with the fundamental precepts of evolutionary medicine and correct ecological thinking. Of that final principle he said: “Malaria is a very big, complex system. It’s got the biology, the ecology, the political and the social pieces.”

He said: “Probably 90 percent of the parasite biomass is in people who are not infected, who are not ill, who are not coming to you, and today we do nothing about these people, nothing at all.  We’re playing defence, to take an American sports analogy.  We’re just sitting back in health care clinics waiting for sick people to come to us and treat them.  We need to turn the game a little bit and go on offence and go out into the community, finding people and treating them so they can no longer transmit.

The Accelerate to Zero strategy was about complete cure, he said: about finding infected people, completely curing them and getting parasites out of the population, combined with complete prevention – i.e. effective transmission prevention. With it went the goals of preparing for the future and sustaining progress.

Dr Magill spoke of the need to create a good environment for the manufacturers who will deliver the new products needed.

He also addressed the need for entomological intelligence when trying to close transmission gaps in territories such as Cambodia, and the need to build an effective value chain in vector product development.

Finish the job

Dr Magill finished with a rallying call: “Let’s finish the job if you will.  We don’t like to get distracted by discussions about elimination and eradication. This is all about saving lives.  It’s saving lives now in sick people and it’s saving lives for ever going forward because we’re going to avert all those deaths by elimination. It’s a pure, simple equation.  We know that this is biologically and technically feasible and we think the new tools that will be developed in the next few years will make a lot of the things we’re talking about much more operational and feasible.

“We think this next decade will be an intense period of experimentation. This is about using current tools and new ways, and really thinking about that long term goal of eradication.

“We’re building an eco-system, as I call it – the eradication eco-system. As Admiral Ziemer said, we cannot do this by any one group or any one method. This really requires a big team. And putting these hubs together and finding out at the product development level, the implementation level, the political level, well, you can see that it’s actually so complex it’s even hard to imagine.

“But we know that this is essentially a group going forward, and I’ve taken the advantage here to say IVCC is a hub in the eradication eco system, and through that hub we can reach out to all the talent in the room.

“I would say that if there’s a problem out there in the vector space world, well this is the group of people to solve it.  You own it; if you don’t like it it’s up to you to change it.”

A personal view of the Stakeholder Day 2014, by journalist Stephen Regan

Early in the stakeholder forum Rear Admiral Tim Ziemer set a challenge for all delegates: “What can you do?  What can I do?  What needs to be done to focus on outcomes, to set our identities aside, to embrace the strategic plan for product development.”

In an upbeat opening speech, the ex US Navy man, who heads the President’s Malaria Initiative said: “We’re not going to be able to achieve on malaria control, sustainability and eradication without a mechanism like IVCC to facilitate developments of new tools and products needed to continue the fight, then eventually get us to elimination, so I hope it’s clear that we’re all in.”

His remarks gave resonance to a growing feeling in the malaria community – very evident during the forum – that now is the time for a focusing of efforts and a coming together.

Observing the audience at the Museum of Liverpool, Tim Ziemer said it was clear that a “unique blend of scientists, researchers, investors and programme specialists” had come together to review, renew, affirm how important it was to rethink.

He told delegates: “It’s not only about product development but also looking at ways of improving the delivery of mechanisms. It’s a difficult task – and you know what’s sobering …? Well, it’s kind of up to us; it’s up to the people in this room to actually deliver on the mission.”

Tim also told delegates: “Product development partners like IVCC have resulted in accelerating new technology development. We’re seeing more promising products in the pipeline than we ever have before.  For an investor that represents an exciting deliverable. …

“The potential to provide more value for money in a high risk, high gain and highly technical field, by leveraging funding to gain support for continued development of critical commodities to combat a disease of poverty like malaria – that reflects an effective research investment.

“We, the United States Government, look at this IVCC as an investment opportunity to leverage some of our research money for the future and we’re very pleased to be a partner.”

Tim added: “We stand within the reach of achieving the goals that we once thought were unimaginable; ending deaths from malaria and then eliminating it from the globe. The goal over the next 20 years will be to sustain and build on this effort that we’ve achieved today – and face challenges such as resistance, mosquito resistant, parasite resistance and the uncertainties around donor and national funding for malaria control.

“We’re all in this together, it’s really up to us as critical partners in the fight to do something about it.”