The continued impact of vector control intervention is dependent on sustained efficacy of insecticides. To maintain efficacy of current insecticides and new chemistries in the pipeline, insecticide resistance prevention and management is imperative.
Guidance on best practice strategies and approaches is available to national vector control programmes, but adopting and applying these recommendations in real-world situations has proven to be challenging.
Objectives and Development
ResistanceSIM is a digital simulation game for insecticide resistance management developed by Liverpool School of Tropical Medicine (LSTM) and partners, with support from the Bill & Melinda Gates Foundation via IVCC, to strengthen capacity at country level to address the gap. The tool was developed in consultation with stakeholders and malaria programmes to define learning objectives, target audiences, and the role of mathematical models in development.
VERV rewards the manufacturer of a new and novel public-use insecticide with a voucher to receive an expedited U.S. Environmental Protection Agency (EPA) registration review of a second, more profitable product with no sacrifices in safety or thoroughness. Getting this second chemistry to market faster allows the registrant the opportunity to generate a financial return to mitigate the development costs and potential losses on the first chemistry. The expedited review is valuable because it increases the speed to market of the second chemistry and acts as an incentive to invest in novel new insecticides for insect-borne diseases.
The development of a totally novel insecticide from discovery through to launch can cost between $100-$250Million and take more than twelve years, making a return on investment in vector control markets almost impossible. Awarding a VERV gives an innovator company an opportunity to generate a financial return on another product as well as reducing the time to market of critically important public health insecticides.
VERV is modelled after the Priority Review Voucher (PRV) programme (Sec. 524 2007 FDA Amendments Act) that is a proven incentive for neglected tropical diseases administered by the Food and Drug Administration (FDA) since 2008. The programme has no cost to taxpayers and the FDA recoups its review costs with a special user fee. PRV’s have been exercised by winning companies to bring a new drug more quickly to US patients and vouchers have also been sold to other manufacturers for hundreds of millions of dollars. This value to manufacturers is a needed incentive to promote discovery and development of much needed treatments for malaria and neglected tropical diseases.
After test market evaluation, ResitanceSIM was launched at the 2018 Multilateral Initiative on Malaria (MIM) meeting. The tool is currently used in custom training programmes including the Elimination 8 (E8) course to enhance understanding of insecticide resistance strategies, good practices and entomological surveillance. The E8 countries include Botswana, Namibia, South Africa, eSwatini, Zimbabwe, Angola, Mozambique and Zambia.
Other initiatives include pairing the two complimentary gaming tools dealing with insecticide resistance, ResistanceSIM and Resistance101, a simple arcade game, dealing with the fundamentals of insecticide resistance. The DMC-MALVEC project introduced the tools in four sub-Saharan African countries as part of the Horizon 2020 EU Research and Innovation Programme.
Resistance101 can be downloaded from the App store and ResistanceSIM use can be facilitated via LSTM, ETCH group.
