There are thousands of species of mosquitoes that feed on the blood of a wide range of hosts including mammals, birds, reptiles and amphibians. Though the loss of blood seldom debilitates the hosts on which they feed, the saliva of mosquitoes can often result in an immune reaction, leading to a rash. Much more serious though, are the diseases that mosquitoes can transmit through their bites. In moving between their hosts, some mosquitoes transmit extremely harmful diseases affecting humans such as malaria, yellow fever, Chikungunya, West Nile virus, dengue fever, filariasis, Zika virus and other arboviruses.

I first became involved in research on mosquitoes and their control in 1983 when, as a final year undergraduate at the University of Dundee, I did a short research project on the biological control of the yellow fever mosquito, Aedes aegypti, using the ‘elephant mosquito’, Toxorhynchites brevipalpis. Toxorhynchites is a fascinating genus of mosquitoes with a wingspan which can exceed 12 mm. Fortunately, the large adult mosquitoes feed only on nectar and fruit juices. Better still, the larvae are predatory on other aquatic insects including other mosquito larvae.

Since the introduction of DDT in the 1940s, mosquito control programmes have used large amounts of insecticides from different insecticide classes in order to reduce or eradicate mosquito vector-borne diseases. In response to this insecticide selection pressure, mosquitoes have evolved several different mechanisms to resist their effect. The main two types of mechanisms found in mosquitoes are: mutations in the genes of the target site of an insecticide class, leading to target site insensitivity; and changes in the metabolic enzymes inside the mosquitoes meaning that insecticides are broken down before they can have their effect. It was the latter mechanism of resistance that was the subject of my PhD at the London School of Hygiene & Tropical Medicine during which I purified and characterised esterase enzymes associated with insecticide resistance in populations of the southern house mosquito, Culex quinquefasciatus, from Cuba and South America.

Whilst I continued to conduct research on mosquitoes off and on since the completion of my PhD, it wasn’t until very recently that I fully devoted my career to working on them. In 2010, I had what one might call a career epiphany moment, when I decided that I wanted to devote the rest of my working life to the control of mosquito vectors of malaria. As part of a consultancy with IVCC, I was visiting facilities in West Africa conducting vector research. One of the facilities we visited was IRSS/Centre Muraz in Bobo-Dioulasso, Burkina Faso and, during this visit, we went to a village in the Vallée du Kou where they were running a community trial on a new long-lasting insecticidal net (LLIN). As I stood outside one of the village huts, a group of children congregated to see what all of these strangers were doing in their village. We smiled at each other and waved. Then, as we left the village to drive back to town, I learnt that the number of infected mosquito bites these children received every year are in the hundreds and that malaria is the main cause of morbidityand mortalitywith children in the area. This was my motivation for wanting for wanting to join IVCC and, I’m very happy to say, I became a member of the IVCC team in December 2016.

Researchers at Duke University in the United States and UK based Product Development Partnership IVCC have proposed a new mechanism for stimulating public sector product development to fight malaria and neglected tropical diseases (NTDs). The Vector Expedited Review Voucher (VERV) is based on a similar proposal, called the Priority Review Voucher (PRV) that has been stimulating drug development in NTDs in the United States since it was first introduced in 2007.

“It’s about reducing inefficiency in the regulatory process, and using the gains to fix a market failure in product development to benefit society as a whole,” said David Ridley, a professor at Duke University’s Fuqua School of Business and part of the team proposing the voucher reward for approving new public health insecticides through the U.S. Environmental Protection Agency (EPA).

The team’s findings, “A Voucher System to Speed Regulatory Review Could Promote a New Generation of Insecticides to Fight Vector-Borne Diseases,” are published in the August edition of Health Affairs.

Nick Hamon, CEO of IVCC said: “Insecticides used in bednets and for treating homes have prevented millions of deaths from malaria and other diseases. But while the population of disease-carrying insects resistant to current treatments has grown, no new class of insecticides have been developed specifically for public health in the last 40 years because there is little profit opportunity to innovate in these markets.”

The Vector Expedited Review Voucher proposal would offer the company behind the new product an expedited regulatory review for a second, more profitable product intended to protect crops – as a way to encourage large agrochemical companies to invest in developing less profitable innovative products for public health use.

The VERV proposal is based on the system David Ridley, Jeffrey Moe and Henry Grabowski of Duke University proposed for the U.S. Food and Drug Administration a decade ago to encourage the development of treatments for neglected tropical diseases.

Congress made that proposal law in 2007. The FDA has issued 14 vouchers since that program began. They offer review of a drug in six months rather than the usual 10 months, which can make a huge difference to firms bringing a new product to market. Seven of the vouchers issued so far have been sold, fetching as much as $350 million.

“We brought a creative solution to drug development, and now we want to apply it to public health insecticide development,” Moe said.

Ridley and Moe partnered with Nick Hamon, CEO of the IVCC, a UK based not for profit product development partnership (PDP) that works to prevent the spread of malaria and other NTDs. IVCC is funded by the Bill & Melinda Gates Foundation, UKaid, USAID, Unitaid and The Swiss Agency for Corporation and Development (SDC).

“Medicines are an important tool in fighting these diseases, but they are not the only tool,” said Professor Moe. Whereas 65 percent of research and development funding for malaria was for drugs and vaccines, only 6 percent was for vector control, according to the paper. Similarly, the market for vector control insecticides is significantly less than $1 billion, while agricultural chemicals exceed $47 billion in annual sales. The development of a novel insecticide from discovery through to launch can cost between $100-$250m can take up to twelve years, making a return on investment in vector control almost impossible. Awarding a VERV gives an innovator company an opportunity to generate a financial return on an agricultural product as well as reducing the time to market of critically important products.

The Vector Expedited Review Voucher (VERV) proposal incorporates lessons learned through 10 years of the FDA Priority Review Voucher program, by proposing that ensuring that projects that gain a voucher are truly novel and will go where they’re needed.

“Not a week goes by in which we don’t discuss ways we can make the voucher review program better,” Ridley said.

Ridley, who also works with Duke’s Margolis Center for Health Policy, said he expects to see more of the vector review vouchers to be used by the companies that win them, because the industry is dominated by larger players that are less likely to sell to competitors.

“However, we might be surprised,” he said. “There could be companies we’ve never heard of that receive investor funding and develop products because of the potential value of a VERV. That’s one of the beauties of prizes like this – you don’t pick the winners in advance.”

Sumitomo Chemical and IVCC are proud to announce that Sumishield® 50WG has been prequalified by the World Health Organization (WHO).   With a brand-new mode of action chemistry for indoor residual spraying (IRS), Sumishield® 50WG represents a significant breakthrough, providing a new tool to allow program managers to rotate between chemistries and be better equipped to manage resistance.

IVCC supported Sumitomo Chemical by providing scientific advice, laboratory support as well as leading rigorous field trials to prove Sumishield® 50WG’s efficacy.

Dr. Nick Hamon, Chief Executive Officer at Innovative Vector Control Consortium (IVCC), said: “Mosquito resistance to current insecticides is threatening the huge gains made so far in reducing deaths from malaria, so we desperately need effective chemistry with modes of action new to public health to combat these resistant mosquitoes, and enable rotation with other products.  News that Sumishield® 50WG has recently obtained a WHO PQ listing is therefore very welcome and will prove to be a very valuable tool in the vector control toolbox.”

“IVCC and its partners on the Unitaid-funded NgenIRS project are looking forward to adding this new third generation indoor residual spray (3GIRS) to the toolbox of insecticides that can be supported through the established reduced pricing mechanism.  This will give African malaria programs a second affordable long-lasting insecticide to be used in rotation for resistance management.”

With a single mode of action chemistry based on the neonicotinoid insecticide, clothianidin, Sumishield 50WG gives malaria prevention programs greater flexibility when rotating with other chemistries. The formulation has proven efficacy under WHO supervised trials and continues to work effectively for up to nine months after spraying, even against highly resistant mosquitoes.

Due to a non-repellent formula, mosquitoes are exposed to SumiShield 50WG for longer, increasing mortality and reducing the chances of resistance developing. The odourless spray also has very low mammalian toxicity, doesn’t cause irritation through skin contact and won’t stain walls, which creates better acceptance by householders.

WHO figures show that nearly half the world’s population is at risk of malaria and despite great gains madea drop in both incidence and mortality rates in recent years, there are over 200 million new cases every year. Increased prevention and control measures have led to significant gains, but these are under threat due to insecticide resistance, which affects 75% of countries with ongoing transmission of the disease. Rotating insecticides is one of the key strategies for avoiding resistance, however nearly 87% of affected countries are failing to do this, largely due to a lack of alternative chemistries to choose from.

For further information on the WHO Prequalification of SumiShield, visit : http://www.who.int/entity/pq-vector-control/prequalified-lists/sumishield50wg/en/index.html

IVCC is pleased to announce that it has secured partnership role on a recently granted contract to Abt Associates to reduce the burden of malaria across Africa.

IVCC is part of a five-year, $472 million contract awarded to Abt Associates, under the Prevention of Mosquito-Borne Diseases through Vector Control IDIQ, by The United States Agency for International Development (USAID) through the U.S. President’s Malaria Initiative (PMI).  Through this contract, Abt Associates will support PMI and USAID to plan and implement an integrated vector control approach with the overall goal of reducing the burden of malaria in Africa.

As a partner, IVCC will be responsible for advising on the Indoor Residual Spraying (IRS) and other vector control product development pipeline and the timing and availability of products for trials and pilot launches.

IVCC will also be responsible for building and negotiating Public Private Partnerships with manufacturers of new vector control technologies and will, in partnership with Abt Associates and industrial partners, lead the planning and project management of the late stages of product development launch.  Through its relationship with Innovation to Impact (I2I), IVCC will also assist in managing products through the WHO/pre-qualification and policy recommendation review processes.

Nick Hamon, CEO of IVCC said: “Since 2000, Africa has seen major reductions in morbidity and mortality from malaria, primarily due to investments in vector control interventions.  IVCC will be able to leverage its expertise in integrating best practices and innovative solutions in the field of product development, product introduction, design of sustainable approaches to vector control and resistance management.”

“Through our partnership with Abt, this project gives IVCC increased connectivity to the market place and an additional route for testing new interventions which will further support our Access programmes.”