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.”

IVCC receives £12 million from the UK Department for International Development (DfID) to develop the next generation of public health vector control tools.

IVCC has been awarded £12 million over the next five years by the UK Department for International Development (DfID) to support the development of new insecticides to combat malaria.
This is part of the UK Government’s commitment to combating diseases that place an enormous burden on the world’s poor. £138 million will go to nine product development partnerships for the development of new tools to treat, control and ultimately eliminate some of the world’s deadliest diseases, including malaria.

International Development Secretary, Justine Greening, said, “The development of new technologies is vital if we are to improve the health of the poorest people through better treatment and prevention, and avoid the unnecessary deaths of children. Working together in product development partnerships, the public and private sectors have a chance to bring together their expertise for the benefit of millions of the world’s poorest and most vulnerable people.”

The CEO of IVCC, Dr Nick Hamon commended DfID for its investment in saving lives amongst the poorest people. ‘This support from the UK government is vital to sustaining the enormous gains that have been made over the past 10 years in preventing malaria through effective vector control tools. Insecticide treated bednets and indoor residual spraying have proved to be very effective at reducing deaths and illness from malaria, but increasing resistance to existing insecticides puts these gains at risk.

With this support from DfID and other major partners such as the Bill and Melinda Gates Foundation, IVCC will move to the next phase in our development of the first new public health insecticides in 30 years. This novel chemistry will play a major part in bringing to an end this entirely preventable deadly disease which kills hundreds of thousands of children annually, devastates families and keeps countries poor.’

Since it was formed in 2005 IVCC has worked with some of the world’s leading agrochemical companies to identify new active ingredients that will form the basis of totally new insecticides for malaria prevention, and ultimately help to bring about the eradication of the disease. Companies partnering with IVCC have recently introduced two new insecticide formulations that prolong the effective life of current interventions and are proving to be valuable additional tools for malaria prevention.

The World Health Organization Pesticide Evaluation Scheme (WHOPES) has issued a recommendation for a new polymer-enhanced, long-lasting Indoor Residual Spray for malaria vector control. This deltamethrin based spray was jointly developed by Bayer CropScience and IVCC (the Innovative Vector Control Consortium). It represents a viable cost-effective alternative to DDT for malaria control programs. Market introduction across Sub-Saharan Africa and other malaria endemic areas is expected to occur during 2014 once relevant national regulatory approvals are in place.

Since 2007, Bayer CropScience has been working with its partners in IVCC to develop longer lasting indoor residual spray formulations and new active ingredients to manage insect resistance in malaria vector control. The new polymer-enhanced formulation of deltamethrin offers a residual effectiveness of six months. The World Health Organization (WHO) has recognized this unique formulation as having a longer residual lifespan than any other pyrethroid insecticide formulation.

“The success of the international community’s goal of eradicating malaria globally depends ultimately on new ideas and innovation,” said Dr. David Nicholson, Head of Research & Development at Bayer CropScience. “Our long-lasting indoor-residual spray is an effective malaria intervention. As a global innovation and market leader in vector control, we will continue to work closely with IVCC to foster the introduction of new vector control tools for public health.”

“We are delighted to have met this important research milestone in our collaboration with Bayer CropScience”, said Nick Hamon, CEO of IVCC. “This collaborative achievement illustrates the progress which has been made on the original objectives to deliver effective and affordable vector control interventions. I look forward to further successful outcomes from the IVCC partnership with Bayer CropScience.”

There are many countries in Sub-Saharan Africa where the transmission period for malaria can be longer than six months. In these situations, when indoor residual spraying is regarded as an appropriate intervention, a product with longer-lasting efficacy can be very important, reducing the frequency of spraying required and saving considerable costs for malaria control programs.

All insecticide sprays for malaria control are required to be evaluated and recommended by the WHO for effectiveness and safety. Until now the only product formally recognized to have residual effectiveness exceeding six months has been DDT. However, as a Persistent Organic Pollutant (POP), the production and use of DDT is strictly restricted.

Syngenta and IVCC collaboration delivers new long-lasting insecticide formulation, Actellic® 300CS, now recommended by the World Health Organization to fight insecticide resistant mosquitoes.

Syngenta and IVCC are proud to announce that The World Health Organization Pesticide Evaluation Scheme (WHOPES) has granted a formal recommendation for the use of Actellic® 300CS in malaria vector control. The WHO recommendation opens up additional opportunities for more malaria control programs around the world to access this new long lasting insecticide formulation designed for the control of pyrethroid resistant mosquitoes.

Syngenta believes that people deserve to live their lives uninterrupted by mosquitoes and the diseases that they can transmit. Syngenta has a rich pipeline of insecticides and access to advanced delivery technologies and consequently has been providing leading edge solutions on mosquito control for decades.

Mosquitoes have evolved to survive a number of the existing control products and this threatens the effectiveness of disease prevention programs. IVCC is a product development partnership committed to working with industrial partners to accelerate the development and introduction of new tools to meet these challenges. Syngenta and IVCC have had a long standing collaboration to accelerate and enrich the innovation pipeline for mosquito control.

The development of Actellic 300CS was initiated in 2007, not only to control resistance to the pyrethroid class of chemistry, but also deliver longer lasting performance to facilitate greater program efficiency in spraying programs. Since then, the WHO Global Plan for Insecticide Resistance Management recommends the deployment of non pyrethroid products when programs are looking for technology to complement mass distribution of long lasting insecticide treated mosquito nets.

Syngenta used their expertise in microencapsulation technology to create Actellic 300CS, which is designed specifically for residual spraying. Numerous independent trials have demonstrated at least 9 months residual performance on a range of household surfaces, a significant improvement over current alternatives. Trials have also demonstrated control of pyrethroid resistant strains in both Anopheles and Culex species of mosquitoes.

This unique combination of controlling pyrethroid resistance with proprietary long lasting technology provides the opportunity for malaria control program managers have a greater impact on malaria as part of their integrated control program. Long lasting performance allows for reduction of spray program costs through moving to just one application per season whilst also managing pyrethroid resistance. This is essential when long lasting insecticide treated nets are currently dominated by this class of chemistry.

Actellic 300CS is the first commercial product to exit the IVCC pipeline, and this important WHO recognition meets one of Syngenta [MSB1] and IVCC’s commitments to provide access to new technology in disease endemic countries. More than a million people are now estimated to be protected by Actellic 300CS and production has been scaled up to support all key markets.

This development is just one step on the journey to develop new solutions to controlling mosquito-borne disease, and more alternatives are urgently needed, especially in the fight against growing insecticide resistance. Syngenta and IVCC continue to collaborate on the development of the next generation of insecticides, which will provide a robust solution to future insecticide resistance and equip malaria control programs with the tools they need to defeat malaria.

For more information on Actellic 300CS or Syngenta products please contact: vector.control@syngenta.com

Footnote: Actellic is a registered trademark of the the Syngenta Group companies

Syngenta and IVCC collaboration deliver new long-lasting insecticide formulation, Actellic® 300CS, now recommended by the World Health Organization to fight insecticide resistant mosquitoes