New Nets Prevent 13 Million Malaria Cases in Sub-Saharan Africa

Compared to standard nets, the introduction of 56 million state-of-the-art mosquito nets in 17 countries across sub-Saharan Africa averted an estimated 13 million malaria cases and 24,600 deaths.

17 April 2024

GENEVA/LIVERPOOL – The New Nets Project, an initiative funded by Unitaid and the Global Fund and led by the Innovative Vector Control Consortium (IVCC), piloted the use of dual-insecticide nets in malaria-endemic countries between 2019 and 2022 to address the growing threat of insecticide resistance.

Anopheles mosquitoes are increasingly resistant to the pyrethroid insecticides used on standard insecticide-treated nets (ITNs). This may reduce the nets’ ability to protect people from malaria, so we must continue to develop and test new tools.

The BASF Interceptor® G2 ITNs are coated with chlorfenapyr, a new generation pyrrole insecticide, in combination with the standard pyrethroid insecticide. DCT’s Royal Guard® net incorporates a combination of pyriproxyfen and pyrethroid into the yarn of the net. Both ITNs are more effective against mosquitoes with pyrethroid resistance than standard nets are.

Between 2019 and 2022, the New Nets Project supported the deployment of 38.4 million nets across sub-Saharan Africa. In parallel, the Global Fund and PMI supported the deployment of millions of additional nets under an internal initiative (NTI). As a result, a total of 56 million mosquito nets were introduced in 17 countries across sub-Saharan Africa.

Two clinical trials and five pilot studies, delivered through the New Nets Project as well as through partner funding, found the new ITNs to improve malaria control by approximately 20-50% in countries reporting insecticide resistance in sub-Saharan Africa, compared to standard nets.

The epidemiological evidence built throughout the project led the World Health Organization (WHO) to publish new recommendations supporting the use of pyrethroid-chlorfenapyr nets instead of pyrethroid-only nets in countries facing pyrethroid resistance. WHO also issued a conditional recommendation for the deployment of pyrethroid-pyriproxyfen nets instead of pyrethroid-only nets to prevent malaria in adults and children in areas with pyrethroid resistance.

Dr. Philippe Duneton, Executive Director of Unitaid, said: “The New Nets Project has made a massive contribution to malaria control efforts, helping to accelerate introduction of next-generation bed nets – a critically important tool for reducing malaria cases and deaths. The success of this project was not guaranteed from the outset, but our collective efforts to tackle multiple access barriers simultaneously helped ensure that new nets could reach communities as quickly as possible. These partnerships will serve us well as we continue to seek out promising innovations to address challenges in the fight against malaria.”  

The additional cost per case of malaria averted using the Interceptor® G2 nets compared to a standard net ranged from $0.66–$3.56* The reduction in malaria cases and deaths from using the Interceptor® G2 nets, compared to a standard net, equated to a potential US$28.9 million in financial savings to health systems.

As the number of dual active ingredient ITNs being used increases year on year, the subsequent financial savings to the health system will also increase, underlining the long-term financial and public health benefits of this additional investment.

In addition, the operational pilots also produced a set of guidelines for how to effectively incorporate these new nets into multi-product campaigns and continuous distribution.

Peter Sands, Executive Director of the Global Fund, said: “We are delighted to see that the dual active ingredient insecticide-treated nets have demonstrated exceptional impact against malaria. The success of the New Nets Project is proof that, by fostering collaboration across global health partners, harnessing innovation, and using market-shaping approaches, we can fight insecticide resistance, make our interventions highly cost-effective and accelerate progress against malaria. Together with our partners, we will continue to invest in the insecticide-treated net innovation pipeline to avert more cases, save more lives, and get back on track towards the global malaria goals.”

Catalytic market-shaping work under the New Nets Project increased supply and demand of dual active ingredient nets, ensuring equitable and affordable access to novel vector control products for country level control programs and vulnerable populations.

UK-based social finance company MedAccess and the Bill & Melinda Gates Foundation supported access to Interceptor® G2 nets in 20+ countries by providing a volume guarantee that enabled BASF to reduce the price procurers pay for the nets. This, combined with continued efforts by partners to scale the introduction of all dual active ingredient nets as they receive WHO prequalification, will help to ensure sustainability beyond the completion of the project.

David McGuire, Director Access and Market Shaping at IVCC, said: “The catalytic market-shaping work under the New Nets Project to increase supply and demand for dual-insecticide nets laid the foundation for ensuring equitable and affordable access to these novel vector control products. The NNP has demonstrated, along with the NgenIRS project, the importance and potential impact of market interventions to ensure that the most vulnerable have access to the best vector control. Similar approaches will be critical for novel products emerging from IVCC’s development pipeline.”

The evidence built through the New Nets Project for the use of the dual active ingredient ITNs is testament to the importance of product-development and catalytic market-shaping interventions to deliver and scale up high-impact, cost-effective prevention tools that meet the needs of malaria-endemic countries.

Dr. Michael Charles, CEO of the RBM Partnership to End Malaria, said: “The findings of the New Nets Project demonstrate the value of investments into state-of-the-art tools in the fight against malaria. We always say that there is no silver bullet to eliminating malaria and we cannot rely on single interventions, but rather invest in a suite of tools, which when combined, will have the biggest impact on defeating this disease. The dual-insecticide nets are a shining example of one of these tools and the results, coupled with the savings for health systems, make the case for their continued rollout globally.”

* These calculated savings are based on end-of-project pricing and differ between locations depending on local factors including local infrastructure and scale of procurement.

For further information, please contact:

Laura Roberts, Communications Manager

laura.roberts@ivcc.com

(+44) 07849 700582

Image credit: PSI Mali

IVCC is delighted to take part in the upcoming Annual Meeting of the American Society of Tropical Medicine & Hygiene (ASTMH) in Chicago, USA from 18th to 22nd October.

David McGuire, IVCC’s Director of Access and Market Shaping, will present an overview of vector control for malaria elimination during the Alan J. Magill Malaria Eradication Symposium: Using Vector Control to Advance Malaria Elimination, on Thursday 19th October, starting at 10:15* (Grand Ballroom CDEF – Ballroom Level (East Tower)).

Led by IVCC, the New Nets Project (NNP) piloted new tools to strengthen the insecticide-treated net (ITN) market. At ASTMH, NNP Partners** will present evaluations of new, insecticide-treated net products meta-analysis of observational studies, and economic evaluations from five sub-Saharan African settings.

Supported by IVCC, Project BITE*** (Bite Interruption Toward Elimination) aims to create a toolbox of vector control products to address malaria and other mosquito-borne diseases in the Indo-Pacific Region. Hear about the most recent project findings during Symposium 43 and hear about the latest thinking when it comes to locations where traditional epidemiological data, via a randomized controlled trial or other form of study, is not practical.

Other presentations will touch on a range of IVCC projects, see the full list below. There are poster presentations, as well as oral presentations.

Sessions:
148 – Malaria – Prevention I, October 22, 2023, 08:00 to 09:45, Grand Ballroom B – Ballroom Level (East Tower). Do Attractive Targeted Sugar Bait (ATSB) stations reduce malaria burden in Zambia? First results from a Phase III community-randomized efficacy trial of ATSB in Western Province, Zambia (Abstract #7201).

158 – Mosquitoes – Epidemiology and Vector Control I, October 22, 2023, 08:00 to 09:45, Regency Ballroom C – Ballroom Level (West Tower). The IVCC supported project, iDEM presents The impact of integrated vector management on the incidence of dengue in urban Malaysia: the iDEM cluster-randomized controlled trial (Abstract #7224, presented by Tulane School of Public Health and Tropical Medicine).

162 – Malaria Prevention II, October 22, 2023, 11:30 to 13:15, Grand Ballroom B – Ballroom Level (East Tower). We recommend the full symposia and highlight the talk by IVCC collaborator, Joshua Yukich at 13:00 on Evaluation of new, insecticide-treated net products, meta-analysis of observational studies, and economic evaluations from five sub-Saharan African settings (Abstract # 7242)

Symposia:
43 – Targeting “Gaps in Protection” to Prevent Malaria in Hard to Reach Communities: A Staged Approach to Test New Vector – Control Tools, and Insights Toward Future Evaluation, October 19, 2023, 15:00 to 16:45.

Posters:
5951: Residual bio-efficacy of Attractive Targeted Sugar Bait stations targeting malaria vectors during seasonal deployment in Western province, Zambia (presented by Macha Research Trust, Choma, Zambia, October 20, Riverside Centre – Exhibit Level (East Tower) and Grand Hall GHI)

Find out more about the 2023 Annual ASTMH Meeting online, including the full conference programme, details about keynote speakers, the event’s sponsors, and exhibitors.

*All times shown are given in Central Daylight Time (CDT), the local time zone (Chicago is GMT -5h).

** NNP implementation partners are: The Alliance for Malaria Prevention, Imperial College London, LSTM, LSTMH, PATH, PSI and Tulane University. NNP Industry partners are: BASF and DCT (Disease Control Technologies). NNP Funding partners are: Unitaid and The Global Fund. The Bill & Melinda Gates Foundation, along with USAID are supporting partners.

***Project BITE partners are UCSF Global Health Group’s Malaria Elimination Initiative.