Mosquito net distribution could help halve the number of deaths from Malaria during the coronavirus outbreak in Africa, researchers say.

There are concerns that malaria control activities – such as distributing insecticidal nets – could be severely disrupted as a result of the pandemic. Writing in Nature Medicine, Imperial’s COVID-19 Response Team estimate that malaria deaths could more than double in 2020 compared to 2019. But swift action could substantially reduce the burden of malaria and prevent joint malaria and COVID-19 epidemics simultaneously overwhelming vulnerable health systems. In the article the researchers estimate the impact of disruption of malaria prevention activities and other core health services under four different COVID-19 epidemic scenarios.

An estimated 228 million long-lasting insecticidal nets (LLINs) were due to be delivered across Sub-Saharan Africa this year, more than ever before. They estimate that if these mosquito nets are not deployed and preventative chemotherapy and case management is reduced by half for six months, there could be 779,000 malaria deaths in sub-Saharan Africa over 12 months.

If prevention activities were to stop during the outbreak, the team estimates that 200,000 deaths could still be prevented over six months if treatment of malaria is maintained. The researchers recommend that routine distributions of LLINs should be prioritised alongside maintaining access to antimalarial treatment and the use of chemoprevention to prevent substantial malaria epidemics.

 “It is vitally important to get malaria prevention measures out now to reduce the pressure on health systems as COVID-19 cases increase.”

Dr Thomas Churcher, Imperial’s School of Public Health

“In the face of COVID-19 it will still be important to ensure vector control interventions continue to be deployed as much as possible in order to not only sustain the gains already made in malaria elimination but ensure we do not have a resurgence in malaria.”

Okefu Oyale Okoko, Deputy Director/Head Integrated Vector Management Branch National Malaria Elimination Programme (NMEP) Public Health Department Federal Ministry of Health Abuja

“The efforts to maintain net campaigns across Sub-Saharan Africa are absolutely vital. We know how to prevent, track and treat malaria, but the strain Covid-19 puts on health systems risks hard fought for progress. This important modelling is a reminder that efforts to end malaria sit on a knife edge. Protecting people against Covid-19 cannot be pursued in isolation. Governments must see maintaining efforts against malaria as a core part of pandemic preparedness or risk a catastrophic domino effect.”

James Whiting, Executive Director, Malaria No More UK

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For more information contact:

Stephen Johns
Imperial College London
s.johns@imperial.ac.uk

+44 (0) 20 7594 9531
+44 (0) 7792 657226

The RBM Partnership to End Malaria is leading the global malaria community in celebrating the milestone of 2 billion insecticide-treated mosquito nets (ITNs) delivered worldwide since 2004. The development and scale up of these nets are responsible for 68% of the malaria cases prevented in Africa since 2000, contributing to global efforts that saved more than 7 million lives and prevented more than 1 billion malaria cases.

A new video highlights the global collaboration it took to boost funding, pioneer, produce, and deliver the insecticide-treated mosquito nets to millions of families around the world living at risk of malaria, a preventable disease that kills a child every 2 minutes. The film follows the journey of one of the nets passed among representatives from the global malaria community including advocates, a scientist, global leaders and malaria-endemic country health workers to reach a family in Nampula, Mozambique – one of 5 countries with the highest burden of malaria. It also features a classroom of young women in Nyanza Province, Kenya, including Clementina Akinyi. Ms Akinyi, now in her last year of high school, grew up sleeping under insecticide-treated nets, and was photographed as a young child under a mosquito net – an image which became iconic for the fight against malaria.

According to the latest World Malaria Report, between 2010 and 2018, the number of pregnant women and children under 5 in sub-Saharan Africa who slept under an insecticide-treated net more than doubled, up from 26% to 61%. Key initiatives driving this progress include The Global Fund to Fight AIDS, Tuberculosis and Malaria and the U.S. President’s Malaria Initiative (PMI), which purchased and worked with malaria-endemic countries and partners to distribute 1.13 billion and 400 million insecticide-treated mosquito nets, respectively. Many other governments, notably the UK, and organisations, including UNICEF, International Federation of the Red Cross and Red Crescent Societies (IFRC), the World Bank, the United Nations Foundation’s Nothing But Nets initiative and Against Malaria Foundation, also made significant contributions to the 2 billion net milestone.

While current evidence suggests that nets treated with pyrethroid insecticides continue to be effective against the mosquito, resistance to pyrethroids – the only insecticide class currently used in ITNs – is widespread and highest in the WHO African Region. To combat insecticide resistance, partners are developing, testing and scaling up nets with new insecticide combinations and harnessing data to better target where to distribute current and new nets. At IVCC, we are leading the implementation of the New Nets Project which began in 2019 in Burkina Faso and will expand in 2020 to Côte d’Ivoire, Mali, Mozambique, Nigeria and Rwanda. The pilot project is funded by Unitaid and the Global Fund. The Bill & Melinda Gates Foundation and U.S. Agency for International Development are providing supplementary funding. And, in October 2019, MedAccess and the foundation announced an agreement with a mosquito net manufacturer to accelerate the availability of 35 million new nets. Ultimately the project and its partners seek to not only establish the necessary evidence base needed to support an appropriate policy recommendation, but to also make the new nets a sustainable choice for countries looking for the best value for money in controlling malaria.

 “The milestone of delivering 2 billion life-saving nets is a hallmark example of effective global partnership and sustained commitment over the past two decades. As we enter a new decade, we must now step up action to meet the ambitious global targets of further reducing malaria deaths and cases significantly by 2030. Political commitment and engagement from all levels of society will be crucial to ensure we reach those most vulnerable – pregnant women and children under 5 in sub-Saharan Africa – who still suffer from malaria with life-saving mosquito nets. Equally, we need to continue investing in developing, testing and scaling up nets with new insecticides and active ingredients to stay ahead of the evolving mosquito.”

Dr Abdourahmane Diallo
CEO, RBM Partnership to End Malaria

Notes to Editors

To arrange an interview with a representative for an organisation referenced in this press release, please contact the RBM Partnership press office at Grayling on RBMPartnership@grayling.com or call +44 (0)20 3861 3747.

This video marking the announcement is available for media outlets to use and share, with credit to the RBM Partnership to End Malaria. Pre-recorded interviews with the below spokespeople and case studies are also available on request.

• Dr Abdourahmane Diallo, CEO, RBM Partnership to End Malaria^*
• Marijke Wijnroks, Chief of Staff, The Global Fund to Fight AIDS, Tuberculosis and Malaria^*
• Kajal Patel, global advocate for malaria and malaria survivor^*
• Dr Ellie Sherrard-Smith, Research Associate, Imperial College London^*
• Clementina Akinyi, anti-malaria mosquito net champion

^{*Also available for further comment}

 To support this major milestone for global health and to engage in the celebration online, social media users can use #EndMalaria and #zeromalariastartswithme.

About the RBM Partnership to End Malaria

The RBM Partnership to End Malaria is the largest global platform for coordinated action against malaria. Originally established as Roll Back Malaria (RBM) Partnership in 1998, it mobilises for action and resources and forges consensus among partners. The Partnership is comprised of more than 500 partners, including malaria endemic countries, their bilateral and multilateral development partners, the private sector, nongovernmental and community-based organisations, foundations, and research and academic institutions. www.endmalaria.org

About IVCC

IVCC is the only Product Development Partnership (PDP) working in vector control. IVCC was established in 2005, through a $50million grant to the Liverpool School of Tropical Medicine (LSTM) from the Bill & Melinda Gates Foundation, and is a registered charity in the UK. We work with stakeholders to facilitate the development of novel and improved public health insecticides and formulations to combat the rapidly growing problem of insecticide resistance. We bring together partners from industry, the public sector and academia to create new solutions to prevent disease transmission. By focusing resources and targeting practical scientific solutions we accelerate the process from innovation to impact.

IVCC plays its part in a major milestone which will accelerate the availability of latest mosquito net technology for communities with greatest needs.

The joint announcement made by BASF, MedAccess and the Bill & Melinda Gates Foundation last month is a key achievement for public private partnership and reflects the commitment of organizations such as IVCC who partnered with BASF to support the development of the Interceptor® G2 nets. It also supports the objectives of the New Nets Project, co-financed by the Global Fund to Fight AIDS, Tuberculosis and Malaria and Unitaid, and led by IVCC.

IVCC worked with BASF to support the development and registration of Interceptor® G2 and this ground-breaking product represents a key achievement for the PDP model of product development and collaboration with industry.

IVCC has developed and led the NNP project to bring together the partnerships required to deliver the multiple interventions required to optimise effective scale up of this and other exciting new products.

See full announcement on the right.

IVCC is to lead a consortium of partners on a ground-breaking project funded by Unitaid and the Global Fund to bring to market new versions of insecticide-treated bed nets to fight malaria-carrying mosquitoes that have become resistant to older insecticides. It is hoped that the nets will provide a stronger line of defence against malaria for millions of people.

The New Nets Project, signed in Geneva yesterday will pilot long-lasting insecticidal bed nets treated with new insecticide combinations in sub-Saharan African countries hardest hit by malaria.

The Global Fund and Unitaid will each contribute US$33 million to the four-year project. The coalition, consisting of PATH, Population Services International (PSI) / Alliance for Malaria Prevention (AMP), London School of Hygiene and Tropical Medicine (LSHTM), with support from Imperial College London, Liverpool School of Tropical Medicine, and Tulane University, will run between 2018 and 2022.

The project will build the evidence needed to allow WHO to consider making new policy around the use of these nets and will also assess their cost-effectiveness under pilot conditions.

The production volumes procured for the pilots will help the project to negotiate significant price reductions. These reductions are needed to make the new nets a sustainable choice for countries looking for the best value for money in controlling malaria.

Nick Hamon, CEO of IVCC said; “The continued success and impact on lives saved of the NGenIRS project means that IVCC is well positioned, with its project partners, to demonstrate the public health value of new dual active ingredient bed nets and deliver radically new solutions to combat the growing threat of insecticide resistance which is prevalent across malaria endemic countries.

Unitaid’s Executive Director Lelio Marmora added: “Working with partners such as the Global Fund, we can leverage the effect of our innovations, such as new insecticides and new insecticide-treated nets,” said “Together we can make a powerful impact against malaria.”

Mosquito nets provide a physical barrier against mosquitoes and treating the nets with insecticide makes them lethal for mosquitoes that land on them. One of the most effective means of preventing malaria is sleeping under a long-lasting insecticidal net.

Mosquitoes’ resistance to insecticides threatens to undermine progress against malaria. Although the number of new malaria cases has fallen dramatically over the past 15 years, progress has recently stalled. According to the World Health Organization, there were 216 million cases of malaria worldwide in 2016, 5 million more cases than the year before.

A child dies of malaria every two minutes, although the disease is preventable and curable.

“By investing in insecticide-treated nets and other tools, the Global Fund partnership has greatly reduced the burden of malaria,” said Peter Sands, Executive Director of the Global Fund. “This project is a step toward accelerating impact by embracing innovation – with the ultimate goal of malaria elimination.”

The New Nets Project will support the WHO’s malaria goals, which aim by 2030 to reduce malaria cases and deaths by 90 percent, eliminate the disease in at least 35 countries and prevent a resurgence in countries that are malaria-free.

IVCC is leading another Unitaid-funded initiative, the US$65 million NgenIRS project, which is ushering in new long-lasting indoor residual insecticide sprays to replace less-effective older chemistries and formulations. Unitaid’s work against malaria extends to the Asia Pacific Region, where it is collaborating with the Asia Pacific Leaders Malaria Alliance (APLMA) on the Vector Control Platform for Asia Pacific (VCAP), a collaborative platform to improve access to new vector control tools.