With mosquito resistance to older generation insecticides growing, malaria scientists have had to develop alternative technologies. But how can we ensure effective new products get to market?
Vector control technologies that use new and more effective insecticides have been in development since growing insecticide resistance among mosquitos contributed to the stalling of the global malaria response in 2015. These technologies, such as bed nets, indoor sprays, and sugar baits, bring renewed hope against the threat of resistance, but only if the products actually reach the people who need them.
Dr. Tom McLean, Director of Access at the Innovative Vector Control Consortium (IVCC) outlines the “Four As” strategy for getting new malaria technologies to market, and the access barriers people face.
Getting products to market – the Four As
Successfully developing a new healthcare product for malaria control relies on four factors to ensure the product is accessed widely. It must be available, affordable, acceptable, and adopted.
Any product must be safe for both humans and animals, and it must clearly demonstrate its effectiveness through rigorous trials. Once the manufacturers who develop these products have established their safety and efficacy through the regulatory and policy process, they need to scale up manufacturing and distribution to reach the populations in need of them.
Malaria control technologies are mostly used in resource-limited settings. This means that high-priced interventions are simply not affordable to the people who would benefit the most from them. Suppliers need visibility on long-term demand to set prices, while procurers need assurance of long-term affordability. Innovative finance tools, such as volume guarantees, can also help to reduce the risks that both sides face.
People will only use a product – no matter how good the clinical data – if they understand its benefits and it is easy and comfortable to use. Awareness raising and education are critical to bringing a new tool to a community and driving acceptance, but the process begins at the development stage as scientists must understand what people are prepared to do.
Topical repellents are an example of the importance of acceptability. They are effective and are affordable, but people don’t want to cover their bodies with an oily repellent three times a day, so their use is limited.
Purchasers need to be aware of the products that are available to them and the evidence that these products would have cost effective impact in the communities they serve. Pilot implementations in the countries most in need can provide local examples of best practice and improved impact which helps to overcome inertia in the local decision making and procurement systems.
All of these require collaboration with many partners. Partnerships between manufacturers, global procurers and national governments through to smaller civil society groups and community health workers are essential in getting BASF’s next-generation mosquito nets to market and part of the global drive to achieve zero new malaria cases by 2040.
Getting products to people
Once a product achieves the four factors above and is being procured by a country’s ministry of health, or a global purchaser, it needs to be distributed to communities. But what are the challenges of getting tools like nets into communities who need them? Tom explains the key hurdles and how to overcome them.
- Procuring enough of the product to meet demand
Getting this right requires reliable demand data and thorough modelling. It also requires assurance that funds are in place to meet the demand.
- Tailoring to local epidemiological and community needs
Different tools are needed in different places within a country. Therefore, product distribution needs to be planned geographically and regionally, based on local data about the epidemiological and ecological environment rather than a blanket national approach.
- Overcoming logistical challenges
Some malaria-endemic areas are logistically difficult to get to, especially for large heavy trucks carrying goods on dirt roads. Logistics and transport must be appropriate for the location in need of the product.
- Mobile populations
Many communities are mobile in their lifestyle, both moving home for prolonged periods of time, and commuting daily for work. The demands of being nomadic and travelling for work create barriers to providing populations with vector control technologies. Products must be delivered when people are in, and static technologies such as indoor sprays would have to be repeated at different addresses.
- Emergency and conflict situations
Many malaria outbreaks are seen in emergency and conflict situations, with efforts to provide malaria control hampered by the fragility and hostility. Coordinated responses must involve working with local partners who can assist with navigating the complexities of humanitarian crises.
How COVID-19 has affected access to malaria control technologies
In many countries, the malaria response has remained resilient in the face of COVID-19. Very early in the pandemic, the World Health Organization gathered key malaria partners to work together to ensure there was no collapse in malaria control. They collected data about the effects of COVID-19 on the malaria response and mobilised to counteract them.
Previously, bed nets were distributed from centralised locations that were accessible to as many people as possible. People could collect their bed nets at their convenience. Since COVID-19 and lockdown restrictions, in-country implementers are delivering bed nets to people’s homes. This has been widely successful and ensured bed net distribution has stayed at pre-pandemic levels.