Malaria-carrying mosquitos are becoming more and more resistant to the insecticides used on bed nets, which are one of the main weapons against malaria. The Global Fund and Unitaid have joined forces to evaluate and pilot nets treated with a new combination of insecticides —a pyrethroid plus an unrelated active ingredient— that could be more effective against resistant mosquitoes.
Each organization is contributing US$33 million, and a consortium led by the Innovative Vector Control Consortium (IVCC) will lead the four-year initiative in six to eight sub-Saharan African countries. Here are three things you need to know about the New Nets Project:
1. The obstacle
The new nets could enhance the fight against malaria, but they are likely to be more expensive and the World Health Organization has yet to weigh in on their added impact on the disease above-and-beyond the current standard nets. "One of the new nets being evaluated has been prequalified by WHO as a standard long-lasting insecticide-treated nets, but it does not have a policy recommendation stating it can, and should, be used to address resistance," explains Unitaid senior technical manager Alexandra Cameron.
"Often new products reach the market, but due to their higher price and limited understanding of their added value and cost-effectiveness, they have minimal uptake. This limits public health impact and acts as a disincentive for future research and development," says Cameron.
2. The strategy
The initiative will generate the epidemiological data WHO needs to evaluate the added public health benefit of the nets. At the same time, implementers will start to pilot the new bed nets in countries, and will establish the market conditions for future deployment through increased volumes and other market-shaping activities that could facilitate price reductions.
"Through this pilot implementation, we want to prime the market and answer some operational questions, so if and when WHO recommends these nets, adoption at country level can be faster," says Cameron. Partners will conduct operational research on how to distribute the nets in the context of large-scale campaigns and look at the direct and indirect costs and benefits of new nets under a range of operational settings.
3. The partners
Another innovative aspect is the partnership with the Global Fund, which will facilitate bed net delivery and lay the foundations for scale-up as the world's largest procurer and distributor of insecticide-treated nets. The initiative also brings together four implementing partners, "each of them responsible for very distinctive activities in line with their skills and experience," says Unitaid’s Programme Manager Ana Álvarez.
Consortium leader IVCC will be in charge of market interventions such as price negotiations with suppliers and a time-limited co-payment for the nets, to absorb their likely extra cost so that bed net coverage in countries is not reduced. The London School of Health and Tropical Medicine (LSHTM) will conduct randomized control trials of the nets; Population Services International (PSI) will support the pilots, drawing on their experience in mass distribution of nets; and PATH will conduct research on cost-effectiveness.
"Here's the spirit of the project: we want to determine the additional public health gains that could be achieved with new nets. If new nets have public health value and WHO recommends them, we want to achieve these gains in countries as quickly as possible by priming the market for future deployment" — Alexandra Cameron, senior technical manager, Unitaid