In January of this year I attended the launch of the new WHO-UNICEF report on malaria, which was held in a packed committee room in the UK Houses of Parliament, a suitable venue for such a significant event. The report summarises the remarkable progress made in the last 15 years in reversing malaria mortality and incidence, with global malaria cases falling by 37 percent and death rates by nearly 60 percent – equivalent to more than 6.2 million malaria deaths averted.
Coinciding with this launch was the publication of a paper in the journal Nature by Bhatt et al, that sought for the first time to estimate accurately the contributions to the reduction in disease burden the main malaria control interventions have made namely insecticidal net and sprays and curative drugs.
The paper was welcomed by Sumitomo Chemical after having been at the forefront of designing and manufacturing malaria control interventions for the last 20 years, developing the first in category Long Lasting Insecticidal Net (LNs) – The Olyset® Net.
Bhatt and co-authors concluded that long lasting insecticide treated nets (LNs) were “by far the most important intervention across Africa” and accounted for an estimated 68 percent of the declines in Plasmodium falciparum (malaria) infection prevalence in the last 15 years. Indoor residual sprays (IRS) contributed to around 13 percent while artemisinin-based combination therapies (ACTs) contributed to 19 percent of the declines. So while treatment of people with ACTs is clearly important, insecticide-based vector control tools are making a huge impact (81 percent if you combine LNs and IRS). The authors stress that these contributions do not necessarily reflect the comparative effectiveness of these different interventions as both the timing and different scale that these tools have been deployed is also important. Despite that caveat, these are still impressive figures that the insecticide industry should be justifiably proud of.
While it can sometimes seem distasteful to attribute dollar values to people’s lives it is the persuasive work of health economists and others that has been so important in attracting funding to help reduce malaria and set targets for its elimination and eventual eradication. The recently published document “Action and Investment to defeat Malaria” that has been produced by the Roll Back Malaria (RBM) partnership shows that if the 2016–2030 malaria elimination goals (that are seeking to avert nearly three billion cases of malaria and save over 10 million lives) are achieved, there will be a return on investment of 40:1 globally and a staggering 60:1 for sub-Saharan Africa. Dr Fatoumata Nafo-Traoré, executive director of RBM, said recently “If we are able to reach these targets, the world stands to generate US$4 trillion of additional economic output across the 2016–2030 timeframe.”
However, while brilliant progress has been made the final miles in the malaria elimination battle will be the hardest. Malaria and its mosquito vector are tenacious and adaptable foes – we may have won one or two battles but the war is far from won. Testament to that adaptability is the rapidly growing resistance to current insecticides used to kill or incapacitate the mosquito vector. In order to defeat malaria and achieve eradication there is no doubt that we will need new insecticides (64 endemic countries worldwide report resistance to at least one class of insecticide*) and new innovative tools to deal with the changing nature of malaria transmission – as outdoor biting vectors now play an increasing role in maintaining transmission.
New tools will mean large investment; estimates to develop an entirely new insecticide range from US$200 to US$500 million in what is already a relatively small market in terms of value. The questionable case for investment is compounded still further by flat lining funding from the major donors ( Global Fund, UN , USAID), – the result is that the IRS market has not seen a new class of insecticide for nearly 40 years.
With growing resistance time is now of the essence. So industry faces a double or even triple challenge: providing expensive innovation to a low value market in order to stay one step ahead of the mosquito, to reach scale to achieve return on investment, all whilst being at the centre of a quest to eliminate the disease and therefore the market itself. So we at Sumitomo Chemical concluded that we needed innovation, but also rapidly scalable innovation to deliver health impact fast.
Sumitomo Chemical are therefore proud to launch SumiShield50WGTM, a new mode of action indoor residual spray this year alongside a novel matrix release larvicide product Sumilarv® 2MR also due to market in 2017, maintaining our legacy of innovation. To alleviate the difficult economic case for innovation Sumitomo Chemical screened their existing portfolio of active ingredients and managed to find two very promising candidates from the field of environmental health; Clothainidin (SumiShield) and Pyriproxyfen (Sumilarv2MR).
Field trials are showing up to seven months efficacy even against resistant mosquitoes for SumiShield and lab trials are showing up to six months residuality for Sumilarv 2MR. We believe these two new tools alongside those from our industry partners will allow us to remain one step ahead of the mosquito to deliver humanitarian gains, health and economic growth for endemic countries but also a return on investment even in this challenging environment.
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