IVCC's is a Product Development Partnership (PDP) dedicated to finding innovative approaches to preventing vector-borne diseases by directly targeting the vector, which transmits the disease. Where vector control has been consistently applied in the past (2000-2015), the results have been impressive, with 78% of averted clinical cases of malaria being attributed to insecticidal treated nets and Indoor Residual Spraying (IRS) [1]. IRS involves the spraying of internal walls and eaves of houses with a residual insecticide. For several months, the insecticide will kill mosquitoes and other nuisance insects resting on these surfaces, preventing the transmission of parasites to people. To be effective and provide community protection, IRS must be applied to a high proportion of households in an area (usually more than 80%) and additionally, the World Health Organization (WHO) makes a clear recommendation to pre-emptively address the growing problem of insecticide resistance. As resistance spread to older insecticides, not many countries could afford a switch to the new third generation IRS product available on the market. These new insecticides are effective against pyrethroid resistant vectors, with a residual efficacy of at least six months. Coverage of IRS declined, and, in some cases, countries completely stopped their IRS programmes. Funded by Unitaid, NgenIRS was established to employ a series of market interventions to address the factors hindering wide-scale use of these insecticides. Factors including high prices, limited competition, a small and volatile market and weak evidence base on impact and cost effectiveness. NgenIRS' initiatives included product co-payment mechanism, expansion of the evidence base, improved forecasting, annual volume guarantees and increased competition. Through partnerships with manufacturers, donors, implementers and national malaria programmes NgenIRS has reversed the downward trend in the IRS market and laid the foundation for expanded coverage. Pre-emptive, annual rotation of effective insecticides with different modes of action, is now a reality to manage insecticide resistance, in line with WHO's recommendations. Thanks to this work there are now three products on the market, the median price has dropped by 37%, and partners saved US$39 million over the project period. Partners were able to avert between 4.6 – 9.2 million malaria cases and save an estimated 13,400 – 26,800 lives. NgenIRS, with PATH as evidence lead has developed a compelling evidence base. Overall, the third generation IRS, in addition to standard long lasting insecticidal nets (LLINs) resulted in a 22 – 47% reduction in confirmed cases recorded in the public health system. Compared to similar regions without IRS and collectively, results show that 3GIRS in addition to LLINs is a cost-effective to highly cost-effective public health intervention in a variety of transmission settings across sub-Saharan Africa. The NgenIRS programme demonstrated the effectiveness of market interventions in vector control and set the stage for the New Nets Project. This Project seeks to build the evidence base around nets treated with new insecticide combinations and make them a sustainable choice for countries looking for the best value for money in controlling malaria. These catalytic market shaping interventions ensure that vector control products are available, affordable, acceptable and adopted in the communities that need them most. This equitable impact of interventions amongst all people will be crucial to the eradication of malaria. |
