Patrick Sieyes, Head of Global Growth, Vestergaard
Pandemics like COVID-19 inevitably invite reflection on other scourges like malaria, still rampant in Nigeria and many parts of the world. Despite committed efforts by health workers, researchers, national malaria control programs, international organizations and private companies, malaria still claimed over 400,000 lives in 2019. We are left to ponder what it will take to make Nigeria – and the world – malaria-free.
COVID-19 has extracted a heavy toll on health systems globally. In Africa in particular, it is impeding the fight against malaria. Results from the Global Fund’s survey of the impact of COVID-19 on malaria programmes indicate a significant decrease in malaria diagnosis and treatment, with stockouts of antimalarial medicine for children under five years of age and the fear that the sharp reduction in malaria diagnosis might ultimately lead to an increase in mortality in 2021.
At the same time, the pandemic offers learning opportunities for malaria elimination approaches that should not be squandered. In the first instance, the COVID-19 response revealed that it is possible to innovate and rapidly deploy the most effective tools to combat killer diseases. Switching to door-to-door distribution of bednets, instead of crowded events, has been one of the effective approaches to keep COVID-19 infections at bay. Access to real-time data on COVID-19 helped shape the most effective strategies, and coordinated international efforts resulting in effective vaccines within a year. This unprecedented achievement proves that success follows when all the right stakeholders join all efforts. This should inspire us to step up the fight against malaria.
Secondly, to successfully reduce the malaria burden locally and globally, vector surveillance must be increased and strengthened. In a private-public partnership, Vestergaard, a large manufacturer of long-lasting insecticidal nets (LLINs), and the Nigerian Institute of Medical Research (NIMR) are collaborating to conduct entomological studies – originally in six states, but increased insecticide resistance required expanding this number of sentinel sites to all 36 Nigerian states. Nigeria can only benefit from locally generated data that couples vector surveillance with digital solutions to generate near real-time data that will allow threat assessment and informed decision-making based on local conditions.
In the third instance, recent gaps in quality inspection systems highlighted the importance of more robust testing and sampling of bed nets at the pre-shipment level to achieve the WHO’s 2030 malaria targets. Standards are essential to ensure that quality-assured products reach the population and continue to perform over the lifetime of the net. In the case of pyrethroid-PBO nets, systematic post-market surveillance programmes in the field are of particular importance. Manufacturers have taken different approaches to incorporate PBO synergists into net materials, leading to variability in initial PBO concentration in the different nets. The ability to release and retain PBO in the product, despite the various factors of loss throughout the lifetime of the net, is key in ensuring effective protection. There are currently no long-term field studies confirming the insecticidal activity of low-content PBO nets and post-market surveillance activities can play a critical role in closing the evidence gap and informing procurement and deployment decisions.
Finally, mutations result in insecticide-resistance, requiring innovation to move faster than the mosquitoes mutate. New chemistry takes years of research, evaluation tools need to be tailored to conditions in different geographic regions, and new products must be widely integrated into current campaigns. Rapidly mutating mosquitoes demand that tools get to market faster than ever. This can only be done through key institutions, malaria-endemic countries and the private sector working hand in hand. Collaboration and innovation will remain key until malaria is wiped out completely.