Vector Control: Never has the pipeline of new products been so rich.but.. Nick Hamon PhD WHO PQ, Copenhagen September 2018
IVCC: A Product Development Partnership for Vector Control IVCC is a Product Development Partnership (PDP) investing donor funds in R&D to overcome barriers to innovation in vector control. We facilitate the development and delivery of novel and improved vector control tools and solutions in challenged markets to combat the rapidly growing problem of insecticide resistance Addressing market challenges Innovator community expert support De-risking innovation Technical project and product management platform R&D political outreach Impact driven Broad non-
Vector control using LLINs and IRS accounts for most of the malaria burden reductions achieved since 2000 Shrinking Malaria Map 2000 2015 Malaria deaths globally fell from 839,000 in 2000 to an estimated 446,000 in 2016. The WHO African Region accounted for 91% of all malaria deaths in 2016, followed by the WHO South East Asia Region (6%). Last December, we noted a troubling shift in the trajectory of this disease. The data showed that less than half of countries with ongoing transmission were on track to reach critical targets for reductions in the death and disease caused by malaria. Progress appeared to have stalled. The World malaria report 2017 shows that this worrying trend continues. in some countries and regions, we are beginning to see reversals in the gains achieved
Vector control is a central supporting element of the WHO Global Technical Strategy
Sources of Suitable Chemistry Are Drying Up Innovation, product development and market access historically comes from the agrochemical industry as repurposed insecticides Rapidly declining numbers of insecticide R&D Based manufacturers Limited number of insecticide classes / modes of action in agriculture Physical and chemical properties of insecticides needed in agriculture are often different to those needed in vector control New modes of action needed for Insecticide Resistance Management
Malaria is at the crossroads Regress (status quo) Maintain the gains Elimination Eradication 2040 6
A great deal of focus on vector control tools and technologies in the past few years
A wide range of options are available to prevent transmission Which are deployable at scale, affordable and truly decreasing malaria burden?
Current vector control tools and technologies
Exploration of vector-control technologies is a rich area of research Never has the pipeline been so rich.but the promise is also fragile and high risk Product Development Valley of Death Cost of Goods Environmental Safety Mode of action Toxicology Efficacy 10 8 6 4 2 0 Implementation Cost Safety Regulatory IP Speed of action Spectrum Resistance status End User Suitability Ability to Manufacture
Which intervention, cost and impact: We have a great deal more to learn! Topical repellents Crude estimated $$ cost per person protected per year Treated clothing Indoor aerosols Space spraying Auto-dissemination Targeted IRS Outdoor Barrier Larval Source Eave Tubes LLIN ATSB Gene Drives However.. Compliance? Acceptance? Resistance? Length of protection? Robustness? Distribution cost? Need for additional intervention(s)? Length of protection? Personal, community protection or both? Product Development Investment Support / maintenance costs Impact Market innovation 0 10 20 30 40 50 60 70 80 90 100 11
Diverse range of emerging technologies
Diverse range of emerging technologies Solid Evidence of Impact Emerging
Diverse range of emerging technologies Solid Evidence of Impact Emerging
Diverse range of emerging and high potential technologies All categories Insecticides?
IVCC Product Developing Pipeline of Insecticides Application Technology Appl.Eq. XLLIRS ATSB New Product Classes for Malaria Novel a.i.s 4.5 million chemical compounds Repurposed a.i.s 27 classes identified existing insecticides classes class optimisation leads class selection different MoA different MoA New Dual LLIN New LLIRS Choosing Chemistry Established Product Classes for Malaria IRM Best Practise ATSB Novel a.i. IRS Identify and Engage Partners PolyZone Actellic CS SumiShield Interceptor G2 Sylando? Fludora Fusion Olyset Duo? Dual a.i. LLIN 2005 2008 2013 2017 2020 2024 2027 +3 years if Epidemiology
Diverse range of emerging and high potential technologies 25 Mali 2017: Outdoor Entomological Inoculation Rate per Month 20 15 10 5 0 JUL AUG SEP OCT NOV DEC ATSB CONTROL
USAID Zika Grand Challenge PoC projects being supported by IVCC BITE-PREVENTION PROJECTS Transfluthrin sandals Metofluthrin emanator BIORATIONAL INSECTICIDE PROJECTS Chromobacterium AUTOMATED TRAP AND ENHANCED LURE PROJECTS VectorWEB Human Scent Mimic Transfluthrin emanator Electronic Mosquito Barrier RNAi insecticide (larvicide) RNAi insecticide Intelligent trap and mobile application (Automated sensor on trap) Targeting Zika but potentially applicable to all mosquito-borne diseases including malaria and NTDs
Diverse range of emerging and high potential technologies Addressing where breeding sites are few, fixed and findable
Diverse range of emerging and high potential technologies
Genetic Approaches - Gene Drives, Wolbachia, Sterile Male. High potential, high cost, high risk
Building the Eradication Toolbox Individual Products Toolbox of Interventions High Transmission Higher impact Lowest probability Mode of Action IRM Rationale Novel Active Ingredients Repurposed Chemistry Existing Tools and Technologies Formulation and Efficacy Integrated Vector Management Cost of AI Cost of intervention Flexibility Timeline Toxicology Regulatory and Approval Probability of Success Market Access Lower Transmission Lower impact Highest probability
Layering of vector control interventions for high and low transmission settings Low transmission settings Geographic areas where transmission rates are low to moderate, sustained and well-managed application of currently available tools may be sufficient to achieve local elimination Moderate transmission settings New interventions that target predictable features of the biology/ecologies of the local vectors High transmission settings Transformational new interventions that significantly reduce the vectorial capacity of wild populations will be needed, ideally implemented with a one-time application with a long-lasting impact, such as genetic modification that impacts vectorial capacity of the wild vector population. Pyrethroid Resistance (<90% mortality) Dashed lines = no pyrethroid resistance Solid lines = pyrethroid resistance Keep on going as we are: standard LLIN Maintain gains: standard LLIN+LLIRS standard LLIN+ATSB LLIN with new AI LLIN+ XLLIRS Accelerate to zero: LLIN+XLLIRS+ATSB Figures are intended to be illustrative and not predictions for a particular location. Assume no seasonality in transmission and falciparum malaria transmitted by Anopheles gambiae s.s.
Accelerating to Zero Innovation must go beyond products alone
Innovation must go beyond products alone A pragmatic approval process that partners with innovators
Innovation must go beyond products alone Capacity building in country
Innovation must go beyond products alone Novel application and formulation technology approaches Improving formulations Increasing accuracy of application Train operators to maximize impact
Innovation must go beyond products alone A way to pay for innovation
Innovation must go beyond products alone Vector Expedited Review Voucher (VERV) a PRV for vector control.
Innovation must go beyond products alone Support for evaluating novel tool Public Health Value and market introduction
Innovation must go beyond products alone Support for evaluating novel tool Public Health Value and market introduction
Innovation must go beyond products alone Support for evaluating novel tool Public Health Value and market introduction
Innovation must go beyond products alone A complete rethink of what partnership and collaboration means?
The economic and social impact of eradication by 2040 on agricultural households in Africa?
Accelerating to Zero. So.what else?
We must address orthodoxies and basic biology questions: Orthodoxies - Widely shared and deeply held beliefs that may be holding us back
Understanding where else should we look for transformational innovation. Completion by end 2018
We must use the right metrics to measure impact and take the appropriate level of risk? ITN development took 19 years from start to scale up Approximately ~1 million lives at stake each year in the late 1990's People treated or people impacted?
We know that novel interventions are saving lives Market-shaping intervention to support PMI (leader IRS), GFPRs & other implementers expand coverage with 3GIRS Mali It is estimated that NgenIRS- Burkina Faso Ethiopia supported IRS campaigns in Ghana Benin Zambia Uganda Rwanda Zimbab we Kenya Tanzania Mozambique Malawi Madagascar 12 countries in 2017 averted between 960k and 1.92m cases of malaria and between 1,820 and 3,640 deaths, mostly children
Thank you for your time and attention