CASTLE ROCK, Colorado — According to a Scientific Reports journal submission in 2019 by Collins, Vaselli, Sylla and others on the topic of tropical disease and public health, malaria is still the leading cause of morbidity and mortality in the tropics. Globally, malaria caused approximately 445,000 deaths in 2016. The scholars cite that the provision of long-lasting insecticidal nets (LLINs) has significantly reduced the burden of malaria cases. However, increasing numbers of mosquito populations gaining resistance to the standard chemical composition of the insecticide in LLINs is threatening the progress on this front. In response to this growing insecticide resistance, a coalition has formed called the New Nets Project. The New Nets Project is a multi-faceted collaboration of governmental agencies, medical firms, NGOs, universities, disease experts and local community partners with a focus on eradicating malaria as a leading cause of death in sub-Saharan Africa.
Resistance to Pyrethroid
To counter the mosquitos’ resistance to the commonly used insecticide class pyrethroid, the global health community, more specifically the New Nets Project, has responded with a new insecticide. These new nets, often referred to as dual active ingredient insecticide-treated nets (ITNs), or more technically as synergist piperonyl butoxide ITNs, are a unique addition to the fight against malaria. Dual active ingredient ITNs are a second-generation approach to insecticide nets that incorporate chemical synergists (substances that effectively target resistance) and new active ingredients that kill mosquitoes resistant to pyrethroid.
A Coalition with Ambition
The necessity for new methods in fighting these growing numbers of pyrethroid-resistant mosquitoes is a pressing issue for sub-Saharan Africa, hence the formation of the New Nets Project in September 2018. The New Nets Project is a coalition of partners that span the globe including Unitaid and The Global Fund to Fight AIDS, Tuberculosis and Malaria as funding partners.
The New Nets Project has USAID and the Bill & Melinda Gates Foundation as supporting partners and industry partners BASF, a U.K.-based chemical supplier, and Disease Control Technologies, an insecticide net manufacturer. Finally, implementation partners for the New Nets Project encompass the Innovative Vector Control Consortium (IVCC), London School of Hygiene & Tropical Medicine, the Alliance for Malaria Prevention and PATH to name a few.
A Robust Body of Evidence
The New Nets Project’s goals are to assemble a robust body of evidence necessary for the World Health Organization (WHO) to propose a global health policy using these dual active ingredient ITNs. The aims of this project are to build the evidentiary basis to make the usage of these nets widespread, cost-effective and sustainable in the developing countries that need these nets the most. In 2019, the project first deployed the new nets in Burkina Faso and Rwanda; for the years 2020 and 2021 project partners added more countries for pilot programs. These more recent pilot programs have since expanded with help from PATH.
PATH (Program for Appropriate Technology in Health) is the core member of the New Nets Project “responsible for the design and implementation” of pilot program evidence. PATH has been coordinating evidence-sharing by partnering with national malaria control programs across sub-Saharan Africa, among them Burkina Faso, Mozambique, Nigeria and Rwanda. Additionally, PATH collaborates with research institutions and communicates with public health, policy and tropical disease specialists all over the globe. The result of these combined efforts is embodied in the reduction of malaria cases and the improvement of public health.
An exciting development with the newer dual active ingredient ITNs is that the new nets are already presenting promising results in the early pilot programs. Findings determined that using any form of a mosquito net (untreated nets and standard ITNs) can reduce the likelihood of malaria transmission. But, what is more exciting is that the usage of dual active ingredient ITNs in the two districts tested saw more significant reductions in malaria compared to districts solely using standard ITNs.
For instance, early trials of dual active ingredient ITNs that occurred in two districts in Mozambique, Niassa and Manica, have led to remarkable progress. Dr. Baltazar Candrinho, the project director of Mozambique’s National Malaria Control Program, reported that while the New Nets Project is still evaluating the whole body of evidence; there has been an approximate 50% reduction in malaria based on Mozambique’s official national data.
Piling on to this success, the New Nets Project reported more recently on March 25, 2022, after a two-year epidemiological trial conducted by New Nets Project partners in Tanzania. The results showed a “44% reduction in malaria incidence in children 6 months to 10 years” of age. The New Nets Project is conducting further studies in Benin and results should be available sometime in mid-2022. Expectations are that the study will be another compelling contribution to the body of work fighting to make malaria less prevalent.
– Chester Lankford