3. Creating long-term resilience against malaria vectors while addressing the immediate need to suppress pathogen transmission

In: Innovative strategies for vector control
Authors:
Fredros O. Okumu Environmental Health & Ecological Sciences, Ifakara Health Institute, P.O. Box 53, Ifakara, Tanzania.
School of Public Health, University of the Witwatersrand, 1 Smuts Avenue, Braamfontein 2000, Republic of South Africa.
Institute of Biodiversity, Animal Health & Comparative Medicine, University of Glasgow, G12 8QQ Glasgow, United Kingdom.
School of Life Science and Bioengineering, Nelson Mandela African Institution of Science & Technology, P.O. Box 447, Arusha, Tanzania.

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Marceline F. Finda Environmental Health & Ecological Sciences, Ifakara Health Institute, P.O. Box 53, Ifakara, Tanzania.
School of Public Health, University of the Witwatersrand, 1 Smuts Avenue, Braamfontein 2000, Republic of South Africa.

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Recent decades of malaria control have been dominated by extensive commoditisation of frontline interventions. Bed nets, insecticides, drugs and diagnostics have been scaled up in endemic countries, preventing millions of malaria cases and deaths. Unfortunately after years of progress, such gains are stagnating or diminishing due to challenges, such as insecticide and drug resistance, sub-optimal user compliance and the high costs for supply and replacements of these commodities. Without any viable vaccines or approaches that effectively tackle the environmental basis of malaria transmission, current commodities, and in particular the insecticide-based interventions, are incapable of preventing reinfections and rebounds, especially in low-income communities. This paper discusses a transitional approach for malaria prevention, involving judicious use of current tools while gradually building long-term resilience to sustain control of important vectors. The idea should be to carefully transition from insecticide-based to non-insecticidal approaches, without losing the gains made so far against malaria. In the short and medium-term, countries may deploy evidence-driven suites of current tools, e.g. insecticide treated nets (ITNs) and indoor residual spraying (IRS), while gradually introducing improved versions, such as nets with multiple chemical ingredients and long-lasting IRS formulations to suppress transmission. Depending on local evidence, these may be supplemented with niche technologies, such as spatial repellents, endectocides, odour-baited traps or mosquitocidal sugar baits to address gaps such as outdoor-biting and pyrethroid resistance. Once this is in place, countries should establish programmes to build long-term resilience to sustain the accrued gains and prevent transmission rebounds. Examples may include: incentivising the private sector to supply high-quality commodities e.g. locally-manufactured mosquito nets, providing subsidies to promote mosquito-free dwellings for low-income families, expanding community engagement in disease control and strengthening health systems to more effectively detect and manage cases. To secure these developments, endemic countries should also establish multi-sectorial initiatives prioritising disease control beyond malaria. Examples may include environmental sanitation to reduce vectors, institutionalised health education and capacity-building on biology and control of disease, appropriate legislation to improve compliance and protect vulnerable sub-populations and longterm domestic financing for malaria control. These programmes should be supported by a strong in-country research culture to constantly identify gaps, monitor progress and seek transformative approaches with potential to accelerate progress. If integrated in the wider public health context, this phased approach could contain ongoing malaria transmission, reduce over-reliance on insecticide-based tools and minimise transmission rebounds even in poor communities.

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  • Alonso PL, Lindsay SW, Armstrong J, De Francisco A, Shenton F, Greenwood B, Conteh M, Cham K, Hill A and David P (1991) The effect of insecticide-treated bed nets on mortality of Gambian children. Lancet 337: 1499-1502.

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  • Baltzell K, Harvard K, Hanley M, Gosling R and Chen I (2019) What is community engagement and how can it drive malaria elimination? Case studies and stakeholder interviews. Malar J 18: 245.

  • Barat LM (2006) Four malaria success stories: how malaria burden was successfully reduced in Brazil, Eritrea, India, and Vietnam. Am J Top Med Hyg 74: 12-16.

  • Bayoh MN, Mathias DK, Odiere MR, Mutuku FM, Kamau L, Gimnig JE, Vulule JM, Hawley WA, Hamel MJ and Walker ED (2010) Anopheles gambiae: historical population decline associated with regional distribution of insecticide-treated bed nets in western Nyanza Province, Kenya. Malar J 9: 62.

  • Bhatt S, Weiss D, Cameron E, Bisanzio D, Mappin B, Dalrymple U, Battle K, Moyes C, Henry A and Eckhoff P (2015) The effect of malaria control on Plasmodium falciparum in Africa between 2000 and 2015. Nature 526: 207-211.

  • Bruce-Chwatt B and Zulueta J (1980) The rise and fall of malaria in Europe; a historico-epidemiological study. Oxford University Press, Oxford, UK.

  • Burrows J, Slater H, Macintyre F, Rees S, Thomas A, Okumu F, Van Huijsduijnen RH, Duparc S and Wells TN (2018) A discovery and development roadmap for new endectocidal transmission-blocking agents in malaria. Malar J 17: 462.

  • Calvo-Agudo M, González-Cabrera J, Picó Y, Calatayud-Vernich P, Urbaneja A, Dicke M and Tena A (2019) Neonicotinoids in excretion product of phloem-feeding insects kill beneficial insects. Proc Nat Acad Sci U S A 116: 16817-16822.

  • Chaccour CJ, Ngha’bi K, Abizanda G, Barrio AI, Aldaz A, Okumu F, Slater H, Del Pozo JL and Killeen G (2018) Targeting cattle for malaria elimination: marked reduction of Anopheles arabiensis survival for over six months using a slow-release ivermectin implant formulation. Parasites & Vectors 11: 287.

  • Chaki PP, Dongus S, Fillinger U, Kelly A and Killeen GF (2011) Community-owned resource persons for malaria vector control: enabling factors and challenges in an operational programme in Dar es Salaam, United Republic of Tanzania. Hum Resourc Health 9: 21.

  • Curtis CF and Mnzava AE (2000) Comparison of house spraying and insecticide-treated nets for malaria control. Bull Wrld Hlth Org 78: 1389-1400.

  • Davidson G (1953) Experiments on the effects of residual insecticides in houses against Anopheles gambiae and A. funestus. Bull Entomol Res 44: 231-254.

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