Next-Generation LLINs: Programmatic Implications Matthew Lynch October 26, 2015

New ITN products Synergist + pyrethroids Pyrethroids + other insecticides These next generation nets provide significant challenges that need to be addressed soon 2

Current status Two PBO nets are currently available with WHOPES interim recommendations as LLINs ERG has met to discuss PBO deployment, recommendations to countries and partners will be available shortly Other combination nets still in testing phase 3

Changing processes Lesson of recent experience is that the processes of developing and bringing new vector control tools to the market needed changing VCAG (jointly managed by GMP and NTD) is to assess the public health value “proof of principle” of new technologies i2i initiative is a multi-stakeholder platform to support the overall process of getting vector control products to the end user 4

WHO role transformation: evaluations & normative guidance WHO moving towards a pre-qualification process similar to that used for drugs in accredited GLP facilities LLIN manufacturers will test their products at such GLP facilities they select There is provision for independent oversight in the generation of data by manufacturers WHO will also review the issue of equivalence in Q1 of

Costs As global funding has plateaued for malaria control, this new technology poses a challenge: significantly higher costs for LLIN universal coverage Options are to increase vector control investments, or find ways to increase efficiency without increasing risk 6

Surveillance Targeting next-gen nets to geographic areas with insecticide resistance is one option – Requires detailed data and surveillance of insecticide resistance characteristics – Requires significantly increased technical capacity at country level to operate such a resistance surveillance system – Requires major changes to procurement and current supply chain procedures and planning 7

Targeting MPAC 2015 meeting recommended: – in most situations, discontinuing vector control confers a high risk of malaria resurgence. – In areas with ongoing local malaria transmission, the scale- back of vector control is not recommended. Question is whether there are other options to consider? Could one identify geographic areas which are “low-risk” and could be “graduated” to targeted, less expensive or cost- shared vector control interventions? Identifying areas that can potentially benefit from geographical targeting requires national capacity in disease surveillance, treatment coverage and vector control response as the need may arise 8

Challenges – Tracking performance of new nets Will key outcomes be entomological, epidemiological, or both? How to generalize data from surveillance sites to larger areas? What will be the geographic level of intervention? – Country capacity for surveillance, targeting, tracking performance – Increasing implementation efficiency to reduce costs – Procurement changes for sub-national distribution – Maintaining incentives for innovation – Who will take lead roles in making the many changes needed? 9