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Text. Why Vector Control ?. Vector Control is one cornerstone of historic success in malaria control. Vector Control is 60% of the RBM Global Malaria Action Plan Budget! 2011 Malaria Report Reduction of >50% in cases between 2000 and 2009: 11 African countries and 32 outside of Africa.

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  2. Why Vector Control ? • Vector Control is one cornerstone of historic success in malaria control. • Vector Control is 60% of the RBM Global Malaria Action Plan Budget! • 2011 Malaria Report Reduction of >50% in cases between 2000 and 2009: 11 African countries and 32 outside of Africa

  3. Insecticide resistance is growing! • 2010 data • Already needs updating! • Increasing in • Incidence • Intensity • 100X resistance observed • Scope • All four classes • Are there really blank spaces?

  4. The resistance frequency Tipping Point strikes rapidly ! Pyrethroid resistance in Mexico exploded in 2007-2008 Tipping point theory matches the field observations.

  5. Resistance and control failure KwaZulu Natal, South Africa

  6. Recent data on resistance • Resistance is increasing in incidence and intensity! • Burkina Fasso 0% mortality to diagnostic doses of Pyrethroids and DDT. • LT50 doubled in 4 months. Now Unable to reach 50% mortality even after 10 hour exposure. • LLIN mortality of 100% on susceptible mosquitoes down to 40% on wild. • Tiassale, Cote D’Ivoire population resistant to 4 classes ! • Resistance ratios of 124 for Deltamethrin, 24 for Bendiocarb. Unpublished Data —not for circulation

  7. The impact of pyrethroid resistance on the effectiveness of insecticide treated nets against Anopheline mosquitoes: a systematic review. Authors and affiliations: Clare Strode1, Sarah Donegan1, Paul Garner1, Ahmada Enyati2 and Janet Hemingway1. 1Liverpool School of Tropical Medicine, Liverpool, United Kingdom 2School of Public Health and Health Sciences Research Center, Mazandaran University of Medical Science, Sari, Iran. Running Title: The impact of pyrethroid resistance on ITN efficacy.

  8. Insecticide Resistance is an issue for many NTDs !

  9. Challenges for Vector Control Product Development Insecticide Resistance Products for resistance management Protecting people from infection from resistant mosquitoes Managing the resistant populations Outdoor Transmission Bed nets and IRS only work inside the home Outdoor transmission is exposed by successful indoor campaigns Products that protect outside the home are required Cost of Implementation Durability Logistics Coverage User choice ‘The question is not why don't people use the products we make but why don't we make products that people will use ? Products for the Elimination Analytical Framework Pre-conditioning for MDA. EIR reduction Vector Barrier products. Targeted, Short Term, High Efficacy To be explored !

  10. Human hookworm vaccine initiative Vaccine Development Program PDPs work across different diseases and modalities Vaccine Microbicides &prevention Therapeuticproduct Diagnostics HIV/AIDS TB Malaria NTD2 Diarrhea3 Respiratory

  11. IVCC Strategic Roadmap May 2013 Spin Out Resistance Breaking Bi-treated Net Formulations Long Lasting Non pyrethroid IRS Formulations IRS Formulations Completed New Paradigms (Outdoor Transmission) New Active Ingredient Bayer Miniportfolio Crop Protection Product Development Opportunities Species and Geographical Extension New Active Ingredient Sumitomo Miniportfolio New Active Ingredient Syngenta Miniportfolio Information Systems and Diagnostics Vector Shield for Radical Cure Elimination Decision support information systems, and insecticide quantification kits spin out to delivery vehicles

  12. 4. lack of appropriate insecticides and formulations for sustainable long term IRS and LLIN programmes New insecticides • IVCC products: • Novel insecticides to overcome resistance and reduce application costs of insecticide use • Three new active ingredients to manage resistance • New long lasting formulations • Non-pyrethroid and bi-treated LLINs First new products launched in 2012

  13. Agrochemical Industry Partners

  14. Field Trials Sites

  15. IVCC Public Health Insecticides Portfolio — March 2013 LLIRS Formulation Dupont AI Library Screening Syngenta AI Library Screening Sumitomo AI Library Screening Dow/Scynexis LLIN Combination Vestergaard LLIN Combination Sumitomo Discovery Platform Bayer LLIRS Formulation BASF LLIRS Formulation Syngenta LLIRS Formulation Bayer Agricultural AI Review LLIN Combination Dupont LLIN Combination BASF Project “Venus” Akzo Nobel Crop Protection development compounds New Formulations New Active Ingredients Proof of Concept Data Mining Lead Generation Screening Lead Optimisation Development Toxicology Registration Proof of Concept Development WHOPES Phase I Phase II Phase III Country Registration Completed Active In preparation

  16. New Paradigms in vector control Stages of development of a New Paradigm in vector control • Development of intervention concept and draft TPP • Proof of concept • Verification of epidemiological efficacy and confirmation of TPP • Policy endorsement and product category adoption Examples Insecticidal Medicines Insecticidal Lotions Repellents Clothing ( Insecticidal and / or Repellent) Odour Baited Traps etc etc

  17. example of first stage requirementsDevelopment of an Intervention Concept and Draft TPP This stage is largely based on experimental work, possibly with a supporting paper or modelling exercise with key experiments to elucidate the key parameters of the model. These issues are retested at each stage with differing levels of requirement

  18. Insecticide diagnostics 2. lack of diagnostics to support quality assurance of insecticide-based products at their point of use • IVCC product: IQK • Insecticide quantification kits (IQKs) developed for • Pyrethroids • Carbamates • DDT • Organophosphates • Kits currently moving into operational use • and commercial production • South African manufacturer and distributor • has been identified and is in the • qualification stage of licensing

  19. IVCC insecticide portfolio — the global health context The current IVCC portfolio is developing the new insecticides and formulations that will overcome resistance and provide sustainable long term suppression of transmission The new analytical framework calls for transmission suppression in preparation for Radical Cure Elimination and the vector shield to protect from re-infection In the mean time we need to continue to protect the at-risk populations from the growing threat of insecticide resistance These objectives continue to call for new insecticides and further innovation in vector control

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