Malaria experts in Burkina Faso and DRC on the deployment of PBO LLINs

In May 2021, Vestergaard sponsored two high-level dialogues with malaria policymakers and experts in Burkina Faso and the Democratic Republic of the Congo (DRC). Burkina Faso and DRC are two countries where the burden of malaria is among the highest in the world. The two panels discussed the introduction of new generation long-lasting insecticidal nets (LLINs), focusing on the conditions for deployment of PBO LLINs in mass distribution campaigns.

The meetings gathered over 60 malaria stakeholders and included renowned scientists and members from civil society organisations such as Speak Up Africa. The forum in DRC was attended by Dr Patrick Bashizi,WHO (Moderator); Dr Benjamin Bola, the Head of State’s Advisor for Health and Wellness; Prof Eric Mukomena, the Director of the National Malaria Control Program and Mr Joseph Nkinzo, President of the National Counsel for Civil Society; among others. In Burkina Faso, attendees included a delegation from the Ministry of Health; Dr Guathier Tougri, the coordinator of the National Malaria Control Program; Dr Moyenga, a representative from WHO, leading national research institutes (CNRFP, IRSS, Nouna) and Professor Hilary Ranson from the Liverpool School of Tropical Medicine who represented the Partnership to Improve the Impact of Vector Control (PIIVEC) at the event.

PBO LLINs have become a key tool to prevent malaria in areas of pyrethroid resistance. Dr Gauthier Tougri, the Coordinator of Burkina Faso’s National Malaria Control Program, celebrated “the dawn of a new era for vector control programmes,” one where bio-efficacy data in the local context and stratification of interventions should lead to optimised vector control strategies that drive better malaria outcomes.

Speakers also highlighted the need for greater resources and attention to be devoted to the quality assurance of vector control commodities delivered in-country. “With the support of civil society, the implementation of a quality control system for vector control inputs in seven provincial health divisions by 2022 will be one of the strategic responses to improve the effectiveness of vector control,” indicated Prof Eric Mukomena, Director of the National Malaria Control Program in DRC.

In both countries, malaria is the leading cause of death and the main reason for primary healthcare visits. Burkina Faso and DRC belong to the High Burden, High impact initiative endorsed by WHO and the RBM Partnership to End Malaria. While acknowledging that new generation LLINs can help drive malaria down, Prof Hilary Ranson highlighted that Burkina Faso was a “hot spot” for insecticide resistance. Ranson insisted on the need to deploy more new tools to “stay ahead of mosquitoes’ resistance” to insecticides in order to make progress in the fight against malaria. The humble mosquito net is credited for 68% of the malaria clinical cases averted in Sub Saharan Africa between 2000 and 2015. However, its efficacy has been significantly reduced due to the rise of insecticide resistance in mosquito species responsible for the transmission of the parasite. DRC and Burkina Faso have thus prioritised the deployment of innovative PBO and dual active ingredient LLINs.

PBO LLINs have demonstrated increased efficacy against pyrethroid-resistant mosquitoes in two randomised controlled trials. The rapid loss of PBO and the heterogeneity of both the formulations and the PBO content found in various PBO LLINs on the market raised an outstanding concern during the discussions: PBO LLIN products need to provide evidence of their increased efficacy throughout their intended lifetime. The high-level discussions led to an agreement that post-market surveillance activities are required to better understand how long PBO continues to be released at the surface of the net fabric in field conditions.

Panellists also discussed residual transmission with the change of vector behaviour, the need for new resistance management strategies, the search for new chemistry and new delivery mechanisms, as well as the data requirements to support decision-making related to vector control.

The meetings were important venues for the leadership of the two countries to reaffirm the importance of malaria programmes. Dr Benjamin Bola from DRC captured this sentiment with his comment, “Malaria, which causes about 6 deaths per hour in the Democratic Republic of Congo, must be seen as a crisis and the entire national and international community must be mobilised for its eradication.”