Plicy updates n Malaria Vectr cntrl Side event n DDT at the 7th COP Geneva, 5 May 2014 1
Crdinating Internatinal Investments in Malaria Vectr Cntrl GPIRM 2012 2013 Maintain and prmte up-t-date evidence and cnsensus-based recmmendatins, nrms and standards fr malaria vectr cntrl; and Stimulate the develpment and testing f new vectr cntrl technlgies, tls and guidelines 2013 2013 2
Malaria Plicy Advisry Cmmittee (MPAC) MPAC prvides independent strategic advice and technical input t WHO fr the develpment f plicies related t malaria cntrl and eliminatin. 3 Established in 2011, inaugural meeting Feb 2012 Appinted by WHO Directr General fr 3 -year terms, renewable nce 15 members with a brad range f expertise and prfessinal affiliatin Current chair: Dr Kevin Marsh Seven meetings t date Next meeting Nvember 2015 in Geneva Assciated dcuments available n GMP website. All meeting reprts published in the Malaria Jurnal. MPAC grups TEG: VCAG & VCTEG: and ERG cnvened n limited perid
Vectr Cntrl Technical Expert Grup Tpics reviewed in 2014 Cmbining IRS and LLINs: guidance endrsed by MPAC in March Sund management f ld LLINs: recmmendatins endrsed by MPAC in March GPIRM implementatin update: nte reviewed by MPAC in Sept 2014 Cntrl f residual malaria parasite transmissin: guidance nte reviewed and endrsed by MPAC in Sept 2014 4
Recmmendatin: Cmbining IRS with LLINs Limited evidence that cmbining IRS with LLINs in areas f high LLIN cverage reduce malaria burden Cntrl prgrammes shuld deliver either IRS r LLINs at high cverage and high standard (quality) and nt as a means t cmpensate fr the deficiencies in the implementatin f the primary interventin IRS and LLINs can be cmbined when managing insecticide resistance - using nn-pyrethrid IRS Prgrammes that are currently implementing bth shuld evaluate the effectiveness f the tw interventin evidence is needed http://www.wh.int/malaria/publicatins/atz/wh-guidance-cmbining-irs_llinsmar2014.pdf 5
Recmmendatins: Cntrl f Residual transmissin 1. NMCPs in cllabratin with research institutins shuld generate lcal evidence n the magnitude f the prblem f residual transmissin f malaria, including infrmatin n human and vectr behaviur, and interventin effectiveness. 2. Industry and their partners are encuraged t develp new vectr cntrl tls t address residual transmissin. Resurces will be needed t supprt develpment, evaluatin and implementatin f such tls. 3. Natinal regulatry authrities shuld ensure that registratin prcesses supprt the rapid availability t the lcal market f validated new vectr cntrl prducts. 6
Update: implementatin f the GPIRM in malaria vectrs The Glbal plan fr IRM (GPIRM) was launched in May 2012, as a cllective strategy t tackle IR. Resistance particularly t PY has since increased at an alarming rate, evidence emerging frm sme areas indicating IR is cmprmising effectiveness f VC. Sme prgress made: 1) enhancement in capacity and resurces fr insecticide resistance mnitring, 2) establishment f glbal and reginal IR databases, and 3) develpment f new IRS frmulatins with extended efficacy, and 2 nd generatin PBO+ PY LLINs. But adptin t plicy and peratinal implementatin at cuntry level have been pr due t a lack f plitical, with majr financial, human and infrastructural resurce deficiencies. Urgent effrts needed t ensure crrect use f existing interventins and availability f new tls t maintain the effectiveness f malaria VC. WHO is nw cnducting a cmprehensive situatin analysis in rder t develp a glbal respnse plan. 7
Recmmendatin: Larval Surce Management in Sub- Saharan Africa (April 2012) Anti-larval measures are likely t be cst-effective fr malaria cntrl ONLY in settings where the vectr breeding sites are: a) few, b) fixed and c) findable. In sub-saharan Africa:- Larviciding measures shuld never be seen as a substitute fr ITNs r IRS in areas with significant malaria risk; mst likely t be cst effective in urban areas, include areas with a shrt transmissin seasn, cl temp extending the duratin f immature stages, breeding sites that are man-made & hmgenus; In rural setting larviciding is nt recmmended unless there are particular circumstance limiting breeding sites and evidence cnfirming such measure can reduce malaria incidence. Key challenge: cntinued prmtin f larviciding in ptentially inapprpriate settings Guidance n mnitring and evaluatin f LSM in cntrl and eliminatin settings 8
WHO Glbal Strategic Framewrk fr IVM Defined IVM as a strategy t imprve the efficacy, cst-effectiveness, eclgical sundness and sustainability f disease vectr cntrl A multi-disease cntrl apprach and systematic applicatin f a range f interventins, ften in cmbinatin and synergistically. T facilitate effrts t implement IVM fr disease vectr cntrl, WHO develped Cre structure fr training curriculum n Integrated Vectr Management (WHO, 2012); Guidance n plicy develpment fr Integrated Vectr Management (WHO, 2012) Handbk fr Integrated Vectr Management (WHO, 2012); Mnitring and Evaluatin Indicatrs fr Integrated Vectr Management (WHO, 2012). A tlkit fr Integrated Vectr Management in Sub-Saharan Africa 9
WHO Psitin Statement n DDT WHO recmmends DDT nly fr Indr Residual Spraying. Prvided that the guidelines and recmmendatins f WHO and the Stckhlm Cnventin are all met, and until lcally apprpriate and cst-effective alternatives are available fr a sustainable transitin frm DDT. Cnditin fr use f DDT shuld be 1) Evidence based (susceptibility t lcal msquites), and prper IR mnitring plan 2) Reprted t WHO and Stckhlm Cnventin 3) Standard peratin prcedure fr safe use and handling, regulatin t avid leakage and misuse f pesticide http://whqlibdc.wh.int/hq/2011/who_htm_gmp_2011_eng.pdf 10
Vectr Cntrl Technical Expert Grup Tpics fr review in 2015 Guide fr testing LLIN with claim f efficacy against substantive pyrethrid resistance Guidance n where it is nt safe t scale-back vectr cntrl cverage after malaria transmissin has been reduced. Glbal Insecticide Resistance Respnse plan 11
Vectr Cntrl Advisry Grup VCAG was established in 2012 t review evidence n new paradigms and technlgies fr vectr cntrl It is expected this prcess will shrten the time frm develpment t deplyment f newly validated vectr cntrl tls fr cntrl f malaria and ther vectr-brne diseases. T date, this expert grup has reviewed 16 submissins Established 8 new paradigms fr vectr cntrl 12
Vectr Cntrl Advisry Grup In Feb 2014, VCAG assessed the paradigm Vectr cntrl prducts fr use in areas f high insecticide resistance Prttype claim = the PBO + pyrethrid LLIN increase msquit death and decrease human infectin in areas f high pyrethrid resistance VCAG reviewed evidence and supprted prttype claim f increased bi-efficacy f PBO + pyrethrid LLIN cmpared with pyrethrid nly LLIN where msquites have metablic resistance mechanisms. But where d yu deply PBO + Pyrethrid nets cnsidering hetergeneity and cmplexity f resistance? 13
Expert Review Grup.1 Operatinal cnsideratin fr deplyment f Pyrethrid + PBO LLIN with imprved efficacy in areas with substantive pyrethrid resistance Due t the cmplexity f pyrethrid resistance (frequency, intensity and mechanism), it is still unclear under which cnditins deplyment f these nets is justified n the basis f increase effectiveness against malaria and/r fr applicatin in a resistance management strategy. Grup will review evidence that PBO nets can reduce malaria cases under specific scenaris f transmissin and PY resistance Define scenaris under which PBO nets are predicted t be mre cst effective alternative t standard LLINs Review meeting planned fr July 2015 14
Expert Review Grup. 2 Evidence review n the use f Ivermectin t prevent r reduce malaria transmissin Ivermectin MDA fr cntrl f Onch, LF and ther helminth. It als kills msquites TOR Determine the expected level f ivermectin impact n malaria transmissin Define the target prduct prfile (TPP) f ivermectin as a malaria transmissin blcking tl Identify evidence gaps and define apprpriate studies t address these gaps Determine ivermectin clinical and regulatry develpment path fr malaria deplyment 15
Cnclusin In additin t peratinal cnstraints, vectr cntrl is faced with tw majr threats insecticide resistance and vectr behaviur r residual transmissin While waiting fr new tls and as natinal capabilities are built, there is a strng need t ensure that the impact f current tls is maximized WHO has created relevant plicy mechanisms and has develped apprpriate plicy and technical guidelines in respnse t these needs In rder t have desired impact n malaria, brader malaria partnership is required t supprt cuntries t translate WHO plicies and guidelines int actin at the cuntry level. 16
Thank yu All dcumentatin n the WHO malaria website www.wh.int/malaria/publicatins 17