Vector Control: ‘Never has the pipeline of new products been so

rich’….but…..

Nick Hamon PhDWHO PQ, Copenhagen | September 2018

Building Partnerships Creating Solutions Saving Lives

IVCC is a Product Development Partnership (PDP) investing donor funds in R&D to overcome barriers to innovation in

vector control.

We facilitate the development and delivery of novel and improved vector

control tools and solutions in challenged markets to combat the rapidly growing

problem of insecticide resistance

Addressing market challenges

Technical project and product management platform

Innovator community expert support

R&DImpact driven Broad non-

political outreach

IVCC: A Product Development Partnership for Vector Control

De-risking innovation

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Vector control using LLINs and IRS accounts for most of the malaria burden reductions achieved since 2000

‘Last December, we noted a troubling shift in the

trajectory of this disease. The data showed that less than

half of countries with ongoing transmission were on track to

reach critical targets for reductions in the death and disease caused by malaria. Progress appeared to have stalled. The World malaria report 2017 shows that this

worrying trend continues. …in some countries and regions,

we are beginning to see reversals in the gains

achieved’

Shrinking Malaria Map2000 – 2015

Malaria deaths globally fell from 839,000 in 2000 to an estimated 446,000 in 2016.

The WHO African Region accounted for 91% of all malaria deaths in 2016, followed by

the WHO South East Asia Region (6%).

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Vector control is a central supporting element of the WHO Global Technical Strategy

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Sources of Suitable Chemistry Are Drying Up

Innovation, product development and

market access historically comes from

the agrochemical industry as repurposed

insecticides

Rapidly declining numbers of insecticide

R&D Based manufacturers

Limited number of insecticide classes / modes of action

in agriculture

Physical and chemical properties of

insecticides needed in agriculture are often

different to those needed in vector

control

New modes of action needed for Insecticide

Resistance Management

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Malaria is at the crossroads

6

Regress (status quo)

Maintain the gains

Eradication 2040

Elimination

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A great deal of focus on vector control tools and technologies in the past few years

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A wide range of options are available to prevent transmission

Which are deployable at scale, affordable and truly decreasing

malaria burden?

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Current vector control tools and technologies

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Exploration of vector-control technologies is a rich area of research‘Never has the pipeline been so rich’….but the promise is also fragile and high risk

0

2

4

6

8

10Efficacy

ImplementationCost

Safety

Regulatory

IP

End UserSuitability

Ability toManufacture

Resistancestatus

Spectrum

Speed of action

EnvironmentalSafety

Cost of Goods

Toxicology

Mode of action

Product Development

Valley of Death

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Which intervention, cost and impact: We have a great deal more to learn!

0 10 20 30 40 50 60 70 80 90 100

Gene Drives

ATSB

LLIN

Eave Tubes

Larval Source…

Outdoor Barrier…

Targeted IRS

Auto-dissemination

Space spraying

Indoor aerosols

Treated clothing

Topical repellents

Crude estimated $$ cost per person protected per year

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However…..Compliance?Acceptance?Resistance?

Length of protection?Robustness?

Distribution cost?Need for additional intervention(s)?

Length of protection?Personal, community protection or both?

Product Development InvestmentSupport / maintenance costs

ImpactMarket innovation…

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Diverse range of emerging technologies

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Diverse range of emerging technologies

Solid Evidence of Impact Emerging

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Diverse range of emerging technologies

Solid Evidence of Impact Emerging

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Diverse range of emerging and high potential technologies

All categories

Insecticides?

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Choosing Chemistry

IRM Best Practise

4.5 million chemical

compounds

27 classes identified

class optimisation

class selection different MoA

New LLIRS

New Dual LLIN

existing insecticidesclasses

leads different MoA

2005 2008 2013 2017 2020 2024 2027

Identify and Engage Partners PolyZone

Actellic CS

Novel a.i.s

Repurposed a.i.s

SumiShieldInterceptor

G2Fludora Fusion

+3 years if Epidemiology

IVCC Product Developing Pipeline of Insecticides

Novel a.i. IRS

Dual a.i. LLIN

ATSB

XLLIRS

Appl.Eq.

Established Product Classes

for Malaria

New Product Classes for

Malaria

ATSB

Olyset Duo?

Sylando?

Application Technology

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Diverse range of emerging and high potential technologies

0

5

10

15

20

25

JUL AUG SEP OCT NOV DEC

Mali 2017: Outdoor Entomological Inoculation Rate per Month

ATSB CONTROL

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USAID Zika Grand Challenge PoC projects being supported by IVCC

Transfluthrin sandals

Transfluthrinemanator

Metofluthrin emanator

Electronic Mosquito Barrier

RNAi insecticide

BITE-PREVENTION PROJECTS

VectorWEB

Intelligent trap and mobile application

Human ScentMimic

AUTOMATED TRAP AND ENHANCED LURE PROJECTS

Chromobacterium

RNAi insecticide (larvicide)

BIORATIONAL INSECTICIDE PROJECTS

Targeting Zika but potentially applicable to all mosquito-borne diseases including malaria and NTDs

(Automated sensor on trap)

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Diverse range of emerging and high potential technologiesAddressing ‘where breeding sites are few, fixed and findable’

Building Partnerships Creating Solutions Saving Lives

Diverse range of emerging and high potential technologies

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Genetic Approaches - Gene Drives, Wolbachia, Sterile Male….High potential, high cost, high risk

Formulation and Efficacy

Mode of Action

Cost of AI

Toxicology

Flexibility

High TransmissionHigher impact

Lowest probability

Lower TransmissionLower impact

Highest probability

Building the Eradication Toolbox

IRM Rationale

Integrated Vector Management

Cost of intervention

Regulatory and Approval

Timeline

Market Access

Probability of Success

Novel Active IngredientsRepurposed Chemistry

Existing Tools and Technologies

Individual Products Toolbox of Interventions

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Layering of vector control interventions for high and low transmission settings…

Figures are intended to be illustrative and not predictions for a particular location. Assume no seasonality in transmission and falciparum malaria transmitted by Anopheles gambiae s.s.

Dashed lines = no pyrethroid resistance Solid lines = pyrethroid resistance

Maintain gains: standard LLIN+LLIRS

Accelerate to zero:LLIN+XLLIRS+ATSB

LLIN with new AI

standard LLIN+ATSB

LLIN+ XLLIRS

Keep on going as we are: standard LLIN

Pyrethroid Resistance

(<90% mortality)

Low transmission settingsGeographic areas where transmission rates are low to moderate, sustained and well-managed application of currently available tools may be sufficient to achieve local elimination

Moderate transmission settingsNew interventions that target predictable features of the biology/ecologies of the local vectors

High transmission settingsTransformational new interventions that significantly reduce the vectorial capacity of wild populations will be needed, ideally implemented with a one-time application with a long-lasting impact, such as genetic modification that impacts vectorial capacity of the wild vector population.”

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Accelerating to Zero’Innovation must go beyond products alone

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Innovation must go beyond products aloneA pragmatic approval process that partners with innovators

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Innovation must go beyond products aloneCapacity building in country

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Innovation must go beyond products aloneNovel application and formulation technology approaches

Improving formulations Increasing accuracy of application

Train operators to maximize impact

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Innovation must go beyond products aloneA way to pay for innovation

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Innovation must go beyond products aloneVector Expedited Review Voucher (VERV)…a PRV for vector control.

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Innovation must go beyond products aloneSupport for evaluating novel tool ‘Public Health Value’ and market introduction

Building Partnerships Creating Solutions Saving Lives

Innovation must go beyond products aloneSupport for evaluating novel tool ‘Public Health Value’ and market introduction

Building Partnerships Creating Solutions Saving Lives

Innovation must go beyond products aloneSupport for evaluating novel tool ‘Public Health Value’ and market introduction

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Innovation must go beyond products aloneA complete rethink of what partnership and collaboration means?

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The economic and social impact of eradication by 2040 on agricultural households in Africa?

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Accelerating to Zero’….

So….what else?

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We must address orthodoxies and basic biology questions: Orthodoxies - Widely shared and deeply held beliefs that may be holding us back

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Understanding where else should we look for transformational innovation….

Completion by end 2018

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We must use the right metrics to measure impact and take the appropriate level of risk?

ITN development took 19 years from start to scale up Approximately ~1 million lives at stake each year in the late

1990's

People treated or people impacted?

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Market-shaping intervention to support PMI (leader IRS), GFPRs & other implementers expand coverage with 3GIRS

Mali

Ethiopia

Kenya

Ghana

Rwanda

Tanzania

Mozambique

Zambia

Benin

Madagascar

Uganda

Zimbabwe

Burkina Faso

Malawi

It is estimated that NgenIRS-

supported IRS campaigns in

12 countries in 2017 averted

between 960k and 1.92m

cases of malaria and

between 1,820 and 3,640

deaths, mostly children

We know that novel interventions are saving lives

Thank you for your time and attention