Vector Control Saving Lives

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saving lives

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Malaria mortality rates have declined by more than25% globally, and by more than 33% in sub-Saharan

Africa. Conservative estimates suggest that over amillion lives have been saved; many millions more havebeen protected from the harm that malaria brings aswell as the economic consequences that devastatecommunities and countries where malaria is endemic.

Much of this progress has been due to advances invector control – preventing infection is always betterthan cure. Increased protection from indoor residualspraying and the distribution of insecticide-treatedbednets has been very effective in reducing thetransmission of malaria, and has likely had impact onother insect-borne diseases.

Among the challenges facing modern malaria control,the development of resistance to insecticides byAnopheles mosquitoes in more than 60 countriesworldwide, is one of the most worrisome. If theoutstanding effectiveness of current vector controlinterventions is to be maintained, urgent andcoordinated action is required to prevent resistancefrom spreading. At the same time, there is a pressingneed for the development of new vector control tools,especially new insecticides, to meet and ultimatelyovercome this challenge.

If we do not act now, more than half of the benefitsof vector control could be lost – with devastatingpublic health consequences not only in sub-SaharanAfrica, but throughout the world. Recent episodesof West Nile Virus in the USA and cases of locallytransmitted malaria in Greece are a reminder thatvector borne diseases have no boundaries. We mustnot be complacent.

To address these issues, the WHO Global MalariaProgramme coordinated the development of theGlobal Plan for Insecticide Resistance Management inmalaria vectors (GPIRM). Launched in May 2012, theGPIRM synthesized input from over 130 stakeholdersrepresenting all the constituencies of the malariacontrol community and resulted in an urgent call toaction, laying the foundations for integrated insecticideresistance management practices in all malaria-endemic countries.

The GPIRM is based on five major pillars, and laysout clear actions for each pillar spanning the short,medium and long term. These include planning and

implementation of insecticide resistance management;ensuring proper, timely entomological and resistance

management and effective data management;developing innovative vector control tools; fillingthe gaps in knowledge on mechanisms of resistanceand impact; and ensuring that enabling mechanisms(advocacy, human and financial resources) are in place.

These activities call for action from a wide constituencyof actors in malaria control. IVCC has a crucial role toplay in the third pillar – developing innovative vectorcontrol tools. It has demonstrated the strength of theproduct development partnership (pdp) model in theway it has brought together stakeholders from diversebackgrounds including endemic countries, academicinstitutions, agro-chemical organisations, regulators,implementing non-governmental organisations, anddevelopment partners.

This ability to engage the right partners from bothpublic and private sectors in a clear and commonobjective of developing the tools we need todefeat malaria is essential, especially at this crucialmoment in the battle. IVCC has already developedan impressive pipeline for reformulations of existinginsecticides, and the ongoing search for new activeingredients is promising. But greater investmentsare urgently required to speed up the research anddevelopment process.

Malaria is also being tackled through the developmentof better diagnostic tests and treatments, and thesearch for a vaccine. These developments, however,are built on a foundation of universal access to vectorcontrol, which will always be central to the control andelimination of malaria.

One of the rewarding elements of being at the heartof the fight against malaria is to see how effectivewe are when we work together towards commonobjectives. That is why, knowing the reality of theenormous challenges that face us, I am both hopefuland optimistic that together we can meet the challengeof insecticide resistance, and create a world that is freefrom the scourge of malaria.

VECTORCONTROL,SAVINGLIVES

IVCC Annual Report 2011-2012 3 VCC Annual Report 2011-2012

In the last decade, there has been remarkableprogress in malaria control.

Robert Newman 03

Chairman’s Foreword 04

Chief Executve Officer’s Report 06

Product Development Roadmap 08

The Next Stages 10

Current Product Portfolio 12

Delivering New Products 14

Partnerships 16

Building Partnerships 17

IQKTM Quality Assurance 18

Monitoring Tools 20

Financial Statement 22

t h e

c h al l e n

g e

Robert Newman

c ont e nt s

Professor Janet Hemingway

Malaria mortality rates havefallen by more than

Robert Newman,

Director, WHO Global Malaria Programme

“If we do not act now, more than

half of the benets of vector control

could be lost.”

globally, mainly due to the increaseduse of insecticide treated bednets andindoor residual spraying


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VCC Annual Report 2011-2012 IVCC Annual Report 2011-2012 7

CTORCONTROL,SAVINGLIVES VECTORCONTROL,SAVINGLIVES

This year the World Health Organization (WHO)recognised the increasing importance of pyrethroidresistance in malaria vectors, with a call to action inthe form of the Global Plan for Insecticide ResistanceManagement. This describes the need to developimmediate plans for reducing the rate at whichresistance to current insecticides is developing,to maintain the effectiveness of vector controlinterventions while we await new insecticides comingonto the market.

The speed at which pyrethroid resistance hasbeen selected in African vectors has taken manyby surprise and non-pyrethroid formulations forlong-lasting insecticidal nets (LLINs) and indoorresidual spraying (IRS) are urgently needed to sustainthe gains already made from the recent scale-upof malaria control activities. The IVCC portfolio isstarting to address this issue, with a balanced rangeof collaborative projects designed to bring newinsecticide formulations to market in the next two years, and a number of projects aimed at developingnew insecticides over the next 7-10 years.

The introduction of new paradigms for mainstreamvector control to complement the IRS and LLINinterventions has now become more of a priorityfor IVCC. We have formed an External Scientific

Advisory Committee to help define the targetproduct profiles for new paradigms and ensure thatthese can be rapidly brought to market. A numberof these methods are currently undergoing trials inCambodia in collaboration with the Ministry of Healthand National Malaria Control Programme. Thesetechnologies are likely to have relevance to malariacontrol in Africa where the importance of the outdoorbiting and resting Anopheles arabiensis mosquito isincreasingly being recognised.

IVCC diagnostics and information systems projects,started six years ago, are now being put intooperational use. The early adopters of the InsecticideQuantification Kits (IQK) immediately understoodtheir value as an important tool for monitoring thequality of IRS spray activities. Initial large-scale trialsof IQK, in both Equatorial Guinea and Zanzibar,immediately resulted in repeat orders of the kits forroutine operational use. We are currently completingthe development of these kits with funding fromthe Wellcome Trust, and identifying appropriaterecommendation, manufacture and supply routes.

We are grateful for the continued support andcommitment of our funders and partners. Together wewill be able to ensure that new products for diseasevector control are developed in a timely and effectivemanner. Prevention activities can then be scaled-up andsustained over a substantive period of time to reducethe burden of infectious diseases worldwide.

The need for a Product Development Partnership

such as IVCC has never been greater.

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t oac t i on

Chief Executive Ocer’s Report

Professor Janet Hemingway,

Chief Executive Officer, IVCC


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VCC Annual Report 2011-2012 IVCC Annual Report 2010-2011 9

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Product Development Roadmap

VECTORCONTROL,SAVINGLIVES

IVCC Annual Report 2011-2012 9


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IVCC Annual Report 2011-2012 11

Chief Operating Ocer Tom McLean reects on a yearof advances and future challenges.

What has been the most exciting developmentin the vector control projects?

One of the most exciting developments over thelast year has been the launch of the WHO Global

Plan for Insecticide Resistance Management in Malaria(GPIRM). Many stakeholders in the vector control arenacontributed to GPIRM, including many IVCC partners,and GPIRM has now established the global context forthe crucial work IVCC is doing. It acknowledges thatsubstantial investment is required to develop newactive ingredients and, within its broad programme ofaction, one of the key components emphasises the needto develop new, innovative vector control tools – theheart of IVCC’s mission. It is a huge move forward for usto see this progress in creating the global environmentfor what we are doing.

How is the global recession impacting

your work?

Recession affects all of our funders and that makestheir life challenging and, as a consequence, ours

too. Raising money to underpin the vital research anddevelopment that we are catalysts for is a key part ofwhat we do, and in these more difficult times it is achallenge. As funding works on very long time scales,our funders have put in place five-year programmes,

so we do not see short terms spikes and troughs.Nevertheless, the longer-term horizon in what we canask for from our funders is more difficult now than itwas 6-7 years ago, and, at the same time, the urgencyof our task becomes more apparent.

What has been challenging withinproduct development?

Having all the technical aspects of the productdevelopment up and running with our partners,

we realised there is a significant number of issues inthe process of development that require collaborationbetween many stakeholders constituencies. These areissues such as the registration process, the method formanaging intellectual property created, and recognisingthe value of vector control products as they arrive inthe market place.

All of those points are not within the control of anyone stakeholder and so one of the big challenges of last year has been bringing together those stakeholders thatinfluence decisions on how to manage the issues.

Will there be any close partnerships with any

new companies in the next year?

We are always on the lookout for new partnersin manufacturing and distribution. And actively

seeking partners for our information systems and tools,who can take the work that we have done in creatingtechnology platforms for insecticide diagnostics, andplacing those within the market place where they canbe of maximum benefit.

Looking into the future, what are your next

plans and projects?

The crucial plan for information systems and toolsis focused around delivery. It is about getting them

from the product development stage into physicallyoperating in the market place. And for the workbased on insecticides, the next stages are really aboutconsolidating the product development portfolios, anddelivering all the plans that have been put in place, thenbuilding the infrastructure around the technical work todeliver the whole of the programme.

The next stages

“Raising money to underpin

the vital research and

development that we are

catalysts for is a key part

of what we do.”Tom McLean, Chief Operating Officer

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IVCC Annual Report 2011-2012


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Current Product Portfolio

IVCC Annual Report 2011-2012 IVCC Annual Report 2011-201213



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Delivering new products

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The new formulation not only increases the residualperformance of the insecticide, something sprayprogramme managers were keen to see, but alsoprovides an effective tool for controlling pyrethroidresistant mosquitoes in the field.

Syngenta’s Actellic CS is a longer-lasting formulationthat comes out of an IVCC programme to examinethe status of all the existing WHOPES recommendedinsecticides for IRS use and apply modern formulationexpertise to increase residual life. The new formulationmakes the insecticide more effective on morechallenging surfaces, such as traditional muds usedin house building in rural African communities,and reduces IRS programme costs by increasingthe required interval between applications. Amajor challenge was the development of a stableformulation that also delivered long lasting activity.

Syngenta’s existing insecticide formulation for IRSuse, Actellic EC, already had WHOPES approval butwas only effective for two to three months, dependingupon the type of surface and environmentalconditions. Prompted by IVCC, Syngenta exploreda range of novel formulation options leading to thesuccessful development of Actellic CS, which employsmicro encapsulation technology. IVCC organised andsupported the collaborative network of laboratory

testing sites to demonstrate the efficacy of theproduct against pyrethroid resistant mosquitoes.

Laboratory testing at Syngenta’s Stein facility, atthe Kilimanjaro Christian Medical Centre, Tanzania,and the Entomological Research Centre of Cotonou,Benin led to field trials of a number of candidateformulations in experimental huts at sites in Tanzaniaand Benin where residual life of six months or morewas demonstrated, even on surfaces such as cementand mud. Further work by Syngenta in Cote D’Ivoireprovided additional support to the project.

Welcoming the commercial release of the newformulation, IVCC Chief Operating Officer Tom McLeanacknowledged the partnership approach that deliveredthe product on time. ‘The successful development ofthis new formulation demonstrates the strength ofIVCC’s product development partnership model, whichbrings together stakeholders from diverse backgrounds,’he said. ‘We anticipate similar results both in newformulations and new active ingredients from our otherdevelopment partnerships. The current pipeline fornew product development is healthy, and in time willprovide the urgently needed tools to stop insecticideresistance spreading, with potentially devastating publichealth consequences.’

IVCC’s product development pipeline is delivering results, with its rst new non-pyrethroid insecticide formulation becoming commercially available in 2012.


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Asked to comment on the event afterwards,many stakeholders rated it as an essentialpart of their calendar – one commentatordescribing it as ‘the most important meetingfor the ‘who is who’ in vector control’.

Most stakeholders stressed the importanceof the meeting for making new contacts, andgaining valuable information about recentprogress in vector control.

IVCC takes seriously its role as a catalyst –bringing together the actors engaged in vectorcontrol – and is considering how to expandthe stakeholder days in different contexts tomake them even more inclusive, and betternetworking opportunities. One objective is tomake more contact with people working incountry control programmes.

Building partnershipsThis year saw the IVCC Stakeholder Day move from

strength to strength, bringing together private andpublic sector partners from around the world.



Last year Sumitomo, working in partnership withIVCC, initiated a search within its chemical libraries fornovel insecticide chemistry that may have potentialin the future for controlling resistant insect diseasevectors. Samples selected from Sumitomo’s chemical

compound library have already been screened and 20%of these compounds have shown a promising activityagainst adult mosquitoes. Some of these have shown alevel of biological activity – up to 90% of the referencestandard as a contact insecticide.

Diverse structural portfolios of these selectedcompounds will help provide a guide to novelpotential entities suitable for development andcommercialisation.

Noriyasu Sakamoto, Chemistry Group Manager atSumitomo responsible for this screening activitysaid, ‘Sumitomo scientists are excited about workingtogether with IVCC to fight against malaria. Webelieve that Sumitomo’s long history of public healthinsecticide discovery will contribute to achieving thisimportant mission.’

IVCC Chief Executive Officer, Professor JanetHemingway said, ‘We are delighted to have SumitomoChemical as a partner; they are a major innovator inboth basic chemistry and in bed net technology withdemonstrated long-term commitment to this market.’

New Active Ingredient Screening Project

par t ne r s h i ps

Sumitomo introduced ‘Olyset Net’ over 10 yearsago. This was the first World Health Organizationrecommended long-lasting insecticidal net (or LLIN)and it remains a highly effective weapon in the fightagainst malaria.

We recognised that, for some markets, improvementscould be made in the speed of action and efficacy

against both susceptible and resistant mosquitoes.This, coupled with reports of increased levels ofresistance to pyrethroids and concerns that this may insome cases result in operational failure, has led to thedevelopment of an LLIN containing a combination ofactive ingredients designed to work against pyrethroid-resistant malaria-transmitting insects.

Sumitomo’s partnership with IVCC has been veryhelpful in providing guidance in the complexityof evaluating such a novel type of bed net, andparticularly in generating extensive lab and fielddata in many settings and against resistant as well assusceptible strains of mosquito.

John Lucas, Global Business Development Managerat Sumitomo said, ‘It’s great to be working alongsideIVCC in this important venture. We have been reallyimpressed not only by the quality of the work butalso by the level of commitment and enthusiasmfrom the various field co-operators we have beenfortunate enough to be partnered with. There is nodoubt that this positive approach will help accelerate

the development of this innovative product, which weanticipate will be available within a few years’.

Resistance Management LLIN

Sumitomo Chemicals

“Sumitomo scientists are

excited about working

together with IVCC to

ght against malaria.” Noriyasu Sakamoto, Chemistry Group Manager


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IVCC Annual Report 2011-2012 IVCC Annual Report 2011-2012 19

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Indoor Residual Spraying (IRS) is a major controlmeasure in the fight against malaria, and has beena significant factor in the reduction of deaths fromvector-borne diseases over the past decade. The successof an IRS programme, however, depends heavily upon

spray quality, and, until now it has proved challengingto assure the quality of IRS programmes.

To solve this problem IVCC has worked with leadingresearch teams in Europe, to develop innovative newquality control technologies. Insecticide QuantificationKits (IQKTM) are chemical or enzyme-based, biochemicalassays that cover the insecticide classes mostcommonly used in IRS campaigns and can be used ator near the spray site to assess the level of insecticidepresent on the sprayed surface.

The IQK tests involve a simple sampling step followedby a vial or strip test with a sensor unit and a ‘trafficlight’ type indicator. This allows immediate visualassessment of the amount of insecticide in the sample.

Until the IQKs were developed, the only meansavailable to spray programme managers fortesting the effectiveness of spraying were testsusing live mosquitoes or high performance liquidchromatography. Both of these methods have provedimpractical or unsatisfactory.

By contrast the IQKs are cost-effective, easy to use andhave a unique ability to provide a rapid assessment ofspray team performance so that any problems can berectified promptly, whether by re-spraying, retrainingor improved supervision. The IQK technologies have

passed the “proof of concept” stage, having beenproved effective both in the laboratory and also in fieldtrials carried out as part of IRS programmes.

In Bioko Island, Equatorial Guinea, IQK field trials in2012 demonstrated that over 4000 samples fromwooden and cement sprayed surfaces matched closelywith those obtained by high performance liquidchromatography in subsequent validation experiments.The application of the IQK kit in Bioko has, for the firsttime, allowed programme managers to see exactly howtheir spray teams are performing and take immediateremedial action when issues with spraying are spotted.

Similarly, in Tanzania and on the South Pacific islandof Vanuatu, pilot studies of the different kit typeshave demonstrated that the IQK can be easily usedin the field to visually determine spray quality, withinformation rapidly fed straight back into sprayoperations. Use of the IQK in Tanzania and Vanuatu

provided valuable information for the quality assuranceof the spraying programmes, and prompted appropriateaction for improving the intervention.

IQK pilot trials have demonstrated the value of includingon-the-spot testing of insecticides in IRS operations.Following the success of these field trials IVCC is nowengaging with manufacturing and distribution partnersto ensure that IRS spray campaign managers worldwidehave ready access to these effective and convenienttools no later than the end of 2013.

A critical step on the road to eliminating Malaria is to limit infectionrates by controlling mosquito populations in aected areas.

IQK TM

Quality Assurance


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Many control programmes, however, have fragmentedor poor quality tools that are unable to efficientlyevaluate those programmes. An effective system isessential for measuring the performance of a controlprogramme, with continuous surveillance capturingreal time data, issues and programmatic decisions thatcan be made in a timely fashion.

The Malaria Decision Support System (MDSS) projectwas established with the goal of developing a rangeof advanced tools that would assist in the operationalrunning, monitoring and evaluation of a malariacontrol/elimination programme. Development of asoftware platform that could be configured for anyenvironment was completed in 2011, in partnershipwith the Dengue Decision Support System. The finalsoftware tools operate in both resource-poor andresource-rich environments and can be tailored tooperate as a single database to an integrated system,combining data from several resources, producingmaps, reports and alerts for disease outbreaks.

The software, called the Disease Data ManagementSystem (DDMS), is now facing the challenge of beingimplemented in three very different and uniquesituations, demonstrating its versatility.

In Zambia following the detection of high levels ofinsecticide resistance, the DDMS entomology module isbeing used as part of insecticide resistance monitoring.This complements the recently published GlobalInsecticide Resistance Management Plan by the WorldHealth Organization, which emphasises the essential role

of accurate recording and reporting of entomologicalindicators in disease control programmes.

A Spanish version of the software has been developedfor the Bioko Island Malaria Control Programmeoff the African coast of Equatorial Guinea. Thishighly successful programme has developed andimplemented several excellent tools for monitoring,evaluation and surveillance that has resulted insignificantly reduced levels of disease. The DDMSwill be used to allow the integration of the data fromindividual systems, and has also been configured toallow remote access by partners, allowing up-to-dateinvestigations of data sets from any location.

The Kingdom of Saudi Arabia is one of 32 countrieswith a goal of malaria elimination aimed at reducingmalaria incidences to well below 1 in 100,000 people.To achieve this they need adequate informationsystems, and the DDMS, which is currently beingArabised for their malaria elimination programme, willenable them to cover all aspects of the programmefrom interventions to tracking of individual cases anddisease outbreak alerts.

By combining the Dengue and Malaria decisionsupport system projects a unique platform has beensuccessfully developed and is now in the processof being implemented in several diverse settings.While the current implementations are for malariaprogrammes, the combination of the diseases hasresulted in a platform that will suit most vector -bornedisease control programmes.

For more information download the screencast atwww.ivcc.com/downloadables/index.htm

Monitoring and evaluation of malaria interventions and

their impact are essential for understanding the progress,challenges and success of disease control.

The Malaria Decision Support System

IVCC Annual Report 2011-2012 IVCC Annual Report 2011-2012 21

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Finance Report 2011/12

IVCC is a not for profit company limited by guaranteewith charitable status in both the UK and the US. Theannual statutory accounts of IVCC are audited byGrant Thornton UK LLP and are produced using theStatement of Recommended Practice: Accounting forCharities (SORP) issued in March 2005. This ensurescompliance under both the Companies Act 2006 andamended Charities Act 2006.

IVCC benefits from shared accounting and auditarrangements with its host institution the LiverpoolSchool of Tropical Medicine (LSTM). A finance andinvestment committee made up of senior employeesand trustees external to the organization givegovernance oversight on all financial operationsof IVCC and meet 4 times a year. A specialisttaxation service is provided externally. The team hasextensive knowledge of all major funders within thesector and the expertise to comply with all externalfunder audit requirements.

All internal audit work is carried out by anindependent external organization whose remit isto provide independent and objective assurance toadd valve and improve the organisation’s operations.This is carried out through the evaluation andimprovement to risk management, governance andcontrol processes. An audit committee exists tooversee all recommendations made.

This year saw a significant investment in upgradingthe financial reporting system to accommodate theincreasing complexity in donor reporting needs. Anequally significant investment is under way to expandthe capabilities of the research database reportingtool. This will be fully rolled out in early 2013.

Financial Audit and Governance

2011/12 saw a significant increase in programmeactivity, with total spending reaching £6.1million upfrom £4.3 million in 2010/11.

A total of £4.5 million was spent directly oncharitable project activities with a further £0.6million paid out on related project supportingactivities. Core administration support costs of £1.0million were also incurred. This represents 16% oftotal costs and will fall to 12% during 2012/13.

Several activities that are currently undertakenby senior staff within IVCC such as fund raising,advocacy, and new paradigms portfolio managementare planned to grow in importance and scope withinthe next year. This has caused IVCC to create specificroles funded by our core Gates Foundation grant todeliver those objectives and the majority of thesepositions were filled during the year.

A scaling up of research activity for 2012/13 hasbegun as the new active ingredient projects gainmomentum and this will see an increase in productdevelopment costs.

Costs for new Tools and Technologies will move ontofunding from other donors as the final tranche of theinitial BMGF award is spent.

IVCC continues to use a conservative investmentstrategy using a combination of money marketdeposits and secure US government and corporatebonds, in line with current unsettled marketconditions. Consequently, returns are low on boththe sterling and dollar funds held. The total interestreceived during the year was £36k and this will beused to fund future project activity.

Financial Performance Interest

IVCC’s current work is entirely reliant on grantfunding. Over the past few years IVCC has beenworking hard to attract new sources of funding andreduce its reliance on any one donor. As a resultof these efforts, next year will see BMGF’s fundingreduce to 81% of the total budget, down from 84%this year and 96% the year before and the number offunders expand to 8.

Funding Mix

Forecasting various long term funding and income scenarios enablesIVCC to manage its product portfolio more effectively. It alsoprovides a base analysis for fundraising activities aimed at financingthe portfolio in line with the latest projections.

Given the continuing uncertainty in the financial environmentand market conditions, it is clear that the portfolio and newpotential fundraising opportunities have to be managed even moredynamically than in the past.

The total funding required to enable IVCC to meet all of its currentobjectives up to 2022 is dominated by the new active ingredientsportfolio. Year on year funding steadily rises from 2012, peaking in 2017at $50.55 million before dropping off by 2022 at $12.97 million.

Substantial investments from the first five years of IVCC havecreated products such as insecticide combination nets, resistancemonitoring tools and insecticide diagnostics that are ready for fieldimplementation and only small investments are now needed forfield demonstration of these products.

Until now the funding of active ingredient development has beenstructured to focus on ensuring that the early stages of AI screening

and optimization are well funded in order to fill the pipeline with

enough suitable candidates to cope with the anticipated failurerates and to maximize the opportunity to find a candidate withsubstantial agricultural application that will attract high levelsof industry partner funding. The strategy has been particularlysuccessful and the technical performance of the pipeline suggeststhat 3 new active ingredients are indeed achievable if suitablefunding is forthcoming.

However, by the pre-trials development stages the funding ratefalls short of that demanded by the cost model and funding needsto be secured to take promising lead candidates to the next phase.Routes to coping with this funding rate include:

1. Increased co-funding from the partner companies (especially ifany agrochemical applications emerge).

2. Alternative donor funding.

3. High risk strategy of reducing the number of candidates in thepipeline and risk non delivery.

Efforts to tackle this shortfall are under way with the creation of anadvocacy and a fundraising position within IVCC’s core team.

Funding Requirements 2012-2022

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www.ivcc.com

“If nothing is done and insecticide

resistance eventually leads to

wide-spread failure of pyrethroids,

the public health consequences would be devastating: much of the

progress achieved in reducing the

burden of malaria would be lost.”

Professor Janet Hemingway,

Chief Executive, IVCC

Vector Control Saving Lives

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