Global plan for insecticide resistance management in malaria vectors

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Part 2Collective strategy against insecticide resistanceFigure 21: Features that could be included in insecticide resistance monitoring plansContextCurrent capabilityChoice of sentinel sitesVector control and insecticide resistance in the country (including overview of available data); inventory of pesticideuse in agriculture and public healthAssessment of current insecticide resistance monitoring capability in country (people with capacity in entomology,epidemiology, statistics and information technology, field collection, laboratory work, transport, test equipment,insectaries, collaborating research institutes)Criteria used for stratification and for choice of sentinel sites; GPS coordinates of sentinel sitesEntomologicalmonitoringBasic entomological monitoring: vector species,distribution, seasonality, behaviourKey activitiesInsecticideresistancemonitoringQuality ofinterventionsand coverageInsecticide resistance monitoring: insect susceptibility,resistance mechanismsOperational quality of and coverage rates for indoorresidual spraying and insecticide-treated nets, e.g. decayrates after spraying to assess performanceDetailed plan of type and frequency ofmonitoring to be undertaken, includingmethod and reporting time frameMonitoringinsecticide useInsecticide use: inventory and disposalCapacity-buildingDetailed plan for capacity-buildingData interpretationPlan for data interpretation and analysisFunding of vector control programme should include orbe conditional on an entomological monitoring plan.Budget and resourcesDissemination andreportingDecision-makingDetailed budget of activities and plan for resource mobilization (human, financial, infrastructure)Data dissemination plan (e.g. summaries, newsletters, graphs, maps)Data reporting among districts, provinces, national programme, regional networkPlan for incorporation of monitoring results into decision-making (strategy to be adjusted on the basis of datacollected) and inter-sectoral coordination, including decision bodies.From the WHO Global Malaria Programme, based on reference (14), Global Fund tool for strengthening monitoring and evaluation systems and on interviews.Other indicators should be part of a broader plan for monitoring and evaluating malaria control but will also be used for IRM decision-making.Link vector control funding to the design and implementation of themonitoring insecticide resistance plan.To ensure successful monitoring of insecticide resistance, fundingof wide-scale vector control should be conditional on a plan forsuch monitoring.B. Build and maintain national capacity to collect andinterpret data on resistance.Enable national malaria and vector control programmes to guidemonitoring.In order to ensure routine monitoring in a country, the nationalmalaria and vector control programmes or the relevant nationalauthority must be responsible for and guide IRM activities.In order to assume responsibility for monitoring insecticideresistance, national malaria and vector control programmesor another authority must acquire the capability to overseedata collection efficiently, including adequate entomological,epidemiological, statistical and information technology capability.For example, all programmes must have at least one chiefentomologist and ideally one entomologist in each region orprovince of large countries. The entomologists will work witha team of trained technicians and auxiliary staff, who can beemployed internally or by partners (e.g. research institutes) tocollect data on insecticide resistance in the field.58GLOBAL PLAN FOR INSECTICIDE RESISTANCE MANAGEMENT IN MALARIA VECTORS (GPIRM)
Examples of regional entomological capacity-building.Entomological capacity for the collection and interpretation of datamust be built in order for national malaria control programmes totake appropriate decisions on IRM. Each country has a differentsituation, which must be addressed differently. Entomologicalcapacity-building has been approached in two main ways bycountries and regions: strengthening the capacity of the nationalmalaria control programme; and forming partnerships withacademic and research institutions. Both strategies have beensuccessful. Ideally, capacity should be built for entomologicalsurveillance broadly; however, when such capacity is nonexistent,building capacity for monitoring insecticide resistance could bean important entry point.National capacity-building can be supported by regionalcoordination networks. For example, Roll Back Malaria vectorcontrol working groups can be used, in addition to regional andsubregional networks. Donors can also support capacity andinfrastructure to monitor insecticide resistance. For example,the PMI and the Bill and Melinda Gates Foundation (through the‘Filling the gap’ project as described below) support capacitybuildingfor monitoring insecticide resistance in several countries.Partnerships with research institutions.Partnerships with national research institutions can be mutuallybeneficial for developing entomological capacity. In the WHOAfrican Region, each of the seven countries that are part of the‘Filling the gap’ project have formed partnerships with nationalresearch institutions. As a result the cost and logistical challengesof building entomological capacity were significantly reduced fornational malaria control programmes, as the research institutionsalready had experts and facilities. This capability was supplementedby the procurement of adequate equipment and laboratory suppliesfor molecular differentiation of vector species, identification ofinsecticide resistance mechanisms and testing tools.Strengthening the capacity of national malaria controlprogrammes.Although strengthening the capacity of a national malaria controlprogramme requires more investment and consideration thanpartnering with research institutions, it can yield beneficial results.In sub-Saharan Africa, the African Network for Vector Resistanceto Insecticides has played a role in capacity-building. It hasprepared frameworks and protocols for resistance surveillanceand management for its member countries and has supportedthem in collecting and publishing information on insecticideresistance in Africa. It has also fostered collaboration betweencontrol programmes and research institutes at national andinternational levels and, with WHO, has organized training inentomology in many countries.The WHO Eastern Mediterranean Region has invested heavilyin building entomological capacity to support national malariacontrol programmes, following a Regional Committee resolution 1to establish a Regional MSc course in entomology and vectorcontrol. Investment in the MSc course, established in collaborationwith the Blue Nile Institute, Gezira University (Sudan), the LondonSchool of Hygiene and Tropical Medicine, the Liverpool School ofTropical Medicine (United Kingdom) and Witwatersrand University(South Africa), has produced a large cadre of vector controlprogramme staff (80 people have been trained over the past3 years), who can be relied upon to collect and interpret data onresistance in their respective countries to assist decision-makingin vector control. Similarly, in the WHO African Region, about300 national technicians have been trained, although to a morebasic level than through the MSc course in the WHO EasternMediterranean Region.Many other training and diploma courses have been conductedin the WHO Eastern Mediterranean Region. In the WHO WesternPacific Region, training and diploma courses in integrated vectormanagement have been organized for insecticide resistancemonitoring in the context of both dengue and malaria. Asthe recommendations of the GPIRM for IRM strategies areimplemented, capacity in entomology and vector control and itsflexibility in all the WHO regions will be a key asset.Example of capacity-building in Sudan (5).Having invested in capacity-building in entomology andvector control, Sudan has established a strong entomologicalsurveillance system. The system includes monitoring forinsecticide resistance at 74 functional sentinel sites in 12 ofthe 15 provinces of the country once or twice a year. Thereare at least two entomologists in each province, supportedby a core team of 14 entomologists at central level to guidevector control decisions. Although this capacity building requireda significant investment, it rapidly yielded benefits. Monitoringrevealed insecticide resistance in many provinces, leading localdecision-makers to modify their vector control plans to introduceinsecticide rotations to manage emerging resistance.Key considerations in strengthening national capacity.• When establishing courses, institutions must develop aunique curriculum, which is tailored to the needs of vectorcontrol programmes, and which has a practical, field-basedcomponent. Admission criteria should take into accountpractical experience in control programmes as well asacademic background.• Monitoring and reporting of insecticide resistance must besystematic and organized so that the data can be used mosteffectively (e.g. to identify ‘hot spots’ of resistance).• Any capacity-building initiative should include a mechanismfor engaging WHO and the national ministry of health infollow-ups with district teams to monitor progress, sharepractical experience and best practices.1 Fifty-second Session of the Regional Committee for the Eastern Mediterranean (2005), ResolutionEM/RC52/R.6 on Integrated vector management59
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WHO Global Malaria ProgrammeGLOBAL
Page 4 and 5:
Navigating the GPIRMExecutive summa
Page 6 and 7:
ContributorsThe Global Plan for Ins
Page 8 and 9: Elissa Jensen, United States Presid
Page 11: ForewordThe past decade has seen un
Page 15 and 16: 1.3 Potential effectof resistance o
Page 17 and 18: 2.2 Country activitiesPillar I. Pla
Page 19 and 20: PART 3 TECHNICALRECOMMENDATIONSFOR
Page 23 and 24: PART 1THE THREAT OFINSECTICIDE RESI
Page 25 and 26: Attributes of the four classes of i
Page 27 and 28: 1.2 Status ofinsecticideresistance1
Page 29 and 30: 1.2.2 Resistance is widespread and
Page 31 and 32: Figure 7: Insecticide-resistance me
Page 33 and 34: The operational impact of resistanc
Page 35 and 36: Case study 2. Experimental hut tria
Page 37 and 38: Figure 12: Genetic heritability dri
Page 39 and 40: Figure 14: kdr West and kdr East mu
Page 41 and 42: Monitoring of insecticide resistanc
Page 43 and 44: Figure 15: Impact of insecticide re
Page 45 and 46: Figure 16: Potential applications o
Page 49 and 50: PART 2COLLECTIVE STRATEGYAGAINST IN
Page 51 and 52: Overview of the strategy against in
Page 53 and 54: 2.2.1 Pillar I. Plan and implement
Page 55 and 56: Step 2: Design an IRM strategy.Prin
Page 57: Figure 20: Recommendations for moni
Page 61 and 62: Establish a strong intersectoral bo
Page 63 and 64: Standardized data format and timely
Page 65 and 66: New products to supplement IRM stra
Page 67 and 68: Currently, WHOPES addresses only pr
Page 69 and 70: The practical issues in implementat
Page 71 and 72: Adequate, sustainable human and fin
Page 73 and 74: The overall cost increase is due to
Page 75 and 76: 2.5.3 Financial cost of monitoring
Page 77: Obvious parallels can be drawn betw
Page 80 and 81: Part 3Technical recommendations for
Page 89 and 90: PART 4NEAR-TERMACTION PLAN4.1 Role
Page 91 and 92: • Convene experts to review new s
Page 93 and 94: Figure 32: What should we do over t
Page 95 and 96: Technical support to countries• P
Page 97 and 98: Global database• Malaria-endemic
Page 99 and 100: Within 1-2 years.Accelerated fundin
Page 101 and 102: 24. Ranson H et al. Pyrethroid resi
Page 103 and 104: First steps in malaria vector contr
Page 105 and 106: Vector control remains the single l
Page 107 and 108: Annex 2 Long-lastinginsecticidal ne
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Annex 3 History of insecticideresis
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in many countries, will improve und
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Annex 5 Example of ‘tippingpoint
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Role of other factors.Recent studie
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Annex 8 Main hypotheses usedto mode
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Figure A8.2: Estimated impact of in
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Combinations.How do combinations wo
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Figure A9.2: Incremental annual cos
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Annex 10 Genetic researchagendaBack
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Table A11.1: Cost of indoor residua
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References.1. United States Preside
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Global plan for insecticide resistance management in malaria vectors

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