Global plan for insecticide resistance management in malaria vectors

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Part 2Collective strategy against insecticide resistanceThe new paradigms under development fall into four maincategories:• Spatial repellents: Repellents cause vectors to moveaway from the treated space and therefore prevent bloodfeeding;• Area-wide treatments: These treatments alter genes in abroad vector population to change their traits;• Traps and targets: Baited traps attract vectors to sites thatexpose them to insecticides;• Animal treatments: Animals in frequent contact withvectors, such as cattle, are treated with an agent that isnot harmful to them but inhibits vector survival.Strengthen capacity for faster flow of new products.There is not currently a defined system for evaluating the evidencefor new forms of vector control. Therefore, WHO has proposed thecreation of a ‘vector control advisory group’ (VCAG) to make initialrecommendations regarding new vector control tools for publichealth purposes. This would apply to the development of vectorcontrol tools for both malaria and other vector-borne diseases. Thegroup would consist of experts from a range of entomological andvector control disciplines. It would help the development of newand innovative vector control tools by clarifying and acceleratingthe process by which these are recommended for, and adopted in,public health practice. One of its roles would be to consider ‘proofof principle’, i.e. whether the new intervention is effective for somedefined public health purpose and, under defined circumstances,will be useful and feasible for its intended user. Once ‘proof ofprinciple’ has been established by the group, the responsibility forspecific product assessment would pass to WHOPES.If the new tool is destined for malaria control purposes, policyrecommendations would be made by the Malaria Policy AdvisoryCommittee (MPAC) convened by the WHO Global MalariaProgramme. If, however, the new tool has been developed forapplication in the control of other vector-borne diseases, policyrecommendations would be made by the Department of Control ofNeglected Tropical Diseases (NTD) and its Strategic and TechnicalAdvisory Group (STAG) for vector-borne neglected and tropicaldiseases.WHOPES was established in 1960 to promote and coordinate thetesting and evaluation of pesticides for public health. Its globalobjectives are to facilitate the search for alternative pesticides andapplication methods that are safe and cost-effective and to designand promote policies, strategies and guidelines for the selective,judicious application of pesticides for public health. In addition, itassists and monitors their implementation by Member States. Itstesting and evaluation programme is illustrated in Figure 26.Figure 26: Four-phase testing and evaluation programme of the WHO Pesticide Evaluation Scheme (WHOPES)Application: conditions,procedure, requirementsWHOPES workinggroupWHO/FAO panel ofexpertsLaboratorySmallscalefieldstudiesLarge-scalefield studiesSpecificationsSafety, efficacy, operational acceptability, quality standardWHO guidelines:procedure, criteriaFAO/WHOmanual(specifications)From the WHO Pesticide Evaluation Scheme (WHOPES)66GLOBAL PLAN FOR INSECTICIDE RESISTANCE MANAGEMENT IN MALARIA VECTORS (GPIRM)
Currently, WHOPES addresses only products for existing vectorcontrol interventions (IRS, LLINs, larvicides, space spray productsand pesticide products for personal protection). If a new vectorcontrol tool is recommended by the vector control advisory group,WHOPES will: establish relevant testing guidelines for safety andefficacy; make recommendations on use after their safety andefficacy assessment; and develop specifications for their qualitycontrol and international trade.The Malaria Policy Advisory Committee (MPAC) and the NTD STAGwill in parallel establish the role of the new vector control tool in thecontext of malaria and of vector-borne NTD control and in relationto other interventions, respectively. For example, the MPAC woulddetermine the circumstances in which the new tool might be usedwith or instead of another form of malaria vector control. Therelations among these four groups are shown in Figure 27.Figure 27: Roles of proposed vector control advisory group (VCAG), the WHO Pesticide Evaluation Scheme (WHOPES), and theMalaria Policy Advisory Committee (MPAC)WHOPES: Standard tests todefine efficacy, assess safety,specificationsVCAG:Validated paradigmMPAC/GMP: Considers hownew tool fits among otheranti-malaria interventionsSTAG/NTD: Considers how newtool fits among other anti-diseaseinterventions for vector-borne NTDsGMP, Global Malaria Programme; STAG/NTD, Strategic and Technical Advisory Group for the Control of Neglected Tropical Diseases.The roles and interactions of these groups should be further clarified.WHOPES’ ability to respond to a growing number and new types ofproducts is critical to the success of the accelerated vector controlpipeline. This will require increasing the capacity of WHOPESby ensuring sufficient human and financial resources are madeavailable. Capacity must be increased not only within WHOPESbut also throughout the network of collaborating centres andinstitutions that conduct assessments on its behalf. Success willfurther depend on partnerships and dialogue among WHOPES,technical policy setting bodies within WHO, manufacturers, localregulatory authorities, and implementing partners.67
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WHO Global Malaria ProgrammeGLOBAL
Page 4 and 5:
Navigating the GPIRMExecutive summa
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ContributorsThe Global Plan for Ins
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Elissa Jensen, United States Presid
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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 and 58: Figure 20: Recommendations for moni
Page 59 and 60: Examples of regional entomological
Page 61 and 62: Establish a strong intersectoral bo
Page 63 and 64: Standardized data format and timely
Page 65: New products to supplement IRM stra
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
Page 109 and 110: Annex 3 History of insecticideresis
Page 111 and 112: in many countries, will improve und
Page 113 and 114: Annex 5 Example of ‘tippingpoint
Page 115 and 116: 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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For more information, please contac
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Global plan for insecticide resistance management in malaria vectors

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