NextGen Nets Are Needed Now More Than Ever for Malaria Elimination

By Bongo Mgeni, Charles Simba, Kanuth Dimoso and Luigi Nuñez, PSI

The global health sector currently faces unprecedented and significant supply chain constraints due to the spread of COVID-19. For the global malaria community, these challenges are making insecticide-treated mosquito nets (ITNs) and medications harder to distribute. In the face of this crisis, PSI remains committed to building sustainable local net markets—with global and local partners—in order to prevent malaria resurgence from becoming the next global health crisis.

Since 2004, PSI has distributed 392 million ITNs across 39 countries, approximately 20% of the 2 billion nets dispersed by the global malaria community.  But even prior to COVID-19 interference, we faced a challenge with distribution efforts. Despite achieving significant health impact, traditional pyrethroid nets are no longer as effective as a vector control interventions in some places due to insecticide resistance.

To solve this latter challenge, PSI is working to introduce next-generation ITNs to the market through collaboration with partners on several key projects. In pursuit of this goal, we are working with The Alliance for Malaria Prevention (AMP) in the technical coordination of Unitaid’s New Nets project, piloting the introduction of next-generation nets in key geographies. In addition, PSI is distributing next-generation nets as part of our Global Fund portfolio. Finally, PSI is proud to be the ITN lead on The U.S. President’s Malaria Initiative (PMI) Vector Link Project, supporting the distribution of both traditional pyrethroid and next-generation PBO (piperonyl butoxide) nets in countries like Malawi and Tanzania.

Not only do we distribute nets, we also help build the markets that manufacture them, for sustainable net production and job creation in the communities we serve. We are especially proud of this work in Tanzania.

PSI Tanzania has coordinated with the Tanzanian National Malaria Control Program (NMCP), the Zanzibar Malaria Elimination Program (ZAMEP), and the Tanzanian President’s Office of Regional Administration & Local Government (PORALG) to distribute about 27 million ITNs to date—including 4.56 million between December 2019 and April 2020 alone.

Meanwhile, PSI Tanzania has been able to leverage both local distributors and for net distributions through mass campaigns and routine channels (i.e. through schools, health facilities, and community-based initiatives), facilitated by projects such as The PMI VectorWorks P and The PMI VectorLink Project. Sustained universal coverage with ITNs is essential to malaria control, and eventually, elimination; we and our partners remain committed to this goal.

While mass campaigns deliver nets in a single, time-limited operation, continuous distribution channels use existing infrastructure to deliver nets continuously over time. The WHO recommends the use of continuous distribution channels for maintaining universal coverage of insecticide-treated nets (ITNs), and as an implementing partner on The PMI VectorLink Project and the PMI VectorWorks Projects, PSI Tanzania supports their government counterparts to translate this global guidance into action within their communities. Although cost-effectiveness comparisons are still underway, estimates of existing studies showed that continuous distribution systems involved higher domestic contributions from countries, compared to mass campaigns, suggesting greater buy-in or potential for health system strengthening with continuous distribution.

As an implementing partner implementing on the PMI VectorLink and PMI VectorWorks projects, PSI Tanzania delivers nets through a Tanzanian logistics company called Simba Logistics Equipment Supply (SLES). This local distributor has been used for distributions since 2016 and has developed an online tracking system that is used by program staff to monitor ITN movements. An app is used by truck drivers to report how many numbers are being collected and how many have been dropped off. The app also reports the quantities by distribution channel, truck, drop-off site, and date. The app reports data in real-time and SLES has built a web-based dashboard that highlights these data.

Many nets are still produced and imported from outside the country. For example, a large quantity of nets has been procured and imported by PMI and the Global Fund. However, as of March 17th, 2020, PSI Tanzania has distributed 868,960 locally manufactured ITNs to 1,897 health facilities, working with the Tanzanian manufacturer, A to Z Company.

As part of the global malaria community, we look forward to successfully continuing programming to prevent resurgence during the coronavirus pandemic and ultimately eliminate malaria as a health threat, especially for the most vulnerable among us. To adapt and prevent a future crisis, PSI will continue to work with local entities and global peers to fight malaria and build sustainable markets for vector control, especially in the face of COVID challenges to our supply chain. As we approach World Malaria Day 2020—to all our partners in this fight, we look forward to working with you, and stay the course!

Funding for this blog post was provided by the U.S. President’s Malaria Initiative. The contents are the responsibility of the authors and do not necessarily reflect the views of USAID or the United States government.

Images courtesy of Luigi Nuñez

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