The Ugandan government has stepped up distribution of treated bednets. CEO of Vestergaard, a firm that manufactures the nets, spoke to GAAKI KIGAMBO about ongoing efforts to fight malaria

In what ways is PermaNet 3.0 different from PermaNet 2.0?
PermaNet 3.0 is made from two types of fabric: Polyester sides coated with the insecticide deltamethrin and a polyethylene roof incorporated with deltamethrin and a synergist, piperonyl butoxide (PBO).

Compared with pyrethroid-only LLINs, PermaNet 3.0 delivers increased efficacy against pyrethroid resistant malaria mosquitoes.

Why did you choose Uganda as the first African country to supply PermaNet 3.0 on a large scale?
The government of Uganda has pioneered a proactive and data-driven strategy to counter insecticide resistance by adopting an approach that takes into account the need for the most effective coverage.

They have recognised that we cannot adopt a one-size-fits-all strategy, but rather that different areas have different characteristics and require different solutions.

As part of its overall bed net distribution campaign, the Uganda government has taken a bold step to become the first African country to select and deploy, on a large scale, a combination of long-lasting insecticidal nets (PBO nets) proven to be more effective against mosquitoes that are becoming increasingly resistant to the only insecticide recommended by the WHO. 

The PBO nets will be deployed in districts where high levels of insecticide resistance are documented.

Your company takes pride in its role in the reduction of malaria deaths globally by more than one-third in the past decade. How have you imagined your role with regard to the global target to eradicate malaria by 2030?
Vestergaard is the largest manufacturer of insecticidal bed nets. More than 1.3 billion people have benefited from PermaNet bed nets. We are committed to furthering scientific research and knowledge to win the war against malaria. 

The Vestergaard Vector Lab in Ghana is a state-of-the-art insectary that conducts testing of Vestergaard’s vector products, with a production capacity of over a million mosquitoes a year.

In addition, Vestergaard created IR Mapper, a database and interactive mapping tool developed by Vestergaard in collaboration with the Kenya Medical Research Institute and ESRI East Africa. It is the most comprehensive online tool for mapping insecticide resistance in malaria vectors, consolidating reports onto filterable maps to guide decision making for deployment of the most effective insecticidal tools in specific areas, and is updated on a daily basis. Our research and development is continuing to develop third generation nets and other vector control products that can be used in an integrated approach to allow broader control options for the ever-changing mosquito.

In your view, is that global target realistic? What is required to achieve such targets?
We need to keep malaria on the global agenda, ensure sustainable funding, continue the pace and application of innovation to match the evolution of the disease and enable quick deployment of the best vector control tools available.

In your assessment, how much of the requirements are already in place to date, especially across Africa, towards its achievement?

Malaria-carrying mosquitoes are becoming increasingly resistant to the only class of insecticides, called pyrethroids, that have been approved by WHO for use in bed nets.

In 2015, over 75 per cent of the countries monitoring pyrethroids reported resistance, and that growing. We cannot adopt a one-size-fits-all strategy, but rather need one that recognises that different areas have different characteristics and require different solutions.

What is required now is large-scale deployment of PBO LLINs, supporting the conclusive evidence for impact at scale, beyond laboratory, hut and small-scale village trials. Encouraging innovation and scale-up of new tools should also enable other tools under development to reach the market in a timely fashion.

By 2020, Uganda aims to have reduced malaria deaths to near zero, morbidity levels to 30 cases per 1,000 population, malaria parasite prevalence to less than seven per cent. How do you assess such ambitions?
Uganda has the sixth highest number of annual deaths from malaria in Africa.

A 2015 study showed that malaria is still the major cause of death in Uganda, with 70,000 to 100,000 Ugandans dying each year from the disease.

In 2015, malaria cases saw a sixfold increase. What this means is that, more than ever, we need to innovate and invest resources in developing new products that can combat the growing threat of insecticide resistance.

Vestergaard commends the Uganda government for their forward-thinking leadership and their willingness to invest in new technologies.  Approaches such as these help companies like Vestergaard continue to innovate and develop new technologies to address pressing global concerns such as malaria.

You do not produce your nets for the open market. Why is that so?
Vestergaard has an extensive distributor network across most African countries that can sell the product in the open market, so in theory the product is accessible but the open market is challenging to operate in as the retail market includes many other products of variable quality and cost.