Global Malaria News

Summary

A new type of net called a PBO net is being trialed that could prove effective in killing those mosquitoes that are showing resistance to the insecticide used on standard nets.

PBO, piperonyl butoxide, is a chemical synergist that is safe for humans that is added to the net and works by ‘switching off’ the mosquitoes’ insecticide resistance mechanism allowing the insecticide on the net to do its job – cause ‘knock down’ – i.e. kill the malaria-carrying mosquitoes.

AMF funded six million PBO nets that were distributed in Uganda between March 2017 and March 2018 to protect 10.8 million people and an 18-month randomized controlled trial (RCT), a gold-standard study, to help answer the following question:

Are PBO nets more effective at preventing malaria in areas where some mosquitoes have developed resistance to the insecticide used on LLINs and, if so, how much more effective and under what conditions?

Work has been proceeding well, on time and on budget with the results planned for publication in Spring 2019.

Full detail

The current situation

Malaria is decreasing globally. In the last 15 years, malaria deaths and cases have fallen by 60% with long-lasting insecticide-treated nets credited in studies for being responsible for 70% of this decline.

However, there are currently two significant challenges to achieving further reductions in malaria. First, there is not enough funding to ensure basic malaria control activities take place in all malaria-affected countries. Second, some mosquitoes are showing resistance to the insecticide that is used on long-lasting insecticide-treated nets (LLINs).

Darwin showed how species adapt to their environment and that is what some populations of mosquitoes are doing. It is not surprising, therefore, that some mosquitoes are showing insecticide resistance.

Although only a small proportion of all mosquitoes, estimated at <2%, show this resistance, we must act now to ensure the population of resistant mosquitoes does not spread and existing resistance levels are reversed.

Although LLINs can still be effective in acting as a physical barrier to prevent a malaria-carrying mosquito reaching a person sleeping underneath the net, we do not want to lose the very important element in malaria control - the ‘knock down’ (killing) of mosquitoes that occurs when they land on and walk on a net and pick up insecticide via their feet.

Defeating insecticide resistance: PBO Nets

A major tool in defeating insecticide resistance could be the PBO net. This is a standard LLIN that has a chemical ‘synergist’ called piperonyl butoxide (PBO) added to it. PBO, which is safe for humans, works by switching off the mosquitoes’ insecticide resistance mechanism leaving the net to have its normal knock down effect.

In recent years, the results from laboratory and small-scale hut trials indicated that the PBO net could be highly effective against insecticide resistant mosquitoes. There was widespread agreement in the scientific community that the PBO nets needed to be tried at scale. As PBO nets provide protection that is at least as good as that from standard LLINs, there is no ethical issue when considering the distribution of PBO nets at scale.

AMF agreed to back this view and funded 6 million PBO nets that were distributed in Uganda between March 2017 and March 2018, including in areas where levels of insecticide resistance had been recorded. All of these nets were funded by AMF donors to whom we had made the promise that 100% of their donations would fund nets. Two different types of PBO nets were funded from two different manufacturers.

Assessing the effectiveness of PBO nets

As this was the first time PBOs had been deployed at scale, AMF also funded a rigorous academic study to test their effectiveness compared to standard (‘non-PBO’) LLINs. Funding for the study was provided only by donors who were comfortable funding research.

The study has a clear aim to answer the following question:

Are PBO nets more effective at preventing malaria in areas where some mosquitoes have developed resistance to the insecticide used on the nets and if so, how much more effective and under what conditions?

The AMF-funded study is being led by the Liverpool School of Tropical Medicine (LSTM) who are working closely with the London School of Hygiene and Tropical Medicine (LSHTM), University of California San Francisco (UCSF) and researchers at the Infectious Diseases Research Collaboration (IDRC) in Kampala and at Makerere University, both of the latter in Uganda.

The study has been designed to provide results that are statistically significant. This has been achieved by having many study sites, 124 ‘clusters’, so that the study has statistical ‘power’, and by ensuring that clusters can be compared with the only relevant difference between them being whether they received standard LLINs or PBO nets. In this way, any differences in outcome can be linked to the net type.

The primary indicator being monitored in the study is malaria prevalence in children and this is being done using highly accurate testing methodologies. The effect of PBO nets on the mosquito population is also being studied. The study team carried out tests and collected data before nets were distributed, a baseline study, and has collected data in two further stages, at 6 months and 12 months post-distribution of the nets.

Work has been proceeding well, on time and on budget with the results planned for publication in Spring 2019. Another organisation has agreed to fund data collection at 18-months and a further study at 24-months may occur.

It is important to us that the study be open to all. During the planning and consultative phase, AMF shared widely the study protocol and received valuable input. All results will be published in full.

By understanding to what extent PBO nets can play a role in combatting insecticide resistance in mosquitoes, the ultimate value of this study is to help net funders, including health ministries, make informed decisions about the nets they purchase and distribute that will optimize malaria control.

Of note, a recent trial in Tanzania has reported positive results from a smaller scale deployment of PBO nets: malaria prevalence was less in areas using PBO nets than in control areas using standard nets. At 9 months after nets were distributed, malaria prevalence was 531 out of the 1,852 children tested (29%) compared to 767/1,809 (42%) in the control area; at 21 months 865/1,930 (45%) compared to 1,255/2,034 (62%). These are significant improvements.

We will keep our supporters up to date both with the results of the study and as we continue to explore innovations in the fight against malaria.

AMF is delighted and honored that founder Rob Mather has been presented with the Commonwealth's 53rd Point of Light award, representing the United Kingdom. The Commonwealth Points of Light are awarded by Her Majesty the Queen to recognize outstanding individual volunteers who are making a change in their community.

The award for Rob was presented by HRH Prince William, the Duke of Cambridge, on 16th April, the opening day of the Commonwealth Heads of Government Meeting, at the Queen Elizabeth II Centre.

Rob said:

“It is an honour to have the work of the Against Malaria Foundation (AMF) recognised in this way. Many people and organisations have supported AMF in a voluntary capacity over many years and this recognition is of them also as AMF would not have been able to contribute in the way it has without them.

“All of us at AMF are passionate about contributing to the reduction and eventual elimination of malaria. My own motivation has been simple. My four children go to sleep at night where a mosquito bite would lead to an annoying itch. Many other people have children and family members for whom the consequences of a mosquito bite could be severe illness, or far worse, so we won’t stop working as a team and with many partners until that has been changed.”

Commonwealth Points of Light 2018 (incl short video)
Point of Light award

We have now reached US$160 million raised - thanks to a donation from London, England!

We have also just passed 316,000 donations received, with this coming from over 102,000 people in 187 countries! As always, our sincere thanks to everyone for their support and generosity.

You can see all of our previous milestones on our Milestones page.

AMF has signed an agreement with the Malawi Ministry of Health to fund 4.3 million nets for distribution from August to December 2018. This represents 40% of Malawi's long-lasting insecticide treated net (LLIN) need for their 2018 universal coverage campaign.

The nets will be distributed in 12 of Malawi's 28 districts, specifically Dedza, Dowa, Kasungu, Nkhotakota and Ntcheu Districts (all in the Central Region) and Balaka, Chikwawa, Chiradzulu, Mangochi, Mulanje, Neno, Phalombe and Thyolo Districts (all in the Southern Region).

In total, 7.8 million people will be protected. Malaria is one of the primary health issues in Malawi, with high incidence levels seen across the majority of the country. These nets have the potential to play a major part in reducing deaths and illness.

AMF allocates individual donations to specific distributions and so far we have allocated 29,533 individual donations from 12,511 donors from 102 countries. These figures will increase as further donations are allocated. Many donations, large and small, help fund these nets.

We will report openly on progress and performance throughout and after the distribution.

Key elements of our agreement include:

• AMF is funding 4,300,000 LLINs for distribution in 2018
• This is a co-funding partnership with non-net costs (shipping, pre-distribution, distribution) funded by the Global Fund
• '105%' data collection will be used for the household-level registration process to support accurate data gathering - 5% of households will be re-visited as a check on registration numbers
• AMF will collect household registration data from the entirety of a proportion of villages as an independent check on registration and population numbers
• Household-level data will be collected on paper and then entered into AMF’s Data Entry System (DES) for analysis and verification. This, and the above elements combined, are the basis for a highly accountable distribution.
• Post-distribution monitoring of net use and condition (PDMs) will take place every six months for two and a half years in all districts. AMF will fund this.

Further information

AMF has signed an agreement with the Ghana Ministry of Health to fund 3.6 million nets for distribution from August to December 2018. This represents 35% of Ghana's long-lasting insecticide treated net (LLIN) need for their 2018 universal coverage campaign.

The nets will be distributed in four of Ghana's ten regions, specifically Brong Ahafo, Western, Upper East and Northern.

In total, 6.5 million people will be protected. Malaria is one of the primary health issues in Ghana, with high incidence levels seen across the majority of the country. These nets have the potential to play a major part in reducing deaths and illness.

AMF allocates individual donations to specific distributions and so far we have allocated 9,868 individual donations from 5,707 donors from 77 countries. These figures will increase as further donations are allocated. Many donations, large and small, help fund these nets.

We will report openly on progress and performance throughout and after the distribution.

Key elements of our agreement include:

• AMF is funding 3,600,000 LLINs for distribution in 2018
• This is a co-funding partnership with non-net costs (shipping, pre-distribution, distribution) funded by the Global Fund
• '101.5%' data collection will be used for the household-level registration process to support accurate data gathering - 1.5% of households will be re-visited as a check on registration numbers
• AMF will collect household registration data from the entirety of a proportion of villages as an independent check on registration and population numbers
• Household-level data will be collected using electronic devices and then imported into AMF's Data Entry System (DES) for analysis and verification. This, and the above elements combined, are the basis for a highly accountable distribution.
• Post-distribution monitoring of net use and condition (PDMs) will take place every six months for two and a half years in all regions. AMF will fund this.

Further information

We are delighted to report that AMF now has tax-deductible status for donors in Norway.

AMF has been granted this status effective 01 January 2017 by Skatteetaten, Norway’s tax authority, so any donations made to AMF on or after that date can be considered tax-deductible by the donor.

• To qualify, a minimum of NOK 500* must be donated in one (calendar) year
• A maximum of NOK 30,000* is tax-deductible per donor (with this total being the total given to all charities, not per charity) for 2017 and NOK 40,000 for 2018.
• Taxpayers should include information about their donations in their tax return

* At current exchange rates (Jan 2018), NOK 500 ~ US$60 and NOK 30,000 ~ US$3,700, NOK 40,000 ~ US$5,000

Note: All online donations from Norwegian residents automatically receive an acknowledgement with a link to a downloadable tax receipt. For those wishing to make donations by bank transfer or cheque, the relevant bank account and address information can be found on our donations page, and tax receipts are sent on request.

We have now reached US$150 million raised - thanks to a donation from Germany!

We are also nearing 300,000 donations raised, with this coming from nearly 100,000 people in 186 countries! As always, our sincere thanks to everyone for their support and generosity.

You can see all of our previous milestones on our Milestones page.

As 2017 draws to a close we would like to thank all who have supported and worked with AMF this year as without donors, distribution partners, volunteers and pro bono supporters we would not be able to do what we do in contributing to the fight against malaria. Thank you!

Distributions update

Distributions and follow-up surveys are currently being undertaken in a number of countries. 1.2 million nets are being distributed in Papua New Guinea , 2.4 million nets in Togo and 12.7 million in Uganda. Approximately 3 million nets will also be distributed in Zambia shortly, after the registration phase is complete - allowing us to determine the exact number of nets needed.

In addition many Post-Distribution Check-Ups have been performed in Ghana, DRC and Malawi this year with further check-ups being carried out in 2018 in additional countries. The results of these surveys will be added to the website in the New Year.

Future distributions

There remains a huge need for nets. The gap for the next few years runs into tens of millions of nets. We are involved in discussions in a number of countries requiring individually between 3 million and 33 million nets for the period 2018 to 2019.

AMF's gap for more funding remains large and we agree with GiveWell's assessment that the total funding gap for LLINs for 2018-2020 appears to be hundreds of millions of dollars.

We will publish commitments as they are made.

280,000th donation and over US$142 million raised so far!

We are thrilled to have recently received our 280,000th donation, with most donations ranging from a few dollars (and £, €, CAN$, NZ$, AUS$, bitcoin and more) to many thousands.

We are so grateful to you for your support. Thank you!

Tax-Deductibility

We now have tax-deductible status in a dozen countries, most recently in Ireland. We continue to assess the need for tax-deductibility status in other countries, some of which are already in the application stage and we hope to complete in the very near future.

New additions to the team

We are very happy to welcome two new members of the AMF team this year.

Julian is Operations Manager and Jenny is responsible for donation administration. They bring the total up to seven, including; Rob (CEO), Andrew (Head of Technology), Shaun (Programme Director), David (Uganda Representative) and Peter (Executive Chairman).

AMF top ranked!

AMF has again been top-ranked by the three leading organisations 'dedicated to finding outstanding giving opportunities'.

GiveWell has ranked AMF their #1 charity, for the sixth time in seven years, and recommends to donors:
"We recommend that donors give 70% of their donation to the Against Malaria Foundation... "
Giving What We Can has confirmed AMF is again a top-ranked charity for the seventh year in a row.

The Life You Can Save has AMF as a top-ranked charity for the seventh year in a row. A suggestion for the Christmas/Holiday season!

Donate nets instead of gifts.

We send the recipient/s an email (on a date you choose e.g. 25th Dec) with your personal message and a link to their 'gift page', allowing them to follow the progress of their nets.

May we wish you a very happy and healthy 2018!

Rob, Andrew, Peter, Julian, Jenny, Shaun and David