Last week, publication of the WHO report on insecticide resistance did not go unnoticed. It was taken up by the journal Nature, and in a news article by Amy Maxmen some truly remarkable statements by some of the leading malaria researchers are to be found. I trust that these people saw the article and gave consent to its publication, so any quote in it must really have come from them. Be prepared...
First is David Brendling-Bennett (Gates Foundation), whose statements I commented on before in another editorial. To Nature, Mr. Brendling-Bennett stated "We don't want to wait for failures to happen". But let us look at the image from the WHO report that shows the seriousness of the situation:
What does this map tell us? That there are no problems with insecticides and that we should only guard against failures happening? I guess anyone will acknowledge that the situation is far from satisfactory. Failures are happening, and they are in front of our eyes. Millions of bednets with pyrethroids are being purchased and distributed in countries where full-blown resistance to pyrethroids has been reported. Will the manufacturers stop the machines even though they know how serious this situation is? No. Conclusion: there is no failure that can be stopped here. And without a new class of insecticides for bednet impregnation the world is in deep trouble.
Even more amazing is the statement by Prof. Janet Hemingway (CEO of the IVCC) in the same article, where she says "In 2004 there were pockets of resistance in Africa, now there are pockets of susceptibility". A jaw-dropping statement by a person that will defend chemical control against all odds as the ultimate way forward in vector control. Does Prof. Hemingway acknowledge finally that chemical control is the sure road to trouble? Let's place this comment in perspective. Since the middle of the last decade, scaling up of bednet technology started in earnest. By 2010 we already saw massive problems. To me this means that if we develop new insecticides that will be deployed on an equally massive scale as pyrethroids, the same will happen. That means that a new insecticide coming out of the IVCC pipeline will have an effective lifespan of 5-7 years. If that is what we will be happy with, then fine, but is this really what we want (and need)?
Managing resistance is the way forward, according to Robert Newman (WHO), but there isn't much to manage in places where the only control people ever see is a bednet. There is nothing to rotate or mosaic when it gets to nets: its pyrethroids or nothing.
The really sad statement follows from Prof. Coetzee (Univ. of Witwatersrand, S Africa) with her comment that "In some countries malaria control means one person, sitting in one room, and he's lucky if he has a chair". This describes the harsh discrepancy between what is being discussed in high-profile meetings in Geneva and the reality of malaria in the real world.
I am amazed how open these statements are, and appreciate those that made them for their frankness. It shows, however, that we're heading for bad weather unless we drastically start changing the way we do things. But then, who wants to change things? In a book on change that I read recently it stated in the opening sections: 'The only person that really wants to change things is a baby with a wet diper'. So true...