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Cinderella science

December 1, 2012 - 14:43 -- Bart G.J. Knols

The guest blog below was contributed by Prof. Matt Thomas, of Penn State University. Read more about Professor Thomas here.

Everybody would like to see the burden of malaria reduced and while there might be some disciplinary biases, most would agree that long-term sustainable management of malaria requires integrated strategies built on solid foundations of local knowledge and capacity. 
Of the broad approaches available (and by available I include potential tools somewhere along the development pipeline), vector control is clearly pivotal. This is not to diminish the importance of other technologies, such as drugs or diagnostics, but much of the recent decline in malaria can be attributed to wide-scale implementation of vector control tools such as long lasting insecticide treated bed nets (LLINs) and indoor residual insecticide sprays (IRS). Furthermore, in nearly every historical case where malaria has been substantially reduced or locally eliminated, vector control has been key. 

Given its unequivocal importance, it would seem reasonable to expect substantial ongoing research investment in vector control. If nothing else, the dramatic rise in insecticide resistance that threatens to render the current generation of LLINs and IRS products ineffective, ought to be stimulating a vibrant research portfolio. Yet vector control currently attracts only 4% of the global malaria R&D budget. This contrasts with around 30% each for drugs and vaccines. 
Vector control research delivers considerable impact with little funding and often little glamour (hence “Cinderella”). Certain techniques benefit from relatively low product development costs, and in some cases there are additional cross-subsidies via the agrochemical sector. This is good news but it doesn’t follow that all future technologies can and should be developed on a shoestring. How much more effective could vector control be if the research budget was in some way commensurate with its impact? 
At US$50 million over 5 years, the support from the Bill and Melinda Gates Foundation to the Innovative Vector Control Consortium (IVCC) stands out as the largest single investment in vector control research to date. While an impressive figure, it is dwarfed by the approximate US$200 million per year currently committed to vaccine research. Mine is not an anti-vaccine position but whether an effective and affordable malaria vaccine can be delivered into Africa over the next 10 or even 20 years is a genuinely open question. The current and future importance of vector control is not. 
Requests for increased funding are a familiar cry and at a time of global financial insecurity and ‘fiscal cliffs’ this might seem a big ask.  But the reason we’re facing a resistance crisis is not because of lack of innovation. Insufficient investment in new chemical products and alternative non-chemical tools is leaving the vector control community hamstrung to address the technical and operational challenges. As with the popular myth, the key to a happy ending is to give Cinderella a break. 
Some relevant recent literature:
Namountougou M, Simard F, Baldet T, Diabaté A, Ouédraogo JB, et al. (2012). Multiple insecticide resistance in Anopheles gambiae s.l. populations from Burkina Faso, West Africa. PLoS ONE 7(11): e48412.
PATH (2011). Staying the Course? Malaria research and development in a time of economic uncertainty. Seattle: PATH (Program for Appropriate Technology in Health). 98 p.
Science, 16 November 2012, p.871-872.
Thomas, M.B., Godfray, H.C.J., Read, A.F., van den Berg, H., Tabashnik, B.E., van Lenteren, J.C., Waage, J.K. & Takken, W. (2012). Lessons from agriculture for the sustainable management of malaria vectors. PLoS Medicine 9(7): e1001262.