Long lasting insecticide impregnated nets LLINs

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Long lasting insecticide impregnated nets
LLINs

• Presentation to LLIN Business Plan Meeting, Sept.
  04, Johannesburg

Dr. Gerhard Hesse c/o Bayer Environmental Science
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Long lasting insecticide impregnated nets
LLINs why we need coverage with ITN/LLIN?

• Preconditions
• 100 coverage with plain nets will not
  dramatically impact Malaria
• But a coverage with 25 ITN has an impact (P.
  Guillet)
• Today total coverage and ITN coverage is below
  need (Malaria still gtgt)
• What to do
• Increase coverage with insecticide treated nets
• How to do
• Scale-up capacity for overall net production
• Provide technologies for in-, and post-process
  LLIN production
• with that scale-up capacity for LLIN production
• with that scale-up distribution and use of
  LLINs

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Long lasting insecticide impregnated nets
LLINs - Definitions

• WHO definition a ready-to-use pre-treated
  mosquito net, which requires no further
• re-treatment during its expected
  lifespan (4-5 years - ?)
• that depends on the material
  (Polyethylen gt Polyester)
• that depends on how the net is
  handled in general
• WHOPES guidelines gt 20 washes - 80 mortality
  after 24 hrs (95 KD after 60 min)
• that depends on the washing procedure, type
  of detergent,
• on the washing frequency
• Example NetMark country surveys in Senegal,
  Sudan, Zambia
• Approx. 50 of answers show washing in the range
  of 1x a week to 1x a month !!
• in rural area more frequent washings than in
  urban areas
• so WHO 20 washes once a week lt half a year
• once a month lt 2
  years
• Lifespan definition is ????
• Best definition is increased wash resistance, so
  why not 20 washes !

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Long lasting insecticide impregnated nets
LLINs LLINs and WHOPES

• Raises the question on the value of WHOPES
  evaluation, WHO/FAO specs
• undoubtedly necessary as quality criteria
• undoubtedly necessary as product purchasing or
  selecting criteria
• but should not be a delay factor for new LLIN
  technologies (costs, time, requirements)
• Market needs volumes of nets, the two nets tested
  have limited capacities
• WHOPES fast track is required and should be
  adopted by customers
• Finding a technology which produces good results
  is not difficult
• Finding a technology which produces constantly
  good results is impossible
• Finding a coating polymer which lasts up to 10-15
  washes is not difficult
• But gt 21 washes needs a special coating polymer
  or the insecticide in the fibre
• Does the textile commodity polymer need full
  WHOPES / WHO specification?
• BP asking to refine standards in an open
  dialogue with WHO, will be done !
• Q. Do we enhance the search for the optimum
  solution the magic bullet ?

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Long lasting insecticide impregnated nets
LLINs Environment for technology
inventions

• Technology inventions for LLINs are a
  competitive business and are run on various
  levels (Academia, commercial sector, small
  enterprises, PP partnerships)
• Inventions need funds, time and partners which
  develop it to maturity and in the shortest time
  to market
• Therefore the only successful models at the
  moment are private-private-public partnerships
  (textile manufacturers-pesticide industry,
  polymer providers-pesticide industry, master
  batch companies-pesticide industry-net
  manufacturers) funded by the running business
• The rest might not survive because of no funding
  from whatever source
• These technologies are targeted to existing
  models or spin-offs from existing technologies
  with shortest time to market
• Under these conditions we might not find the
  magic bullet

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Long lasting insecticide impregnated nets
LLINs Target 1 Public funding for new
technologies

• Quote the Business Plan
• negotiating the
  establishment of a technology trust !!
• The inventing community is very divers,
  therefore
• something like a coordination trust is
  worthwhile to establish,
• even RD oriented companies have to sincerely
  evaluate the ROI into these technologies, e.g.
  pesticide industry with their marginal
  participation in the business,
• Public funds have to be made available to allow
  academia or specialised small companies to invent
  
• The trust should than enhance the transfer of the
  inventions to a marketer, which develops the
  product to maturity (WHOPES 5 Ps of
  marketing)
• This hopefully avoids the not invented here
  syndrome
• And the perceived exclusivity is no good
  syndrome
• Intellectual property rights (patents ??) have to
  be observed

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Long lasting insecticide impregnated nets
LLINs Comparison of pre-treatment technologies

• Industrial in process production of pre-treated
  LLINs
• extrusion technology from master batches is real
  high tech (Olyset)
• in process coating needs additional equipment
  (PermaNet)
• cons high capital investment necessary
• occupational health risks high
• excludes most parts of the industry
• technology transfer not possible
• pros high LLIN production output

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Long lasting insecticide impregnated nets
LLINs Comparison of pre-treatment technologies

• Industrial post process production of pre-treated
  LLINs
• Mechanised treatment
• cons medium capital investment necessary
• technology transfer difficult
• pros lesser occupational health risk
• mass impregnation
• Manual treatment
• cons higher occupational health risk
• lower output because of extra step in
  handling
• pros very small capital investment necessary
• suitable for smaller sized industry,
  impregnation centres etc
• technology transfer is no problem

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Long lasting insecticide impregnated nets
LLINs Other technologies

• IN PROCESS TECHNOLOGIES
• and
• 
  POST PROCESS TECHNOLOGIES
• produce new industrially pre-treated LLINs
• What about the existing untreated nets which are
  already on the market ?
• their conversion produces old re-treated LLINs

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Long lasting insecticide impregnated nets
LLINs demand versus capacity scenario

• Business Plan 521 Mio people with 120 Mio in
  vulnerable groups,
• 2 persons per net,
  lifespan of the net approx. 4 years
• We need 40-50 Mio nets / p.a. (or 20 Mio ITNs )
• to meet the Abuja targets within 5 years
• BP 2003 capacity is somewhere between 30-35 Mio
  nets / p.a. (4.5 Mio LLINs)
• we have a gap between demand and supply of
  nets,
• 
  and a huge gap for LLINs (Fig 10 in BP)
• Taking the lifespan of a net with 4 years,
• we accumulate in 2002 - 2005 approx. 80 100 Mio
  new nets
• (152 Mio BP 02-06)
• from these approx. 18 Mio might be LLINs
  (Olyset, PermaNet)
• Even doubling the capacity for the two is far
  away from feeding the demand
• but we talk about 100 150 Mio existing nets
  which can be turned into LLINs

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Long lasting insecticide impregnated nets LLINs
Target 2 increase capacity of net
manufacturers

• Q. Sleeping capacity which can be increased
  rather quick ??
• to wake it up it needs
• certainty and commitment from the donors
• sustainability versus short term institutional
  market
• commitment by the implementors (like NGOs)
• To keep it awake it needs
• planning and forecasting tools
• to make investment into up-scaled net production
• investment into up-scaled LLIN
  production
• investment into new technologies for
  impregnation

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Long lasting insecticide impregnated nets LLINs
Target 3 public funds for industrial scale-up

• Use donor money to support net manufacturers in
  the decision to go for scale-up in the production
  of LLINs
• No discrimination conc. the technology level or
  the location
• Public sector has to create the trust in the
  market
• Public sector has to create a business
  environment that allows private sector to make
  investments, e.g. MMSS, reputational purchasing
  agencies, guaranteed purchase, transparency etc
• Wake up sleeping capacities
• Get rid of only sporadic full capacity
• Support all level entrepreneur ship

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Long lasting insecticide impregnated nets
LLINs do we wait for the industrial up-scale ??

• Scenario in 2005 we may have the capacity of gt 5
  Mio LLINs / p.a.
• time investment in new high tech
  plants 1 year before production
• money investment 2.5 Mio for an
  additional 1 Mio LLIN / p.a.
• to meet the 40 Mio need we
  investments approx. 100 Mio
• If the request is coverage with pre-treated
  LLINs
• this is an unrealistic target in the Abuja
  timeframe
• there is already competition for the few
  pre-treated LLINs
• but still public sector attention is
  focussed here
• If the request is capacity increase of
  pre-treated nets
• this is not a short to medium term target !!
• who pays for the investments ??
• risk if you built a new plant it has a certain
  output
• who guarantees the long term and sustainable
  market ??
• 
  Answer to the question in the
  headline NO

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Long lasting insecticide impregnated nets LLINs
Target 4 turn existing untreated nets into
LLINs

• If the request is coverage with LLINs - this is
  the biggest target
• Public Sector has no special focus for that
  (driven by industry and NGOs)
• To convert those nets into LLINs, we need
• a low tech effective and safe approach, which is
  available
• effective one time re-treatment campaigns (!!)
• NGOs, NetMark, multi approach projects,
  impregnation centres
• centres are cheaper / more effective because
  scale-up is done accord. to need
• Opportunistic free treatment of existing nets
  with distribution of new LLIN
• Overcomes the non perceived added value
  discussion of pre-treated LLINs
• Economical benefit, with the currently offered
  technology nearly double as much field
• re-treated LLINs can be generated than
  industrially pre-treated LLINs
• Also here the public sector should enhance the
  business environment, because this
• segment by nature might be only short term
• NB we might need this solution after reaching 21
  washes !!!

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Long lasting insecticide impregnated nets
LLINs to reach the coverage with ITN/LLIN

• Abuja targets for 2005 are not SMART
• (specific/simple, manageable, achievable,
  realistic and timely)
• Scaling up the production of nets and LLINs has
  to be enhanced
• Investment scenarios for this have to be created
  by the public sector
• There is no excuse in not reaching the coverage
  because the necessary quantities of industrial
  pre-treated LLINs are not available
• Appeal to donors do not waste time waiting for
  the magic bullet, if there are no pre-treated
  LLINs do not loose interest in field converted
  LLINs or even conventional re-treatment
• Technologies on all levels are available or will
  be short term available
• Investment scenarios in optimised technologies
  have to be created by the public sector
• Public sector should take into consideration the
  implementation skills of the NGO and private
  sector community