Global Plan for Insecticide Resistance Management in Malaria Vectors

The next few years will be critical in the fight against malaria; the global health community needs to recognize that mosquito resistance to insecticides is now also a serious challenge to malaria control efforts. Insecticide resistance has been identified in 64 countries around the world, affecting all WHO Regions with ongoing malaria transmission. Countries in Sub-Saharan Africa and India are of greatest concern because of a combination of high levels of malaria transmission and widespread reports of resistance, in some areas to all four classes of insecticides.

The main factor driving resistance has been the heavy reliance by vector control programs on a single class of insecticides, the pyrethroids. In some endemic areas, the use of insecticides in agriculture has also played a part in the rise of resistant mosquitoes. As a result, in many endemic regions, current vector control strategies are at potential risk and there is a danger that in the future they may not provide as robust protection from parasite-carrying mosquitoes as had been assumed. Urgent action will be required to prevent resistance from emerging at new sites, and to maintain the effectiveness of vector control interventions in the short, medium and long-term.

This global plan for insecticide resistance management in malaria vectors (GPIRM) was developed in response to requests from both the World Health Assembly and the Board of the Roll Back Malaria Partnership. WHO gathered, analyzed and synthesized input from over 130 stakeholders representing all the constituencies of the malaria control community, including national malaria control programs, vector control specialists, major donor organizations, multilateral and implementing agencies, as well as representatives of academic institutions, product development partnerships and industry. The GPIRM will trigger coordinated action from all stakeholders and will lay the foundations for integrated insecticide resistance management practices in all malaria-endemic countries.

The GPIRM puts forward a comprehensive strategy for global and country levels, including a short-term action plan with clear responsibilities, and sets out research and development priorities for academia and industry. Affected countries and stakeholders are urged to take immediate action to preserve the effectiveness of current vector control methods, and to ensure that a new generation of insecticides is made available as soon as possible. Close collaboration between malaria control programs and the agricultural sector will also be crucial. In addition, targeted communication and educational activities will be needed to make communities aware of the problem.

Part 1, The threat of insecticide resistance, explains what insecticide resistance is and why it is a concern for malaria control; it also presents the available approaches to managing resistance. This section will be particularly helpful for readers who wish to understand the threat of resistance (e.g. extent, trajectory, operational impact) and interesting for those who have a good level of knowledge on this topic. Other readers may wish to skim through this part.

Part 2, Collective strategy against insecticide resistance, outlines the activities necessary to preserve the effectiveness of malaria vector control. Insecticide resistance management must be a collective response, and all stakeholders have a role to play in making the strategy successful. It is important that stakeholders understand the overall strategy, at both global and country levels.

Part 3, Technical recommendations for countries, outlines a framework for policy-making to manage insecticide resistance, depending on the type of vector control interventions already in place and on the mechanism and level of resistance. This framework will be refined during further consultations as new evidence becomes available. This section considers different scenarios at country level and contains tables of consensus recommendations on how to address each of these scenarios. The section will be most helpful for managers of national malaria control and vector control programmes, WHO regional and country staff and agencies involved in planning and implementing vector control strategies.

Part 4, Near-term action plan, describes the roles of each stakeholder group and lists concrete activities that should be undertaken in the short term (particularly within the next 12 months) to implement the strategy. All stakeholder groups should read this section in order to understand their respective roles in preserving effective malaria vector control.