Implementation of the global plan for insecticide resistance management in malaria vectors: progress, challenges and the way forward

Abstract

In recent years, there has been an increase in resistance of malaria vectors to insecticides, particularly to pyrethroids which are widely used in insecticide-treated nets. The Global Plan for Insecticide Resistance Management in malaria vectors (GPIRM), released in May 2012, is a collective strategy for the malaria community to tackle this challenge. This review outlines progress made to date and the challenges experienced in the implementation of GPIRM, and outlines focus areas requiring urgent attention. Whilst there has been some advancement, uptake of GPIRM at the national level has generally been poor for various reasons, including limited availability of vector control tools with new mechanisms of action as well as critical financial, human and infrastructural resource deficiencies. There is an urgent need for a global response plan to address these deficits and ensure the correct and efficient use of available tools in order to maintain the effectiveness of current vector control efforts whilst novel vector control tools are under development. Emphasis must be placed on enhancing national capacities (such as human and infrastructural resources) to enable efficient monitoring and management of insecticide resistance, and to support availability and accessibility of appropriate new vector control products. Lack of action by the global community to address the threat of insecticide resistance is unacceptable and deprives affected communities of their basic right of universal access to effective malaria prevention. Aligning efforts and assigning the needed resources will ensure the optimal implementation of GPIRM with the ultimate goal of maintaining effective malaria vector control.

Figure 1

Five pillars of the Global Plan for Insecticide Resistance Management in malaria vectors. Excerpt from GPIRM [6].

Figure 2

Status of pyrethroid resistance in malaria vectors and national insecticide resistance monitoring and management plans. Reported resistance status based on standard WHO susceptibility tests and CDC bottle assays using criteria of confirmed resistance (<90% mortality), possible resistance requiring confirmation (90-97% mortality) and susceptibility (≥98% mortality) with the lowest mortality displayed if multiple insecticides, vectors or time points were tested for a single locality. Status of national plans based on capacity assessment reports provided to WHO, September 2014.