The world is losing the fight against malaria, a disease that has taken a devastating toll in Asia and Africa and is emerging in developed countries such as the United States. This was exacerbated by a business decision made by one of the world's largest manufacturers of mosquito nets more than a decade ago.
For more than two decades, inexpensive, durable and easy-to-distribute insecticide-coated bed nets have been an important tool in controlling malaria, which causes symptoms ranging from severe coughing to kidney failure and can kill within 24 hours. Not only do mosquito nets protect those who sleep underneath, their chemical coating also calms infectious diseases and reduces mosquito infestation by killing insects.
According to Bill & Melinda Gates**, between 2000 and 2015, they prevented 68% of malaria cases.
But in the years since, serious problems have arisen.
The results have been absolutely fantastic," said Tim Freeman, Rotary League Manager Against Malaria at Papua New Guinea, which is now the epicentre of malaria in the Western Pacific. "By 2015, I think we had a chance here. We may be close to eliminating malaria from this country. Now I don't think there is any possible elimination. ”
Papua New Guinea uses a mosquito net used by a family in Siar Village, Papua New Guinea, providing an example for other countries of how easy it is to derail disease management strategies. Located on the northeastern coast of Australia, this beautiful and extremely impoverished island nation is home to over 10 million people. Researchers first noticed a sharp increase in malaria cases there in 2017. In 2022, Papua New Guinea is grappling with an 88% surge in infections.
Papua New Guinea isn't the only place where cases have surged: the World Health Organization estimates that in 2022 there were about 2 cases globally4.9 billion people are infected, of which 6080,000 deaths, well above pre-COVID-19 pandemic levels. Scientists say a lack of funding, insecticide resistance and climate change are all driving the continued rise in malaria cases around the world.
But researchers in Papua New Guinea say they have found another problem: Permanet 2, made by the Swiss company Vestergaard0 。
Research shows that the company has changed the chemical coating of the only mosquito nets used in the country, making Papua New Guinea's main mosquito defenses much less effective. The change was not disclosed to the global health organization that oversees malaria control or to those who buy or rely on bed nets.
Suspected cases in Papua New Guinea.
Interviews with more than three dozen malaria and cyber experts, as well as business leaders and industry advisors from around the world, including some who have worked in Westguardgard, show that the public health movement against "forever chemicals" is thriving while the network is lax regulated. Manufacturing and quality. It took researchers years to discover that the new coating, while cutting costs and potentially ultimately reducing long-term cancer risk, undermines a key tool in the fight against malaria.
Vestergaard says it changed the coating mainly because the company stopped using per- and polyfluoroalkyl substances, known as PFAS or permanent chemicals, for production. Two consultants with knowledge of network technology, including a former Vestergaard employee who spoke on condition of anonymity, said that network manufacturers could have used more expensive alternatives when making the switch and changed other production methods to maintain effectiveness.
The company has yet to acknowledge the decline in the efficacy of its nets and said it adheres to the World Health Organization's guidelines, which do not require nets manufacturers to notify the organization of production changes until 2017.
Other manufacturers have also experienced quality issues, raising concerns that what can be traced so clearly in Papua New Guinea is an indication of broader challenges ahead as malaria cases continue to rise.
In September, Vestergaard celebrated the distribution of its billionth insecticide-treated bed net. The company brought together business leaders, philanthropists and global health** at the United Nations to promote its work.
We have the tools, we have the innovations," said Mikkel Vestergaard Fransen, the former CEO of the family business. "No one needs to die of malaria anymore. ”
Mikel Westgard Fransen, former CEO of Estergaard, at a UN General Assembly event in New York (left), however, researchers in Papua New Guinea say the tool is failing.
Mosquitoes in Papua New Guinea are mostly not insecticide resistant, and the country has been exclusively using permanet 2 for many years0 to fight them. This makes it a natural laboratory for web research, which is hard to do elsewhere.
In 2019, scientists there tested unused and unopened Vestergaard nets from villages and provincial health clinics across the country, some of which were produced as early as 2007. They found that nets produced before 2012 – the oldest nets – were effective, while only 17 percent of recent tests passed tests that measured the number of mosquitoes that died or became incapacitated after exposure to mesh.
Our team thought it was a mistake," said Moshe Raman, deputy director of science and research at the Papua New Guinea Institute of Medical Research.
This is not the case. Researchers including Freeman and Stephen Carr, head of the entomology laboratory at the Papua New Guinea Institute of Medical Research, published their findings in the journal Nature in 2020, but it was initially difficult to explain why the nets had become so ineffective. It will take another year and a half to correlate the changes in the chemical coating of the web.
Carol Essex, a spokesperson for Vestergaard, criticized the researchers' cone testing technique and told Bloomberg News, Permanet 20 Meets World Health Organization efficacy standards.
"The purpose of the cone test is not to directly measure malaria transmission, and the resurgence of malaria cases cannot be attributed to permanet 2," Essex said0 performance of mosquito nets. ”
The World Health Organization allows the net to carry out two different tests: the cone test, and if it does not pass, the tunnel test. These tests vary in the time and distance at which mosquitoes are exposed to the insecticide, with the cone test lasting only a few minutes and the larger tunnel test lasting 12 to 14 hours. Researchers in Papua New Guinea conducted the cone test because they said it was the more stringent of the two. They highlighted the results of a cone test released in 2014, which was 92% effective on mosquito nets distributed in Papua New Guinea before 2009.
Papua New Guinea Institute of Medical Research team members tested mosquito nets at the Bedanath Centre in Madang and they continued their work in the journal Nature and published an article in the Journal of Malaria in November 2022 showing that changes in the coating of Vestergaard nets led to a decrease in efficacy. In January 2023, the company issued a statement saying: "Any changes made to our products are in compliance with global regulations and will only be implemented after verifying that the product meets the World Health Organization Product Specifications and the World Health Organization Efficacy Standards." ”
In August, Papua New Guinea's health minister, Lino Tom, wrote to WHO Director-General Tedros Adhanom Ghebreyesus, asking the organization to set up a task force to investigate "mounting evidence" that bed nets are no longer as effective as they once were. In a statement to Bloomberg, the World Health Organization said it was "very concerned about its impact" and asked researchers to provide data to investigate the issue.
Malaria is a serious infection that affects children under the age of five and pregnant women the most.
The World Bank estimates that in some African countries, the disease reduces GDP growth by about 13%。While not traditionally thought to be a problem in the continental United States, nine homegrown malaria infections occurred in the United States in 2023, the first case in 20 years.
The World Health Organization reports in its 2023 Global Malaria Report that about half of the world's population is currently at risk of contracting malaria. Climate change could lengthen malaria seasons in many parts of the world, and mosquitoes in some African countries are becoming more resistant to many different insecticides, the agency said. Network quality is becoming increasingly important in the fight against this disease, as it is one of the few factors that is completely under human control.
Mosquito nets are often the main tool used to combat malaria in the world's poorest regions. Hannypein, a 23-year-old mother of three in Sial Village, Madang Province, Papua New Guinea, cherishes them even more when a malaria outbreak a few years ago caused her to have a high fever that prevented her from eating or walking for several days.
My first child was only two months old at the time, and that really affected me and my baby," she said. "I don't want my kids to go through this kind of thing, I make sure they sleep under a mosquito net. ”
Other companies have also been criticized for the quality of their networks. In April, the World Health Organization sent a letter of concern to Mainpol GmbH, Germany, because some of the company's nets contained too much or too little insecticide. In response to questions, Mainpol sent a link to a document from the World Health Organization's inspection of its production site in China since May, stating that the plant complies with international standards "taking into account the corrective actions taken and planned." In 2021, an investigation into the global fight against AIDS, tuberculosis and malaria** found that Dubai-based and now-defunct Tana Netting produced mosquito nets that were not durable enough.
Muhammad Mukhtar, director of Pakistan's National Malaria Control Programme, said that in 2020, Pakistan** received a batch of mosquito nets with too little insecticide and too small in size. He declined to name the manufacturer, but said they were now blacklisted in Pakistan.
It's a big lesson," Mukhtar said. According to a study published in February in the journal Insects, researchers also found that new mosquito nets equipped with two insecticides instead of one did not last as long as they should.
In 2021, researchers at a hospital in Lahore, Pakistan, worried that these examples, combined with significant price reductions, indicated a deterioration in overall network quality.
As competition grows, so does quality," says Mark Rowland, professor of medical entomology at the London School of Hygiene & Tropical Medicine, of the nets. "There's no doubt that the Nets have become inadequate. You can't blame them entirely because they need to be profitable. ”
The fight against malaria is a top priority for prominent charities, international groups, and other prominent charities, including the Malaria Initiative, an interagency effort in the United States. However, the total funding for 2022 was $4.1 billion, well below the annual target of $7.8 billion set by the World Health Organization.
Funding to fight the disease falls far short of the World Health Organization's 2022 target.
Gates will "have focused and acted to sustain the impact of effective nets," Philipp Verhoff, the group's malaria director, said in an email. He did not comment specifically on the situation in Papua New Guinea.
Until the turn of the century, most mosquito nets did not have a built-in coating. Melanie Renshaw, chief director of the African Leaders Malaria Alliance, said that instead, woven fabrics must be immersed in insecticides every year. The whole village comes together to wash it in a communal bucket, which is a labor-intensive process and many people don't like the feeling of it drying dirty laundry.
Japan's Sumitomo Chemical Corporation was the first web to incorporate a chemical coating into the manufacturing process. Roland says it lasts for several years, even after cleaning. Time magazine listed mosquito nets as one of the best inventions of 2004. Once funding increases dramatically and more nets can be distributed, infections and deaths plummet.
The surge in investment in the fight against malaria has created new competition for manufacturers. The industry, once dominated by Vestergaard and Sumitomo, now has more than a dozen new entrants. As companies cut costs in order to win contracts, like Permanet 20 Such a network, which used to cost almost $5, now costs only $1$85.
In April 2018, Bill Gates attended the London Malaria Summit Papua New Guinea researchers didn't make a breakthrough until 2021. After not getting an answer from Westgard, Karl, one of the researchers, said he had the opportunity to meet someone who was proficient in net production. Their discussion led him to take a closer look at the insecticides applied to mosquito nets. A lab in Australia confirmed that this bonding had changed sometime in 2012 or 2013.
The initial coating contains PFAS, known as "forever chemicals" because they decompose very slowly. While PFAS are still widely used to make shoes and backpacks waterproofing and to produce firefighting foam, they are associated with an increased risk of cancer, decreased fertility, and stunted growth in children.
Their use is restricted in many countries, and industries are always looking for alternatives. According to net-making experts, Vestergaard's paint** shop stopped its PFAS products, while the net-maker opted for an alternative, and it was also much cheaper. The company's leadership continued to replace the coating, but did not notify the World Health Organization, which oversees the quality of the nets.
While we are constantly looking for ways to make our nets more affordable so that donor investments achieve maximum coverage while meeting WHO standards, the main reason for replacing the adhesive is for the merchant to stop using the ingredient," said a spokesperson for Essex, Westgard.
As with such parameters in all industries, there are acceptable boundaries for performance, and Permanet 20 is still within those boundaries," Essex said.
permanet 2.0 has been used in more than 200 countries around the world. The impact of less effective nets is unclear in countries where other brands are used or where other causes of increased malaria incidence play a greater role. But researchers in Papua New Guinea are worried, arguing that the impact of climate change or insecticide resistance is not as great as in other parts of the world where malaria is on the rise.
We don't think it's a Papua New Guinea problem," said Freeman, Rotary Papua New Guinea's Malaria Fight Programme Manager. "We think it's a global problem. ”
When researchers in Papua New Guinea discovered a problem with the Westgard net, they voiced their concerns to the World Health Organization and other organizations. Freeman said that the global ** has sent different brands of mosquito nets to Papua New Guinea, but other than that, they have not received much attention. The nets, he said, weren't much better.
In November 2023, the village of Siar, Papua New Guinea, distributed mosquito nets to local residents, and even though insecticides are not as effective at killing mosquitoes as before, mosquito nets remain a physical barrier against disease-carrying insects. Without exception, everyone interviewed by Bloomberg said it was crucial not to undermine support for its widespread use.
Innovation continues, and several companies, including Vestergaard, have now launched new nets containing a wide range of chemicals. At the same time, permanet 20 is still sold worldwide.
It's a huge embarrassment," Freeman said. "For 10 years, they have been distributing lower quality nets than in the past. No one wants to admit it. ”