Delivery of a novel intervention for vector control: Learning frameworks to support complex decisions

Abstract

Malaria remains a serious public health challenge, particularly in sub-Saharan Africa where initial progress from use of bed nets or indoor spraying is faltering in the face of insecticide resistance and other challenges. Vector control is a critical component for eliminating malaria. Consequently, there is increasing demand for novel approaches to mosquito vector control. This study focuses on moving one innovation – employing released modified mosquitoes to target their own species – from an external discovery laboratory through the early phases of evaluation and delivery into disease affected countries. A stepwise approach (contained studies, confined studies, pilot field studies) is considered best practice, in order to build knowledge on safety and efficacy while also increasing capacity of the decision makers. In reality, a diverse range of decision makers must make judgements about novel interventions in the face of uncertainty and lack of direct experience. To date, considerations regarding partnership with researchers in a disease endemic country and establishing the standards for containment studies are barely mentioned in the literature on genetic strategies, which focuses instead on national frameworks and biological criteria for the field study phase. This thesis raises the question of what constitutes good practices and supportive decision tools in this scenario, using action research, interviews and literature review and testing of some early prototypes. The researcher confirmed the value of simple frameworks to organise information, document evidence and inform future decisions, particularly when identifying appropriate research partners. Benchmarking the point at which to transfer a research organism to a partner can support those addressing the series of complex decisions unique to novel malaria interventions with more confidence and transparency. Learning tools are only effective when balanced with commitment to provide the resources and time for their use, and for ongoing skill development to face the challenges of such complex decisions.