Integrated vector management
and malaria control
WHO EMRO Regional meeting, Muscat, 27/03/2002
Dr. Pierre F. Guillet
Parasitic Diseases & Vector Control
WHO Geneva

Few definitions...
Integrated Vector Control (IVC)
The utilisation of all appropriate technological
and management techniques to bring about
an effective degree of vector suppression in
a cost effective manner.
WHO, 1983

Definitions
• Selective Vector Control
The targeted use of different vector
control methods alone or in
combination to prevent or reduce
human-vector contact cost-effectively,
while addressing sustainability issues
WHO Expert Committee on malaria, 1994

Declaration of the 50th session of
the WHA, resolution 50.13
• To take steps to reduce reliance on
insecticides for control of vector borne
diseases through promotion of integrated
pest management approaches in accordance
with WHO Guidelines, and through support
for the development and adaptation of viable
alternative methods of disease vector control

Definitions
• Integrated Vector Management
• A process of evidence-based decision making
procedures aimed to plan, deliver, monitor and
evaluate targeted, cost-effective and sustainable
combinations of regulatory and operational vector
control measures, with a measurable impact on
transmission risks, adhering to the principles of
subsidiarity, intersectorality and partnership.
WHO, draft working definition, 2001

Elements
of IVM
• It’s about process, not contents
• spells out the need for an evidence base
• retains economics and sustainability as key
criteria
• mentions both regulatory and operational
measures
• further defines output indicators

Elements
of IVM
• Ecosystems analysis as a starting point
• Leads to a logical build-up of integrated
measures, from environmental management
to biological and chemical control
approaches
• Leaving chemicals as a measure of last
resort, recognises their value as a resource
that need to be sustained as long as possible

IVM, a basis for implementation
of vector control interventions
• Vector control, an essential element of vector
borne disease control
• Not an individual programme but a component of
disease control, in line with national policies and
health sector reform
• Based on sound knowledge of ecological and
epidemiological situations, cost effectiveness
analysis and judicious integration of available
options

• Should be effective, safe, environmentally
sound, economically feasible, socially
acceptable and sustainable.
IVM Objectives
• To reduce vector breeding where and when
possible
• To reduce abundance and longevity of vectors
• To reduce human vector contact (personal
protection)

Strategies
• Vector management principles and decision
making criteria to be integrated into existing
frameworks of national health policies
• Establishment or strengthening of vector
control services in conjunction with
– the creation of enabling policy framework for
intersectoral collaboration
– the strengthening of legislative and relevant
regulatory frameworks and their enforcement

• Social mobilisation: involvement of
mobilisation
communities
• Capacity building: addressing human,
building
material & financial resources
• Promotion of research
• Initiation and strengthening of regional
collaboration networks

Steps towards implementation
• To prepare and disseminate technical
guidelines for:
– situation analysis and need assessment for IVM
– planning, implementing, monitoring and
evaluating vector control interventions based on
IVM
• To provide technical assistance to the Member
States for above steps

IVM and malaria
control
Fundamental parameters to consider:
– Anopheline female life expectancy
(daily survival rate)
– duration of sprorogonic cycle
– feeding and resting habits
– stability of transmission
– development of human immunity

Larval control:
a limited role
• Reduce adult densities but not life expectancy
(Mac Donald and Garrett Jones formulas)
• proper planning and experienced staff needed
• expensive and labour intensive
• potential environmental impact
• more suitable for urban and peri-urban
environments and few special settings (low
vectorial capacity…)

Indoor residual spraying
• Gold standard method in
malaria control but..
– absence of vector control structures
in a number of countries
– limited choice of insecticides
– cost and logistical constraints (increase in human
populations)
– high impact of insecticide resistance
– increasing problem of acceptability

Insecticide treated materials
& personal protection
• A highly targeted and selective
use of insecticides
• When compared to IRS, reduce
by 150 to 300 times consumption
of insecticides. Difference even higher with
long lasting insecticidal nets
• How does it work: personal protection
versus community protection

ITNs or ITMs?
• Immediate and long term efficacy of ITNs
already established
• Efficacy of impregnated curtains to be
confirmed (expected differences according to
local conditions and type of curtains)
• Long lasting impregnated plastic sheeting’s
and impregnated blankets for refugee
settings and complex emergencies

ITNs, strengths
and limitations
• No need for vector control services
• Distribution by various channels: health
services, private sector, NGO’s...
• Opportunities for partnerships
• Social acceptance
• Low retreatment rates, especially in Africa
• Heavy reliance on pyrethroids (resistance)

• ITNs, a tool for multi-disease
prevention
• Better integration of human communities in health
programmes
• A first level approach to catalyse and build up
interest on vector control at central and peripheral
levels
• Opportunities for innovative approaches (e.g. LLINs)
• Optimal combinations of drugs and insecticides
• ITNs, not a universal silver bullet but a component of
IVM strategies and approaches

Other interventions
• Space spraying, very limited in malaria prevention
• Environmental management
– house improvement (e.g. La Réunion)
– sanitation in urban areas and modifications of
environment
• Biological control (bacterial larvicides (Bti),
larvivorous fishes…)

EMRO, an heterogeneous region
• A range of cost-effective strategies may
be developed, depending upon local
ecological and epidemiological contexts
as well as resources available (human,
financial, logistical..)
• From highly malaria endemic countries
(e.g. Sudan) to eradication almost
completed (Morocco, Oman…)

IVM, development of new tools…still
an heavy reliance on insecticides
• Need for strengthening pesticide management
practices and resistance monitoring networks
We are loosing our weapons:
• Need for detailed comparative risk benefit
analysis
• Public information and legislative campaigns
to preserve the availability and use of
pesticides for disease vector control

On going challenges in malaria control
• Epidemic prevision and response
• Emergencies (war, natural disasters..), follow up
of population movements
• Risk assessment for vector borne diseases in
planning agricultural development schemes
• POPs negotiations and DDT phasing out
• Capacity building, training in vector control
• Co-ordination to further improve country support
Et la lutte continue !!