LAUSR

Background The program to eradicate malaria is at a critical juncture as a new wave of insecticides for mosquito control enter their final stages of development. Previous insecticides have been deployed one-at-a-time until their utility was compromised, without the strategic management of resistance. Recent investment has led to the near-synchronous development of new insecticides, and with it the current opportunity to build resistance management into mosquito-control methods to maximize the chance of eradicating malaria. Methods Here, building on the parameter framework of an existing mathematical model, resistance-management strategies using multiple insecticides are compared to suggest how to deploy combinations of available and new insecticides on bed nets to achieve maximum impact. Results Although results support the use of different strategies in different settings, deploying new insecticides ideally together in (or at least as a part of) a mixture is shown to be a robust strategy across most settings. Conclusions Substantially building on previous works, alternative solutions for the resistance management of new insecticides to be used in bed nets for malaria vector control are found. The results support a mixture product concept as the most robust way to deploy new insecticides, even if they are mixed with a pyrethroid that has lower effectiveness due to pre-existing resistance. This can help deciding on deployment strategies and policies around the sustainable use of these new anti-malaria tools.