Modelling new insecticide-treated bed nets for malaria-vector control: how to strategically manage resistance?

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. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12936-022-04083-z.