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Tim Freeman's work takes him to some of the most remote places in Papua New Guinea PNG.
For those who don't know, it is a very very complex country in terms of terrain. We've got lots of mountains and such like, and getting stuff is very expensive and often we have to go to places with aeroplanes and sometimes even helicopters.
Those helicopters that traversing mountainous terrain. It's all part of an important mission that Tim's been chipping away at for decades. He's the program manager of Rotarians Against Malaria, an NGO funded by the Global Fund and partnered with Papua New Guinea's National Malaria Control program, and their goal is to eliminate malaria in the country.
I have a team of people here that we literally we jump from one province to another every one to two months, and basically this team of people work with the local health authorities and we literally visit every village.
Tim says they do a census, checking every household in every village of the country for the purpose of distributing mosquito nets. Malaria is transmitted almost entirely through mosquitos who carry the disease and in the poorest parts of the world. One of the primary tools against these mosquitos are insecticide nets that can kill them before they bite and infect someone. How many nets total have you distributed over your time there?
Oh, overall since we've been here, about twenty million nets, I think.
And for a while it really seemed like their strategy was working.
By the time we got to twenty fifteen, the number of cases that we were recording in the country was half of what it was in two thousand and six, So everybody here was very excited, thinking, right, we're on the way to elimination.
In twenty ten, the total number of suspected malaria cases in Papua New Guinea was one point seven million. By twenty fifteen, there were only around nine hundred thousand, and Tim says it looked like the country was on track to completely eliminate malaria by twenty thirty. But then something changed.
All those dreams disappeared very quickly.
Today on the show Why, researchers say a single business decision made by the world's biggest manufacturer of bednets reversed years of work to eradicate malaria in a country that at least for a while, was on track to beat it. I'm Sarah Holder, and this is the big take from Bloomberg News.
Malaria is a horrifying disease. It is a high fever, shaking and chills. You have trouble breathing, diarrhea, abdominal pain, fatigue, You suffer. People with malaria suffer.
That's my colleague Michelle fey Cortez. She's a global healthcare reporter and senior editor at Bloomberg, and she broke down why malaria is such a high stakes disease.
It can be very quickly fatal. People can die within twenty four hours with malaria, and it's not the sort of thing that you recover from quickly. It takes weeks and months. It's just a terrible disease.
Malaria can be devastating for individuals and families, but it can also have an impact at scale. The World Health Organization or WHO, estimates the disease is responsible for dampening the GDPs of some African countries by one point three percent, and in its most recent malaria report, the organization says as much as half of the world's population is now
at risk, including some parts of the US. One of the most effective tools for combating malaria was developed at the turn of the century, long lasting insecticidal nets.
That's a fancy name for a net that is coded in insecticide.
That's my colleague Anna Edney. She also covers healthcare at Bloomberg. She and Michelle teamed up on this reporting, and you'll hear from both of them in the episode. They say all their sources agreed that these nets that came with insecticide built in were a total game changer.
Before these were invented, villages were receiving nets, and they were having to dip them in the insecticide themselves, and then when you wash them that can cause problems. You need to dip it again, and so it's.
Laborious, laborious, and they didn't work as well. These new pre treated nets were much more effective, and the results spoke for themselves. Mosquito populations would plummet in the communities where they were widely used, and malaria cases went down with them.
When you look cumulatively over the course of time, the impact of these insecticide treated nets is just amazing. One of the few public health measures that has really made a significant difference on one of the leading causes of death in the developing world.
For a long time, all the insecticide treated nets in Papua New Guinea came from one source, a Swiss company called Vestigard.
Vestiguard has an amazing reputation for quality. They were one of the very first companies to get involved in this space, and everyone told us they were the gold standard, that the nets that they were putting out and the other efforts that they had made when it comes to public health were really top notch.
Thanks to Vestigard's nets, it looked like the country was on track to a malaria free future. But between twenty fifteen and twenty twenty two, something shifted. Researchers found that the annual number of malaria cases in Papua New Guinea nearly doubled, completely, erasing the progress to him and his team had seen. So what happened, that's after the break
we're back. From twenty six to twenty fifteen, Papa New Guinea was on course to wipe out malaria from the country, largely thanks to an insecticide laced mosquito net from the Swiss company Vestigard. But in twenty sixteen cases started to climb and researchers wanted to know why. Over the next five years, as the problem continued to worsen, they considered a lot of possibilities climate change, mosquitos growing resistant insecticides.
The list goes on. The country had reserves of unopened vestigard nets going back to two thousand and seven, and they were able to test their effectiveness at killing mosquitoes from year to year.
They found that the nets worked much much better prior to twenty twelve twenty thirteen, and they actually got worse in the later years. There were only about seventeen percent effective compared to one hundred percent effective before twenty twelve.
A team of researchers published those findings that the older vestigard nets were much more effective than the newer ones in a peer reviewed journal in twenty twenty, but they still didn't know why it was happening. How could these nets, which were touted as the gold standard in the fight against malaria suddenly drop off in quality.
They really couldn't figure it out, and they did try for quite some time. Then some researchers from Papua New Guinea went to a meeting in Liverpool actually, and they came across another expert in chemical coatings, and that person said, have you actually looked at the way the nets were made, at what was being put on the nets to see
if there was a change there. So that's when a light bulb moment occurred and the researchers sent off the nets and found out in fact that there had been a change in the coating of the netting that happened in twenty twelve twenty thirteen, and that that is what they believe was the cause of the issue.
It would turn out that right around twenty twelve and twenty thirteen, Vestiguard changed the way it bonded the insecticide to its nets. Up until that point to get the insecticide to stick to the net for years, even after multiple washes, the company had used what are known.
As polychloro alcohol substances, which you might know is pfos or forever chemicals.
PFAX chemicals have historically been used and things a lot of us use every day, from nonstick cookwaar to water repellent clothes to stain resistant fabrics and carpets. But even if pfast chemicals are really good at getting insecticide to stick to mosquito nets. They're not without their own risks.
There's a cancer risk that's associated with pfas as well as potentially developmental issues for kids, so not great to have that in the coding.
And it reached out to Vestiguard to ask the company why it had decided to stop using pfast chemicals in its manufacturing process.
Vestor Guard said that they changed the nets because the supplier that they got the ingredients for the coding from stopped selling the PIFAs material and that they needed to change that. They didn't say who the supplier was, but they said that they decided to go with a different ingredient, which they didn't tell us what the ingredient was.
To report the story, Anna and Michelle spoke with more than three dozen malaria and net experts, business leaders, and industry consultants from around the globe, and while Vestigard told Bloomberg that it had stopped using a p fas coding because of supplier issues, Anna and Michelle also talked to two consultants with knowledge of net technology, including one who used to work at Vestigard and asked not to be named, and they said, Vestiguard could have chosen a more effective
substitute for prefast chemicals, and the fight against malaria and Papua New Guinea wouldn't have lost as much ground if only the company had decided to go with a more expensive option. They said. The reason the nets stopped working as well was because the company had picked a cheaper replacement.
They had different options that they could have gone with, but they decided to go with this option.
How has Vestigard responded to that criticism and the allegation that the nets are less effective?
So they haven't acknowledged that the nets are less effective. They have acknowledged that there is a broad range of what can be considered an effective net and that they still fit into that category. So they still meet who's criteria for being a net that and be sold to prevent malaria, but they still aren't as good as they once were.
Until twenty seventeen, the WHO did not require net manufacturers to inform them of manufacturing changes, and Vestiguard didn't disclose the change to their nets, but that had wide implications.
The thing is is that at the time, the company didn't notify the World Health Organization that they were changing the way they made the bed nets, and they didn't tell anyone who was being affected by that. They also didn't tell anyone when we started seeing these rates increasing and as people on the ground in Papua New Guinea were trying to figure out what was going on. They also didn't say it then.
And has done a lot of reporting on healthcare products that don't work as well as they're supposed to, and she says the story of Vestigard in Papua New Guinea is an example of what can happen when the balance between cost and quality is thrown off.
One thing that was reinforced when I was reporting as that when, particularly in public health, we're looking at products that we're trying to buy for either medicine or preventing disease, is anything along those lines that just buying the cheapest thing is not always going to be the best.
Papua New Guinea has been able to secure nets made by other manufacturers, but Vestigard is still producing and distributing its nets all over the world. The company can test the methods that researchers used to show that their nets were less effective than before, but the World's Health Organization has told Bloomberg it is very concerned by the implications of the research. They've asked for the underlying data to
look into it more. The WHO has also raised concerns about the quality of nets manufactured by other companies and in other countries, and compounding trends in the industry like growing global demand for nets and more competition among suppliers, have some researchers worried that the quality of these life saving nets will only continue to drop. Tim Freeman says they're feeling the effects of those shifts on the ground in Papua New Guinea.
The simple message here is the nets that we are receiving now, not only from vesta God, don't seem to be as good as the ones that we had in the past. So this is not just a problem for vestor God. It seems to be right across the board. What I want to see is new generational nets that are much more efficient than the previous ones that via in distributing for the last ten years.
Though today's nets aren't perfect, Anna and Michelle's sources emphasize that having nets at all is better than having no nets, Even as people on the ground advocate for better ones.
Everyone that we've talked to has said, you know, please don't denigrate nets. We need people to believe in the nets. We need the funders to pay for the nets. We need the doctors to distribute the nets. We need the people on the ground who are dealing with malaria and their daily rates to believe in the nets and to use them, to put their kids under them, to sleep under them every night. But that doesn't mean that they're as good as they can be. It doesn't mean that
they're as good as they used to be. And that's something that we really do feel like should be a discussion in public health circles.
This is the Big Take from Bloomberg News. I'm Sarah Holder. This episode was produced by David Fox. It was edited by Aaron Edwards, Caitlin Kenny, and Angelie Cordero. It was mixed by Alex Uguia. It was fact checked by Tiffany Choi. Our senior producers are Naomi Shaven and Jill did Dy Carly. We get editorial direction from Elizabeth Ponso. Nicole beemsterbor is our executive producer. Sage Bauman is Bloomberg's head of Podcasts.
Thanks for listening, Please follow and review, The Big Take wherever you listen to podcasts that helps new listeners find the show. We'll be back tomorrow.