Almost 2.7 million DawaPlus low quality Long-Lasting Insecticide Nets (LLINs) were distributed to beneficiaries in Northern, Muchinga and Copperbelt provinces of Zambia in 2017 and 2018, the National Malaria Elimination Centre (NMEC) has finally issued an official confirmation.

NMEC’s response came following two investigative articles published by News Diggers in August and September 2019.

The two-pages statement, exclusively obtained and published by our newspaper, recognises that a “failure may decrease the efficacy of the nets to kill mosquitoes”, wrote NMEC in its conclusion paragraph. Failure here is in reference to dosage of insecticide mixed to the polyester not being of the correct proportions, making the treated nets’ efficiency below global standards set out by the World Health Organisation (WHO).

Nonetheless, Zambia’s health authorities – represented by NMEC in this instance – have not responded to our repetitive requests about shortcomings in testing products destined to address serious public health issues such as malaria prevention. While admitting that 2.7 million nets produced by a foreign company named Tana Netting – currently rebranded Moon Netting, NMEC downplayed the vital role of compliant good-quality treated nets in protecting individuals and communities, and advanced that “LLINs are still effective if communities are encouraged to sleep under LLINs every night as they offer protection and serve as a physical barrier between the individual and the biting mosquito”, read the statement.

While specialists amongst the global malaria prevention community recommend that individuals should use nets even if they are sub-standard, Zambian authorities haven’t explained the reasons behind not testing the 2.7 million Dawa-Plus substandard nets when they first arrived into the country in 2017. Authorities have also failed to answer our questions about current safeguards and quality control mechanisms to prevent in the future distribution of low quality medical and public health solutions.

As a result, the statement constitutes no real reassurance for the Zambian public who is reported to be witnessing rising levels of insecticide resistance by mosquitoes, namely in provinces where the sub-standard nets were distributed.

Questions around whether Zambia’s health authorities have put in place processes to quarantine sub-standard mosquito nets while awaiting test results have not received any answers either. Similarly, WHO has not responded to our requests, and to date, the only reaction obtained from this international United Nations (UN) agency – which acts as a prevention and compliance global partner to countries facing malaria epidemics, Zambia included – was to address our concerns for local authorities.

The WHO country office has therefore remained coy on the matter. A query was sent by email and repeated calls were made to which there was no official response. A senior official who asked not to be named because he had not been cleared to speak on the matter, asked for more time to consult with the NMEC. At the time of writing, there has been no follow-up from WHO local offices nor from their headquarters.

In its turn, NMEC detailed in the same statement the chronology of events which has led to this story breaking out. According to NMEC, on February 1 this year, Zambia received a notice of potential manufacturing issues from the Global Fund and President Malaria Initiative (PMI) for Dawa Plus 2.0. The donors’ notice was also sent to all the countries that received the nets, revealed the statement.

The NMEC also added that another notice followed on “Quality Assurance Information” dated 22nd March 2019 from the Global Fund. “The purpose of this notice was to provide recommendations and advice on the basis of information that was provided by H. Sheikh Noor-ud-Din & Sons (HSNDS) regarding the quality issues of DawaPlus 2.0 commercialised by Tana Nettings,” said NMEC in a statement.

The statement further said the notice was for internal and external dissemination and country teams were expected to communicate this information to their relevant stakeholders. “This was duly communicated to relevant stakeholders under the auspices of the malaria programme in Zambia,” it said.

The notice was not however shared with the public, and no plans have been announced to recall or replace the substandard Dawa Plus 2.0 nets.

In August this year, commenting on this issue, a senior source within the Ministry of Health who asked to remain anonymous, said no tests were carried before or after distribution of these controversial nets. The source also added that NMEC as an affiliate of the ministry of health has been aware of the nets, which were short in size and of poor finishing, but did not point to the most questionable aspect, which is the inappropriate dosage of insecticide which makes them even less effective. To date, both NMEC and the ministry of health have not officially confirmed nor denied reports that absolutely no tests had taken place prior to 2017 distribution
According to the National Malaria Elimination Strategic Plan, Zambia aims to achieve 100 percent malaria free status by 2021. Experts and malaria campaign groups warn that the use of untreated nets could hinder the country’s elimination targets.

Malaria continues to be the leading cause of rife sickness and death in Zambia. According to NMEC, more than 16 million people are at risk of malaria in Zambia. The country includes several highly malaria-endemic regions. According to official statistics, malaria incidences vary from under 50 per 1,000 population in some districts to above 500 cases per 1,000 population in others. Malaria prevalence in the most vulnerable age group (children under five years) varies from below 3 percent in some districts such as urban Lusaka to 30 percent in the most rural provinces.

In Africa, Zambia joins Ghana to publicly confirm the alleged low-quality LLINs were distributed by both countries’ malaria control bodies. Zambians aren’t therefore alone when it comes to receiving sub-standard mosquito nets. NMEC said through its response to News Diggers request that Zambia is among several countries that received DawaPlus LLINs through support from the Global Fund. The NMEC has named Angola, Benin, Cameroon, DRC, Ghana, Guinea, Kenya, Madagascar, Malawi, Mali, Mozambique, Niger, Nigeria, Rwanda, South Sudan and Sudan as the African countries which have received such non-compliant nets. In Asia, Afghanistan, Pakistan, Myanmar and the Philippines were listed as other recipients affected by the same public health issue.