In response to the article entitled WHOPES and Its Impact on Long-Lasting Insecticidal Net Availability, an Africa Fighting Malaria (AFM) occasional paper by Philip Coticelli, Vestergaard Frandsen submits the following information to complement the opinions presented in the article.

As an effort to educate the public about the proven effectiveness of long lasting insecticidal nets (LNs), such an article is valued contribution. AFM states in the Executive Summary that “the Roll Back Malaria Partnership (RBM) has made LN distribution a top priority for malaria control and called on the private sector to develop and produce more LNs.” Vestergaard Frandsen has responded to the call and in 2005-06, made major investments to increase its production 5-fold. Millions of children remain exposed to malaria without access to LNs, but availability is not the problem. The potential production capacity reported by AFM (Table 1) contains speculation, error, and omission. In fact, production capacity of over 1 million PermaNets has remained unsold in each month in 2007, in addition to the excess production of the other WHOPES-recommended LNs. Market supply of LNs continue to outstrip demand.

Having participated in the WHOPES evaluation process that is open to all manufacturers, Vestergaard Frandsen believes that the article’s statements about this process are false. On this matter, we defer to the WHO’s own response which provides an accurate, factual description of the process. See http://www.fightingmalaria.org/pdfs/WHOPES_response.pdf.

AFM’s statements about PermaNet, the LN product manufactured by Vestergaard Frandsen, are also false and misleading. Unfortunately, our company was not contacted for questions or input, even though it is a major subject of the article. The article uses isolated data points, taken out of context, to draw otherwise unjustifiable conclusions. Regarding the price of LNs, AFM cites PermaNet prices that are far higher than Vestergaard Frandsen’s price. Most sizes of PermaNet are under US$5, and shipping and logistics costs, even to inland destination, rarely surpass 7%.

Regarding quality control, Vestergaard Frandsen is an industry leader in the rigor of our quality testing. AFM chose to use one data point from one study as measure of the quality of PermaNet; such a shallow analysis fails to consider this sole data point in the vast body of published, independent research on PermaNet. Research papers by authors from the Centers for Disease Control (CDC), London School of Hygiene and Tropical Medicine, Kenya Medical Research Institute, and others have demonstrated the high quality of PermaNet. Moreover, Vestergaard Frandsen provides its customers with a Certificate of Quality based on a battery of tests on every production batch. External inspection by an independent body is frequently conducted by our customers, and verifies our data to demonstrate compliance. In addition, Vestergaard Frandsen is the only LN manufacturer which offers post-use quality control: clients can send samples from the field to our labs to monitor, at no charge, PermaNet’s chemical performance and projected lifetime.

Safety standards are of the utmost importance for any public health product, and the safety of PermaNet is assured for every production batch. The simplistic arithmetic in AFM’s article ignores the comprehensive risk assessments conducted by reputed scientists under WHOPES testing protocols. Moreover, the reference to the Graham et al. article is taken out of context; this article states that “Deltamethrin content on unwashed whole PermaNet 2.0 was found to be very variable (27 – 142 mg ai/m2), although the mean value of 55.3 (95% Cl: 10.1-100.6) mg ai/m2 came very close to the target concentration” of 55 mg/m2. The sampling procedure used in this research also used an analytical portion of netting material which is 20 times smaller than the WHO specification for this test, which likely explains the variable content.

AFM in its conclusion recommends that the bar be lowered so that more products can compete with PermaNet. Rather, other manufacturers (in addition to those which have already received recommendations) should be challenged to clear the bar established by WHOPES, and to deliver products that are as safe and effective as PermaNet. Such products will foster fair and healthy competition to the benefit of people affected by malaria, instead of fostering dissemination of untested health products. Finally, Vestergaard Frandsen believes that the combined efforts of the malaria-fighting community can raise the bar to protect even more children, even more effectively, and passionately strives every day to improve its lifesaving tools.