The United Nations’ 28th annual climate change conference (COP28) was held in Dubai between 30 November and 12 December 2023. For the first time in a COP, climate and health was a key topic, including signature of a declaration on climate and health by 121 countries that includes a specific reference to Promoting steps to curb emissions and reduce waste in the health sector, such as by assessing the greenhouse gas emissions of health systems, and developing action plans, nationally determined decarbonization targets, and procurement standards for national health systems, including supply chains.
Climate change and its effect on malaria transmission patterns has been a growing concern for many at the country, regional and global levels for decades. The 2023 World Malaria Report, released on 30 November, included a spotlight on the growing threat of climate change for malaria.
The malaria community, particularly stakeholders involved in vector control which uses insecticides transported in containers or applied to products, has looked at its contribution to climate change in the form of operations and waste management. The AMP Partnership has been focused specifically on insecticide-treated nets (ITNs) as its Net Mapping Project shows that three billion ITNs have been shipped from manufacturers to malaria-endemic countries since 2004. This is an enormous achievement for malaria prevention under the leadership of national malaria programmes, but it is also a vast amount of plastic waste that has been generated both at the point of distribution (the packaging) and as ITNs become unserviceable for sleeping under and are repurposed and then discarded completely.
Plastic packaging and baling materials
Plastic waste from ITNs (packages, baling materials, etc.), particularly for campaigns during which substantial quantities of nets are distributed over large geographical areas in a short period, became a major challenge for national malaria programmes with the WHO policy shift from targeted to universal coverage with vector control and the significantly increased volume of ITNs needed for distribution. Many national programmes became increasingly concerned about the volume of plastic and the lack of capacity (human, financial, infrastructure) to manage it according to WHO guidelines.
Owing to these concerns, many national malaria programmes began requesting “naked” or bulk packaged nets for campaign distribution to minimize the volume of waste. For several years, most countries have been specifying bulk packaged nets for mass campaigns, significantly reducing the amount of waste imported to the country for vector control purposes. However, close to 100 million ITNs are still distributed through other channels (such as through health facilities, schools or communities) and the majority of these nets are still procured with individual plastic packaging to protect them during a longer storage period. Additionally, in certain contexts, individual packages may still be requested for mass campaign nets if it is unsure that ITNs can be distributed according to the timelines (e.g. in contexts of insecurity where ITNs may be in storage longer) or for other reasons.
National malaria programmes and their partners are emphasizing waste management as a priority in their campaign planning and budgeting, particularly for ITNs that cannot be bulk packaged and thus generate significant waste in communities where the distribution occurs. This newsletter highlights some of the efforts being made to address and manage ITN waste in innovative ways. If you have additional examples of innovative waste management that you wish to share with AMP partners, please contact email@example.com.
AMP has recently completed a review of plastic waste management, including a series of prioritized recommendations for different stakeholders such as national programmes, funding partners, technical partners and manufacturers. This review will be available in early 2024.
Unserviceable (end-of-life) nets
ITNs are distributed to and used in different contexts that affect the lifespan of the net. A paper by Bertozzi-Villa et al. highlighted the different ITN retention times across countries and supported a hypothesis that “nets are discarded more quickly than official policy presumes”. In many countries, ITNs that are no longer considered serviceable for sleeping under for malaria prevention are repurposed for other household uses such as eaves coverings, chicken coops and crop protection. In most countries, repurposing is typically not guided by policies established at the country level that promote beneficial or neutral repurposing while dissuading misuse of old nets, particularly for fishing.
When ITNs are no longer serviceable for any purpose – sleeping under or repurposing for other uses – they are considered “end-of-life” nets and will exit completely from the supply chain. However, to date there are limited experiences with collection and disposal of end-of-life nets, while their presence in the environment is well documented almost everywhere that ITNs have been distributed through mass campaigns and other distribution channels.
As with ITN repurposing, few national malaria programmes have policies in place for end-of-life nets. There are potentially important gains to be made by removing them from the environment, both environmental and financial through recycling into new products that can be sold for profit. However, end-of-life net collection and final disposal will require partnerships with private sector companies with capacities and regulations to manage this type of plastic waste. Additionally, in the context of insufficient resources for procuring sufficient ITNs to cover all populations at risk, national programmes will need to find solutions that are cost neutral to ensure sustainable approaches to management of unserviceable nets.
AMP partners are aware of their responsibility towards minimizing the negative environmental impact of ITN distribution for the households that we try to protect. National malaria programmes and their partners are working to find innovative solutions to the problems generated by ITN distribution as highlighted in the challenges, successes and innovative practices found in this newsletter.
 WHO (2011) Recommendations on the Sound Management of Packaging for Long-Lasting Insecticidal Nets. https://continuousdistribution.org/wp-content/uploads/2022/03/WHO-Recommendations-LLIN-Packaging.pdf