Next-gen insecticidal bed nets cost 30-37% more, blocking adoption where needed most

Pyrethroid resistance has rendered standard pyrethroid-only bed nets (PY ITNs) significantly less effective across most of sub-Saharan Africa, yet the next-generation nets that overcome this resistance (PY-PBO nets and PY-chlorfenapyr nets) cost 30-37% more per unit. Replacing the roughly 350 million standard nets distributed every 2-3 years with next-gen nets would require an additional $132-159 million per year. This matters because the countries with the highest pyrethroid resistance are also the poorest and most dependent on donor funding for their entire malaria programs. National malaria programs face an impossible choice: buy fewer effective nets (leaving coverage gaps) or buy more cheap nets that do not work. Either way, people die. The Global Fund and PMI, which fund most net procurement, have finite budgets that have not grown proportionally with the price increase. The problem persists because the insecticide market is an oligopoly with only 2-3 manufacturers producing next-gen nets, limiting price competition. WHO prequalification for new net types takes 3-5 years, slowing market entry. Meanwhile, resistance continues to intensify because the same pyrethroids are used in agriculture, creating environmental selection pressure that no health-sector intervention can control.