Guillermo García
Director of International Programs, MCD Global Health
Carlos Guerra
Chief Science Officer, MCD Global Health
In 2004, a remarkable life-saving public-private health project began on Equatorial Guinea’s Bioko Island, off the coast of West Africa. Known as the Bioko Island Malaria Control Project (BIMCP), its initial focus used approaches such as IRS and insecticide-treated nets to control malaria.
Project aims to eliminate malaria
In 2019, BIMCP evolved into the Bioko Island Malaria Elimination Project (BIMEP), with ambitions to ultimately interrupt malaria transmission on Bioko. Progress has been extraordinary: the mortality rate of children under five has reduced by 78% and malaria prevalence has decreased by 75%.1 The significant body of operational research, data and knowledge that BIMEP has produced over the years can hopefully be used to inform malaria control in other countries.
“Many funders of malaria interventions look for innovations such as genetically modified mosquitoes and vaccines,” explains Guillermo García, Director of International Programs at MCD Global Health, a nonprofit public health organisation and BIMEP partner. “We are exploring those strategies too. Yet, there are proven tools such as indoor residual spraying that have reduced transmission and even eliminated malaria from certain countries, and these need continued support.”
There are only a handful
of tools in the malaria
control toolbox.
How intelligent use of data improves IRS delivery
In recent years, indoor residual spraying — which involves applying insecticides to interior walls and ceilings of homes — has fallen out of favour to control malaria, as it is often seen as costly and resource-intensive. However, its use on Bioko proves how it can be applied in a more economical, resource-efficient but effective way, says Carlos Guerra, Chief Science Officer, MCD Global Health.
First, depending on location, BIMEP discovered that lower IRS coverage (50%) can be just as protective as the recommended higher coverage (80%).2 Second, use of data systems has been a game-changer in how IRS is delivered.3
“Thanks to our robust geo-referenced data, we know how many houses have been sprayed and therefore what fraction of the population has been protected,” says Guerra. “We can measure impact, challenges and gaps in coverage. We know where the people most at risk are, and we can guide our teams in the field more precisely. So, while indoor residual spraying has not traditionally been a simple strategy to deploy, we’ve shown that by leveraging data it can be much more cost-effective.”
This type of data-driven delivery is an innovation in itself — one that should give confidence to funders that IRS is indeed a viable and important solution. Plus, new interventions won’t be successful overnight. They will need to be implemented in settings that already have a range of ongoing tried and true malaria controls.
Importance of partnerships in malaria control
Although Bioko Island is still a long way from achieving malaria elimination, MCD Global Health and its funding partners in the BIMEP — including the Government of Equatorial Guinea and companies in the energy sector — have achieved much over the last two decades, creating an effective landscape to test innovations alongside robust classic malaria strategies. “Obviously, no one organisation can tackle this on their own,” says Guerra. “Malaria control is hard.”
For programmes around the world, it’s been made harder with the withdrawal of US funding. “One of the biggest challenges we have is funding,” admits Guerra. “On Bioko Island, we can be optimistic that funding for malaria interventions will remain. For interventions in the rest of the world, we can’t — and unfortunately, malaria doesn’t stop because funding stops.”
“There are only a handful of tools in the malaria control toolbox,” García agrees. “We must secure funding for those interventions we know work while looking for alternative strategies that may be more effective. If we can stop people dying from malaria, then that is the motivation for all of us to keep going.”
[1] Equatorial Guinea National Malaria Control Program (NMCP) and MCD Global Health. Bioko Island Malaria Indicator Survey. 2023. Bioko Island, Equatorial Guinea.
[2] Galick DS, Vaz LM, Ondo L, Iyana MM, Bikie FEE, Avue RMN, et al. Reconsidering indoor residual spraying coverage targets: a retrospective analysis of high-resolution programmatic malaria control data. PNAS. 2025 https://www.pnas.org/doi/10.1073/pnas.2421531122
[3] García GA, et al. Real-time, spatial decision support to optimize malaria vector control: The case of indoor residual spraying on Bioko Island, Equatorial Guinea. PLOS Digital Health [Internet]. 2022;1(5):1–18. https://doi.org/10.1371/journal.pdig.0000025
