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Speaker 1: Bloomberg Audio Studios, podcasts, radio news.

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Speaker 2: Tim Freeman's work takes him to some of the most

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Speaker 2: remote places in Papua New Guinea PNG.

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Speaker 3: For those who don't know, it is a very very

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Speaker 3: complex country in terms of terrain. We've got lots of

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Speaker 3: mountains and such like, and getting stuff is very expensive

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Speaker 3: and often we have to go to places with aeroplanes

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Speaker 3: and sometimes even helicopters.

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Speaker 2: Those helicopters that traversing mountainous terrain. It's all part of

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Speaker 2: an important mission that Tim's been chipping away at for decades.

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Speaker 2: He's the program manager of Rotarians Against Malaria, an NGO

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Speaker 2: funded by the Global Fund and partnered with Papua New

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Speaker 2: Guinea's National Malaria Control program, and their goal is to

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Speaker 2: eliminate malaria in the country.

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Speaker 3: I have a team of people here that we literally

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Speaker 3: we jump from one province to another every one to

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Speaker 3: two months, and basically this team of people work with

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Speaker 3: the local health authorities and we literally visit every village.

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Speaker 2: Tim says they do a census, checking every household in

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Speaker 2: every village of the country for the purpose of distributing

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Speaker 2: mosquito nets. Malaria is transmitted almost entirely through mosquitos who

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Speaker 2: carry the disease and in the poorest parts of the world.

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Speaker 2: One of the primary tools against these mosquitos are insecticide

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Speaker 2: nets that can kill them before they bite and infect someone.

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Speaker 2: How many nets total have you distributed over your time there?

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Speaker 3: Oh, overall since we've been here, about twenty million nets,

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Speaker 3: I think.

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Speaker 2: And for a while it really seemed like their strategy

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Speaker 2: was working.

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Speaker 3: By the time we got to twenty fifteen, the number

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Speaker 3: of cases that we were recording in the country was

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Speaker 3: half of what it was in two thousand and six,

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Speaker 3: So everybody here was very excited, thinking, right, we're on

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Speaker 3: the way to elimination.

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Speaker 2: In twenty ten, the total number of suspected malaria cases

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Speaker 2: in Papua New Guinea was one point seven million. By

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Speaker 2: twenty fifteen, there were only around nine hundred thousand, and

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Speaker 2: Tim says it looked like the country was on track

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Speaker 2: to completely eliminate malaria by twenty thirty. But then something changed.

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Speaker 3: All those dreams disappeared very quickly.

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Speaker 2: Today on the show Why, researchers say a single business

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Speaker 2: decision made by the world's biggest manufacturer of bednets reversed

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Speaker 2: years of work to eradicate malaria in a country that

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Speaker 2: at least for a while, was on track to beat it.

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Speaker 2: I'm Sarah Holder, and this is the big take from

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Speaker 2: Bloomberg News.

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Speaker 1: Malaria is a horrifying disease. It is a high fever,

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Speaker 1: shaking and chills. You have trouble breathing, diarrhea, abdominal pain, fatigue,

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Speaker 1: You suffer. People with malaria suffer.

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Speaker 2: That's my colleague Michelle fey Cortez. She's a global healthcare

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Speaker 2: reporter and senior editor at Bloomberg, and she broke down

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Speaker 2: why malaria is such a high stakes disease.

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Speaker 1: It can be very quickly fatal. People can die within

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Speaker 1: twenty four hours with malaria, and it's not the sort

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Speaker 1: of thing that you recover from quickly. It takes weeks

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Speaker 1: and months. It's just a terrible disease.

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Speaker 2: Malaria can be devastating for individuals and families, but it

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Speaker 2: can also have an impact at scale. The World Health

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Speaker 2: Organization or WHO, estimates the disease is responsible for dampening

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Speaker 2: the GDPs of some African countries by one point three percent,

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Speaker 2: and in its most recent malaria report, the organization says

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Speaker 2: as much as half of the world's population is now

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Speaker 2: at risk, including some parts of the US. One of

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Speaker 2: the most effective tools for combating malaria was developed at

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Speaker 2: the turn of the century, long lasting insecticidal nets.

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Speaker 4: That's a fancy name for a net that is coded

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Speaker 4: in insecticide.

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Speaker 2: That's my colleague Anna Edney. She also covers healthcare at Bloomberg.

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Speaker 2: She and Michelle teamed up on this reporting, and you'll

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Speaker 2: hear from both of them in the episode. They say

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Speaker 2: all their sources agreed that these nets that came with

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Speaker 2: insecticide built in were a total game changer.

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Speaker 4: Before these were invented, villages were receiving nets, and they

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Speaker 4: were having to dip them in the insecticide themselves, and

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Speaker 4: then when you wash them that can cause problems. You

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Speaker 4: need to dip it again, and so it's.

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Speaker 2: Laborious, laborious, and they didn't work as well. These new

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Speaker 2: pre treated nets were much more effective, and the results

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Speaker 2: spoke for themselves. Mosquito populations would plummet in the communities

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Speaker 2: where they were widely used, and malaria cases went down

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Speaker 2: with them.

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Speaker 1: When you look cumulatively over the course of time, the

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Speaker 1: impact of these insecticide treated nets is just amazing. One

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Speaker 1: of the few public health measures that has really made

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Speaker 1: a significant difference on one of the leading causes of

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Speaker 1: death in the developing world.

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Speaker 2: For a long time, all the insecticide treated nets in

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Speaker 2: Papua New Guinea came from one source, a Swiss company

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Speaker 2: called Vestigard.

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Speaker 1: Vestiguard has an amazing reputation for quality. They were one

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Speaker 1: of the very first companies to get involved in this space,

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Speaker 1: and everyone told us they were the gold standard, that

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Speaker 1: the nets that they were putting out and the other

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Speaker 1: efforts that they had made when it comes to public

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Speaker 1: health were really top notch.

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Speaker 2: Thanks to Vestigard's nets, it looked like the country was

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Speaker 2: on track to a malaria free future. But between twenty

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Speaker 2: fifteen and twenty twenty two, something shifted. Researchers found that

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Speaker 2: the annual number of malaria cases in Papua New Guinea

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Speaker 2: nearly doubled, completely, erasing the progress to him and his

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Speaker 2: team had seen. So what happened, that's after the break

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Speaker 2: we're back. From twenty six to twenty fifteen, Papa New

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Speaker 2: Guinea was on course to wipe out malaria from the country,

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Speaker 2: largely thanks to an insecticide laced mosquito net from the

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Speaker 2: Swiss company Vestigard. But in twenty sixteen cases started to

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Speaker 2: climb and researchers wanted to know why. Over the next

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Speaker 2: five years, as the problem continued to worsen, they considered

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Speaker 2: a lot of possibilities climate change, mosquitos growing resistant insecticides.

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Speaker 2: The list goes on. The country had reserves of unopened

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Speaker 2: vestigard nets going back to two thousand and seven, and

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Speaker 2: they were able to test their effectiveness at killing mosquitoes

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Speaker 2: from year to year.

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Speaker 4: They found that the nets worked much much better prior

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Speaker 4: to twenty twelve twenty thirteen, and they actually got worse

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Speaker 4: in the later years. There were only about seventeen percent

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Speaker 4: effective compared to one hundred percent effective before twenty twelve.

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Speaker 2: A team of researchers published those findings that the older

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Speaker 2: vestigard nets were much more effective than the newer ones

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Speaker 2: in a peer reviewed journal in twenty twenty, but they

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Speaker 2: still didn't know why it was happening. How could these nets,

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Speaker 2: which were touted as the gold standard in the fight

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Speaker 2: against malaria suddenly drop off in quality.

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Speaker 1: They really couldn't figure it out, and they did try

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Speaker 1: for quite some time. Then some researchers from Papua New

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Speaker 1: Guinea went to a meeting in Liverpool actually, and they

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Speaker 1: came across another expert in chemical coatings, and that person said,

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Speaker 1: have you actually looked at the way the nets were made,

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Speaker 1: at what was being put on the nets to see

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Speaker 1: if there was a change there. So that's when a

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Speaker 1: light bulb moment occurred and the researchers sent off the

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Speaker 1: nets and found out in fact that there had been

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Speaker 1: a change in the coating of the netting that happened

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Speaker 1: in twenty twelve twenty thirteen, and that that is what

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Speaker 1: they believe was the cause of the issue.

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Speaker 2: It would turn out that right around twenty twelve and

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Speaker 2: twenty thirteen, Vestiguard changed the way it bonded the insecticide

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Speaker 2: to its nets. Up until that point to get the

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Speaker 2: insecticide to stick to the net for years, even after

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Speaker 2: multiple washes, the company had used what are known.

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Speaker 4: As polychloro alcohol substances, which you might know is pfos

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Speaker 4: or forever chemicals.

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Speaker 2: PFAX chemicals have historically been used and things a lot

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Speaker 2: of us use every day, from nonstick cookwaar to water

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Speaker 2: repellent clothes to stain resistant fabrics and carpets. But even

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Speaker 2: if pfast chemicals are really good at getting insecticide to

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Speaker 2: stick to mosquito nets. They're not without their own risks.

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Speaker 4: There's a cancer risk that's associated with pfas as well

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Speaker 4: as potentially developmental issues for kids, so not great to

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Speaker 4: have that in the coding.

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Speaker 2: And it reached out to Vestiguard to ask the company

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Speaker 2: why it had decided to stop using pfast chemicals in

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Speaker 2: its manufacturing process.

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Speaker 4: Vestor Guard said that they changed the nets because the

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Speaker 4: supplier that they got the ingredients for the coding from

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Speaker 4: stopped selling the PIFAs material and that they needed to

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Speaker 4: change that. They didn't say who the supplier was, but

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Speaker 4: they said that they decided to go with a different ingredient,

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Speaker 4: which they didn't tell us what the ingredient was.

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Speaker 2: To report the story, Anna and Michelle spoke with more

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Speaker 2: than three dozen malaria and net experts, business leaders, and

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Speaker 2: industry consultants from around the globe, and while Vestigard told

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Speaker 2: Bloomberg that it had stopped using a p fas coding

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Speaker 2: because of supplier issues, Anna and Michelle also talked to

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Speaker 2: two consultants with knowledge of net technology, including one who

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Speaker 2: used to work at Vestigard and asked not to be named,

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Speaker 2: and they said, Vestiguard could have chosen a more effective

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Speaker 2: substitute for prefast chemicals, and the fight against malaria and

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Speaker 2: Papua New Guinea wouldn't have lost as much ground if

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Speaker 2: only the company had decided to go with a more

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Speaker 2: expensive option. They said. The reason the nets stopped working

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Speaker 2: as well was because the company had picked a cheaper replacement.

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Speaker 4: They had different options that they could have gone with,

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Speaker 4: but they decided to go with this option.

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Speaker 2: How has Vestigard responded to that criticism and the allegation

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Speaker 2: that the nets are less effective?

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Speaker 4: So they haven't acknowledged that the nets are less effective.

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Speaker 4: They have acknowledged that there is a broad range of

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Speaker 4: what can be considered an effective net and that they

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Speaker 4: still fit into that category. So they still meet who's

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Speaker 4: criteria for being a net that and be sold to

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Speaker 4: prevent malaria, but they still aren't as good as they

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Speaker 4: once were.

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Speaker 2: Until twenty seventeen, the WHO did not require net manufacturers

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Speaker 2: to inform them of manufacturing changes, and Vestiguard didn't disclose

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Speaker 2: the change to their nets, but that had wide implications.

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Speaker 1: The thing is is that at the time, the company

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Speaker 1: didn't notify the World Health Organization that they were changing

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Speaker 1: the way they made the bed nets, and they didn't

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Speaker 1: tell anyone who was being affected by that. They also

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Speaker 1: didn't tell anyone when we started seeing these rates increasing

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Speaker 1: and as people on the ground in Papua New Guinea

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Speaker 1: were trying to figure out what was going on. They

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Speaker 1: also didn't say it then.

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Speaker 2: And has done a lot of reporting on healthcare products

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Speaker 2: that don't work as well as they're supposed to, and

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Speaker 2: she says the story of Vestigard in Papua New Guinea

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Speaker 2: is an example of what can happen when the balance

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Speaker 2: between cost and quality is thrown off.

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Speaker 4: One thing that was reinforced when I was reporting as

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Speaker 4: that when, particularly in public health, we're looking at products

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Speaker 4: that we're trying to buy for either medicine or preventing disease,

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Speaker 4: is anything along those lines that just buying the cheapest

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Speaker 4: thing is not always going to be the best.

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Speaker 2: Papua New Guinea has been able to secure nets made

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Speaker 2: by other manufacturers, but Vestigard is still producing and distributing

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Speaker 2: its nets all over the world. The company can test

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Speaker 2: the methods that researchers used to show that their nets

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Speaker 2: were less effective than before, but the World's Health Organization

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Speaker 2: has told Bloomberg it is very concerned by the implications

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Speaker 2: of the research. They've asked for the underlying data to

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Speaker 2: look into it more. The WHO has also raised concerns

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Speaker 2: about the quality of nets manufactured by other companies and

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Speaker 2: in other countries, and compounding trends in the industry like

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Speaker 2: growing global demand for nets and more competition among suppliers,

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Speaker 2: have some researchers worried that the quality of these life

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Speaker 2: saving nets will only continue to drop. Tim Freeman says

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Speaker 2: they're feeling the effects of those shifts on the ground

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Speaker 2: in Papua New Guinea.

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Speaker 3: The simple message here is the nets that we are

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Speaker 3: receiving now, not only from vesta God, don't seem to

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Speaker 3: be as good as the ones that we had in

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Speaker 3: the past. So this is not just a problem for

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Speaker 3: vestor God. It seems to be right across the board.

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Speaker 3: What I want to see is new generational nets that

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Speaker 3: are much more efficient than the previous ones that via

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Speaker 3: in distributing for the last ten years.

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Speaker 2: Though today's nets aren't perfect, Anna and Michelle's sources emphasize

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Speaker 2: that having nets at all is better than having no nets,

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Speaker 2: Even as people on the ground advocate for better ones.

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Speaker 1: Everyone that we've talked to has said, you know, please

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Speaker 1: don't denigrate nets. We need people to believe in the nets.

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Speaker 1: We need the funders to pay for the nets. We

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Speaker 1: need the doctors to distribute the nets. We need the

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Speaker 1: people on the ground who are dealing with malaria and

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Speaker 1: their daily rates to believe in the nets and to

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Speaker 1: use them, to put their kids under them, to sleep

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Speaker 1: under them every night. But that doesn't mean that they're

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Speaker 1: as good as they can be. It doesn't mean that

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Speaker 1: they're as good as they used to be. And that's

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Speaker 1: something that we really do feel like should be a

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Speaker 1: discussion in public health circles.

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Speaker 2: This is the Big Take from Bloomberg News. I'm Sarah Holder.

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Speaker 2: This episode was produced by David Fox. It was edited

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Speaker 2: by Aaron Edwards, Caitlin Kenny, and Angelie Cordero. It was

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Speaker 2: mixed by Alex Uguia. It was fact checked by Tiffany Choi.

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Speaker 2: Our senior producers are Naomi Shaven and Jill did Dy Carly.

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Speaker 2: We get editorial direction from Elizabeth Ponso. Nicole beemsterbor is

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Speaker 2: our executive producer. Sage Bauman is Bloomberg's head of Podcasts.

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Speaker 2: Thanks for listening, Please follow and review, The Big Take

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Speaker 2: wherever you listen to podcasts that helps new listeners find

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Speaker 2: the show. We'll be back tomorrow.