Michelle L Gatton 1 , 2 , 3 , Nakul Chitnis 4 , 5 , Thomas Churcher 6 , Martin J Donnelly 7 , Azra C Ghani 8 , H Charles J Godfray 1 , 9 , Fred Gould 1 , 10 , Ian Hastings 11 , John Marshall 6 , Hilary Ranson 7 , Mark Rowland 12 , Jeff Shaman 1 , 13 , Steve W Lindsay 1 , 14 , T Meagher
Over the past decade the use of long-lasting insecticidal nets (LLINs), in combination with improved drug therapies, indoor residual spraying (IRS), and better health infrastructure, has helped reduce malaria in many African countries for the first time in a generation. However, insecticide resistance in the vector is an evolving threat to these gains. We review emerging and historical data on behavioral resistance in response to LLINs and IRS. Overall the current literature suggests behavioral and species changes may be emerging, but the data are sparse and, at times unconvincing. However, preliminary modeling has demonstrated that behavioral resistance could have significant impacts on the effectiveness of malaria control. We propose seven recommendations to improve understanding of resistance in malaria vectors. Determining the public health impact of physiological and behavioral insecticide resistance is an urgent priority if we are to maintain the significant gains made in reducing malaria morbidity and mortality.