Fig. 2

The effect of control measures on mitigating the impact of A. stephensi introduction for regions with different pre-existing malaria endemicity. A The change in clinical incidence over time (per 100,000 people per year) following A. stephensi introduction in three locations, with low (~0.1%), medium (~2.5%) and high slide prevalence (~12%). Each location had an EIP of 8 and 40% ITN usage, 0% IRS and 0% LSM pre-A. stephensi introduction and establishment. To aid clarity and interpretation of the figure, we only display the temporal trends of the PBO-ITN and PBO-ITN/IRS/LSM package of interventions, though the impacts of all modelled interventions are displayed in Fig. 2B. Different coloured lines indicate intervention scenarios be it no additional interventions (black), or scale up of PBO-ITNs (blue) or the use of PBO-ITN/IRS/LSM. Coloured shapes show the 95% CIs for model predictions given uncertainty in parameters. The left vertical dashed line indicates the start to the introduction of An. stephensi, which occurs between the dashed lines and is fully established by year 3. As above, the time scale on the x-axis is deliberately omitted due to uncertainty in the timing of events, with clinical incidence fluctuating with 3-year ITN mass campaigns and annual IRS. Additionally, uncertainty continues up to 400 cases per 100,000, but this has been curtailed in order to improve interpretation of median trends. B The median annual increase in malaria incidence per 100,000 per year comparing before and after scenarios for each of the locations across a range of intervention combinations. Red arrows and numbers refer to the percentage increase in the median incidence following the establishment of A. stephensi compared to the 3 years prior to the introduction. Black lines and numbers show the percentage reduction in cases relative to no additional interventions over 3 years caused by the introduction of the different control interventions