As the spread of mosquito-borne diseases has captured headlines in recent months, so too has a novel approach to mosquito control that might one day stop them: gene drive. Although it is in early development, this promising genetic technique could help end the transmission of many deadly pathogens, including malaria.
Gene drives let modifications made to a single organism spread rapidly through the entire population by making sure that targeted genes are passed on to nearly all its offspring. In theory, it would be possible to use gene drives to create mosquitoes that produce sterile offspring, vastly reducing the number that can transmit malaria or other viruses.
Using gene drives to make precise changes to the genome of Anopheles gambiae, the mosquito species that causes the deadliest type of malaria, or to Aedes aegypti, a species that transmits viruses such as dengue, Zika, chikungunya, and yellow fever could eradicate diseases that claim nearly 700,000 human lives each year.
Researchers are already exploring the risks and benefits of using gene drive for public health. Just last week, the US National Academy of Sciences issued guidance on responsible research into the technology; this follows a similar report from the UK House of Lords. A host of prominent researchers have weighed in with their views through scientific publications and journals.
While vitally important, these conversations have been missing something invaluable: the perspectives of representatives from malaria-affected countries, largely in South and Central America, Africa, and southern Asia.
As the former minister of health in the Republic of Namibia, I have seen firsthand the devastating effects that malaria has on individuals, families, and communities. I believe that Africans could reap a huge benefit from the promise of gene drive. An estimated 300,000 children in sub-Saharan Africa die from malaria each year, representing 95 percent of all child malaria deaths globally. Existing mosquito control methods, such as bed nets and insecticides, provide some protection from malaria, but they cannot end it in most settings unless combined with new, transformative interventions.
I am concerned that more Africans aren’t part of the conversation about gene drive because there is much we still don’t know about this technology. We don’t know how effectively genes spread through mosquitoes in a natural setting. We don’t know the precise environmental or ecological implications of introducing genetic changes in a handful of mosquito species. And we don’t have consensus on the ethical considerations of such an approach.
African scientists and public health experts must be deeply involved in weighing these issues as researchers consider using gene drives to stop malaria in Africa. Our countries live with malaria every day, and the perspectives of our citizens should inform the debate. Dialogue with African governments and regulators should be grounded in science, with a diverse group of stakeholders participating in discussion and decision-making.
This type of collaboration is already paying dividends in Brazil, where researchers are exploring how the Wolbachia bacteria could prevent mosquitoes from spreading dengue and Zika. Brazilian scientists were brought on board early and played an integral role in fostering open dialogue with health authorities and local communities. As a result, public conversation about Wolbachia has been productive and inclusive, and it could speed adoption of the technology if field trials prove successful.
The international community should adopt a similar approach to research into gene drive.
We can start by engaging scientists, researchers, and national disease control programs with decades of experience fighting malaria and other diseases transmitted by mosquitoes in Africa, South and Central America, and southern Asia. Their knowledge of local epidemiology and entomology will be vital to determining how gene drives may one day be applied to mosquito control.
Regional cooperation is vital, as mosquitoes with gene drives will easily pass between sovereign countries with different public health policies. Although the technology is years away from being a reality, it’s never too early to engage expert advisory groups — from the World Health Organization to the African Union and other regional organizations — that can counsel governments on policymaking.
Finally, we must invest in local universities and research institutions to train more specialists in scientific disciplines like biomedical engineering. Building local expertise in these areas — including capacity in entomological surveillance and intelligence — will benefit countries in the malaria belt for years to come.
Like many friends and colleagues, I have devoted my career to ending malaria. That a novel technology could help make this dream possible in my lifetime fills me with hope. But to advance gene drive research and its application safely and transparently, we must listen closely to the people with everything to gain if it works.
Richard Nchabi Kamwi, MD, is ambassador of the SADC Malaria Elimination 8 (E8) Initiative, a board member of Roll Back Malaria, and the former minister of health of the Republic of Namibia.
