Mosquitoes know no borders, so should interventions to end malaria
Tuesday February 21 2023
The Kenya Medical Research Institute (Kemri) has announced the discovery of a new species of mosquito – the Anopheles Stephensi – which now threatens to reverse all the gains made in the fight against malaria in Kenya and beyond. Kemri says this species spreads fast and warns of an imminent surge in infections and deaths.
Malaria has been on the rise, with Africa hardest hit. The latest World Malaria Report indicates that four African countries accounted for half of malaria deaths worldwide in 2021.
Nigeria led the pack with 31.3 percent of the reported cases. The Democratic Republic of Congo came second, with 12.6 percent. Tanzania and Niger had four percent each. Kenya accounted for 2 percent of the deaths in 2020 and 1.9 percent in 2021.
It is an understatement to say that the picture is worrying. The situation before 2019 suggested that the war against malaria was being won.
The turning of the tide suggests that not enough is being done, or perhaps we just dropped the ball. There is need for the global community to rededicate itself to the engagement against this killer disease. It is possible that the sudden advent of Covid-19 led attention away from other scourges, among them malaria. The statistics are telling us, however, that whatever the factors may be, it is time to re-engage.
Efforts and conversations on how to regain the fight are of the essence. Different tools and technologies are currently being explored for the control, and even possible elimination, of malaria. They include modifying mosquitoes genetically to make them harmless. But there is also the need to understand why some of the hitherto effective interventions are no longer working. Plasmodium parasites that carry malaria have become increasingly resistant to existing interventions.
Plasmodium-carrying mosquitoes are becoming resistant to insecticides that were previously effective. Shifts in the patterns in which mosquitoes are biting have also been reported. These include the times and locations. Clear scientific understanding and explanation of the causes and drivers of these shifts are of the essence. The assignments before the scientific fraternity in this field call for sobriety of focus and dialogue.
Apart from scientific discourses, however, there is a need for structured talks on the legal and regulatory environment for implementation of any useful breakthroughs that could come from ongoing research efforts. Defining such legal and regulatory environments is usually the business of individual nation states, based on their existing law and regulation making instruments. Even when an intervention, or set of interventions, has been found to be scientifically workable and safe, individual states must sign and ratify the interventions before they can be introduced in the country.
The challenge with diseases like malaria is that the mosquitoes that carry the parasites do not know national borders. They don’t need passports and visas, like people. Even a proven intervention in one country can only be effective, therefore, when the neighbours also embrace it. It is especially because of this that the legal and regulatory framework talks on mosquitos are very important. But their essence is also underscored by the controversies that genetic modification of organisms tends to kick up.
Conversations on genetic modification have often been invaded by pansophist peddling of fear. Peddling of half-truths inhibits realisation of science-based conclusions – one way or the other. It is useful, however, to acknowledge some useful ongoing efforts.
Such platforms should be neutral, and not appear to advocate any particular technology. They should instead prioritise technologies that are recognised by such entities as the African Union, as essential for addressing the continent’s health challenges. Such platforms should also provide opportunities for Africans to be part of any conversations on the development, testing and deployment of safe and effective technologies.
Africa’s presence at any talks of this kind is especially underscored by the fact that the findings will be implemented on the continent and that they will affect Africans. Second is the need for sober science-based management of divergent opinions – and even controversies – on a wide raft of possible interventions floated. Any new ideas on the table need to demonstrate that thorough research has been done. They must also be found to be safe. Moreover, testing and piloting may have to be done, within acceptable ethical coordinates. Potential primary beneficiaries must, accordingly, be part of the conversation.
Field-testing of genetic modification of mosquitoes to make them plasmodium-free could happen in Africa in five to 10 years, according to expert opinion. This is, of course, if the ongoing technology development stages will be smooth and successful. Currently, no African country has the required legal and regulatory frameworks to govern the field-testing of genetically modified mosquitoes.
When the field-testing stage comes, countries will need regulatory guidance. This will include thorough risk assessment regulations. There will also be a need for transboundary regulatory harmonisation, among other primary concerns. The East African Community can play a crucial role in harmonising regulations to address cross-boundary issues in efforts to support the broader work of the AU in this respect.