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Imagine losing a child every 75 seconds to a preventable and treatable disease! This is the devastating statistic of malaria, the prodigious human killer transmitted by just a bite of an infected female Anopheles mosquito. Data from the World Malaria Report 2022 shows that in 2021 alone, approximately 247 million people worldwide got infected with malaria, and 619,000 died of the disease. Woefully, sub-Saharan Africa accounted for 95% of the new malaria infections (an estimated 234 million cases), and 96% of all deaths (an estimated 593,000 deaths) globally. Four African countries, Nigeria (27%), the Democratic Republic of the Congo (12%), Uganda (5%) and Mozambique (4%), accounted for almost half of all the global malaria cases. Similarly, four African countries, Nigeria (31%), the Democratic Republic of the Congo (13%), the Niger (4%) and the United Republic of Tanzania (4%), accounted for almost half of all malaria deaths globally.

While significant effort has been put into malaria control, mainly focusing on controlling the mosquito vector that transmits the disease, the success over the years is now threatened by the growing resistance of mosquitoes to insecticides used. This current challenge is the reason why scientists are exploring the potential of using genetically modified (GM) mosquitoes to control the disease.

Preparatory research is currently going on in several countries in Africa to explore the possibility of testing GM mosquitoes for malaria control in future. In Burkina Faso, for instance, a group of researchers from the Target Malaria consortium, a not-for-profit research group working on controlling the malaria-transmitting mosquito, released male sterile GM mosquitoes in 2019. This release was intended to test the infrastructure and systems for future releases of GM mosquitoes for malaria control in the country. Preparatory research by different research groups is also ongoing in Uganda, Mali, Tanzania, Cabo Verde, Sao Tome and Principe, and Comoros.

Status of research and regulatory instruments on genetically modified mosquitoes in East Africa

On 17–19 November 2022, the African Institute for Development Policy (AFIDEP), together with the East African Community (EAC)’s health department, the East African Health Research Commission (EAHRC), and the Ifakara Health Institute (IHI), convened a policy dialogue to create awareness of the ongoing preparatory research on GM mosquitoes for malaria control in the EAC region. The policy and regulatory framework requirements needed to guide the testing of the GM mosquitoes for malaria control were also discussed during the dialogue. In attendance were policymakers in the EAC region, including legislators from the national parliamentary committees on health across the seven EAC member states; members of the East African Legislative Assembly; biotechnology/biosafety regulators; national malaria control programmes; and health experts from the region, including researchers on gene drive mosquito technology.

Two research groups – Target Malaria consortium in Uganda, and Transmission Zero in Tanzania – both working on preparatory research to lay the foundation for the testing of GM mosquitoes in the EAC region attended the dialogue. They explained in detail the basic principles of genetic control of malaria mosquitoes, highlighting the potential that this approach may have in eliminating malaria in the region. For many participants, this was their first introduction to GM mosquitoes, and many appreciated the role that the technology could play in the fight against malaria if well-developed and proven effective and safe.

Participants were concerned about the risks associated with releasing engineered mosquitoes in the open environment. Policymakers in attendance also pointed out the need for further discussions on the policy and regulatory frameworks needed to guide research on GM mosquitoes for malaria control in the region. They recommended that the EAC secretariat to mobilise resources and conduct a review of existing policies and regulatory frameworks on the development and use of GM organisms, including mosquitoes. This review would help to identify gaps related to developing and deploying biotechnology for health and, subsequently, feed into guidelines to facilitate the establishment and operationalisation of appropriate regulatory structures for work on GM organisms in the EAC Partner States.

A presentation by the intergovernmental Great Lakes Malaria Initiative on interventions currently in place to curb cross-border transmission of malaria provided participants with useful information while deliberating on options to handle the cross-boundary issues likely to arise with the future release of GM mosquitoes where proven safe and effective.

Proposals on the way forward for the proper development and testing of GM mosquitoes
While the technology is still in its initial stages of development and could take about a decade before widespread use if proven effective and safe, participants appreciated the efforts to create awareness and an understanding of the technology. One participant noted that often in the research process, policymakers and regulators are brought on board towards the end when policies and guidelines are required, a practice that often jeopardises the proper implementation of promising disease control interventions.

Participants also discussed the importance of providing data that addresses the different fears, concerns, and misconceptions regarding GM mosquitoes for malaria control. Importantly, providing data from the risk assessments conducted and engagements with the local communities where exploratory research is conducted is critical in shaping the legal and regulatory frameworks involved.

Beyond GM mosquitoes for malaria control, participants underscored the importance of EAC Partner States increasing their domestic budget allocation and developing favourable policies that encourage local investment in health research and development. African Union members committed to allocate 1% of their GDP to research and development in 2006. However, according to African Union Development Agency’s (AUDA-NEPAD) 2019 African Innovation Outlook, progress toward these goals has been slow. By 2019, the funding for the continent was only 0.42%, which is way below the global average of 1.7%. Thus, it is more difficult to find indigenous, long-lasting solutions to health issues if African governments do not support African research.

At the end of the dialogue, participants proposed to the planning committee to have the policy dialogue as an annual event that builds on conversations and commitments from the previous dialogues.