Description
Introduction, Objective: According to the World Health Organization, there were an estimated 249 million malaria cases and over 600,000 malaria deaths in 2022. Malaria is typically transmitted by female Anopheles species mosquitoes. In laboratory settings, researchers at Imperial College London successfully eliminated Anopheles populations using CRISPR-Cas9-based genome editing and gene drive technology in 2018 (Kyrou et al., Nature Biotechnology 36, 1062-1066). In this study, the researchers induced a CRISPR–Cas9-targeted disruption of the doublesex (Agdsx) gene and inserted a CRISPR–Cas9 gene drive construct into the mosquito’s genome, resulting in the infertility of all female Anopheles mosquitoes in the caged population within 7-11 generations. Employing this approach in the real world is one of the most promising pathways to completely eradicating malaria, but it raises significant ethical concerns, which will be explored in this presentation.
Methodology: The presentation is based on a scoping review using Arksey and O'Malley's (2005) methodology to identify ethical issues related to gene drives and gene editing for eliminating vector-borne diseases, as reflected in scientific literature and WHO guidance published between January 2015 and October 2023. Abstracts (N = 465) from PubMed, ScienceDirect, JSTOR, the Cochrane Database of Systematic Reviews, and WHO IRIS were screened. The final sample included 16 publications.
Results and Discussion: The primary ethical issues identified in the scientific literature and WHO guidance relate to (i) biosafety and environmental impact concerns; (ii) community involvement; (iii) transparency and trust; (iv) harm prevention and control and compensation; (v) the global dimension of the intervention and the need for international cooperation; (vi) the moral status of the Anopheles species designated for elimination; and (vii) the need to define clear criteria for the designation of disease-carrying or invasive species for elimination. While no publication fundamentally objected to the elimination of malaria-carrying mosquito species, most called for the highest possible biosafety and environmental protection standards in pursuing Anopheles species extinction. All publications acknowledged the exceptional global burden of disease of malaria, with several advocating against extending species elimination to organisms carrying diseases with a low global burden of disease.
Conclusions: Genetic engineering holds the promise of creating a malaria-free world and saving millions of lives. To enable a speedy rollout of technologies to eliminate malaria-carrying mosquitoes once they are ready, it is essential to establish a consensus on the related ethical challenges as soon as possible. While the strategy of eliminating malaria-carrying mosquitoes is relatively uncontroversial, consensus on the details of this strategy, particularly ethical challenges related to (i) risk-benefit and safety standards; (ii) community involvement; and (iii) global cooperation, is crucial. The presentation will provide recommendations for the process to reach such a consensus, drawing on the presenter’s experience as a rapporteur on mpox (monkeypox) and ethics for the WHO Expert Group on Ethics & Governance of Infectious Disease Outbreaks and other Emergencies.
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