By Dr Marceline (Lina) Finda, Ifakara Health Institute
In a recent Twitter conversation hosted by Gene Convene, my colleague Dr Fredros Okumu and I were invited to share insights from our latest survey of African stakeholders focusing on gene drive approaches for malaria control.
According to the 2021 World Malaria Report, Africa continues to shoulder the heaviest malaria burden globally, with over 90% of global malaria cases and deaths recorded on the continent. Although progress has been made against the disease since 2000, this remains uneven, due to a number of different factors, including growing resistance to some of the current interventions. Transformational tools such as gene drive approaches have the potential to address some of these challenges and help speed up malaria control and elimination efforts. Researchers have been exploring the potential of gene drive applications to limit the spread of diseases, particularly those spread by insect vectors, such as malaria, for a long time.
With support from FNIH, together with my colleagues Dr Fredros Okumu, Dr Elijah Juma and Rhosheen Mthawanji, we conducted a series of in-depth discussions with stakeholders from 25 different African countries to investigate opinions, concerns and recommendations regarding gene drive modified mosquitoes for malaria control. The stakeholders were recruited from research and academia, regulatory agencies, health and other government ministries, the media and advocacy groups. We started by contacting the stakeholders we had identified via email and invited them to participate in a baseline survey, which included questions related to their perception of the malaria situation in their country, available tools to combat the spread of the disease and the potential use of gene drives in malaria endemic settings.
More than 300 people were contacted in the initial stages of the exercise. Stakeholders who participated in the survey were then further organized into either in-person or virtual focus group discussions. An estimated 18 focus groups of various sizes were established as a result. Using explanatory PowerPoint slides to guide the discussions, participants were invited to provide their input on topics related to both genetic modification at large and the potential use of gene drives for malaria control. As the technology was new to many of the stakeholders involved, a brief overview of gene drive technology was provided to enable them to form their own opinion and have an informed debate on the topic.
The consultation process taught us that although awareness of the existence of gene drive approaches for malaria control amongst African stakeholders is high, understanding of how the technology works is quite low. Several stakeholders also found it hard to distinguish between gene drives and other genetic modification approaches. Nevertheless, a majority of the stakeholders expressed their support for further research on gene drive approaches for malaria vector control, particularly in addressing existing gaps in the fight against the disease.
Stakeholders also raised some concerns regarding the technology, including lack of capacity in malaria endemic settings to support management of gene drive technologies, should these be considered for use, how gene drive technologies fit within specific countries’ malaria control strategies, as well as concerns regarding safe research and implementation of these approaches. It will be fundamental to address these concerns before the technology can be considered for potential field trials.
Moving forward, we hope to expand our stakeholder reach and further investigate some of the questions and concerns raised by stakeholders. We also hope to further investigate solutions to some of the major gaps identified. Some of the possible immediate solutions could be collaborating with gene drive experts and developers to share knowledge of how the technology works, and to address some of the questions and concerns raised.
We look forward to seeing more African participation in the development of these technologies and exploring further how gene drive could fit within different malaria-endemic contexts. We also look forward to publishing our findings from this experience and sharing more of these perspectives as our research progresses.