African Superbugs to the Rescue!
"Brother, can you spare a malaria pill?"
The phone rang in my room at the Seronera Wildlife Lodge in the Serengeti. It was the early days of a group trip to Tanzania and Kenya, but one woman in my group had already discovered the joys of East African baggage handling in Nairobi, where her bags had been misplaced along with those of another member of the group.
"I'm collecting Malarone for the destitute," she said cheerfully. Like most of the people on the trip, she had gotten a prescription for protective anti-malaria medication from her doctor before starting out the trip. Hers had been in the lost bag, so she was looking to replenish her supply.
"No problem," I said, "My doctor prescribed me a couple of extras. I'll bring them down at breakfast."
This transaction—handing off a few spare pills to reduce the threat of a terrible illness—seems so simple. So why can't we manage it on a large scale? Why can't we figure out how to put pills in the hands of the hundreds of millions of people in Africa who fall ill after the bite of a malaria-carrying mosquito every year, or the one million people who die from the disease, nearly all of them children?
The drugs that my group carried were state of the art, with a price to reflect that, retailing at a little under $75 a week. Lariam, the generation of pills before Malarone, caused strange hallucinogenic dreams (actually, my doctor asked if I'd prefer the Lariam, since "some arty types like that sort of thing." I politely declined.) And the old, pennies-a-day quinine-based staples were no longer effective in parts of Tanzania. Too bad, because there's nothing like a truly medicinal gin and tonic (tonic contains quinine).
The pills require vigilance-they must be taken every day and for 7 days after leaving the malarial area (not that most affected people have the luxury of ever "leaving the malarial area"). Likewise, other methods of prevention, like bed nets and interior insecticides require upkeep. Many of the current crop of nets must be resprayed with insecticide at regular intervals, and they must be kept free of holes and tucked tightly around the edge of the mattress. (The first night I used a bed net, I managed to trap a mosquito inside with me.)
But in the end, as simple as it seems like it ought to be, we can't stockpile enough pills, we can't get them in the right hands, there aren't enough bed nets, and they aren't being used with enough consistency, insecticide use is patchy, and use of the most effective insecticide, DDT, is controversial-controversial enough to be banned in some of the worst off countries.
One might think, then, that a new, technological solution, one that required no upkeep and no individual responsibility, would be welcomed.
Researchers have recently conscripted a gene for a toxin from a sea cucumber, of all things, in the fight against malaria. Inserting this gene into mosquitoes creates a toxic environment for the malaria-causing parasite that usually lives happily in a mosquito's gut. These tweaks make it impossible for malaria to be passed from human to human via mosquito.
In order for this scheme to work, the modified mosquitoes have to outbreed normal mosquitoes in the wild. This has been the main challenge for scientists thus far. But the current generation proves to be surprisingly robust in a caged trial, dominating the mosquito population at 70 percent in the ninth generation when feeding on malarial blood. In fact, killing the malaria-causing parasite may actually give the genetically-modified mosquitoes an edge by allowing them to live longer and lay more eggs, according to the scientists at the Malaria Research Institute at Johns Hopkins University.
"This fitness advantage has important implications for devising malaria control strategies," they write in the journal Proceedings of the National Academy of Sciences.
The lab-made mosquitoes aren't quite good enough yet-they don't outbreed regular mosquitoes on a diet of regular blood. But the concept has undeniable appeal, right? Let a few genetically freakish mosquitoes into the population and then sit back and watch as they outbreed their treacherous, malaria-carrying brothers and sisters.
So far, the criticism has been fairly muted, and the researchers themselves are being cautious and circumspect, saying that it could be as long as ten years from now before release into the wild is a possibility.
"What we did was a laboratory, proof-of-principle experiment; we're not anywhere close to releasing them into the wild right now," said study co-author Dr. Jason Rasgon from Johns Hopkins University in Baltimore, Maryland.
"There is quite a lot of research that needs to be done, both in terms of genetics and the ecology of the mosquitoes; and also research to address all the social, ethical and legal issues associated with releasing transgenic organisms into the environment," he said.
But even with that cautious note in the air, many are already seeing visions of the worst possible outcome. "Once new species get out of their ecosystem and they are not kept in check by other processes that's when they start to cause mayhem," Deborah Long of Plantlife Scotland told the Guardian.
Respected groups like the Pew Initiative on Food and Biotechnology are standing by previous statements[PDF] about the possible problems caused by GM insects. "The mobility and range of insects pose international regulatory challenges never faced with GM crops," they wrote in 2004.
In response to initial announcements about the modified mosquitos, the Guardian's James Randerson wrote "it will probably be the perception of risk rather than the actual risks that are important. GM-crops were scuppered in Europe by the what-if fears: in the end, the scientific assessment did not matter." Sadly, he's right.
Lots of study and lots of caution are appropriate, of course, but this is the beginning of storyline that is already too familiar. The logic of bans on DDT, pest-resistant GM crops, and other technological solutions to human problems will be applied here too, and Africa will suffer for our timidity.
When it came right down to it, no one on my trip probably needed the Malarone pills anyway. We had high concentration DEET insect spray in our bags and bed nets in our rooms. Yes, there were malaria warnings for both Tanzania and Kenya, but a downloadable detailed report from the CDC showed risk areas in more detail, and we weren't going to be in them, for the most part.
We were taking the pills as a luxury, our excess of caution born out of our excess of wealth, relatively speaking. I was bitten a few times on the trip, and the knowledge that I was drugged up stilled the alarm I might otherwise have felt. But all around me, I watched citizens of Tanzania and Kenya casually brush away mosquitoes that could have brought them low with a single bite. Even if I'd given away every pill in my stock, it wouldn't have made a dent.
Generosity amongst friends is not so easy to duplicate on the necessary scale, even with the riches of Bill Gates, and the charitable spirit of Mother Teresa. Other solutions are needed.
And while we worry about what might happen to the ecosystem if we release a mosquito with a small change in its genes, millions of people roll in their beds (or on mats on the floor), fevered and ill. We shouldn't release modified mosquitoes before they are ready. But when they are ready and the inevitable invocation of the precautionary principle comes, we should try to weigh the caution we are used to being able to afford against the real suffering of real people whose lives are so different from our own that it is difficult to comprehend.
Katherine Mangu-Ward is an associate editor of reason.
