Malaria kills about three million people a year, at least a child every 30 seconds in Africa alone. One of the reasons that the disease is so deadly is that there is no vaccine to prevent it, and all the methods to control the mosquito, which spreads the disease, are imperfect and expensive (at least to the most impoverished on the planet).  And it has been killing people all over the world for thousands of years. Those who believe that climate change will imperil them from malarial mosquitoes should think again. Malaria carrying anopheles mosquitoes live nearly everywhere. Even in the Arctic Circle malaria can still kill – and it has taken many in the temperate world, perhaps most notably, Oliver Cromwell, who died in September 1658 in Britain of the disease. Malaria is today, as always, more a disease of poverty than climate.

Given this trail of death, any new approaches to combat this ancient scourge should be welcomed. So it is exciting news that scientists at the Johns Hopkins University’s Malaria Research Institute in Maryland have genetically altered a mosquito so that it still bites and behaves identically to the current anopheles genus of mosquito, but it cannot spread malaria. Although only in the research phase, the plan would be to release millions of engineered mosquitoes into malarial locations in order to breed with malarial mosquitoes. The expectation is that over time the interbreeding would lead to a lowering of the number of mosquitoes carrying the ability to spread the disease.

The key to trying an approach such as this is to introduce insects that have advantages over non-engineered mosquitoes so that they not only survive but thrive. Previous attempts at sterilizing harmful insects to interbreed and lower overall populations have failed because the irradiation came at a cost to the insects and lowered the mating advantage of the sterilized – the fertile wild competitors mated more readily.

But according to the researchers these modified mosquitoes are unaffected by the malarial parasite, whereas their infected cousins are weakened slightly. JHU researchers said that "When fed on Plasmodium-infected blood, the transgenic malaria-resistant mosquitoes had a significant fitness advantage over wild-type." And this alleged advantage could be critical to the technology actually being effective in the field. So far research outcomes are positive; when interbred with equal numbers of wild mosquitoes the modified mosquitoes have won out. Over nine generations of interbreeding, lasting several months, the resulting population was 70 percent modified. The implications are clear, after thirty or forty generations (over a couple of years), the wild mosquito would largely be wiped out and the modified mosquito entirely dominant.

With such a positive result the researchers are naturally excited by the possibilities, but of course one test is far from conclusive. First, there are well over a hundred species of disease carrying mosquito and so far the test has been undertaken with only one species, anopheles stephensi, which is relatively easy to work with, and is found most abundantly in South East Asia. If the researchers find that the results are equally effective with the main African mosquitoes (anopheles Gambiae in particular), then that will be the next step. Second, lab and brief field tests are one thing, but actually seeing a major impact in malarial areas is another matter entirely. There are billions of wild mosquitoes and it might take the introduction of many millions of modified mosquitoes over several decades before a significant impact on disease occurred. And we may not see the mosquitoes introduced for over a decade due to the need for safety testing (introducing a modified organism is subject to myriad long-winded testing regimens).

However, the research is promising and should be pursued further. The real danger is in seeing the breakthrough as the latest panacea for combating the disease - after all we have been awaiting a vaccine for the disease for over thirty years. And pursuit of a vaccine has often side-tracked from interventions that save hundreds of thousands of lives today. The 1980s saw the demise of DDT spraying to prevent malaria, with many funds going into alternative interventions (such as bed nets) that were not as effective, as well as so far unproductive vaccine research. It is important that this new research does not indirectly undermine actual interventions in the field.

And it may do so, because each new breakthrough reduces the likelihood of any substantial funding going into the one area that has saved more lives than any other – insecticide development. DDT was a marvelous breakthrough in 1940, but since then there have only been one or two others, and none to match it in impact. That is because the only significant research is done by agrochemical commercial interests. Bill Gates and the G8 need to spend hundreds of millions of dollars on insecticide research, the result would save lives far faster than genetically modified mosquitoes.

Whither Idol's Money?

American Idol's "Idol Gives Back" special on April 24 and 25 helped raise over $60 million to fight poverty in America and Africa. As season five comes to a close tomorrow, fans should be asking where their money went and what the impact on poverty will be.

Over six million dollars of the total was given to Nothing But Nets, an antimalaria bed net distribution initiative claiming that the funds raised have already "saved over 600,000 children." An undisclosed amount will also go to Malaria No More, UNICEF, and the Global Fund to Fight AIDS, TB and Malaria. These groups have good intentions, but their collective strategy of covering Africa with $10 insecticide-treated nets is simplistic and wasteful. Africa needs more than ITNs to stop malaria and overcome chronic poverty. Nothing But Nets claims "one net saves one life," hence six million dollars saves 600,000 lives.

Public health is more complex and this is a spurious calculation. Technical agencies like UNICEF and the Global Fund make more realistic assumptions about ITNs based on scientific evidence. UNICEF, for example, explains on its Web site, "There is evidence that ITNs, when consistently and correctly used, can save six child lives per year for every one thousand children sleeping under them." This estimate is based on a 2003 study in the Lancet, a British medical journal, and amounts to 0.006 lives saved per ITN properly used, not one.

Moreover, consistent and correct use means sleeping under an ITN all night every night. This is quite a caveat. Uganda has one of the most free and vibrant civil societies in Africa. It has received tremendous amounts of foreign aid, including over two millions ITNs by 2005. A 2006 National Statistics Bureau survey that year found only 14% of rural households owned an ITN, and only 8% of young children and pregnant women used one the night before the survey. Malaria No More and the Global Fund have distributed over two million more ITNs in Uganda since then. The fact remains that ITNs are a personal inconvenience for various reasons, the most obvious being nature's nightly call.

This is why the World Health Organization has called for more indoor residual spraying with insecticides that kill or repel malaria-carrying mosquitoes, including DDT. The West used DDT to eradicate malaria, and President Bush's Malaria Initiative has been helping countries to use it safely and effectively. Yet fundraisers, U.N. agencies, and most other donors have continued to focus on ITNs because they are easier to implement. ITNs can be shipped in and dropped off like disaster relief aid, while indoor residual spraying programs require tough policy reforms, development of health systems, and complex monitoring.

New York Sun

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