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Gene drive and malaria: an ethical decision requires context

Written by Aaron Roberts, Institute on Ethics & Policy for Innovation at McMaster University

Gene drive technology is being explored as a durable and cost-effective biocontrol tool for elimination of malaria in Africa. Some critics consider this novel technology, by its very nature, to be an overly risky method for reducing or eliminating malaria.

The most common, and reasonable concern I have heard is about the potential for ecological harm. It is true, the technology has not yet been tested under natural (out of the lab) conditions. The question is whether testing in the wild should proceed, after conducting rigorous safety and efficacy testing in controlled cage conditions, and after receiving the proper regulatory approvals. After all, even if field tests to discover whether the technology is efficacious in the wild proceed and prove successful, those concerned argue that such a release may also result in unintended ecological consequences. The existence of these unknowns has prompted some to call for a global moratorium on research and development of gene drive technology.

Something we must always keep in mind when assessing novel technologies and methods is that it does not make ethical sense to do so in a vacuum. There is a very human tendency to fear the unknown above even terrible certainties – as it is sometimes colloquially said, “Better the devil you know.” This is called a status quo bias. But no decision is made outside of a given context, and ethics demands that context be taken into consideration as we make our decisions.

In the case of humankind’s endeavor to eliminate malaria, the situation we face is grim indeed. The WHO’s 2018 World Malaria Report states that in 2017 alone, there were an estimated 219 million cases of malaria, and an estimated 435,000 deaths from the disease globally. Over 60% of those deaths are of children under the age of 5, which means at current rates another child is dying from malaria every two minutes.

We face this tragic situation armed with flawed and failing tools. Our current methods – drugs and insecticides, each attended by their own negative side-effects on the human body and the environment respectively – are quickly losing efficacy as their targets develop resistance to them. Not only have we not made progress towards the goal of eliminating malaria in the past few years, we have seen a slide backwards. This worsening “status quo” constitutes the set of terrible certainties against which we must measure the risks of conducting research involving environmental release of gene drive applications for malaria elimination.

There is no doubt that malaria is a dire and pressing global problem, and there is no question that we require new tools if we are ever to eliminate it. Gene drive applications constitute one of the most promising tools under research and development. Their ecological side effects are likely to be less harmful than existing methods involving heavy use of pesticides, which also aim to kill mosquitos en masse, and which persist perniciously in the environment. Gene drive applications may be attended by some ecological cost, but so are our current methods, which are not working very well. If we do not innovate, the cost in human lives and suffering will certainly rise. These facts must be foregrounded and weighed in the balance if we are to make an ethical decision about gene drive applications.

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