A new tool could transform malaria control in Africa

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Malaria is evolving fast, with mosquitoes changing transmission patterns due to climate change. Experts stress that new tools and faster timelines will help protect vulnerable communities. In an exclusive interview with Healthcare Rising, Krystal Birungi explains how gene drive, a new tool against malaria reduces mosquito reproduction and controls spread.

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We are seeing changes in mosquito behaviour due to climate change. From your perspective, how is climate change altering malaria transmission patterns?

Africa could see 554,000 additional malaria deaths due to climate change, putting the goal of eliminating malaria by 2030 in jeopardy. Climate change, population growth, and funding shortfalls are all impacting hard-won gains over the past decade. Here is why: shifting temperature and rainfall patterns are expanding and altering malaria risk zones, which will continue to disproportionately affect vulnerable populations, especially children under five. According to a climate impact model developed by Boston Consulting Group and the Malaria Atlas Project to predict changes in extreme weather events and to estimate their impact on malaria deaths to the year 2049, the increase in extreme weather events is reshaping malaria risk. The findings indicate that between 2030 and 2049, climate change is expected to cause 554,000 more malaria deaths than if today’s climate remained unchanged. This is despite some regions seeing reduced transmission rates. Extreme weather events will drive 92% of these additional deaths.

Stepping up malaria control with current tools could reduce the additional deaths, but climate change may weaken their impact by up to 17%, making progress fragile. By 2050, climate change will make malaria eradication harder for 75% of sub-Saharan Africa’s population, equating to 1.3 billion people. Extreme weather is one of the biggest drivers of malaria spikes. Displaced communities are often left unprotected without mosquito nets, indoor spraying, or access to early diagnosis and treatment. 

In Uganda, this includes communities in areas affected by floods and landslides. Even in areas where weather changes have been less extreme, slowly changing conditions have implications for malaria control. For example, in the Karamoja region of Uganda, increasing rains in what has previously been a consistently semi-arid environment mean longer and more unpredictable malaria seasons. Similarly, in the cold mountainous regions of Uganda where the snow caps are melting and temperatures are rising, the conditions are becoming more conducive for malaria mosquito populations, and malaria outbreak risks are increasing.

Insecticide resistance and behavioural shifts are making it harder to fully control malaria mosquitoes. Could you explain why these challenges mean we need to look beyond traditional responses?

Despite widespread use of insecticide-treated nets (ITNs) and artemisinin-based combination therapies (ACTs), many regions continue to suffer high malaria burdens. This is due to insecticide resistance, reduced effectiveness of antimalarial drugs and environmental factors that reduce the effectiveness of these tools. Public health inequities entrenched in systemic social, economic and political factors also continue to perpetuate the cycle of disease and poverty. People in malaria areas face so many challenges that they sometimes forget to use mosquito nets or to go for regular preventive treatments, while many struggle to afford the medication. Traditional remedies are also used to treat the disease and reduce its symptoms.

Science is working to eradicate malaria, and the 86.9% of parents in Uganda that take their children with a fever to seek medical attention shows that change is possible. However, science cannot work alone, people in affected areas need to actively avoid mosquito bites by doing what they can at home. That’s why scientists and public health experts are urgently turning to next-generation technologies like gene drive technology to complement traditional approaches. Gene drive isn’t a silver bullet, but we hope that it could dramatically cut transmission by reducing the number of female mosquitoes, the Anopheles mosquito, which bites and spreads malaria.

For a general audience, how would you explain what gene drive is and how it reduces malaria transmission?

At Target Malaria, the not-for-profit research consortium I work with, we’re exploring gene drive technology as a new frontier in the fight against malaria. This innovative genetic approach has the potential to reduce malaria-carrying mosquito populations drastically and, in doing so, reduce transmission of the disease itself. Our work focuses on reducing the population of Anopheles mosquitoes, the primary vectors of malaria. Our gene drive approach involves introducing genetic modifications that reduce the reproductive capacity of mosquitoes, thereby decreasing their numbers and, consequently, malaria transmission.

Can you walk us through how Target Malaria scientists are designing gene drive mosquitoes?

Target Malaria is developing its technology step by step. This phased approach allows us to engage communities, stakeholders, and national authorities in the process of development and testing. While we have made significant progress in our research over the past few years, we are still several years away from this technology being ready to be used as a tool to control malaria. We do this by introducing a genetic trait into the Anopheles mosquito, one of the main carriers of the malaria parasite. This gene is passed down to offspring at a higher-than-normal rate, gradually reducing the population’s ability to reproduce. Over time, the mosquito population declines, potentially enough to interrupt malaria transmission altogether.

A large-scale modelling study looking at 16 sites across 13 West African countries showed that gene drive mosquitoes could reduce populations of malaria-transmitting species by 71% to 98%. When combined with existing tools like vaccines and new-generation mosquito nets, it could prevent up to 60% more clinical malaria cases. This technology is not designed to eradicate all mosquitoes, nor could it. Of more than 3,500 known mosquito species, only about 30 are a public health concern. Of those, just three are responsible for most malaria transmission in Africa. Our work is focused on this narrow target.

Given that climate change is expanding mosquito habitats and making some regions less accessible to traditional interventions, why is gene drive well suited to these changing conditions?

Unlike conventional methods that require continuous application and maintenance, genetic technologies offer a sustainable and long-term solution to malaria control. More specifically, gene drive approaches could complement existing tools by making them more efficient and addressing some of the gaps that exist in coverage. This approach would require fewer repeat interventions than other common methods, lowering the cost of maintaining the strategy. Gene drive approaches could reduce the population of mosquitoes, making other tools like bed nets more effective. They could also be easier to apply in rural or remote areas where repeat applications of existing tools are difficult.

Gene drive relies heavily on public trust. What approaches have you and your team found most effective in engaging communities and ensuring they feel informed and involved?

For any public health intervention to be successful, it must be accepted and supported by the communities it aims to serve. We place a strong emphasis on community engagement, ensuring that local populations are informed, involved and empowered. By educating communities about malaria prevention and control, we can foster a sense of ownership and responsibility that is crucial for the success and sustainability of these interventions. Our partnerships with local communities are foundational to our research, they are co-creators of this work, not just beneficiaries. In Uganda, the team has built long-term relationships with villages where research is taking place, ensuring residents are informed, consulted, and empowered to contribute to decisions.

To deepen community understanding of gene drive research, Target Malaria has invested in a suite of creative educational tools. These include interactive theatre performances in local languages, visual presentations, and radio and broadcast programmes. These tools help to build trust, transparency, and meaningful dialogue around the science, especially in communities directly involved in the research. Our model of engagement is now seen as a blueprint for responsible research across the continent.

Where does gene drive research currently stand, and what key milestones should we look out for in the next few years?

In Uganda we are currently working under containment in an ACL2 insectary with a genetically modified mosquito without a gene drive. This mosquito, which we refer to as a male bias mosquito, has been modified to produce over 90% male offspring and very few to no female offspring.

We remain committed to working hand in hand with national institutions and communities, guided by responsible science, transparency and collaboration, as we continue exploring solutions that can reduce the heavy burden of malaria across Africa.