New Vision Podcast
New Vision Podcast
The Malaria Podcast: Science fiction
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Every year around 600,000 people die from Malaria. Most of them are children under five years old.
The Malaria Podcast is a three-part series made by science journalist Olivia Ndubuisi exploring the past, present and future of Malaria.
In this final episode, focused on the future, Olivia sits with scientists here in Entebbe, where these young people are exploring the science fiction idea that the mosquito that causes Malaria can be genetically modified to not be able to transmit and give you Malaria.
In this our final episode, we unpack the possibility that the genes of mosquitoes can be modified so that on the one hand their numbers are drastically reduced and on the other they cannot transmit the disease in the first place. My name is Olivia Ndubisi. This is a Malaria Podcast, episode 3, Science Fiction.
SPEAKER_01Welcome to the New Vision Podcast.
SPEAKER_02And I feel like all the rest are more empty than this one.
SPEAKER_03You're telling me where we are.
SPEAKER_02Uh we're in one of the labs where we carry out uh molecular analysis. It's one of our PCR labs. What's a molecular analysis?
SPEAKER_03Um, identification of the mosquito using its DNA. The first time I heard that it was possible to genetically modify mosquitoes, I was in a class at Columbia University. And then I couldn't stop thinking about it. How exactly was this possible? And what will happen when you do that?
SPEAKER_02My name is Crystal Birungi. I'm an entomologist. Um, I work at the Uganda Virtual Research Institute on a project called Target Malaria.
SPEAKER_03Crystal didn't set out as a child to become a person who studies insects or their interactions with the ecosystem for a living. She could have been anything else. But one day, as a child, Crystal's brother got malaria.
SPEAKER_02When I was about 10 years old, my mum was spongy off my five-year-old brother the whole night. She was trying to keep him cool because he was convulsing. He had malaria and he was convulsing. So some children convulse when they get it. And every time this little boy got malaria, he would go into convulsions. And it was the scariest thing. But also, I was old enough to realize there was medication for malaria, but we just couldn't afford it. So all you can do is pray and hope that this child doesn't die. And that just seemed really unfair. It should not be a thing, that this should not be what life is like.
SPEAKER_03When Crystal turned 14, the Global Fund started in Uganda and as part of its program distributed free mosquito nets, free medications, and set up health centers run by local villagers. Crystal's family got mosquito nets, and the difference at their house was like night and day. Suddenly, her brother didn't need to have malaria-induced convulsions anymore, and Crystal saw that malaria was in fact defeatable. That was when she decided she was going to spend her life working to make malaria go away.
SPEAKER_02There are still people who are deciding how many children to have based on the fact that some will die of malaria, and really in this day and age, that should not be a thing. Yeah, so that it remains my motivation. It's still there.
SPEAKER_03The idea of gene drive as we know it today is a coming together of work that started over a hundred years ago. In 2003, scientists decided to apply it to the malaria problem. To explain gene drive, I have to start with gene modification. One of the first things that's important to know is that the challenge with malaria elimination is the sheer scale of the issue. There are just so many mosquitoes spreading the disease. Crystal told me that the weather in sub-Saharan Africa is brilliant, but it's also brilliant for mosquitoes. The idea of this is then that if the population of the malaria-causing mosquitoes can be reduced, then the transmission of the disease can be reduced as well. Here's Crystal.
SPEAKER_02Scientists needed to find a way to make genetic modification more efficient in regards to things like mosquito control, for example.
SPEAKER_03So we had the idea that we could control mosquitoes by modifying them so that, for example, they lay fewer eggs. That is gene modification. That a mosquito that would have laid, say, 300 eggs lays just a few. The problem is that normally genes are only passed down about half the time. This is genetics 101, that's just how it works. Genes are only passed down about half the time. But then this is where gene drive comes in. Crystal again.
SPEAKER_02So this led to the need to have a way to change that inheritance so that the gene that would be modified would last longer in the population and spread faster. And that led scientists to consider something that's naturally occurring in nature, something that they call the selfish genes. So these are genes that kind of co-opt the mechanism so that each and every time they are passed down regardless of what should actually be happening. This was the core basis of how the idea of gene drive came along. That if we could harness that kind of process so that the modification that we've made would be passed down each and every single time, then we could have a product that would be more cost-effective, more sustainable, and faster in general to help us get to the end product of malaria elimination.
SPEAKER_03So with Gene Drive, Crystal and scientists in Uganda collaborating with others across the world are able to genetically modify not all mosquitoes, just the ones causing all the malaria, so that their population drastically reduces. Across in Tanzania, a different team called Transmission Zero is working on using genetic tools as well to eradicate malaria. Their own work could mean that even if you got bitten by the mosquito that would give you the disease, you won't get it because their ability to transmit it has been removed. With Crystal's team in Entebe, the question is no longer if it can work, it already does in the lab. So, are there genetically modified mosquitoes flying about in Uganda? No. Because Gene Drive has not been used anywhere in the world yet. Crystal did tell me that the project in Uganda is the farthest along. Also, there are concerns that people have. One of them is with the ethics of the whole thing. Some people say it's like playing God. They say that mosquitoes have been here and are part of systems we don't fully understand, and that some powers should not be used no matter how good the intention is. I asked Crystal about that. But there are ethical questions, as I'm sure you are aware. One of those questions that people have is just because we can, should we? And are we not playing God by doing that?
SPEAKER_02For those who say just because we can, should we? I think my answer would be we can, so why shouldn't we? Like we can do something that will reduce the number of mosquitoes that will spread malaria, that will save children's lives. So we can. Why shouldn't we? Should be the question. Like, why shouldn't we save children's lives using this technology that we have the ability to do?
SPEAKER_03Another issue is the question about what happens to an environment without those particular mosquitoes. People who are concerned about this ask that say gene drive succeeds and reduces the population of the female anophiles. What does it mean for the ecosystem that there is now the gap that was previously filled by those?
SPEAKER_02We are not attempting to completely eradicate this mosquito species. So the goal is suppression. And it is unlikely it would be able to completely eliminate the species to begin with. But that said, the uh Anophilis can be a mosquito has a relatively small biomass. There hasn't been anything we have found that feeds exclusively on this mosquito, or that other research has shown either. So for the creatures that do feed on it, a lot of times it just makes up a part of the diet, not the entirety of that diet. Which would then imply that these animals would have other things to feed on, even if this mosquito was no longer present. So we have taken the concerns quite seriously, and we've had partners that we've worked with in the past. So um the studies are continuing and we will continue to look into this in terms of research, but also uh it is quite a regulated field, so there are regulators, and we do get approvals from different bodies that are looking into issues like this. Like, is there an environmental risk? So, if indeed there was any substantial evidence that there's going to be an environmental risk, for example, then no release would be made in that kind of instance.
SPEAKER_03Yet another concern is that of awareness by local people. Some people are asking, how much do local people understand about the idea and how much informed consent can they give? Krista told me that her role has had to change to include spreading the word and engaging both locally and internationally. I often think about innovative science and the gap between the people that would eventually be a part of the thing. Yeah. In what practical ways are you thinking about it as a person who is in the process of making an innovative thing?
SPEAKER_02There is a need to make sure that there's a certain level of acceptance within the communities. Otherwise, there is a real risk that you can develop a product that will just not get used. Not because it's not good, but because people do not trust it or do not understand it. So we saw a lot of that, for example, with COVID, where you had a COVID vaccine and then, you know, people were completely distrustful of it when they just handed it to them and with no background information, no open sharing and an understanding of how the research was done or how it was developed. And so this is a real risk that was identified, and we realized we really need to do engagement on this because this technology is particularly promising to help us bridge this gap that has really been an issue. So it meant we'd need to do engagement just not just with our local communities here in Africa or in Uganda, where we have a lot of malaria. I think that's really important and that people from our countries really relate to that. Because my child lives in Uganda. I live in Uganda, so definitely I wouldn't want to do something that will hurt Ugandans because I have to live here. So I think just that additional level of trust is something that is usually underestimated.
SPEAKER_03I was curious, so I asked her about how exactly that engagement was happening.
SPEAKER_02So what we did to make sure we can really communicate, you know, there's communicating, but it may not be effective, was we translated all our information sheets that to do with our methods, the project, into local language. We then worked with language experts to determine what word could represent this concept. After that, we did have meetings with people from the local community and we said, okay, when we say this, what do you understand? Because sometimes a direct translation doesn't work.
SPEAKER_03The question about the gap between science and people was part of my inspiration for making this podcast in the first place. So I consider it incredibly important. While doing my master's, I was learning about progress and innovations in malaria in the US that I'd never heard about all my life while back in Nigeria. And I thought there was a huge gap between those making the science and those who would be using it at the end of the day. This entire project began because I wanted to close that gap in this case, letting people like me know what science and scientists were up to with malaria, and showing how much of this particular work also included scientists here in Uganda. So as I moved about in Entebe and Kampala and met people and had conversations, I asked them about how much they knew about the work going on in their backyard. I was also curious about how they felt about the idea. Are you aware that scientists here in Uganda are working on a thing called DIN Drive and they're trying to use that technology to reduce the population of the mosquitoes that give you malaria? Are you aware that's happening?
SPEAKER_00Yes, I've heard of it before, but I haven't gone deep into it. But I've heard of it before.
SPEAKER_03So, what do you think about an idea like that?
SPEAKER_01It would be fine, only that I'm always careful or cautious about anything that touches nature. But otherwise, anything that would eradicate malaria. And even if it has a negative effect, but if the negative effect is not as big as the impact malaria has on us, especially children and mothers, I I I will take it.
SPEAKER_02No, you're just informing me.
SPEAKER_03Okay, so let me tell you about it. What do you think about that idea?
SPEAKER_02I think that's a good initiative, and we can't wait, so when will it be real? Because malaria is really a big challenge, and I've known people who have passed away because of the same.
SPEAKER_03One of the things I heard a lot was the cost of constantly treating malaria. I heard women in Uganda tell me that if they no longer had to pay or buy drugs for multiple members of the family when they fell ill with malaria multiple times a year, that they can use that money for just about anything else. Paying school fees was top on the list of where that money could go. So conversations around eradicating malaria have real consequences for people here and in my country, and I've seen that firsthand. The consideration for how to get there also has consequences for millions of people globally, and it may not take too long to find out how to get from where we are at the moment to the possibility of gin dripe helping the fight against malaria. Some reports say as early as 2029.
SPEAKER_02If I had a magic wand to use against malaria, I would simply make the disease cease to exist. Because with over half a million people dying every year, most of those children under the age of five and pregnant women, I think even a day of malaria is a day too many. So if I had that kind of power, then I would skip all formalities and just make it so that the disease does not exist.
SPEAKER_03The Malaria Podcast was reported, written and presented by me, Olivia Ndubisi. The editor was Alison McAdams. Mixing and sound design by Jamal Roberts. Artwork by Ibukun Shobola. Additional production in Ntebe by Jimmy Luima. Steam music by Premium Beats. Production support in Ntebe by Blanche Musenguzi. Thank you to Jane Onyeo Ukwajuno for her help with this episode. The Malaria podcast was made with funding from the John Connor Journalism of Ideas Fellowship.