Laurie Zoloth: For the sake of 600,000 children, science must be bold

Malaria, which is carried by mosquitos, was responsible for the deaths of 597,000 last year, overwhelmingly children under age 5. Photo / 123RF

THREE KEY FACTS

• Malaria caused 597,000 deaths last year, mostly children under 5.
• Genetically engineered mosquitoes could combat malaria but raise ethical concerns about unintended ecological consequences.
• Scientists must ensure transparency and responsibility, balancing innovation with ethical considerations and community oversight.

Bold ideas in science research used to thrill us; now they seem pretty threatening. When I have written about the ethics of genetically engineered mosquitoes to combat malaria, many of my friends have expressed alarm. “What if it goes badly wrong?” they ask. What if there are unintended consequences that ripple across ecosystems? What if this is one of those technologies that cross the line from innovative to utterly world-destroying?

And yet, one could also ask, what if we do nothing? For that question, at least, we have an answer. A report last week from the World Health Organisation reveals that 597,000 people died of malaria last year, overwhelmingly children under age 5, and an estimated 263 million people got ill. Thousands of families cradled a baby dying from a preventable fever; thousands of pregnancies ended in stillbirth or maternal death.

For a time in the early 2000s, it seemed as if the world was gaining ground against malaria, but progress has stalled, cases have risen and the hopes for its near-elimination by 2030 have been scuttled. Global warming, armed conflict and lack of funding are all factors. And while new vaccines certainly will help, they are limited in their effectiveness (they reduce the risk of severe malaria by 30% and require four separate clinic visits). For much of the world’s poor, we still rely on the 19th-century technology of bed nets and insecticide.

For the past two decades, scientists have explored whether a new technology known as a gene drive might hold the tantalising promise of eliminating malaria by targeting the mosquitoes that carry the deadly parasite. The reason the gene drive is so potentially revolutionary – but disturbing – is that it uses genetic engineering to introduce changes in mosquitoes that do not stop with one generation, but are preferentially inherited by all future generations.

Scientists might use this technology to hatch more male mosquitoes (which do not bite) than females (which do), or to render the females unable to bite at all. Genetically altered mosquitoes would be released to mate with wild mosquitoes, passing along, or “driving,” these new traits and gradually reducing the population of the mosquito species that carry the deadliest form of malaria. Once released, the process would be out of human control. It is a bold idea.

Betrayed by technology

All such powerful technology presents an ethical puzzle because it is impossible to predict precisely how it could reshape the world. My friends are right to raise questions. We have been betrayed by technology before. (Consider how the Industrial Revolution, the basis of modernity, has changed our global climate, making it hotter, and wetter, driving malaria-transmitting mosquitoes to new habitats.) But given the realities in the WHO. report – the tragic, preventable deaths – not using all the ingenuity we have seems ethically irresponsible.

Even modest genetic interventions have faced fierce opposition. In the Florida Keys, an effort to use genetic engineering to suppress an invasive, disease-carrying mosquito species spent a decade mired in regulatory hurdles and local opposition. (All for a project in which the genetic changes were designed to disappear from the environment within a few generations.)

The prospect of a gene drive that affects all future generations is even more fraught. The European Parliament has supported a global moratorium on the technology, citing the precautionary principle – the idea that it’s better to be safe than sorry when there’s not enough scientific data to fully evaluate the risk. That call has been echoed by a network of anti-genetically modified organism environmental groups and nonprofits that have lobbied against gene drives for years.

So far, they have not succeeded – the latest United Nations agreement on biodiversity calls for regulation but not a ban. But the opposition is ever-present in the minds of researchers.

The scientists behind the biggest effort to use a gene drive to target malaria estimate they will be ready to test it in the real world within five years, pending regulatory and community buy-in. Steadily, quietly, they are testing and retesting how the technology works in controlled settings, addressing every regulatory query carefully to ensure that the mosquitoes will behave the same way in the wild as they do in a lab. Any error could derail the critical goal.

The chorus of opposition to startling new ideas is sometimes preposterously anti-science, sometimes thoughtfully wary, usually just enough to slow funding or drive scientists to other work. Sometimes, the worries have been mistaken. Like many, I marched against nuclear power plants and demanded they be shuttered, instead of demanding scientists work on a solution to the problem of nuclear waste and safety. And now as we confront an accelerating global climate catastrophe, it turns out that nuclear power may be part of an appropriate response.

Deep uncertainty of science

The use of DDT, which helped eliminate malaria in the United States and Europe, was largely stopped globally because of our concerns for birds. Its indiscriminate use in agriculture was clearly harmful, but some scientists have argued that we should have continued to use it in a far more targeted fashion in countries where malaria remained rampant, spraying it inside homes to aggressively eliminate the parasite.

It is particularly problematic when fears are raised by people far from the threat, sometimes wealthy locals, sometimes Westerners thousands of miles away, overwhelming the voices of communities most at risk. Opposition to genetically modified crops may have exacerbated a 2002 famine in Zambia and has also slowed research on altered rice that might save millions of children from vitamin A deficiency, which can cause blindness and death.

We don’t really know the implications of using so many of the technologies we have embraced, nor the real cost of stopping them. What do we do with all the deep uncertainty of modern research science? First, we should stop harboring any fantasies of a technology that is all benefits and no burdens or risks. Such a technology does not exist.

We should stop making moral appeals to leave nature alone. We can be wary of the naïve idea that “when people live in harmony with nature”, they “uphold higher values, enjoy naturally good health and a life free from problems”, as was promised by the Natural Law Party, which nominated Robert F Kennedy Jr as its candidate for president in Michigan.

Just as a perfect future technology does not exist, an idealised past does not exist, either. Humans, from the time we struck the first plow into the dark, wet soil or diverted the first river to get water to the first mud clay pots, have been not leaving nature alone.

But the scientists pursuing these new technologies have a duty. If we are to trust them, they must be honest about the limits of their power and their control. They must embrace reasonable regulations, including independent ethics reviews, robust public debates and community oversight, taking moral and practical responsibility for their work. This means that no one can be abandoned if inadvertently harmed.

In an uncertain world, if you cannot promise outcomes, you must promise character: Scientists must practice honesty, humility and fidelity.

We live in a hard and messy and broken world, where a child dies every two minutes from malaria, and we are outmatched. We live in a world where what seem like unimaginable schemes – limestone in the streams to de-acidify them, or iron in the oceans to capture carbon, or gene drives in the wild – need to be carefully and seriously considered, not dismissed out of hand. Every act, including the acts of science, is a moral act, and it carries risk, but so does standing here and doing nothing.

This article originally appeared in The New York Times.

Written by: Laurie Zoloth

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