How To End Malaria Once and for All | Abdoulaye Diabaté | TED

Summary

In this powerful talk, Abdoulaye Diabaté, a medical entomologist, shares his personal experience with malaria and discusses the ongoing struggle to eradicate the disease in Africa. He introduces the innovative gene drive technology, which aims to control mosquito populations and halt malaria transmission. Despite the promise of this approach, he emphasizes the importance of community engagement, transparency, and capacity building to ensure its successful and ethical implementation.

Takeaways

• 🦟 The speaker, Abdoulaye Diabaté, is a medical entomologist working on eliminating malaria in Africa.
• 🌏 Malaria was once a global public health issue but has been successfully tackled in the US and Europe, yet remains a killer in Africa and Asia.
• 🔗 Malaria is closely linked to poverty and has a significant impact on children and pregnant women, leading to about 600,000 deaths annually.
• 💉 Current interventions like vaccines, bed nets, and first-hand treatments are being threatened by resistance to insecticides and drugs.
• 🧬 The speaker introduces 'gene drive', a method to control mosquito populations by altering genes to reduce their reproductive capacity.
• 🛡 The 'doublesex' gene is targeted to affect female fertility in mosquitoes, with the aim of reducing the population and halting malaria transmission.
• 📉 Mathematical models suggest that releasing gene drive mosquitoes could stop malaria transmission within two years.
• 🚧 The technology of gene drive is in the lab phase and requires careful consideration of potential risks and community engagement before field release.
• 🌱 Target Malaria is taking an incremental approach, starting with non-gene-drive mosquitoes and gradually increasing exposure to the gene drive.
• 🏛 There is a need for community engagement and social license to operate, emphasizing the importance of stakeholder involvement in the process.
• 🏫 Capacity building in Africa is essential for the sustainable implementation of gene drive technology, with the establishment of a center of excellence and support from the Gates Foundation.
• 🌟 The speaker's vision is a world free of malaria, emphasizing the importance of hope and the potential of science to change lives.

Q & A

What is the speaker's relationship with mosquitoes?

The speaker, Abdoulaye Diabaté, does not have a good relationship with mosquitoes, as they are a source of suffering and disease, particularly malaria, which has affected him personally during his childhood.

Why is malaria still a significant problem in Africa and Asia despite being tackled in the US and Europe?

Malaria persists in Africa and Asia due to a combination of factors including poverty, lack of effective interventions, and the complexity of the disease which involves the pathogen Plasmodium, the vector Anopheles mosquitoes, and the human victims.

What is Abdoulaye Diabaté's profession and where is he from?

Abdoulaye Diabaté is a medical entomologist from l'Institut de Recherche en Science de la Santé, and he is speaking from Burkina Faso.

How does malaria relate to poverty?

Malaria is closely linked to poverty because it disproportionately affects the poor who often lack the resources to prevent and treat the disease, creating a cycle of illness and financial hardship.

What is the impact of malaria in terms of global health statistics?

There are approximately 200 million cases of malaria worldwide each year, resulting in about 600,000 deaths, with the majority occurring in Africa and affecting children and pregnant women the most.

What is a gene drive and how does it work?

A gene drive is a natural molecular mechanism that increases the frequency of a particular gene in a population beyond the usual 50% inheritance rate. It can drive the spread of a gene to up to 90% of offspring, potentially altering traits in a species.

How does Target Malaria plan to use gene drive to combat malaria?

Target Malaria is working on using gene drive to control the mosquito population by targeting a gene called doublesex, which is involved in sex determination. By disrupting this gene, they aim to reduce the reproductive capacity of mosquitoes, thereby decreasing malaria transmission.

What are the potential challenges of releasing gene drive mosquitoes in the field?

Challenges include the possibility of mosquitoes developing resistance to the gene drive, geopolitical issues regarding the release of genetically modified organisms across borders, environmental risks, and the need for community acceptance and a social license to operate.

What is the incremental approach adopted by Target Malaria for releasing gene drive mosquitoes?

The incremental approach involves a step-by-step process starting with the release of non-gene-drive mosquitoes, followed by testing in small and large indoor cages, and eventually moving to open field releases after careful consideration of potential risks and additional research.

How far are we from releasing gene drive mosquitoes according to the speaker?

According to Abdoulaye Diabaté, we are approximately four to five years away from releasing gene drive mosquitoes in the field, with the actual release being a matter of minutes, but preparation and community engagement taking the majority of that time.

Why is capacity building important for the success of gene drive technology in Africa?

Capacity building is crucial because it enables African scientists and institutions to independently manage and sustain the gene drive technology, ensuring long-term success in combating malaria without reliance on external support.

Outlines

00:00

🦟 The Personal Impact of Malaria

The speaker, Abdoulaye Diabaté, a medical entomologist, begins by humorously acknowledging the discomfort caused by mosquitoes, drawing attention to their significant impact on human life. He emphasizes the historical and global reach of malaria, noting its successful containment in the US and Europe but highlighting the continued devastation it causes in Africa and Asia, where it remains a major public health issue. Abdoulaye shares his personal story as a survivor of childhood malaria, illustrating the disease's profound personal and psychological effects. He underscores the complexity of malaria, involving the pathogen Plasmodium, the vector anopheles, and the human victim, and points out the challenges in developing effective interventions due to the disease's complexity and the emergence of resistance to current treatments.

05:01

🧬 Gene Drive: A Potential Solution to Malaria

Abdoulaye introduces the concept of 'gene drive', a natural mechanism that can increase the inheritance frequency of a specific gene beyond the usual 50% chance. He explains that Target Malaria is developing a gene drive to control the mosquito population and stop malaria transmission. The gene drive targets the 'doublesex' gene, which is crucial for sex determination in mosquitoes. By disrupting this gene, the team aims to reduce the mosquito population's reproductive capacity, thereby decreasing malaria transmission. The speaker describes the strategy's potential effectiveness, as mathematical models suggest that releasing gene-drive mosquitoes could halt malaria transmission within two years. However, he also acknowledges the challenges and concerns associated with gene drive, such as resistance development, international cooperation, environmental risks, and the necessity of community acceptance and engagement.

10:02

🌐 Community Engagement and Capacity Building for Gene Drive

The speaker discusses the importance of community engagement and capacity building in implementing gene drive technology in Africa. He stresses that the technology must be introduced incrementally, starting with non-gene-drive mosquitoes and gradually increasing exposure to the gene drive in controlled environments. Abdoulaye emphasizes the need for transparency and inclusivity in stakeholder engagement, from local communities to government officials. He also highlights the importance of building a strong technical platform in Africa to ensure self-sufficiency in managing gene drive technology. To this end, a World Bank-funded center of excellence for vector-borne diseases has been established in Burkina Faso, supported by additional funds from the Gates Foundation. The speaker concludes by expressing his vision of a world free of malaria and the role of Target Malaria in making this vision a reality.

Keywords

💡Malaria

Malaria is a life-threatening disease caused by parasites that are transmitted to people through the bites of infected female Anopheles mosquitoes. It is a central theme in the video, as the speaker discusses its historical prevalence and ongoing impact, particularly in Africa and Asia. The script mentions that malaria was once a global public health issue but has been successfully tackled in the US and Europe, yet it continues to kill millions in other regions.

💡Medical Entomologist

A medical entomologist is a specialist who studies the relationship between insects and human health, often focusing on the control of disease-spreading insects. In the video, the speaker identifies himself as a medical entomologist from l'Institut de Recherche en Science de la Santé, emphasizing his expertise in combating malaria through understanding the insect vectors involved.

💡Poverty

Poverty is the state of having very little money and few or no material possessions. The script links malaria to poverty, illustrating that the disease not only affects the poor but also perpetuates the cycle of poverty due to the high costs associated with treatment and loss of productivity. The speaker reflects on the financial burden of being poor in the context of malaria.

💡Gene Drive

Gene drive is a genetic mechanism that increases the inheritance of a particular gene beyond the usual pattern of Mendelian genetics, potentially spreading a beneficial genetic trait throughout a population. In the video, the speaker explains that his team at Target Malaria is working on gene drive technology to control the mosquito population and halt malaria transmission, offering a novel approach to disease control.

💡Plasmodium

Plasmodium is a genus of protozoan parasites that cause malaria in vertebrates. The script describes malaria as a complex parasitic disease involving Plasmodium as the pathogen, which is a critical component in the transmission cycle of the disease. Understanding the biology of Plasmodium is essential for developing interventions against malaria.

💡Anopheles

Anopheles is a genus of mosquito that serves as the vector for the transmission of Plasmodium parasites, which cause malaria. The video script highlights the role of Anopheles mosquitoes as the biological link between the pathogen and the human host, emphasizing the need to control this vector to prevent disease spread.

💡Insecticide Resistance

Insecticide resistance refers to the phenomenon where insects evolve to become less susceptible to the effects of insecticides, rendering them less effective for pest control. In the context of the video, the speaker mentions that bed nets and first-hand treatments for malaria are threatened by insecticide resistance, which complicates efforts to control the mosquito population.

💡Drug Resistance

Drug resistance occurs when microorganisms, such as the Plasmodium parasite, evolve mechanisms to withstand the effects of drugs that were previously effective in inhibiting their growth. The script discusses the challenge of drug resistance in the fight against malaria, indicating that the parasites are becoming resistant to the drugs used for treatment.

💡Sex Determination

Sex determination is the process by which the biological sex of an organism is established. The video script discusses a gene drive strategy that targets the 'doublesex' gene, which is responsible for sex determination in mosquitoes. Disrupting this gene could affect the reproductive capacity of the mosquito population, thereby reducing the spread of malaria.

💡Stakeholder Engagement

Stakeholder engagement is the process of involving all parties with an interest or stake in a project or initiative, ensuring their perspectives are considered and addressed. In the video, the speaker emphasizes the importance of engaging with local communities and other stakeholders to gain social acceptance for the gene drive technology, highlighting the need for transparency and inclusivity in this process.

💡Capacity Building

Capacity building refers to the process of developing the skills, knowledge, and systems needed by organizations or communities to achieve their goals. The script mentions the need for capacity building in Africa to ensure that the continent has the necessary expertise to independently manage and sustain the use of gene drive technology in the fight against malaria.

Highlights

Malaria is as old as humankind and was once a global public health issue.

Malaria has been successfully tackled in the US and Europe, but remains a killer in Africa and Asia.

Abdoulaye Diabaté, a medical entomologist, believes we are closer than ever to eliminating malaria in Africa.

Malaria is closely linked to poverty and affects 200 million people worldwide with about 600,000 deaths annually.

Children and pregnant women in Africa bear the highest burden of malaria deaths.

Diabaté is a childhood malaria survivor and shares his personal experience with the disease.

Malaria is a complex disease involving the pathogen Plasmodium, the vector anopheles, and the human victim.

Current interventions like vaccines, bed nets, and first-hand treatments are threatened by resistance.

Gene drive is a natural molecular mechanism being studied to control mosquito populations and halt malaria transmission.

Gene drive can increase the transmission of a certain gene to the next generation beyond the normal 50 percent chance.

Target Malaria is working on a gene drive that affects female fertility by targeting the doublesex gene in mosquitoes.

The suppression strategy of gene drive could reduce mosquito populations and stop malaria transmission within two years.

Gene drive technology is sustainable, cost-effective, and easy to deploy.

Gene drive has never been tested in Africa and carries hope as well as fear and skepticism.

Target Malaria is taking an incremental approach to testing gene drive, starting with non-gene-drive mosquitoes.

Community engagement and social license are crucial before releasing gene drive mosquitoes.

Capacity building in Africa is essential for the successful implementation of gene drive technology.

A World Bank-funded center of excellence on vector-borne diseases is being established in Burkina Faso.

Diabaté emphasizes the importance of offering hope and a future free of malaria to children everywhere.

Transcripts

(Mosquitoes buzzing)

Mosquitoes.

I don't know about you,

but I don't have a good relationship with them.

(Laughter)

A friend of mine said one day,

if you think that you are too small to make a big difference,

you've never spent a night with mosquitoes in a room.

(Laughter)

But ...

I don't have any mosquitoes in my pocket to release tonight,

so it's going to be fine.

So let's start.

As unbelievable as it may sound, malaria is as old as humankind.

And malaria once was a public health issue all over the world.

But then it has been successfully tackled in the US and Europe.

And yet, decades later,

malaria still kills millions of people

in Africa

and in Asia.

Why?

I'm Abdoulaye Diabaté, a medical entomologist

from l'Institut de Recherche en Science de la Santé.

I'm here today,

flying all the way from Burkina Faso,

to tell you that we might be closer than ever

to eliminate malaria in Africa.

(Applause)

Thank you.

Malaria is tightly linked to poverty.

But then you have no idea of how expensive it is to be poor.

There are 200 million cases worldwide

that end up sadly every year with about 600,000 deaths.

And this is not a random collection of statistics on a piece of paper.

Behind each of these 600,000 deaths,

there is a personal, tragic story, sometimes behind closed doors.

Most of these deaths happen in Africa.

Children and pregnant women bear the highest burden.

And I'm a fortunate childhood malaria survivor.

When I was a kid, I used to think that my dad was a superhero.

I could see him leaving the house every morning at six,

riding his bicycle to the farm, working very hard all day long.

We did not have much for living.

But who said you need more to be happy?

But when happiness hangs by a thread,

it doesn't take much to turn your life around.

My certainty in my dad got deeply shaken the day I got struck down by malaria.

I was three or four years old.

As we used to say in my country,

kids may not understand the complexity of suffering,

but pain has no age.

And gosh, I was in pain.

I can still clearly see myself

laying down there on the bed with high fever and suffering.

I could not eat anything.

Throwing up all the time.

Will I survive? Will I not?

The psychological trauma my parents were going through

was unbearable.

But against all odds, I survived.

But can we say today that we are done with malaria

because Diabaté survived and made it all the way down to Vancouver?

If I say yes, no one can blame me.

But it’s a lie, because many children are still dying of malaria.

The real question then is:

Why have we not been able to defeat it so far?

Well because malaria is a complex parasitic disease

that plays on three grounds.

Plasmodium, the pathogen;

anopheles, the vector;

and human, the victim.

Each of these elements is very complex on its own,

and the interactions make it even more complex

to devise interventions that are really effective.

But of course we are trying.

Currently, there are two vaccines to immunize people,

but the heavy logistics to deliver this vaccine

may not allow us to reach their full potential.

Bed nets and first-hand treatment

are both threatened by insecticide and drug resistance,

meaning that our best interventions have started to fail.

And there is a general consensus today that without additional new tools,

we may never cross the last mile of malaria elimination.

And this is exactly where I come in.

My colleagues and I at Target Malaria,

and are working on something called gene drive:

a way to control mosquito population and halt malaria transmission.

So what is gene drive?

It's a natural molecular mechanism

that augments the frequency of a certain gene in the population

beyond the normal Mendelian inheritance.

So what does it mean?

If you take any gene,

in natural circumstances,

it has only a 50 percent chance of being transmitted to the next generation.

Meaning that if the parents have 100 babies, like in mosquitoes,

only 50 of them will get the gene and the other 50 will not.

But not all genes behave this way in nature.

Some genes have found a very clever way to bypass this law,

and can augment their own prospect to up to 90 percent.

Such genes are said to drive, and so the name "gene drive."

Our most promising strain affects female fertility

by targeting a gene called doublesex.

This gene is responsible for the sex determination in mosquitoes,

and so disrupting the doublesex gene

may affect the sexual development for adult mosquitoes

and their reproduction.

Now

it may sound counterintuitive to affect female fertility

and spread a gene of interest in mosquito population at the same time.

But it's working.

And let me show you how.

We target a specific region of the gene called doublesex

that affects only females.

Males bearing this modified gene are not affected at all.

Females with just one copy of the altered gene are fully fertile.

However, females bearing two copies

of the modified gene

cannot lay eggs,

fail to bite

and also have the physical characteristics of both male and female.

It's called a suppression strategy.

Once these mosquitoes are released in the field,

they're going to spread the gene of interest to the wild population,

and this is going to reduce dramatically their reproductive capacity.

Fewer mosquitoes means less malaria transmission

until it stops.

Mathematical models predict

that releasing such mosquitoes in the field

is going to stop malaria transmission in just 20 generations.

That means in two years.

And the technology is sustainable,

cost-effective and easy to deploy,

as the released mosquitoes will do the job themselves

by finding the last hiding pocket of wild mosquitoes to convert.

Fantastic.

The only problem,

gene drive has never been tested anywhere in Africa.

And while the technology brings a lot of hope,

it also carries its share of fear and skepticism.

The pathway from the bench to the field

is not straightforward and is full of pitfalls.

Maybe the mosquitoes in the field

will develop resistance to the spread of the transgene.

Or maybe two countries don't agree,

but released mosquitoes do not respect the human borders.

Or also, maybe there are risks to the environment.

And finally, the community that we are working with

need to feel comfortable about this technology

and give us the green light to operate.

And so for such,

Target Malaria has adopted an incremental approach, step by step,

whereby we will start releasing first non-gene-drive mosquitoes,

meaning that the gene of interest here cannot self-propagate

and will just go extinct in a few generations.

The gene drive, the exposure of this gene to the environment

is incrementally augmented

in a way that we start first with small cages

and big indoor cages in Europe,

and then these mosquitoes are sent to Burkina Faso,

where they are tested in a contained facility first,

and subsequently in a big indoor small cage field release.

Now the gene drive mosquitoes are going to be tested in an open field

only after this preliminary step

and the potential risks have been looked at very carefully.

And also additional research questions have been developed

to address these risks, if any.

Now the question, how far are we from releasing gene drive?

Four to five years.

But let me tell you this.

Gene drive mosquitoes are already in the lab,

and releasing them in the field

is not going to take us more than 30 minutes.

But we need five years to get ready for these 30 minutes.

And why is that?

The answer is simple.

Because we need to engage the community

and get the social license to operate.

And so if there is one thing that you cannot afford the luxury to miss,

it's the stakeholder engagement.

I cannot just pop up in a village with a bucket of mosquitoes

on the assumption that I'm a scientist working for the public good.

It will not take anyone a PhD to understand

if we are respectful of their values or not.

We need to engage the community

and then co-develop the technology with them.

And so for that,

we've built our engagement strategy on the pyramidal structure,

starting with the villages where we operate

all the way to the top with the government officials.

The engagement is done step-by-step.

It’s done in an inclusive way

and also is done in full transparency.

Ladies and gentlemen,

there is one more thing that needs to be done

before gene drive can be released in the field in Africa.

That is capacity building.

Gene drive holds a lot of promises,

but it will not take us anywhere

if we Africans aren’t enabled to run it on our own.

Sadly,

the technical platform in Africa is really very poor,

and this has to be solved before we can really beat malaria.

And so for that, we've set up in Burkina Faso

a World Bank-funded center of excellence on vector-borne diseases, like malaria.

And also with additional funds from the Gates Foundation,

we are building a critical mass of next generation scientists

all over the continent

to fill the knowledge gap and the know-how gap as well.

In April 1969, a child was born in a remote village of Burkina Faso.

Like any other child of the world,

he had dreams and expectations.

Sadly, however, as he came to learn,

the place where you are born in on this planet

very often affects your perspective on life,

and may even set the path you need to walk through into your future.

That shouldn't be the case.

We are all citizens of the world.

Our dreams and aspirations should not be constrained

by the place where we are born.

And this is the reason why I became a scientist.

To offer endless possibility to any child anywhere on this continent,

so that they can see the future with hope.

But there is no hope if you are cut short with malaria.

But Target Malaria is here to fix that.

A world free of malaria is our vision.

And I will say, yes, we can.

Thank you for your attention.

(Applause)