What happened to Gene Drives at COP15 of the UN Convention on Biodiversity?

In December 2022, States from all around the world gathered in snowy Montreal to discuss the future of biodiversity protection and conservation until 2030. What did they have to say about new technologies such as gene drives?

The Post-2020 Biodiversity Framework (GBF) has been often referred as a ‘breakthrough’ to halt biodiversity loss. However, the discussions and decisions made in Montreal left synthetic biology watchdogs, like the Stop Gene Drives Campaign, with a bitter aftertaste of corporate influence.

Biotechnology giants such as Brazil and Argentina strongly negotiated to remove any mentions to the precautionary principle and risk assessment from all texts. There was also persistence in inserting the dogma of ‘innovation’ wherever possible. After five Open Ended Working Groups over the course of three years and two weeks of COP15 discussions, the world is left with a Target 17 on Biotechnology that does not do anything beyond reiterating the CBD Convention of 1992. One clear sign that the world of biotechnology has evolved since 1992 is that some of the negotiators sitting at the table today were born in that year. Unfortunately, the new Post-2020 Biodiversity Framework does not seem to keep up with it.

In good time, not all was gloom in Montreal. In addition to adopting the GBF, COP15 managed to set up a new multidisciplinary Ad-Hoc Technical Expert Group for horizon scanning, monitoring and technology assessment of synthetic biology. “Expertise from a broad range of scientific disciplines, as well as interdisciplinary and intercultural expertise, indigenous peoples and local communities” will be included in the process.

Another constructive aspect of the decision is that the conflict of interest resolution from the COP14 will apply, aiming to ensure the scientific integrity and independence of the work of expert groups. It builds on harmful past experiences revealed in the Gene Drives Files (= documents obtained under the US freedom of information provisions showing that the Bill and Melinda Gates Foundation financed an agribusiness public affairs firm to covertly skew an expert process under the CBD in order to lobby against the regulation of GDOs). This is an attempt to confine so called ‘independent’ scientist acting on behalf of philanthropists and billionaires in CBD expert groups.

When it comes to the particular issue of gene drives, the most relevant decision was taken at the meeting of the Parties to the Cartagena Protocol (CP-MOP 10). This Protocol manages biosafety matters. Gene Drives present new uncharted challenges in comparison to ‘classic’ Genetically Modified Organisms covered by the Protocol. Accordingly, an Ad-Hoc Technical Expert Group was established in Montreal to develop additional guidance materials on risk assessment and management of gene drive organisms. Important to note: without the ‘m’ of multidisciplinary.

The focus area of this group will be gene drive mosquitoes, as for them gene drives have been furthest developed to date. These guidance materials will be of voluntary nature, but will help to inform risk assessment globally and, hopefully, unveil open questions, concerns and challenges regarding impacts of gene drives on the environment.

What lies ahead?

The next one to two years are decisive for the (multidisciplinary) technical expert groups scanning biotechnologies like gene drives and working on guidance materials. In the meantime, governments and their institutions, Indigenous Peoples and Local communities, and civil society organizations can submit information to be considered by the expert groups. These actors can also directly participate in online forums to raise their concerns and open questions on synthetic biology and gene drives.

At the next COP (16) in Turkey, States will discuss whether the process of horizon scanning and technology assessment should be continued. They will as well present the indicators that will help to measure the progress of reaching Target 17. We are curious to see how the ‘successful’ attainment of that Target will be measured and for what sorts of projects governments will be eligible for funding.

In short, this means two broad possibilities. On the one hand, the UN CBD could continue requesting risk assessment of new technologies such as gene drives in order to be able to measure all their impacts on biodiversity. On the other hand, the process can be cut short and no risk assessment would be guaranteed.

Finally, when it comes to gene drives under the Cartagena Protocol we hope that the process will genuinely work towards better equipping national governments for risk assessment of gene drives.

At the Stop Gene Drives campaign, we believe that a thorough and holistic risk assessment of gene drives will further expose that current levels of scientific understanding are not sufficient to predict their (irreversible) potential impacts. This would bring yet more clarity on why the release of gene drives into the environment is incompatible with the objectives of the Convention and its Protocols.

Further COP related posts/articles by the Stop Gene Drive Campaign:

ECO articles during the COP15:

01.12.2022 Gene drives are the opposite of nature conservation

05.12.2022 Ecuador’s Galápagos Islands are not a laboratory for testing risky gene drive organisms

07.12.2022 All CBD watchdogs should guard against synthetic biology threats to biodiversity

10.12.2022 Brazilian intransigence on biotech is a violation of human rights

18.12.2022 Snowman to snow-mess: negotiations at COP15 are opening doors to risky technologies

Blogpost leading up to the Conference:

Gene drives are the opposite of nature conservation

Civil society organisations around the globe demand a moratorium on genetically engineered gene drives at UN Biodiversity Conference

Berlin, 1 December 2022 – Ahead of the UN Biodiversity Conference COP 15 and its Cartagena Protocol on Biosafety in Montreal over 140 civil society organisations from Africa, Asia, Europe, Australia and the Americas have issued a joint manifesto exposing alarming risks of environmental releases of genetically engineered gene drive organisms which could lead to irreversible ecological consequences and drive entire species into extinction. 

Gene drives use new genetic engineering techniques such as CRISPR-Cas to forcibly spread new genetic information within the genome of populations and entire species of organisms in nature, including traits that can cause their extinction. The signatories of the manifesto are urging national governments at COP15 to resolve critical legal, environmental, biosafety and governance issues as well as fundamental ethical and cultural questions before considering any environmental release of gene drive organisms.

The call for a global moratorium is consistent with demands at previous occasions including at COP13 in Cancun and COP14 in Sharm El-Sheikh. “This controversy will not go away”, said Barbara Pilz, who coordinates the international Stop Gene Drives campaign. “We will continue to fight for a global moratorium on this pretentious concept of reprogramming and extincting entire species in nature.”

The manifesto highlights the need for thorough and genuine risk assessment and  uncovers the lack of participatory decision-making processes on this topic to date. It proposes the inclusion of multi-disciplinary expertise and respect for diverse knowledge systems in any processes of technology assessment involving gene drives. This should include indigenous peoples and local communities whose territories are among those being proposed for the first releases of gene drive organisms.

Recalling the goals of the UN Convention on Biological Diversity, Pilz added:

“We urge decision makers at COP15 to approach the issue of gene drives with utmost caution. Once released, they cannot be controlled, reversed or recalled and will respect no borders. This technology adds immense risks to the conservation of biological diversity and is at odds with the concept of nature protection. Let us not create another destructive legacy to future generations. ”

Representatives of the Stop Gene Drives campaign and of other signatories of the manifesto will attend the events of the Convention on Biological Diversity in person in Montreal this December and can be reached for comment. They will join other strong civil society voices striving for inclusive and participatory processes of precautionary technology assessment and equitable decision making on the subject of synthetic biology and gene drives.

The full text of the manifesto is available here and it is still open for signature.

Contact details in Montreal:

Naomi Kosmehl (Public Relations Lead) – kosmehl@saveourseeds.org

Barbara Pilz (Campaign Manager) – pilz@saveourseeds.org

Phone number: +49 152 23 678426

Further links:

Brochure – Gene Drive Organisms. A New Dimension Of Genetic Engineering: Applications, Risks and Regulation.

Video interview series – Worldwide: Experts on Gene Drives.

A new vaccine against Malaria

This month saw another breakthrough in the treatment and prevention of malaria, this time with the publication of the phase 2 clinical trial results of the new University of Oxford R21 vaccine against malaria. This vaccine demonstrated an 80% efficacy against malaria, the highest efficacy ever seen in a malaria vaccine. Professor Adrian Hill, co-creator of the Astra Zeneca vaccine, describes it as “the best malaria vaccine yet” and has stated that it could help to reduce deaths from Malaria by 70% by 2030 and could eradicate it by 2040¹. This is a stunning milestone in the campaign to eradicate malaria, an extremely promising therapeutic which could help us end malaria for good. This new vaccine could be viewed as an intervention with minimal risk, and maximal gain- with this development, the case against using the extremely risky, untried and poorly tested gene drive mosquito as a tool to end malaria comes further into question.

Malaria vaccine development has been historically plagued with difficulties, with over 100 potential candidates and so far only one approved vaccine, Mosquirix, approved in 2021². This difficulty stems from the fact that the Plasmodium parasite has many developmental stages, meaning there are thousands of potential targets³. The Mosquirix vaccine has had a difficult start, with a lower efficacy of around 30% for 4 years and is limited in the number of doses that can be produced. That said, there is still good data available for its effectiveness when used in combination with preventative chemotherapy, with one recent study from the London School of Hygiene and Tropical medicine showing a 70% reduction in the chance of hospitalisation and severe illness or death from malaria⁴. However, the new R21 vaccine, developed at the Jenner Institute at Oxford University, shows the highest efficacy yet seen in a malaria vaccine, the first of its kind to surpass the minimum 75% efficacy goal set by the World Health Organisation.

The R21 vaccine trial took place in Burkina Faso, and was carried out in 450 infants between 5-17 months old, the demographic most in need of treatments and prevention of malaria, with 16 percent of deaths in children in Africa caused by malaria. The cohort was split into two groups receiving the new vaccine and one control group: Two groups received a dose of the vaccine with either a higher or lower amount of immune-stimulating adjuvant respectively and the other group received a rabies vaccine as the control group. All of the children received three doses four weeks apart followed by a 4^th dose one year later, and were followed for the full two years to see how the vaccine (or control treatment) affected the cases of malaria observed within the cohort.

The higher adjuvant dose performed best, with an 80% relative risk reduction of contracting malaria in the high-adjuvant group compared with the control group, with no serious side-effects reported. The R21 vaccine targets the Plasmodium parasite before it develops in the blood shortly after someone is bitten and is based a small protein from the immature malaria parasite combined with the Matrix-M adjuvant to help increase the immune response⁵. Despite the success, before approval the R21 vaccine must still be tested in larger groups during the ongoing phase 3 trials, involving 4,800 children in Burkina Faso, Mali, Kenya and Tanzania. Professor Halidou Tinto, the trials principal investigator, is confident that the efficacy will be replicated in these phase 3 trials.

R21 marks a real revolution and beacon for hope in the treatment and prevention of malaria. The path towards a vaccine for malaria has been far from smooth, but the potential for bringing us closer to the eradication of malaria in Africa is huge. The vaccine is both very effective, easy to produce and, very importantly, possible to produce for a few dollars- it is possible to produce 200 million doses per year reasonably through the Serum Institute of India and could therefore be rolled out quickly and widely. Professor Tinto hopes that the vaccine will be used from 2023 in around 250,000 children in Burkina Faso, thus maximising the beneficial effects of the vaccine to those who need it most on a short timeline⁶. With innovative new treatments and preventatives emerging such as the R21 vaccine, the chances of drastically reducing the malaria burden and even achieving eradication are looking ever more likely.

Can gene drives spread between mosquito species?

The issue of Malaria in Africa has for a long time been at the forefront of the discussion about gene drive technology. Leading the research is Target Malaria, a non-profit aimed at using genetic means to eliminate malaria. However, despite the initial success in their laboratory studies, there are glaring open questions and unknowns around releasing gene drive Anopheles gambiae sensu strictu mosquitoes into the environment.

High on the list of concerns are the ecological effects. The risk to an ecological system is considerable when we are talking of eliminating just one species. However Anopheles gambiae sensu strictu is just one member of at least nine mosquito species in the ‘Anopheles gambiae complex’ (known as A. gambiae sensu lato, i.e ‘in the wider sense’), a family of mosquito species that look identical and are well-known to interbreed and produce young hybrids that are capable of breeding¹. This has already been troublesome for the fight against malaria as it has been shown to lead to the exchange of mutations that help the survival of species within the complex. For example, Anopheles arabiensis acquired genes that make it resistant to dry and arid conditions through A. gambiae s.s and A. coluzzi, and A. coluzzi acquired a gene for insecticide resistance through A. gambiae s.s^2,3,4. In the context of a gene drive, which actively forces inheritance of a chosen gene upon all its offspring, the consequences of the exchange of genes between species is even more concerning.

The real risk comes when the target of the gene drive is taken into account. The doublesex gene is an essential gene for sexual development, and thus the disruption of it means females develop into intersex, infertile adults that cannot reproduce⁵. Breeding rates drop drastically, and the population crashes. Because of its vital importance to mosquito survival, the gene is called ‘highly conserved’- this means natural selection puts a strong pressure on it remaining unchanged. This is useful to the development of a gene drive as it means that less genetic ‘resistance’ develops and the gene drive is more likely to spread without problems. However, it turns out that this gene is so vital to insect development that it remains almost identical in sequence across the whole Anopheles complex (and even across all insects ever investigated for the gene, making interspecies spread through horizontal gene transfer a further risk)⁶. This identical genetic target, together with the fact of interbreeding, means there is no barrier remaining preventing the gene drive potentially spreading and crashing all 9 species of the A. gambiae complex in Africa. Six of the species under threat play either no or only minor roles in malaria transmission- just the three species A. gambiae sensu strictu, A. coluzzi and A. arabiensis are considered to be major vectors of malaria^7,8.

From the linear, simple perspective of malaria control, it could be argued that this is beneficial- why risk it and leave any possibility that other A. gambiae complex species could take over the role of A. gambiae s.s in transmitting malaria? This concern is justified as the replacement of one vector with another has occurred at least once, with Anopheles funestus being replaced with Anopheles rivolurum after the habitat was sprayed with insecticide in rural Tanzania⁹. However, from an ecological perspective, the elimination of the whole A. gambiae species complex could imply ecological catastrophe. A recent landmark study demonstrated that the alteration of even one gene in a plant that insects rely on can significantly increase the likelihood of insect extinction¹⁰. If the alteration of even one gene can have a detrimental impact on biodiversity, it leads naturally to the question of what happens when 9 species are eliminated.

There is an incredible lack of research on the ecological role of A. gambiae, and the little there is seems to be mostly from Target Malaria themselves. To carry out a risk assessment that is in any way close to satisfactory for a gene drive, this ought to be the first priority. However the few studies there are demonstrate an important ecological role of mosquitoes; one study Target Malaria published showed that around 95% of the larvae of the A. gambiae complex are eaten before they develop¹¹. Furthermore, a recent study showed that the number and diversity of birds and dragonflies were reduced following the use of a biological insecticide¹². Pollination, vital for the ecosystem, is also at risk; as well as being prey for other insects and birds that are pollinators, Anopheles mosquitoes also need sugar to survive. Mosquitoes actually need to feed on sugar through feeding on nectar more frequently than they do on blood. This behaviour may also play a direct role in pollinating¹³.

Target Malaria recently made the step of acknowledging the spread of their gene drive to other mosquito species¹⁴.  However, the central concern of the blog and paper seems to be little more than a game of wordplay and regulatory chess regarding how to define the ‘target organism’ for the purposes of making the risk assessment less complicated. Almost unmentioned in this was the ecological risk; the potential ecological destruction that might ensue as a result of the release of a gene drive being let loose into a ‘leaky’ mosquito species complex.

This question must be taken seriously by developers and regulators. Malaria is indeed a serious issue, but risking the effects of environmental collapse on local populations with a direct reliance on a healthy, resilient ecosystem, could be equally or more deadly. However, due to the impossibility of trialling gene drive organisms in the wild before their official release, the extent of this risk could be overlooked until it is too late. The very nature of their design dictates that any release could result in their unfettered spread, due to the ‘genetic chain-reaction’ that ensues. The current methods suggested to reverse gene drives are entirely theoretical, untested and therefore insufficient to use to remedy the situation should the need arise.

This acknowledgement of the likely spread of the gene drive and subsequent crash of the A. gambiae complex should lead to serious questions around whether this is a safe, reasonable avenue to pursue in the fight against malaria. This risk is just one of many in the story of gene drives and is a neglected area of research. These unanswered questions have led us and many others to call for a global moratorium on the release of gene drives until these risks have been satisfactorily ruled out. To read more on our policy recommendations, click here.

Berlin, 31 May 2022 – Almost 300,000 citizens of the European Union are calling for a global moratorium on the first field release of genetically modified gene drive organisms. The associations Save Our Seeds, the Aurelia Foundation and the Munich Environmental Institute, which are part of the European Stop Gene Drive campaign, handed over a petition to this effect to the German environmental minister Steffi Lemke in Berlin on 31st of May 2022. Enabled by the novel genetic engineering method called gene drive, wild species could be manipulated or even completely eradicated in the future – with unforeseeable consequences for ecosystems.

Gene drives are produced with the help of the new genetic engineering techique CRISPR-Cas. Gene drives can genetically modify or even eradicate entire populations of animals and plants in nature. The so-called gene drive overrides basic principles of evolution and forces the inheritance of a genetic trait to all offspring. This triggers a genetic chain reaction that only stops when all individuals of the affected animal or plant species carry this genetic modification – or have been exterminated. This is intended, for example, to combat disease-carrying insects, invasive species or so-called crop pests in industrial agriculture.

So far, gene drives have only been tested in the laboratory. Now, the research consortium ‘Target Malaria’ in the West African country of Burkina Faso wants to release gene drives into nature for the first time. The goal is to eradicate a mosquitoe species that transmits malaria. But what sounds promising carries enormous risks: once released into the wild, gene drives can neither be retrieved nor can their further development and spread be controlled. If gene drive organisms spread, they could further accelerate the already rapid extinction of species.

At the handover event with German environmental minister Lemke on Leipziger Platz in Berlin, an installation of giant toppling dominoes vividly depicted the risks posed by the gene drive process.

“A genetic chain reaction triggered by Gene Drive organisms could destabilize entire ecosystems and, in extreme cases, cause them to collapse. Every gene drive release – even if it is “only” for experimental purposes – can have unforeseeable and irreversible consequences for pollinator and food webs, already weakened by climate change and high death rate of insects. We urgently need a global gene drive moratorium!”

warns Bernd Rodekohr, manager of the project “Protect the bee from genetic engineering” at the Aurelia Foundation.

“Gene drive organisms do not respect borders and can spread globally,” says the coordinator of the Stop Gene Drive campaign, Mareike Imken. “So far, the global community has neither sufficient knowledge nor binding international agreements under which such a fundamental, irreversible intervention in nature could be regulated.”

The possible use of gene drives is on the agenda of the 15th United Nations Conference of the Parties to the Convention on Biological Diversity (UN CBD), scheduled for autumn in China. EU environment ministers will adopt their common position on the issue in June.

Sophia Guttenberger of the Munich Environmental Institute demands: “Instead of playing Russian roulette with evolution by genetically modifying wild species, we must finally stop the already rapid extinction of species by strengthening the resilience of our ecosystems and stop destroying them everywhere on earth.”

The German envionmental minister Steffi Lemke said at the petition handover:

“I believe that humanity and also science would overestimate themselves with Gene Drives. That’s why I will of course try to reach a position at the Environmental Council of Ministers in June that is based on the European precautionary principle.”

Background:

Gene drive technology uses genetic engineering methods such as the ‘gene scissors’ CRISPR/Cas to introduce certain traits into wild animal and plant populations. For example, if genes that influence fertility or sex are manipulated, entire populations can be wiped out. However, gene drives could also make so-called agricultural pests susceptible to chemical or biological substances or change other characteristics. To do this, both the new trait and the genetic engineering mechanism (CRISPR/Cas) are passed on. In this way, the genetic manipulation continues independently in nature. This “genetic chain reaction” causes all offspring to inherit the desired trait until the entire population or species is genetically modified or eradicated.

Since 2018, the regulation of gene drives has been the subject of controversial debate under the UN Convention on Biological Diversity (UN CBD). At the last Conference of the Parties in Sharm el Sheik, some initial precautionary conditions for release were recommended. But many questions remain unanswered – including, above all, how and by whom the decision on a release of gene drive organisms would have to be taken in view of transboundary spread and unforeseeable ecological, health, economic and social consequences. The existing procedures under the internationally binding Cartagena Protocol of the CBD on Biosafety so far only regulate the intended transfer of genetically modified organisms (e.g. seeds) as products across individual borders. Gene drive organisms, on the other hand, are not products and spread independently in all regions where the target organism is currently present or will be present in the future. In this respect, all potentially affected countries would have to give their consent to a release in advance. Currently, however, only international guidelines for the risk assessment of gene drive organisms and a general process for the technology assessment of new biotechnological processes are on the agenda of the negotiations within the framework of the UN Convention on Biological Diversity. Goal 17 of the planned Global Framework for Biodiversity deals with the prevention of biodiversity damage due to the use of biotechnologies.

Further links:

– For the Stop Gene Drive Campaign’s recommendations on the design of a global gene drive moratorium: https://www.stop-genedrives.eu/en/policy-recommendations/

– To the brochure “Gene Drives. The new dimension of genetic engineering. Applications, risks and regulation.” https://www.stop-genedrives.eu/en/own-publications/

– 15-minute short documentary on the risks and challenges posed by gene drive technology: https://www.youtube.com/watch?v=PLt6ILhQZ7E&t=4s&ab_channel=SaveourSeeds

– All important information about the Stop Gene Drive campaigns on this website and on Twitter.

Press contact:

Mareike Imken
Coordinator of the Stop Gene Drive Campaign
Save our Seeds / Berlin Office of the Future Foundation for Agriculture in the GLS Trust
E-mail: imken[at]saveourseeds.org
Mobile: 0151-53112969
Web: www.stop-genedrives.eu

What risks are we willing to take to (maybe) end malaria?

25.04.22 – After a tremendous decrease in malaria cases in the last two decades, malaria is on the rise again, having killed 677.000 people in 2020, among them 80% children under 5. Apart from being deadly, malaria is detrimental for the livelihoods of entire families, communities and countries: farmers not being able to sow their seeds on time, mothers not being able to sell surpluses on markets to earn a living or children not being able to go to school and benefit from education – a vicious cycle of poverty. While this disease affects one third of the world’s population, some scientists suggest that a new technology called gene drive could be a game-changer.

Gene Drives – manipulating the DNA of mosquitoes to pass down an extinction gene 

The research consortium Target Malaria, mostly funded by the Bill & Melinda Gates Foundation and the Open Philanthropy Fund, is developing genetically engineered mosquitoes in the lab that would either make all offspring male or all female offspring infertile. They use the Crispr-Cas methodology to implant a system into their DNA that would replicate when mosquitoes mate, ensuring that this gene spreads throughout the wild mosquito population. But while some hope that this would be the magic bullet to suppress mosquitoe populations and stop the malaria transmission cycle, this currently unproven high risk technology poses fundamental questions for humanity: How far are we willing to go, how high can the risks and uncertainties be in order to test a hypothesis?

At the same time there are measures at hand that have in the past been used to end malaria in countries such as, most recently, China and El Salvador, being officially declared malaria free in 2021, preceded by Algeria and Argentina in 2019.

Why is there still malaria in the world then?

To fight malaria the whole toolbox of measures (as mentioned above) needs to be employed, ranging from prevention through nets and repellents, to access to rapid tests to break the infection chain and access to medicine a few hours after being bitten to cure humans. Adding to this; a holistic approach, including urban planning, education, drainage systems and access to health care is needed to fight malaria – as well as many other diseases that trap people in poverty and create a vicious cycle.

What is the Stop Gene Drives Campaign asking for?

In light of the huge variety of to date unassessed possible environmental, health and socio-economic hazards, the potential for economic and political conflict and a plethora of social, ethical and cultural caveats that the environmental use of gene drive technology would entail , the Stop Gene Drive Campaign demands a global moratorium on the release of gene drive organisms. This means that no gene drive organism should be allowed to be released into the environment – not even for field trials – unless a range of conditions have been fulfilled. Read our policy recommendations here.  

It seems to us that malaria prevention funds should be directed at strengthening local health care systems,  sanitation and education to turn the fight against malaria into an intersectional approach to fight poverty and neglected diseases in general.

__________

Further readings:

Read more about possible gene drive applications here

Read our FAQ about gene drives here

Read more about gene drive regulation here

Read our interviews with experts on malaria prevention here

_________

References:

Connolly, J. B., Mumford, J. D., Fuchs, S., Turner, G., Beech, C., North, A. R., & Burt, A. (2021). Systematic identification of plausible pathways to potential harm via problem formulation for investigational releases of a population suppression gene drive to control the human malaria vector Anopheles gambiae in West Africa. Malaria Journal 2021 20:1, 20(1), 1–69. https://doi.org/10.1186/S12936-021-03674-6

Czechowski, T., Rinaldi, M. A., Famodimu, M. T., Van Veelen, M., Larson, T. R., Winzer, T., … Graham, I. A. (2019). Flavonoid Versus Artemisinin Anti-malarial Activity in Artemisia annua Whole-Leaf Extracts. Frontiers in Plant Science, 10, 984. https://doi.org/10.3389/FPLS.2019.00984/BIBTEX

ENSSER, VDW, & Critical Scientists Switzerland (CSS). (2019). Gene Drives. A report on their science, applications, social aspects, ethics and regulations. Retrieved from https://ensser.org/publications/2019-publications/gene-drives-a-report-on-their-science-applications-social-aspects-ethics-and-regulations/

Guidance on the environmental risk assessment of genetically modified animals. (2013). EFSA Journal, 11(5). https://doi.org/10.2903/J.EFSA.2013.3200

Landier, J., Parker, D. M., Thu, A. M., Carrara, V. I., Lwin, K. M., Bonnington, C. A., … Nosten, F. H. (2016). The role of early detection and treatment in malaria elimination. Malaria Journal, 15(1), 1–8. https://doi.org/10.1186/S12936-016-1399-Y/TABLES/1

Laurens, M. B. (2020). RTS,S/AS01 vaccine (Mosquirix^TM): an overview. Human Vaccines & Immunotherapeutics, 16(3), 480. https://doi.org/10.1080/21645515.2019.1669415

Malariaprophylaxe und Empfehlungen des Ständigen Ausschusses Reisemedizin (StAR) der DTG. (2021, August). Retrieved April 18, 2022, from https://www.dtg.org/images/Startseite-Download-Box/2021_DTG_Empfehlungen_Malaria.pdf

Maskin, E., Monga, C., Thuilliez, J., & Berthélemy, J. C. (2019). The economics of malaria control in an age of declining aid. Nature Communications 2019 10:1, 10(1), 1–5. https://doi.org/10.1038/s41467-019-09991-4

Okumu, F. O., Govella, N. J., Moore, S. J., Chitnis, N., & Killeen, G. F. (2010). Potential Benefits, Limitations and Target Product-Profiles of Odor-Baited Mosquito Traps for Malaria Control in Africa. PLOS ONE, 5(7), e11573. https://doi.org/10.1371/JOURNAL.PONE.0011573

Prüss-Ustün, A., Wolf, J., Bartram, J., Clasen, T., Cumming, O., Freeman, M. C., … Johnston, R. (2019). Burden of disease from inadequate water, sanitation and hygiene for selected adverse health outcomes: An updated analysis with a focus on low- and middle-income countries. International Journal of Hygiene and Environmental Health, 222(5), 765–777. https://doi.org/10.1016/J.IJHEH.2019.05.004

Q&A on RTS,S malaria vaccine. (n.d.). Retrieved April 18, 2022, from https://www.who.int/news-room/questions-and-answers/item/q-a-on-rts-s-malaria-vaccine

Target Malaria. (n.d.). The Science: What is gene drive? Retrieved from www.targetmalaria.org/ourwork

Target Malaria | Together we can end malaria. (n.d.). Retrieved April 25, 2022, from https://targetmalaria.org/

The Nobel Prize | Women who changed science | Tu Youyou. (n.d.). Retrieved April 19, 2022, from https://www.nobelprize.org/womenwhochangedscience/stories/tu-youyou

WHO. (2019). The use of non-pharmaceutical forms of Artemisia. Retrieved April 19, 2022, from https://www.who.int/news/item/10-10-2019-the-use-of-non-pharmaceutical-forms-of-artemisia

WHO. (2022). Countries and territories certified malaria-free by WHO. Retrieved April 18, 2022, from https://www.who.int/teams/global-malaria-programme/elimination/countries-and-territories-certified-malaria-free-by-who?msclkid=949a737cbf0711ec9474c0ab673942f3

Yang, D., He, Y., Wu, B., Deng, Y., Li, M., Yang, Q., … Liu, Y. (2020). Drinking water and sanitation conditions are associated with the risk of malaria among children under five years old in sub-Saharan Africa: A logistic regression model analysis of national survey data. Journal of Advanced Research, 21, 1–13. https://doi.org/10.1016/J.JARE.2019.09.001

Yasri, S., & Wiwanitkit, V. (2021). Artemisinin resistance: an important emerging clinical problem in tropical medicine. International Journal of Physiology, Pathophysiology and Pharmacology, 13(6), 152. Retrieved from /pmc/articles/PMC8784654/