Pathway to Deployment of Gene Drive Mosquitoes as a Potential Biocontrol Tool for Elimination of Malaria in Sub-Saharan Africa: Recommendations of a Scientific Working Group†
Gene drive technology offers the promise for a high-impact, cost-effective, and durable method to control malaria transmission that would make a significant contribution to elimination. Gene drive systems, such as those based on clustered regularly interspaced short palindromic repeats (CRISPR)/CRISPR associated protein, have the potential to spread beneficial traits through interbreeding populations of malaria mosquitoes. However, the characteristics of this technology have raised concerns that necessitate careful consideration of the product development pathway. A multidisciplinary working group considered the implications of low-threshold gene drive systems on the development pathway described in the World Health Organization Guidance Framework for testing genetically modified (GM) mosquitoes, focusing on reduction of malaria transmission by Anopheles gambiae s.l. mosquitoes in Africa as a case study. The group developed recommendations for the safe and ethical testing of gene drive mosquitoes, drawing on prior experience with other vector control tools, GM organisms, and biocontrol agents. These recommendations are organized according to a testing plan that seeks to maximize safety by incrementally increasing the degree of human and environmental exposure to the investigational product. As with biocontrol agents, emphasis is placed on safety evaluation at the end of physically confined laboratory testing as a major decision point for whether to enter field testing. Progression through the testing pathway is based on fulfillment of safety and efficacy criteria, and is subject to regulatory and ethical approvals, as well as social acceptance. The working group identified several resources that were considered important to support responsible field testing of gene drive mosquitoes…
Mosquito Threat Spurs New Ways to Tackle Old Pest
We need powerful tools to take on the deadliest creature in the world: mosquitoes.
Mosquitoes spread malaria, a disease that sickens more than 200 million people each year and kills 430,000. Genetically engineering mosquitoes to stop the spread of malaria offers great promise in saving many of these lives, and could add an estimated $4 trillion to the global economy over the next 14 years.
A new technology known as gene drive can increase the likelihood that desirable engineered traits in a mosquito are passed on to all of its offspring in the next generation, ultimately spreading these traits throughout a target population.
Since only female mosquitoes feed on blood and transmit malaria parasites from person to person, a gene that boosts the inheritance of the male chromosome would reduce the number of females in the target population and cause it to crash, a strategy known as population suppression. Another type of beneficial gene might kill malaria parasites in mosquitoes before they can be transmitted, a strategy known as population modification.
The result of either scenario — or others in the works — would ultimately stop the spread of malaria.
While the potential to control malaria through genetic manipulation represents an opportunity to make significant advances in eradicating the disease, developing a technology designed to spread new genes through populations must be carefully managed. Any new tools must be as safe as they are effective.
A useful rule of thumb for achieving this appears in an important new paper from the Foundation for the National Institutes of Health. It stipulates that the new technologies “will do no more harm to human health than wild-type mosquitoes of the same genetic background and no more harm to the ecosystem than other conventional vector control interventions.” Showing this to be true requires research as well as patience and dialogue.
While gene-drive research builds on previous mosquito-control experience and prevailing good practices in biotechnology, this is a new approach with unique aspects. In particular, the genetic modification is designed to spread through wild populations. This poses new questions for how to develop and evaluate gene-drive organisms. The majority of questions fall into two categories: how to limit the spread of genetically engineered mosquitoes to a defined geographical region, and what impact they might have on existing ecosystems.
Population suppression approaches are self-limiting by design — all mosquitoes carrying the genes are sterile or die. Important questions here address the implications of loss of the species from the ecosystem. This is less of a concern in places where the mosquitoes are an invasive species, but some people have expressed opinions that regional success will lead to widespread use and result in global extinction of the target mosquito species.
Population modification strategies are designed to persist. The major questions here focus on what can be done should we, for one reason or another, no longer want these mosquitoes out in the wild.
Fortunately, there are major research efforts to develop chemical and genetic control or “recall” mechanisms for gene drive (Safe Genes). The first open-field trials of these will likely take place only after regulatory agencies are satisfied that appropriate mitigation procedures are available.
All of the scientists I know working on this technology have adopted a phased approach outlined in the new paper (which was adapted from previouspublications) to testing safety and effectiveness complete with “go/no go” decision points before any consideration of releasing any insects into the field.
Included in this approach is time to review the implications and the possible risks described above, to engage the public to address concerns they might have, to develop the necessary safety protocols, and to secure regulatory approval.
Inherent in this process is an understanding that each new gene-drive technology is different. While there are some general principles that apply to all, such as containment of the organism during early testing, the risks and challenges of each must be evaluated on a case-by-case basis.
The best way to ensure that gene-drive technology is developed safely is to discuss it openly — in laboratories, within governments, and in public. Engaging nonprofit organizations like the Foundation for the National Institutes of Health contributes to safeguarding public interest in this emerging disease-fighting tool.
With so many people suffering from malaria every year, we cannot afford to leave this potential new tool unexplored. But we must do it the right way.
Anthony A. James, Ph.D., is professor of microbiology and molecular genetics at the University of California, Irvine, School of Medicine and professor of molecular biology and biochemistry at the UCI School of Biological Sciences.
India has a new science adviser. Prime Minister Narendra Modi’s government on Monday tapped Krishnaswamy VijayRaghavan, a molecular biologist and head of India’s Department of Biotechnology, to fill the post. He replaces physicist Rajagopala Chidambaram, a longtime adviser to India’s governments and a key figure in the development of India’s nuclear weapons program.
“It is a great responsibility. … We have our task cut out,” VijayRaghavan tweeted after the appointment was announced. “Connect science to society and society to science. [Science and technology] can be the fulcrum for change.”
The position of principal scientific adviser (PSA) has taken on greater prominence under Modi, who has disbanded other science advisory bodies and has tended to rely on the science adviser and science and environment minister for technical advice.
Housed in New Delhi, the PSA’s office has a small budget but has played a key role in catalyzing science initiatives, including major government investments in nanoelectronics research and the construction of a high-speed fiber optics network for the nation’s research universities.
Chidambaram, 81, recently told ScienceInsider that he was planning to resign from his position because “India needed a younger science adviser.”
VijayRaghavan, who is 64, earned his doctorate at India’s prestigious Tata Institute of Fundamental Research in Mumbai in 1983, and later worked as a researcher at the California Institute of Technology in Pasadena. He returned to India and ultimately became head of the National Center of Biological Sciences in Bengaluru, a prominent research center. In 2013, he was appointed to lead India’s biotechnology department, where he oversaw the deployment of the first vaccine developed by Indian researchers, which targeted rotavirus. His tenure also included a controversial—and ultimately unsuccessful—effort to introduce genetically modified mustard into Indian agriculture.
Anil Gupta, founder of India’s National Innovation Foundation in Ahmedabad, a government-sponsored funding body, says VijayRaghavan has “great hopes for science,” and is known for his ability to connect with young researchers.
Earlier this week, VijayRaghavan hinted at his priorities in a series of tweets. The list included improving access to scientific training and addressing climate change and other environmental challenges. “Our foundations will be built on fundamental research, a basic human quest, which prepares us for the unknown,” VijayRaghavan told ScienceInsider. “Simultaneously, we will apply and develop technologies for speedy national transformation.”
His term as science adviser lasts for 3 years.
Principles for gene drive research
Sponsors and supporters of gene drive research respond to a National Academies report
1 DECEMBER 2017 • VOL 358 ISSUE 6367
The recent outbreak of Zika virus in the Americas renewed attention on the importance of vector-control strategies to fight the many vector-borne diseases that continue to inflict suffering around the world. In 2015, there were ~212 million infections and a death every minute from malaria alone (1). Gene drive technology is being explored as a potentially durable and cost-effective strategy for controlling the transmission of deadly and debilitating vector-borne diseases that affect millions of people worldwide, such as Zika virus and malaria. Additionally, its suitability is being evaluated for various potential applications in conservation biology, including a highly specific and humane method for eliminating invasive species from sensitive ecosystems (2, 3).
The use of gene drives is an emerging technology that promotes the preferential inheritance of a gene of interest, thereby increasing its prevalence in a population. A gene drive is distinct from genome editing, in which the genetic change is not preferentially inherited. A variety of gene drives occur in nature that can cause genetic elements to spread throughout populations to varying degrees, and researchers have been studying how to harness these to solve some of society’s most intractable problems (4). Aided by CRISPR gene-editing technology, the rapid pace with which the research is progressing is demonstrated by recent successes in laboratory experiments (5, 6), although observation of resistance developing in one instance highlights the need for further research (7).
Sciences, Engineering, and Medicine (NASEM) conduct a study that would “summarize current understanding of the scientific discoveries related to gene drives and their accompanying ethical, legal, and social implications,” which was published in 2016 [(2), p. vii)]. The authors noted that the promise of gene drives is tempered by uncertainties regarding potential for harm from unintended consequences or misuse of the technology. The potential persistence of genetic change in the target population caused by a gene drive is both the source of optimism for a durable and affordable tool to combat a variety of pernicious public health and environmental problems as well as the source of concern about the possibility for irreversible harm to the ecosystem that has prompted some to call for a moratorium on the research (2, 8, 9). This led the authors of the National Academies report to advocate for a precautionary contextual approach to the science—i.e., concluding that currently there is insufficient evidence to support deployment of gene drive–modified organisms into the environment but that the potential benefits justify proceeding with laboratory research and highly controlled field trials (2, 10).In recognition of the rapid advances of research in this field, the U.S. National Institutes of Health (NIH) and the Foundation for the NIH requested that the U.S. National Academies of
The report issues a number of recommendations aimed at researchers, funders, and policy-makers on actions important for minimizing potential risks, averting preventable harm, and earning the confidence and support of the public. Of the 32 recommendations made, 13 are specific to funders—including one aimed specifically at “United States funders” (2).
Published by AAAS
RESPONDING TO THE NASEM REPORT
Sponsors of scientific research have a responsibility to support innovation that promotes and sustains the public good (11). They share the common goal of advancing
knowledge and human well-being, while protecting and promoting societal values that underpin the responsible conduct of science. The 2010 report from The Presidential Commission for the Study of Bioethical Issues, “New Directions: The Ethics of Synthetic Biology and Emerging Technologies,” highlights the important point that the responsibility for ensuring the conduct of quality science is not the exclusive domain of scientists, but is a shared responsibility among research sponsors and policy-makers alike (11). In this Policy Forum, we use the term “science” in its broadest sense, referring inclusively to the life and physical sciences as well as social science, and the humanities, i.e. ethics. Moreover, researchers, sponsors, and policy-makers also share the responsibility of monitoring the progress of science and communicating it effectively to the public
(2). Effective public engagement, underpinned by transparent dialogue around both the potential benefits and risks, is critical for enabling well-informed public discussion and debate that is free from the type of sensational hype that has framed new technology in the past (12).
As sponsors and supporters of gene drive research, the signatories to these principles have come together to provide a coordinated response to the NASEM recommendations in the form of commitment to a set of guiding principles (see the box) intended to (i) mobilize and facilitate progress in gene drive research by supporting efforts of the highest scientific and ethical quality; (ii) inspire a transparent atmosphere of conscientiousness, respectfulness, and integrity wherein the research can flourish; and (iii) support existing biosafety requirements and best practices as minimum standards for research. Endorsement of the principles represents a pledge to advance.
Guiding principles for the sponsors and supporters of gene drive research
Advance quality science to promote the public good
The pursuit of gene drive research must be motivated by, and aim to promote, the public good and social value. Funded research shall embody the highest quality science and ethical integrity, consistent with the current best practice guidance set by the research community and relevant decision-making bodies [(2), p. 106)].
Promote stewardship, safety, and good governance
Researchers and sponsors are stewards of science and the public trust. It is imperative that good governance is demonstrably shown in all phases of the research, and especially in relation to risk assessment and management. This requires compliance with applicable national and international biosafety and regulatory policies and standards. Research conducted with respect and humility for the broader ecosystem in which humans live, taking into account the potential immediate and longer-term effects through appropriate ecological risk assessment, is a hallmark of both good stewardship and good governance [(2), pp. 128; 170–172)].
Demonstrate transparency and accountability
Knowledge sharing is not only essential for the advancement of science, but for transparency to foster public trust in emergent technologies. The timely reporting of results and broad sharing of data shall be the norm in gene drive research, consistent with the tradition of openness established in its parent communities of genetic and genomic science. Measures of transparency and accountability that contribute to building public trust and a cohesive community of practice will be supported [(2), pp. 171; 177–178)].
Engage thoughtfully with affected communities, stakeholders, and publics Meaningful engagement with communities, stakeholders, and publics is critical for ensuring the best quality science and building and sustaining public confidence in the research. Funded research shall include the resources needed to permit robust, inclusive, and culturally appropriate engagement to ensure that the perspectives of those most affected are taken into account [(2), pp. 142–143)].
Foster opportunities to strengthen capacity and education
Strengthening capacities in science, ethics, biosafety, and regulation is essential for enabling agile and steady progress in gene drive research globally. Opportunities to partner, educate, and train shall be supported throughout all phases of the research, from the early stages to deployment. Strengthening capabilities within countries for testing and deploying the technology is essential for informed decision-making [(2), pp. 128; 170–172)].
Filmed on Monday October 30, 02017 Seminars about Long-Term Thinking
Watch the Video
Dr. Renee Wegrzyn is a Program Manager at DARPA working to apply the tools of synthetic biology to support biosecurity and outpace infectious disease. Formerly she was Senior Lead Biotechnologist at Booz Allen Hamilton. Dr. Wegrzyn holds Doctor of Philosophy and Bachelor of Science degrees in Applied Biology from the Georgia Institute of Technology.
Genome editing technologies provide the unprecedented ability to modify genetic material in a manner that is targeted, rapid, adaptable, and broadly accessible. Advances in genome editing form the foundation for new transformative applications across all of biology, ranging from highly personalized therapeutics to control of mosquito populations in the wild to reduce vector borne diseases. Extension of these technologies to gene drives and germline editing, which can alter the outcomes of inheritance, brings into focus the potential use of these tools in real clinical or ecological settings.
While the potential for societal benefit from these technologies is immense, longer-term ramifications, such as the potential for these tools to impact large populations of organisms and ecosystems over many generations, must also be considered. Therefore, to support the safe and responsible use of gene editors, it is imperative that we innovate and build-in biosafety and biosecurity technologies early for future applications, including strategies to control, counter, and remediate the outcomes of gene editing. Co-development of safety measures ensures the continued rapid pace of technological progress, helps realize the potential of gene editors, and, importantly, enables novel applications to be accessible to the broadest and most impactful possible range of communities for public benefit.
Dr. Renee Wegrzyn is a Program Manager at DARPA working to apply the tools of synthetic biology to support biosecurity and outpace infectious disease. Dr. Wegrzyn holds Doctor of Philosophy and Bachelor of Science degrees in Applied Biology from the Georgia Institute of Technology.
Video: Entomologist Fred Gould critiques media coverage critical of gene drives
British scientists who led the work said mosquitoes’ growing resistance to control tools such as insecticide-treated bed nets and insecticide spraying, which have helped cut malaria cases since 2000, now threatens “to derail malaria control” in Africa.
“Our study highlights the severe challenges facing public efforts to control mosquitoes and to manage and limit insecticide resistance,” said Martin Donnelly of the Liverpool School of Tropical Medicine, who worked on the study with a team from Britain’s Wellcome Trust Sanger Institute.
Latest World Health Organization (WHO) data show that 216 million people were infected last year with the malaria parasite, which is transmitted by blood-sucking Anopheles mosquitoes.
The disease killed 445,000 people in 2016, the majority of them children in sub-Saharan Africa.
To understand how mosquitoes are evolving, the researchers sequenced the DNA of 765 wild Anopheles mosquitoes taken from 15 locations across eight African countries. Their work, published in the journal Nature on Wednesday, created the largest data resource on natural genetic variation for any species of insect.
Analyzing the data, the scientists found that the Anopheles gambiae mosquitoes were extremely genetically diverse compared with most other animal species. This high genetic diversity enables rapid evolution, they said, and helps to explain how mosquitoes develop insecticide resistance so quickly.
The genome data also showed the rapid evolution insecticide resistance appeared to be due to many previously unknown genetic variants within certain genes. The scientists said these genetic variants for insecticide resistance were not only emerging independently in different parts of Africa, but were also being spread across the continent by mosquito migration.
Michael Chew, an infection and immunobiology expert at Britain’s Wellcome Trust global health charity which helped fund the research, said the findings underlined the importance of pushing scientific research ahead to tackle malaria.
“This species is a major transmitter of malaria and the unexpectedly high genetic diversity found by scientists poses fresh questions for those in malaria research and control programs,” he said in a statement.
“Global efforts to tackle malaria through effective vaccines, insecticides and the best drug combinations require urgent, united action by scientists, drug companies, governments and the WHO.”
Reporting by Kate Kelland; Editing by Alison Williams
Nearly half a million people killed by malaria in 2016
by Faras Ghani
22 hours ago
MORE ON MALARIA
More than 445,000 people were killed by malaria in 2016, and a shortage of funds has resulted in the fight against the disease stalling, according to a World Health Organization report.
There was a five million increase in the number of reported cases last year, rising from 211 million in 2015, the World Malaria Report 2017 added, with 57.3 million of those cases registered in Nigeria alone.
“We can safely say that after an unprecedented period of success, we are no longer making progress,” Abdisalan Noor, lead author of the report, said.
“What is paramount now is taking this year’s malaria report as a wake-up call to stimulate action.”
Based on the report, 90 percent of the reported cases last year were in the African region, which also accounted for 91 percent of all malaria deaths in the same year.
The WHO said a minimum annual investment of $6.5bn was needed by 2020 to meet targets on controlling malaria by 2030.
Malaria Consortium, an NGO specialising in the control of the disease, echoed WHO’s views, saying that with the shortfall in funds, it will be very difficult to reach the desired results.
“An increased funding would definitely help,” James Tibenderana, global technical director at Malaria Consortium, told Al Jazeera.
“But I also feel that we need to work more with the private sector. Around 40 percent of the population affected has no access to the treatment. We either need to make diagnosis and treatment free of charge, or subsidise it.
“Without creating access, we will struggle to bring the figures down. We need to be smarter at how we use prevention methods and how we target them in the right places.”
Nigeria accounted for more than 25 percent of the reported cases.
Fighting between the armed Boko Haram group and the Nigerian military left at least 20,000 people dead and more than 2.6 million displaced in the northeastern region.
More than half a million people were displaced in Nigeria last year, according to the Global Report on Internal Displacement. The mass displacement has also restricted access to healthcare and around two-thirds of health facilities were completely or partially destroyed.
“There was a two percent increase in the number of reported cases in Nigeria, and that’s because malaria prevention activities weren’t carried out due to funding issues,” WHO’s Rex Mpazanje told Al Jazeera.
“Some actions are being taken but it is important to note that the figures should reduce and if we can tackle the issue in Nigeria, this will also have a positive effect on the global figures.”
COMMENT 29 November 2017
Malaria is no longer in decline and that should worry us all
The fight to end malaria is stalling after more than a decade of progress. We need to wake up and reinvigorate attempts to eradicate it, says Azra Ghani
finger-prick test for malaria
Finger-prick tests speed up diagnosis
Global Warming Images/REX/Shutterstock
By Azra Ghani
Malaria – one of the world’s oldest killers – continues to plague large parts of the globe despite decades of effort to wipe it out.
Sadly, as the World Malaria Report published by the World Health Organization today makes clear, progress on eliminating it has stagnated, with the number of cases and deaths unchanged for the past three years.
This is a disease that still results in the death of a child every 2 minutes, despite effective treatment costing roughly the same as a cup of coffee in London.
During the 20th century, several attempts were made to eliminate malaria. In some parts of the world, notably Europe and the US, they worked. But in other areas progress stalled as the tools available to tackle it began to fail and financial and political commitment wavered.
One of the most effective means to combat
From The LA Times:
The world is off track in its goal to eliminate malaria. Here’s why.
A feeding female Anopheles stephensi mosquito, the type of insect that transmits malaria.A photo provided by the Centers for Disease Control and Prevention shows a feeding female Anopheles stephensi mosquito, the type of insect that transmits malaria. (James Gathany / Centers for Disease Control via the Associated Press)
By Ann M. SimmonsContact Reporter
Progress toward the global elimination of malaria has stalled, according to a report to be published Wednesday by the World Health Organization.
The world made big gains against malaria from 2000 to 2015, with annual infections falling 18% and annual deaths dropping 48%. The WHO was so encouraged by the declines that in 2015 it announced a goal of cutting malaria infections and deaths worldwide by at least 40% by 2020.
But in the last three years, many nations have reported significant increases in malaria cases, according to the new report.
“We are not seeing the progress that had been achieved in the past being sustained,” Pedro Alonso, director of the WHO’s Global Malaria Program, told reporters in a telephone briefing last week. “Reductions in disease and death have ceased, and we are therefore not on track to meet the 2020 target.”
Reasons for the slowdown differed across specific regions and countries, health officials said. But contributing factors included insufficient funding, a lack of interventions to prevent spread of the disease, risks posed by conflict in malaria endemic zones, irregular climate patterns, and the emergence of parasite resistance, the report said.
“It’s a bit of wake-up call for all of us who are working hard toward reducing and ultimately eliminating and even eradicating malaria and think we have to take it seriously,” said Larry Slutsker, who heads the Center for Malaria Control and Elimination at the Seattle-based global health nonprofit PATH.
Here are some key figures from the report:
The number of malaria cases worldwide in 2016. That’s down from 237 million in 2010, but about the same as it’s been the last few years.
With 194 million cases in 2016, Africa accounted for almost 90% of the total. Southeast Asia was a distant second with 14.6 million.
A worker fumigates a location in New Delhi to kill mosquitoes.
A worker fumigates a locality to kill mosquitoes at a location in New Delhi, India. EPA/Shutterstock
The estimated number of deaths from malaria last year, or more than 50 people every hour. More than 90% of those deaths are in Africa, and 80% of the victims in Africa are children younger than 5.
“It’s one of the top killers of African children,” Alonso said.
Nigeria had the highest percentage of malaria deaths.
Though Africa has made significant progress in reducing infections and death, Slutsker said, getting countries to prioritize anti-malaria efforts “is something we’re going to have to work more on in the African region.“
“As is the case with many health problems in Africa, there are systems issues,” he said. “ … In terms of building the systems to deliver treatment to people in a timely way, to make the diagnosis and to record those cases … those are systems that need to be built.”
The amount of money that was invested last year in malaria control and elimination efforts globally by governments in countries where malaria is endemic and their international partners. The largest portion of the funding — around 74% — went to Africa. The United States was the largest donor, providing $1 billion, or 38%, of all malaria funding.
Annual funding has held steady since 2010. To meet the 40% reduction target, according to the report, yearly funding must reach $6.5 billion by 2020.
Alonso said the progress made in the fight against malaria over the last 10 to 15 years may have caused “a decreased sense of urgency and a certain degree of complacency,” which might account for the plateau in funding.
“Therefore with [the current] level of funding and the tools that we have, we are not going to see any further progress,” he said.
Women & children waiting for treatment in North Darfur, Sudan.
In this May 2013 file photo, sick women and children wait to be treated for suspected malaria at a hospital in North Darfur, Sudan. Albert Gonzalez Farran / Associated Press
With spending of less than $2 a person in countries where malaria takes the heaviest toll, experts said committing more is not only the right thing to do for moral reasons but also for economic ones.
“Malaria is clearly one of the best humanitarian investments in the world today, creating $20 in economic benefits for every dollar that’s invested in malaria control,” said Martin Edlund, chief executive of the nonprofit Malaria No More. “We still see it as one of the best ways to save lives, to get kids back in school, to get people back to work and free up health system capacity to tackle other challenges. If we want to realize those benefits, we have to continue to invest and we have to continue to innovate.”
The number of mosquito nets treated with insecticides that were distributed around the world, according to manufacturers. Although 505 million of the nets went to countries in sub-Saharan Africa, the proportion of households in this region with sufficient nets remained inadequate, the report said .
“Bed nets have been perhaps the primary driver of the lives saved and the progress that we’ve seen over the last decade or so,” Edlund said. But he cautioned that “bed nets alone won’t solve the problem.”
Also key is stopping transmission of the disease by spraying insecticides indoors, diagnosing people efficiently and providing prompt and effective treatment, he said.
A child sits 22 June 2005 under a mosquito net.
In this file photo, a child sits under a mosquito net in his home in Xai Xai, Mozambique. Alexander Joe / AFP/Getty Images
The number of countries with malaria transmission that reported fewer than 10,000 cases in 2016 — up from 37 in 2010. Kyrgyzstan and Sri Lanka were certified by the WHO as malaria-free in 2016, and with no cases reported that year Algeria appears to be on the verge of receiving that designation. A total of 21 countries have the potential to eliminate the disease within their borders by 2020, according to the agency.
“From our standpoint, this report presents a really clear choice,” Edlund said. “Either we do what’s needed to end the world’s oldest, deadliest disease, or we let malaria resurge at the potential cost of millions of lives and trillions of dollars in economic benefits.”
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For the record, 10:38 p.m.: An earlier version of the report referred to the Program for Appropriate Technology in Health. The Seattle-based global health nonprofit no longer spells out its full name. It is known as PATH.