The Convention on Biological Diversity’s biannual meeting in November did not make a lot of headlines. Big meetings of the parties to relatively obscure international treaties rarely do. But it was the site of a heated debate over whether to impose a moratorium on field releases of gene drive organisms, which advocates think could be the tool that finally lets us eliminate malaria and save more than 400,000 lives every single year.

Ultimately, the parties to the Convention on Biological Diversity (CBD) — a treaty meant to protect vulnerable ecosystems and ratified by every country but the US and Vatican City — decided against a moratorium. Target Malaria, the most prominent group working on gene drives to fight malaria, says that the language the CBD agreed to instead doesn’t change its planning at all. But skeptics of the technology insist they won a major concession all the same.

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But first: What is a gene drive? Gene drives allow humans to change the genetic makeup of a species by changing the DNA of a few individuals, which then spread the modification throughout an entire population.

In the case of malaria, the idea is to change the three species of mosquito (out of some 3,500 mosquito species total) most responsible for its transmission — Anopheles gambiae, Anopheles coluzzii, and Anopheles arabiensis — so that all their offspring would be male, dramatically reducing the species’ populations. Or you could just add a gene making them resistant to the malaria parasite, preventing its transmission to humans. Target Malaria favors the former approach: using gene drives to reduce the populations of a small handful of mosquito species.

A decision by the CBD’s signatories to impose a moratorium on field tests of gene drives would have thrown a wrench into Target Malaria’s plans. While the group is many steps away from actually releasing a gene drive mosquito in the wild — right now, it’s preparing to release genetically modified mosquitos that don’t have gene drives to spread their traits through the whole population — it could be applying for approval for a gene drive release as soon as 2023. If a moratorium were imposed this year it would have had to be repealed in subsequent CBD meetings in 2020 or 2022, or else it would have delayed Target Malaria’s timeline.

And a delay could be incredibly costly in human terms. Malaria killed between 438,000 and 720,000 people in 2015. So starting from the moment we have deployable gene drive technologies that could wipe out the disease, every day we wait kills between 1,200 and 2,000 people.

That doesn’t mean we should release them before they’re ready, of course. But the promise of gene drives, and the costs of ruling them out, did lead a group of scientists, notably including a large number of African scientists from malarial countries, to write an open letter begging the CBD not to pass a moratorium.

The scientists argued that “Science has not brought solutions to all our problems, but improved understanding and evidence have been key to progress. Innovations in vaccines, for example, have saved millions of lives … We should not decide against the use of a tool before potential costs and benefits can be fully evaluated.”

The CBD thus rejected a moratorium. Instead, it agreed to the following language (emphasis mine), stating that the convention:

Calls upon Parties and other Governments, taking into account the current uncertainties regarding engineered gene drives, to apply a precautionary approach, in accordance with the objectives of the Convention, and also calls upon Parties and other Governments to only consider introducing organisms containing engineered gene drives into the environment, including for experimental releases and research and development purposes, when: (a) Scientifically sound case-by-case risk assessments have been carried out; (b) Risk management measures are in place to avoid or minimize potential adverse effects, as appropriate; (c) Where appropriate, the “prior and informed consent”, the “free, prior and informed consent” or “approval and involvement” of potentially affected indigenous peoples and local communities is sought or obtained, where applicable in accordance with national circumstances and legislation; Recognizes that, as there could be potential adverse effects arising from organisms containing engineered gene drives, before these organisms are considered for release into the environment, research and analysis are needed, and specific guidance may be useful, to support case-by-case risk assessment

This might sound like vague international organization-speak, but Delphine Thizy, the stakeholder engagement manager for Target Malaria who attended the convention, argues that the language describes the group’s approach as it is. The requirement of “free, prior and informed consent” is slightly different in a public health context than in individual medical contexts. For instance, when Target Malaria directly collects mosquitos from houses of people in Burkina Faso for research, it requires the consent of everyone whose household they’re entering.

But for interventions like edited mosquitos, where it’s not logistically possible to obtain consent from each and every person affected, it entails consulting with local community members and their representatives, as Target Malaria is already doing. As the language suggests, this mandate is particularly strong for indigenous peoples, who aren’t the primary population in the areas where Target Malaria works.

Thizy describes the debate within the CBD as somewhat polarized, with Bolivia and Venezuela leading the charge for a moratorium. Most of Africa, she says — led by South Africa, Ghana, and Nigeria — was broadly supportive of research, while Egypt and Morocco, which are non-malarial, wanted a moratorium.

Dana Perls, a senior campaigner at Friends of the Earth, which strongly opposes gene drives, adds that Gabon and Madagascar wanted a moratorium as well, arguing that Africa was split, not supportive.

Gene drive skeptics think they won too

Befuddlingly, while Thizy considers defeating the moratorium a win, the two anti-GMO groups most vocally opposed to gene drive research — the ETC Group and Friends of the Earth — also hailed it as a win. In a joint statement by the groups, ETC Group’s co-executive director Jim Thomas declared, “This important decision puts controls on gene drives using simple common sense principles: Don’t mess with someone else’s environment, territories and rights without their consent.”

Kevin Esvelt, a biologist at MIT who helped figure out how to make gene drives using CRISPR gene editing technology, told me he finds this baffling. “The resulting language contains much to restrain reckless cowboys that I very much applaud, but it doesn’t seem to include anything that Target Malaria can’t reasonably claim to be doing already,” he says.

Perls at Friends of the Earth pushed back on that claim, arguing, “The UN decision puts power back in the hands of potentially affected communities, and centers their right to decide whether they want gene drive experiments in their ecosystems.”

A lot of this dispute seems to boil down to a question of where, exactly, you think affected African people stand on the issue. In the joint statement, Mariann Bassey-Orovwuje, the chair of the Alliance for Food Sovereignty in Africa, insisted, “In Africa we are all potentially affected, and we do not want to be lab rats for this exterminator technology. Farmers have already marched in the streets of Burkina Faso to protest genetically engineered mosquitoes and we will march again if they ignore this UN decision.”

Zahra Moloo, a journalist critical of GMOs, published a dispatch from Bana, the town in Burkina where Target Malaria is set to release “sterile male” mosquitos first, and found a few residents who claimed they were not adequately consulted.

But scientists representing African nations in the CBD discussions told the Washington Post that there’s broad support. Charles Mugoya, chief of the National Biosafety Committee in Uganda, for instance, told the Post, “The political leadership at the African Union level has accepted the benefits of this technology. It’s a long way to get the benefits, but we have to start somewhere.”

And earlier reports from Bana, the Burkina Faso town, suggested extensive outreach by Target Malaria and considerable public buy-in and support. Responding to Moloo’s critical article, Target Malaria’s Thizy says, “It’s a good thing to learn from … but I’m pretty confident about the process we’ve taken because we’ve been in that village since 2012. It’s been six years.”

Burkina Faso’s government also did extensive consultation in the village before approving the sterile male test. While Moloo criticizes Target Malaria for not consulting other nearby villages, Thizy analogizes this to criticizing researchers operating entirely within Manhattan for not seeking approval from New Jersey. The sterile male mosquitos, she says, have such short lifespans that their effect will be isolated within Bana.

That’s the difficulty of this debate. Everyone agrees, in principle, that gene drive mosquitos, and genetically modified mosquitos that fall short of gene drives, should only be released if the people who would be most affected agree. And Target Malaria insists that it’s done extensive, years-long consultation. But consent is never unanimous, and groups critical of the technology can, and do, find residents who are opposed.

The question, in 2024 or whenever real gene drive mosquitos are ready for release, is who gets to decide when the African people have consented — and how unanimous a decision you need when millions of lives are on the line.

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