This is a ‘bleeding obvious’ statement. It is well acknowledged that malaria is a disease of poverty addressed in this column on June 13,  May 9, April 18, February 1, October 6 2024 and June 29 2024.  Malaria disappeared from Europe, North America and much of Asia as living standards improved.

And, of course, money is the fuel that keeps the malaria research and treatment business going, which is probably the motivation behind some articles in MalariaWorld this week. One article from PAHO, Pan American Health Organization, which is WHO in Americas region is ‘Best Buys to accelerate disease elimination in the Americas’.

PAHO has developed Best Buys, evidence-based technical briefs that summarize, in a single page, the most cost-effective and high-impact interventions recommended for each disease or condition. The attractive website has a wheel and you can click for any individual disease or all.

What does it say about malaria? The ‘Best Buys’ just seem to be business as usual. Is this approach solving malaria?

1. Expand access to early diagnosis and treatment:
   1. Ensure universal access to diagnosis for suspected cases using rapid diagnostic tests (RDTs) or microscopy
   1. Provide timely, barrier-free diagnosis and treatment in all endemic-area health services 
   1. Engage communities in testing with RDTs for early diagnosis and treatment
   1. Adopt strategies to improve radical cure efficacy or effectiveness for Plasmodium vivax uncomplicated cases
2. Prevent transmission:
   1. Distribute long-lasting insecticidal nets free of charge in endemic areas
3. Consolidate malaria-free micro-territories:
   1. Use microplanning to expand access to services and consolidate malaria-free areas
   1. Innovate in supervision and logistics using information and communication technologies 
   1. Accelerate elimination at the subnational level and pursue subnational verification of elimination
4. Strengthen surveillance to eliminate and prevent re-establishment:
   1. Maintain strong surveillance systems to detect and treat imported cases in all malaria-free countries
   1. Use data and information to guide local-level decision making and action

 The second MalariaWorld article is a blog post by Duma Gideon Boko, President of Botswana and Chair of the African Leaders Malaria Alliance (ALMA), titled ‘Why ending malaria depends on bold financing and global leadership’ in Health Policy Watch. The core principle of the article is that more international funding is needed to pay for mosquito nets, treatments and diagnostic tests. Somehow economists calculate that each dollar ‘invested’ in malaria yields four in economic activity.

Africa will solve malaria the same way the rest of the world did, by lifting everyone out of poverty. Malaria disappears when nutrition, water and sanitation improve. However, this is unlikely to happen as long as African leaders such as Boko continue to emphasise appeals for money from the former colonial powers to pay for nets, drugs and tests. As for African leaders, for every Traore there are at least 10 Bokos.

The lead article in MalariaWorld this week begins “An act of health justice”: Guinea’s children receive the malaria vaccine”. The article links to a posting by the Bill and Melinda Gates vaccine promoter GAVI that describes the national launch of Guinea’s malaria vaccination programme with Prime Minister Amadou Oury Bah and National Transition Council president Dansa Kourouma and Minister for the Promotion of Women, Children and Vulnerable People Charlotte Daffé. To warm applause, the Prime Minister and Kourouma each administer one of the very first doses (see picture).

The article contains the usual discussion items about the scourge of malaria – “In 2023 alone, Guinea recorded nearly 4.43 million cases of malaria, according to WHO’s 2024 World Malaria Report”. It describes the roll-out and promotion but contains no information about the safety or efficacy of the vaccines. Indeed, the article does not even say which vaccine is being administered in Guinea.

I found this information in an August 2025 posting on the GAVI website “Guinea introduces malaria vaccine into routine immunization”. This article has more details about the program. The RTS, S malaria vaccine is being administered. The recommended vaccination schedule in Guinea is 1st dose from 5 months; 2nd dose at 6 months (or a minimum of 4 weeks after the first dose); 3rd dose at 7 months (or a minimum of 4 weeks after the second dose); 4th dose at least 6 months after the third dose for children who come late.

RTS,S/AS01 (Mosquirix by GlaxoSmithKline) was first introduced in 2019 in Ghana, Kenya, and Malawi. In common with the more recently introduced R21/Matrix-M (developed by Oxford University and the Serum Institute of India) it is being rolled out by GAVI in different African nations. Neither were tested against a true placebo. Both were tested for safety and efficacy against a rabies vaccine (Rabipur manufactured by GSK, Marburg, Germany and owned by Bavarian Nordic, Hellerup, Denmark was used in RTS,S study). Nonetheless, these dubious medications are being rolled out in many African nations by GAVI with the support and even participation of the governments of these countries.

Clearly, GAVI have no interest in testing vaccines against true placebos, as is now required for vaccines by US Health Secretary, Robert F Kennedy Jr. I wonder why? And to describe the roll-out as ‘justice’ is at least a little disingenuous.

What type of illness is malaria? What are the symptoms? We hear catastrophic tales about this illness and usually about the worst, possibly fatal, examples.

However, soon after arriving in Kenya I encountered a real life example and wrote about it in February. This week another case in the same family reinforced my idea that malaria in countries where it is considered endemic is very similar to COVID19 in much of the world 2020-2022. A label for generic illness if there is a positive result in a potentially dubious test.

In western countries during COVID ‘pandemic’ if anyone had illness symptoms, cough, fever, stomach upset etc., they were encouraged to get tested either with PCR (polymerase chain reaction) or a Lateral Flow Test. If the test were positive they were considered a case and were usually required to quarantine to prevent spread. If symptoms were more serious they might be treated with an anti-viral drug such as remdesivir or a generic medication sold for another condition. Now most people no longer believe and recognise the pointlessness of all that.

In the recent ‘malaria’ case a young girl had a fever and upset stomach the day after her birthday party in which she ate much children’s party food. I was travelling on business in the far east so was not there. But I did suggest that she be given fluids and monitored at home while her body purged the junk she had eaten.

However, her mother first gave her paracetamol (acetaminophen. So toxic sale is often restricted to make suicide more difficult) to treat the fever and her condition worsened. She was worried and brought her to the same private hospital featured in my February tale. I expect the girl was tested with the same sensitive RDT (rapid diagnostic test) for malaria plasmodia and tested positive. Then she was given the first of three 12-hourly artesunate injections as well as dispersible Artefan tablets (Artemether-Lumefantrine). She went home but her condition worsened and she ended up back in hospital for two nights.

I suspect that she was mildly poisoned by the many artificial ingredients of the party food. Fever is one of the body’s means of purging. But then she was given more mild poisons, paracetamol, and then artesunate and artemether-lumefantrine which lengthened her period of illness.

But it will be recorded as another case of malaria. The test and drug treatment would not occur in a country in which malaria is not present. But if the same circumstances had occurred in 2020 and COVID test were positive, it would have been a COVID case. The belief in malaria is strong in endemic countries as was the belief in COVID worldwide in 2020. Cases will continue as long as people believe and the hospitals continue to make money providing treatments such as this.

This week MalariaWorld features a podcast on Spotify called ‘The tyranny of Defeat, Distraction and Dependency’ by Silas Majambere from his series ‘Malaria Poverty and Politics’. Majambere is described as a Public Health Entomologist who spent 20 years of his career studying and fighting mosquitos that transmit malaria. He discusses the 3Ds of the podcast title.

Defeat – Majambere describes a meeting with a well-dressed young woman in small town in Gambia while he was examining mosquito larvae in a pothole. He asked her what she was doing about the problem of mosquito larvae in potholes that would grow up to be malaria vectors. She said it was the responsibility of others, the authorities, but admitted they were doing little about it. She was accepting defeat to do anything about the problem.

But perhaps a better D is Disbelief. If deep down people really believed that malaria is spread by mosquitos, they would do more about it? I previously highlighted research that found than 53.23% of Chinese expatriate workers in South Sudan believed that attention to food and drinking water hygiene could prevent malaria. Those who have lived with the disease their whole life would have an even better impression of what can help.

In the first podcast in the series, Majambere talks about how shocked his Global North donors are when they see mosquito nets they paid for used as fencing of chicken farms or for fishing. The recipients clearly believe that these are better uses for the nets than the purpose for which they were provided.

Distraction – Majambere discussed all the meetings and plans of malaria researchers. I don’t disagree with him about distractions but I might have a different idea of what the distractions are preventing proper elimination of the causes of malaria. That great distraction of Burkina Faso’s termination of Target Malaria’s gene drive mosquitos continues this week in MalariaWorld with an article in the other great organ of the Scientific Establishment, Nature magazine. Other distractions are perhaps vaccines, IPT programmes, fish that eat larvae, etc.

Dependency – Majambere is spot on with this and he himself is no better example. I am sure his education at Liverpool School of Tropical Medicine and 20-year career as a bug hunter was dependent on money from Global North philanthropists. And also dependent on his belief that malaria is a parasitic illness transmitted by bites from female Anopheles mosquitos. Burkina Faso has shown that African nations do not need to be dependent on Global North financial schemes.

Majembere recognises the importance of poverty on occurrence of malaria. But as a bug-hunter links it to inadequacy of housing and sanitation that increases mosquitos rather than to inadequate nutrition or poor-quality water.

I have a 6-Sigma black belt. I am well trained at systematically identifying the causes of problems before implementing solutions. When applied to malaria the evidence that it is a parasitic illness spread by mosquitos is far from convincing.

The shutdown of the Bill Gates funded Target Malaria’s genetically modified mosquito experiments in Burkina Faso on 18 August continues to cause a major buzz in the malaria business. But the language used by a ‘Science’ article highlighted in MalariaWorld this week seems to take the angst of the neo-colonial promoters of  harmful experimental technologies in Africa to a new level (I previously discussed this topic on 16 August and 29 August.)

The article by Kai Kupperschmidt of 03 September that also appeared in the print edition of Science (Vol 389, Issue 6764) is entitled ‘After ‘humiliating’ raid, Burkina Faso halts ‘gene drive’ project to fight malaria’ with sub-heading ‘Disinformation campaign may have triggered “brutal” shutdown of mosquito lab’. In a week in which Charlie Kirk was brutally murdered in Utah and Israel carried out a brutal attack on negotiators in Qatar, this use of the word brutal to describe these events seems somewhat excessive.

According to the article Target Malaria’s partner scientists were “treated like criminals, with their offices and laboratories sealed and marked as crime scenes.” “Everyone was searched, including their vehicles, on the grounds that researchers might be carrying mosquitos in their pockets.” Four days later, the government suspended all of Target Malaria’s activities in Burkina Faso indefinitely. The scientists killed the mosquitos still living in their insectary, and the government sent a team to spray insecticides in Souroukoudingan to kill the mosquitos released there.

Unpleasant, no doubt, but hardly brutal.

And last week MalariaWorld featured a blog article by Mark Benedict entitled ‘Burkina Faso’s Government Smashes its Trustworthiness Over Transgenic Mosquitoes’. According to Benedict ‘Is it a big loss for Burkina Faso? The largest. The reversal sends a signal to donors and collaborators that government assurances and approvals cannot be relied on to permit projects to reach completion.’ The entire tone of the article is that it is Burkina Faso’s loss that the neo-colonial promoters of harmful experimental technologies in Africa will not be plying their trade there.

Unfortunately for now, many other African countries are led by leaders with less integrity than Ibrahim Traore who will happily take a few dollars to allow their countries to be used for such experiments no matter what the potential effect on their people or environment. For instance, an article in MalariaWorld describes Target Malaria’s meeting in Uganda.

Malaria can be solved in Africa as it was in Europe, North America and most of Asia with improvements to nutrition and sanitation. This can be achieved by improving the overall economies of the nations. But instead, westerners provide harmful experiments and chemical treatments of people and the environment based on the dubious, if widely believed, hypothesis that malaria is a parasitic illness spread by mosquitos.

Every year Improbable Research presents the Ig Nobel awards for bizarre research topics and this week a paper in MalariaWorld is a contender. ‘Do monetary incentives encourage local communities to collect and upload mosquito sound data using smartphones? A case study in the Democratic Republic of the Congo’ by Storer et al of University of Oxford is follow up on earlier research in Tanzania. All 14 authors are funded by the usual suspect for experimental technologies imposed on Africa from abroad, The Bill and Melinda Gates Foundation.

The research is based on a smartphone app called MozzWear used with the HumBug tool in a bed net that records mosquito flight tone data overnight and provides a secure connection to a server at the University of Oxford where the data are uploaded via the mobile or Wi-Fi data network. The data then run through an algorithm pipeline that first detects the mosquito flight tone from background noise and then identifies the mosquito species using their acoustic signature. The previous research in Tanzania did not find that SMS reminders or financial incentives improved compliance.

This study took place in Kinshasa and Bandundu in DRC with control and incentive groups. Control group participants were provided with the HumBug tool (a smartphone running the MozzWear app and the HumBug bed net), and one dollar to pay for an internet connection. The incentive group was provided with the HumBug tool and one dollar for an internet connection, and an additional ten dollars each month paid via airtime to their mobile phones. Participants were instructed to place the smartphone with the MozzWear app in the HumBug net and start the record function at 18:00 hrs and turn it off at 06:00 hrs on their allocated weekly recording day during the trial period (16 weeks total). Once participants were taught how to use the Humbug tool there was no contact between the research team and the participants.

The study found that participation dropped off in both Kinshasa groups and in the incentivised Bandundu group over the 16 weeks. Interestingly, the control Bandundu group continued participating at about 80%. One Kinshasa control group member summed up the reason to participate, “I want to be left with the phones because we will be laughed at (…) if you take them away from us, they will say that we participated in vain.”

I have no idea how effective HumBug with Mozzware is at identifying mosquitos. I wonder how recording mosquitos in this way can possibly help the people (other than those given a free phone). It seems to be just another exploitative example of Bill Gates funding experimental technology in Africa.

This plan that I discussed two weeks ago has remained in the news and this week MalariaWorld reports that Burkina Faso says no to Bill Gates’ plan of creating modified species of mosquitos. The linked article by Chinedu Okafor in Business Insider Africa has some interesting insights. The Ibrahim Traore led government has ordered the suspension of the Target Malaria program led by Bill Gates that aimed to mitigate malaria spread through the release of genetically engineered mosquitos. The government announced the destruction of all related samples in the country in accordance with a strict protocol. Criticism of the initiative includes ethical concerns about environmental and ecological implications.

The research began in Burkina Faso in 2019 with the release of a swarm of genetically modified male mosquitos in the hamlet of Bana, a tiny settlement of around 1,000 people in the country’s west. The program was since spread to other locations. Many accuse Target Malaria of worsening the spread of malaria. I expressed my scepticism that the program could have any effect, positive or negative, based on basic evolutionary principles in my earlier column.

What is most encouraging is that the main reason for its cancellation is the scepticism of Burkina Faso’s government for the scientific neo-colonial schemes of Western-backed NGOs. Since coming to power in 2022, Captain Ibrahim Traoré’s administration has increasingly sought to limit foreign involvement in domestic policy, particularly projects tied to high-profile Western philanthropists such as Bill Gates. Bill Gates promotes himself as an expert on malaria in a column highlighted in MalariaWorld this week that heavily promotes CDC and the mosquito malaria transmission hypothesis.

Officials in Burkina Faso state that they need “locally developed, safer alternatives” rather than experimental technologies imposed from abroad. The suspension also aligns with the military government’s populist agenda, which often portrays Western-funded initiatives as undermining sovereignty.

Let us hope that this attitude to seek locally developed safer alternatives spreads throughout Africa and to other, more harmful experimental technologies imposed from abroad. I have frequently highlighted (and here, here, here, here and here) that many African countries are introducing the experimental malaria vaccines R21/Matrix-M and RTS, S/AS01 and injecting their babies with them. These vaccines were never tested for safety and efficacy against a true placebo. All we know is that they are no more toxic than Rabies vaccines. In normal practice Rabies vaccines are not given to anyone unless they have been bitten by a rabid dog (I will leave the discussion of how real rabies is for others to address). Sadly, many African governments allow their infants to be dosed with these poorly tested potions four times at 6, 7, 8, and 18 months.

There is a very interesting study in MalariaWorld this week examining the link between malaria and malnutrition. ‘Malaria-malnutrition interaction: prevalence, risk factors, and­ the ­impact of intermittent preventive therapy for ­malaria on­ nutritional status of­ school-age children in Muheza, Tanga, Tanzania — A ­cross-sectional survey and ­a­ randomized controlled open-label trial’ by Hhera et al compared three groups of children over eight months.

Two groups of school age children were treated periodically (so-called intermittent preventative treatment, IPT) with ACT drugs (arteminin-based combination therapy), either dihydroartemisinin-piperaquine (DP) or Artesunate amodiaquine (ASAQ). The third group was a control group who only received so-called standard care drug (Artemether Lumefantrine) if they tested positive for malaria plasmodia.

The main outcome of the study was that during the intervention, change in mean weight, height, and BMI over time as estimated from age-treatment interaction was not significantly different in the DP and ASAQ treatment groups compared with the control group.

Malaria, malnutrition and poverty are connected. At baseline, the prevalence of malaria was 27%, 23% of children were underweight, 21% were stunted and 28% were either thin or severely thin. The odds of stunting were 78% higher among children who had malaria compared with those who did not have malaria. Children from low socioeconomic status (SES) had higher odds of being underweight compared with their high SES counterparts.

Digging deeper into the study found interesting nuggets of information. During trial, the average weight gains for the DP, ASAQ, and Standard Care treatment groups were 5.0 kg, 5.1 kg, and 5.2 kg, respectively. For the children’s height, the net gains were 6.0 cm, 6.1 cm, and 6.5 cm in the DP, ASAQ, and Standard Care treatment groups, respectively. It would seem that children who were not dosed with the IPT drugs grew more than those who were, even if not statistically significant. At visit 4 13.2% were stunted compared to 24.8% for DP group and 21.8% for ASAQ group. Control children were also less likely to be underweight or thin. They were more likely to test positive for malaria plasmodia. It makes one wonder how important this fact is.

The authors conclude that public health efforts should combine malaria control with nutrition programs, including community driven strategies to enhance sustainable nutrition education and access to adequate food at home and school. It is great to see some malaria researchers becoming aware of the importance of nutrition.

One of the most bizarre proposals for solving the problem of the malaria is the release of genetically modified mosquitos. This method was questioned in the lead article in MalariaWorld last week ‘Releasing Genetically Modified Mosquitoes in Burkina Faso is Dangerous’ that links to a discussion by a French journal of a publication by Ms. Irina Vekcha, Professor of Genetics at ENSA (University of Agriculture of Senegal), which highlights the dangers of gene drive experimentation, which is currently at the end of its second phase in Burkina Faso, before moving on to the third phase that involves the use of gene drive technology.

And this week an article in Azo Life Sciences, ‘Gene-Edited Mosquitoes Block Malaria Transmission’  discusses a paper in Nature, ‘Driving a protective allele of the mosquito FREP1 gene to combat malaria’ by Li et al.

I am sceptical. The plan reads like one hatched up by a megalomaniacal ‘Bond Villain’. And the funding by many people’s real-life personification of such a character, Bill Gates, in the Burkina Faso release fuels this notion.

However, even if malaria were transmitted by mosquitos, it is difficult to understand how the genetic modifications of mosquitos would be evolutionarily stable to be effective or even dangerous as Ms Vekcha fears. Mosquitos have evolved over hundreds of millions of years and the human addition of a chunk of genetic material to its DNA is not likely to result in a creature as evolved and suited to its environment as those in the wild. While Li et al’s idea of creating Anopheles stephensi that is genetically less likely to be infected with Plasmodium falciparum, is not as ridiculous as the older idea of releasing sterile male mosquitos, the progeny of such creatures will not survive as well as those evolved by old fashioned Darwinism.

It is an effective method for genetic engineering researchers like Li to receive funding from people with more money than sense. But is it dangerous as Vekcha fears? There is much discussion in the article of how unsuccessful trials have been. Previous experiments with GM in Burkina Faso, such as Bt cotton, ended in failure.

The major fear highlighted about the introduction of modified Anopheles gambiae by a team from Imperial College London, led by Andrea Crisanti, is that the only male offspring will lead to the elimination of the species. However, reading a discussion of the natural balance of numbers of males and females in any good book about evolution such as ‘The Selfish Gene’ by Richard Dawkins will soon remove that fear.

My most profound enlightenment during COVID came from reading the book Virus Mania by Englebrecht et al. It drew my attention to the work of Drs Sam and Mark Bailey, Mike Stone, Stefan Lanka and others. This broad topic is well covered by others more expert than me and outside the scope of my column.

But in common with malaria, some viral illnesses are associated with mosquitos and other biting insects. Dengue, Zika and West Nile virus are probably best known. Disease transmission by mosquito is questionable for two reasons – the small aliquot of infected material that could be spread by mosquito bites and the questionable infective nature of viruses themselves.

Two other diseases have been in the news over the last two weeks. Last week News-medical dot net published an ebook on infectious diseases that included an article on Oropouche virus, that is supposedly transmitted through bites from infected Culicoides paraensis biting midges and Culex quinquefasciatus mosquitos. Some of the common symptoms include fever, chills, headache, and myalgia that persist for two to seven days.

And this week BBC reported 7,000 cases of chikungunya virus in China. I previously described chikungunya, whose symptoms are fever and joint pain. This outbreak is being tackled by the Chinese authorities with similar enthusiasm they showed for the three years they tackled COVID. During COVID China implemented severe restrictions, including forcing people into quarantine camps and sealing residential buildings and whole neighbourhoods on short notice for days or even weeks.

In Foshan city, which has been hit the hardest, chikungunya patients must stay in hospital, in beds protected with mosquito nets. They can only be discharged after they test negative or at the end of a week-long stay.

12 other cities in the southern Guangdong province have reported infections. Nearly 3,000 cases were reported in the last week alone. Authorities have instructed residents to remove stagnant water in their homes, such as in flowerpots (see picture), coffee machines or spare bottles – and warned of fines up to 10,000 yuan ($1,400) if they don’t do this. They are also releasing giant “elephant mosquitos” that can devour smaller, chikungunya-spreading bugs; and an army of mosquito-eating fish. Last week, officials in Foshan released 5,000 of these larvae-eating fish into the city’s lakes. In parts of the city, they are even flying drones to detect sources of stagnant water.

Some people have compared these measures to those imposed during the pandemic, and questioned their necessity. This is especially so considering how dubious the link of chikungunya to mosquitos is.