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.

Just two weeks after reporting that Ivermectin was not effective at preventing malaria, I am surprised to see the lead story in MalariaWorld this week is ‘New research supports ivermectin as an effective strategy to control malaria transmission’.

Ivermectin to Control Malaria —  A Cluster-Randomized Trial by Chaccour et al reports from a study in Kwale, Kenya that children 5 to 15 years of age living in an area with high coverage and use of bed nets, ivermectin, administered once a month for three consecutive months, resulted in a 26% lower incidence of malaria infection than albendazole.

So what is the major difference between the two studies, one of children up to 10 years in Burkina Faso and the other of children 5-15 in Kenya? … The control.

The study in Burkina Faso that did not show a significant effect used a placebo control (no effect) while this study carried out by ISGlobal of Barcelona used an ‘active’ control, another anti-parasitic drug called albendazole, which has side-effects. To quote the study ‘Albendazole, which does not have mosquitocidal properties, was used as an active control to provide these participants with the deworming benefit of ivermectin and to facilitate comparability.’

Dewormers are toxic drugs that poison parasites more that the host. They should not be taken unless one needs to. It continues to surprise me that ‘ethics committees’ approve studies without true placebo controls.

This study was approved by the Scientific and Ethics Review Unit of the Kenya Medical Research Institute, the Oxford Tropical Research Ethics Committee, the institutional review board of the Hospital Clinic of Barcelona, and the Research Ethics Review Committee of the World Health Organization.

And while the study noted that the cumulative rate of malaria infection measured using rapid diagnostic tests was 26% lower with ivermectin than albendazole, there were 65% more adverse events (6.19 vs 3.75 per 100). The authors state that there were no serious adverse effects from 56,000 treatments to justify a recommendation of mass treatment. If tested against a true placebo, would they have found a benefit?

Malaria is much less of an issue in Southern Africa than in my current abode in East Africa. But it was a trip to Botswana a few years ago that first drew my attention to this tropical malady. While my destination near Gaborone in the south was not on the malaria map, Kasane in the north and Zimbabwe, to which I intended to travel were. So my travel companion tasked me with getting malaria prophylactics.

My investigation raised my doubts about malaria transmission story and effectiveness of treatments, so I did not get anything. And we did not contract malaria! The East – South difference in the perception of malaria was confirmed after returning to Ireland when the blood transfusion service declined my donation for 12 months because I changed planes at Addis Ababa in Ethiopia!

But a news story in MalariaWorld this week reports increased malaria in Southern Africa. Africa CDC (Centres for disease control) reports that up to week 23, of 2025, Zimbabwe has reported 111,998 cases and 310 deaths (case fatality rate [CFR]: 0.27%) as compared to 29,031 cases with 49 deaths (CFR: 0.17%) in the same period in 2024. Botswana in same period has recorded 2,223 cases and 11 deaths, compared to 218 cases and no deaths in same period in 2024. Namibia also had a significant rise in malaria cases, with over 89,959 cases and 146 deaths reported since November 2024.

So why the increase which is a reverse of recent trends? Dr Memory Mapfumo, an epidemiologist at the Africa CDC blamed prolonged rains that fuelled mosquito breeding, and activities like gold panning, fishing and artisanal mining are exposing more individuals to risk, especially during peak mosquito activity hours. The belief in infectious disease including mosquito transmission of malaria is core belief of Africa CDC, like its well-known US namesake.

But what if malaria is caused by toxins? I wrote about connection to mining before, and last week visited an artisanal goldmine in Kenya that clearly exposes workers to additional health risks such as finely ground mineral material and various toxic chemicals.

Africa CDC reports low usage of mosquito nets, but this does not explain an increase in cases. Movement of people is also used as an explanation of increase, but it is not clear how. Flooding in Okavango (picture from my visit) increasing mosquito habitat was blamed for increase in Botswana. The possible effect of flooding on drinking water quality was not considered.

In Eswatini 20% of cases were among farmers, many involved in illegal farming activities. These farmers often work at night leaving them exposed to mosquito bites. Or is increase in illness influenced by the effects on health of a disrupted body clock?

It is important to be concerned about the increase of cases of malaria in Southern Africa. However, much as Africa CDC tries, it is difficult to explain the increase in case number by concentrating on the supposed link to mosquitos and ignoring other factors that affect health.

Ivermectin is an anti-parasite medication used to treat parasitic diseases, including parasitic worms, hookworm, whipworm, and external parasites and many others off label. Ivermectin works by paralyzing muscles in parasites, causing them to die. Since malaria is supposedly caused by a plasmodium parasite transmitted by mosquito bites, one might expect this powerful anti-parasitic medication to prevent malaria.

And indeed an article in this week’s MalariaWorld tests this hypothesis. ‘Safety and efficacy of repeat ivermectin mass drug administrations for malaria control (RIMDAMAL II): a phase 3, double-blind, placebo-controlled, cluster-randomised, parallel-group trial’ by Somé et al was published by The Lancet Infectious Diseases. Unfortunately, the full article is behind a paywall, but the summary does provide sufficient information for a preliminary examination and study details are available on clinicaltrials.

The study aimed to test the safety of repeated, high-dose ivermectin mass drug administration (MDA) and its efficacy for reducing malaria incidence among children when integrated with seasonal malaria chemoprevention (SMC) delivery. They provided background that previous studies had shown that ivermectin in the blood could kill mosquitos that fed on it.

They conducted a double-blind, placebo-controlled, trial in southwest Burkina Faso over two consecutive rainy seasons (2019–20). 14 villages were randomly assigned (1:1) to ivermectin or placebo MDA by random draw. Each rainy season, eligible participants from the intervention group clusters received monthly high-dose oral ivermectin MDA (three daily doses, approximately 300 μg/kg dosed by height bands) and those from the control group received monthly oral placebo MDA for up to eight treatment rounds. All participants and study personnel, apart from the pharmacist, were masked to group assignment. The primary outcome was weekly malaria incidence in children aged 10 years and younger, as assessed by weekly active case detection until week 16 of year 2, by intention to treat. Adverse events were monitored in all MDA participants through active and passive surveillance. Blood was sampled for secondary parasitological outcomes, including analysis of parasite species distribution among malaria cases. Mosquitos were sampled from pre-selected households in three clusters per group for secondary entomological outcomes, including analysis of blood-fed mosquito survivorship, mosquito biting rates, and entomological inoculation rates.

The average estimated weekly malaria incidence rate per 100 person-weeks among children in the test group was 1·78 (95% CI 1·24–2·53) and 1·84 (1·29–2·64) in the control group (statistically indistinguishable). The risk of adverse events was lower in test group (arthralgia and skin conditions higher in control group), but risk of death (0.27% vs 0.16%) and serious adverse events greater in test group (0.36% vs 0.31%). There was evidence of mosquito deaths in test group week after test but not three weeks later.

Repeated high-dose ivermectin MDA integrated with SMC distributions at the study site did not reduce malaria incidence among children relative to placebo.