Genetically engineered mosquitoes, Zika and other arboviruses, community engagement, costs, and patents: Ethical issues.

Abstract

Genetically engineered (GE) insects, such as the GE OX513A Aedes aegypti mosquitoes, have been designed to suppress their wild-type populations so as to reduce the transmission of vector-borne diseases in humans. Apart from the ecological and epidemiological uncertainties associated with this approach, such biotechnological approaches may be used by individual governments or the global community of nations to avoid addressing the underlying structural, systemic causes of those infections [1]. For instance, the rise in the number of Zika infections in northeastern Brazil is the product of the interaction of multiple factors. A key element is the 2015 El Nino climate phenomenon (in the context of global warming). A recent Human Rights Watch Report identified other factors responsible for the spread of the infection as the failure of the state to make adequate investment in piped water and waste services for the indigent segments of its population and to address racism and socioeconomic health disparities [1]. The report also criticized the violation of sexual and reproductive rights in Brazil. However, a detailed discussion of these structural, systemic factors lies beyond the scope of this Policy Platform, which is based on our expertise in healthcare ethics, political philosophy, feminist philosophy, medical entomology, insect–pathogen interactions, innovations in the control of vector-borne diseases, risk assessment, and environmental ethics. We discuss here key ethical questions raised by the use of GE insects, with the aim of fostering discussion between the public, researchers, policy makers, healthcare organizations, and regulatory agencies at the local, national, and international levels. We affect that goal by outlining a procedural approach to decision-making about the use of the “biotechnology” that goes beyond “community engagement.” The protocol we advocate for entails informed deliberations and decision-making at the community level. It is designed to ensure that the voices of the marginalized and vulnerable groups that would be disproportionately affected by the decision are heard during the community-wide discussions. Moreover, we make the case that the values embedded in the risk assessment should be identified so that the community can make an informed decision about the use of GE insects. In addition, we advocate for the involvement of a variety of actors whose responsibility would be to ensure that the community has the opportunity to make an informed decision based on deliberations about the use of the “biotechnology.”