Population replacement gene drive characteristics for malaria elimination in a range of seasonal transmission settings: a modeling study

Genetically engineering mosquitoes is a promising new vector control strategy to reinvigorate the fight against malaria in Sub-Saharan Africa. Using an agent-based model of malaria transmission with vector genetics, we examine the impacts of releasing population-replacement gene drive mosquitoes on malaria transmission and quantify the gene drive system parameters required to achieve local elimination within a spatially-resolved, seasonal Sahelian setting. We evaluate the performance of two different gene drive systems: "classic" and "integral." Various transmission regimes (low, moderate, and high - corresponding to annual entomological inoculation rates of 10, 30, and 80 infectious bites per person) and other simultaneous interventions, including deployment of insecticide-treated nets (ITNs) and passive healthcare seeking, are also simulated. Local elimination probabilities decreased with pre-existing population target site resistance frequency, increased with transmission-blocking effectiveness of the introduced antiparasitic gene and drive efficiency, and were context dependent with respect to fitness costs associated with the introduced gene. Of the four parameters, transmission-blocking effectiveness may be the most important to focus on for improvements to future gene drive strains because a single release of classic gene drive mosquitoes is likely to locally eliminate malaria in low to moderate transmission settings only when transmission-blocking effectiveness is very high (above ~80-90%). However, simultaneously deploying ITNs and releasing integral rather than classic gene drive mosquitoes significantly boosts elimination probabilities, such that elimination remains highly likely in low to moderate transmission regimes down to transmission-blocking effectiveness values as low as ~50% and in high transmission regimes with transmission-blocking effectiveness values above ~80-90%. Thus, a single release of currently achievable population replacement gene drive mosquitoes, in combination with traditional forms of vector control, can likely locally eliminate malaria in low to moderate transmission regimes within the Sahel. In a high transmission regime, higher levels of transmission-blocking effectiveness than are currently available may be required. Author summaryMalaria remains a significant health burden in Sub-Saharan Africa. The mass deployment of insecticide-treated nets and antimalarial drugs have drastically reduced malaria incidence, but insecticide and drug resistance threaten to stall these efforts. The genetic engineering of mosquito populations is a promising new vector control strategy to reinvigorate the fight against malaria. Releases of engineered gene drive mosquitoes that can spread introduced antimalarial genes quickly throughout the mosquito population may be a particularly effective new method for reducing malaria transmission. Important questions arise, however, about how well these gene drive systems must work in order to deliver substantial reductions in transmission. Here we use a spatial model of individual humans and vectors to simulate the effects of releasing gene drive mosquitoes with antimalarial properties on malaria transmission in a Sahelian setting. We quantify the gene drive system parameters required to achieve local elimination and find that when deployed in combination with traditional forms of vector control, a single release of gene drive mosquitoes with realistically achievable characteristics is highly likely to locally eliminate malaria in low to moderate transmission regimes. In a high transmission regime, improved strains of gene drive mosquitoes may be required. In all settings, releasing gene drive mosquitoes with antimalarial properties helps create a window of opportunity during which malaria prevalence is suppressed and other interventions can be ramped up to achieve elimination, even when a single gene drive mosquito release by itself cannot.