Genetic Research will save Uganda from the communicable disease burden

By: Busiku Esther Sharon

Uganda’s Health Sector strives to achieve and maintain a good health system for Ugandans by trying to handle any emerging health challenges in the country.

The system though is still in an appalling state and according to the World Health Organization, the health status of Ugandans is still poor mainly due to infectious and parasitic diseases which are still a burden to Uganda and yet most of them are preventable and treatable.

The country’s health burden is dominated by communicable diseases which account for over 50% of mortality. Malaria, HIV/AIDS, TB, and respiratory, epidemic-prone and vaccine-preventable diseases are the main causes of morbidity.

Malaria remains the leading cause of death accounting for over 27% of lives lost annually in Uganda.
A 2020 WHO world malaria report states that in 2019 alone, the population presumed at risk was 44,269,584 while 16,243,323 were confirmed cases and 11,629,246 estimated cases.
The report said there were 11,629,246 reported deaths and an estimated 13,576 deaths all due to malaria-related complications.

These numbers are significant hence the need to assess lasting solutions to malaria eradication which explains why the Government even with other competing demands is working closely with its partners to financially invest in the control and management of Malaria in Uganda.

On October 6, 2021, WHO approved Mosquirix, the world’s first malaria vaccine produced by GlaxoSmithKline. The vaccine with a modest efficacy of 50%, once endorsed for investment by the Global Vaccine Alliance will be purchased for countries that request it.

The announcement sparked excitement across the African continent especially countries where malaria is still a health burden. The vaccine, which is a first-generation vaccine against any parasitic disease, could prevent about 5.4m cases of malaria and 23000 deaths in children below 5 years.

Currently, the measures against malaria include the use of insecticides against the mosquitoes, elimination of the breeding spots of mosquito larva, the main one being the mass distribution of mosquito nets across the country.

In February 2020, the Government launched the Long-Lasting Insecticide Mosquito Net (LLIN) Campaign intended to reduce the Malaria morbidity and mortality through achieving universal coverage with LLINs. The campaign aimed to ensure that 85% of targeted populations have access to a LLIN.

For a developing country like Uganda, the above measures may be our only options but there’s need to invest in new technologies especially since studies show that the current temporary measures are not very effective.

Behavioral patterns of these mosquitoes demonstrate that they are ever-evolving, adapting and developing resistance to the control measures. Back in the day spraying insects with insecticides killed them instantly, but now one will spend huge amounts of money on different insecticides and the mosquitoes won’t even flinch.

While we are excited and await Mosquirix, we need as a country to carry out more research and develop new management technologies if like other countries we want to move towards the “Zero Malaria” target or register an impressive progress towards malaria freedom.
Such technologies involve genetic research; non-gene drive, gene editing where the DNA of an organism is changed and gene drive where the frequency of a gene is increased or made more dominant so it can be more transmitted through reproduction.

To bolster genetic research efforts, Target Africa, a research consortium has embarked on a journey to reduce Africa’s malaria burden by developing innovative, cost-effective and sustainable genetic technologies to complement the existing ones.

The consortium has partnered with teams in Africa to explore the behavior of the malaria vector to try and identify the potential ecological consequences of reducing the number of mosquitoes that transmit the disease.

In Ghana for example, they have recently worked on a research project aimed at investigating the ecological implications of reducing Anopheles gambiae populations. They have been working on the creation of a DNA barcode library to catalogue all species that share habitats with Anopheles gambiae, in order to ensure that a reduction in this malaria vector’s population numbers would have no unacceptable consequences for neighboring plant and animal communities.

In Mali their work is focused on non-gene drive genetically modified sterile male mosquitoes – the initial stage of a stepwise approach to develop Target Malaria’s genetic technologies for vector control.

They have also partnered with the Uganda Virus Research Institute which is better placed to carry out their research mainly focused on entomological mosquito collections from islands within Lake Victoria and mainland field sites located in other districts.

While their work here is still in its early stages, there’s need for adequate funding and a collective engagement with all stakeholders in order to aid the fight against malaria.

There’s need for stronger collaboration with the Uganda National Health Research Organization (Uganda’s umbrella organization for health research coordination) to develop and harness these innovations and products to improve health care delivery especially parasitic diseases like malaria.

Uganda’s National Health Policy 2010, that’s guided by the National Development Plan and the 1995 Constitution states that the Government of Uganda has an obligation to provide medical services to its citizens and that Ugandans have a right to access health care services.

It realizes that without good health, individuals, families, communities and nations cannot hope to achieve their social and economic goals hence the need to reduce mortality and morbidity if Uganda is to develop.