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Should Genetically Engineered Mosquitoes be Released into the Environment to Fight Disease?

Mod 6 Discussion

In a post of 150 – 175 words, first, state your stand on this issue, and then convince your peers that your stand is the only rational side to take, and why. Consider the


for both sides,

not just the opposing views of others

– explain how one side is clearly the right option. Then tell us why it is critical that we side with you.

Be sure to support your arguments and take a stand – no sitting on the fence!

Required Reading

Textbook Chapter 11: Should Genetically Engineered Mosquitoes be Released into the Environment to Fight Disease? (Pages 133-148).

Received: 13 February 2017
Revised: 13 March 2017
Accepted: 14 March 2017
DOI: 10.1111/dewb.12147
Ethics of community engagement in field trials of genetically
modified mosquitoes
David B. Resnik
David B. Resnik, National Institute for
Environmental Health Sciences, National
Institutes of Health, Research Triangle Park,
Email: resnikd@niehs.nih.gov
Effective community engagement is an important legal, ethical, and practical prerequisite for conducting field trials of genetically modified mosquitoes, because these studies can substantially impact communities and it is usually not possible to obtain
informed consent from each community member. Researchers who are planning to
conduct field trials should develop a robust community engagement strategy that
meets widely recognized standards for seeking approval from the affected population,
such as timeliness, consent, information sharing, transparency, understanding, responsiveness, mutual understanding, inclusiveness, and respectfulness. Additional research
is needed on the effectiveness of different methods of engaging communities in field
trials of genetically modified mosquitoes and how to respond to public opposition to
genetically modified organisms. For research programs involving the genetic modification of disease vectors to move forward, they must have public acceptance and support, which cannot be achieved without effective community engagement.
Community engagement, Developing nations, Ethics, Genetic modification, Mosquitoes, Public
Between 50 and 100 million people contract dengue annually and
about 22,000 die from the hemorrhagic fever caused by the virus.
Vector-­borne illnesses account for 17% of all infectious diseases
Areas at the highest risk for dengue are developing nations in Africa,
worldwide and cause one million deaths each year, most of which
South and Central America, Southeast Asia, and the Pacific Islands.4 In
occur in developing nations. The most dangerous disease vectors by
2015, Zika reemerged as a serious public health threat. The disease
far are mosquitoes, which can carry malaria, dengue, Zika, yellow fever,
spread rapidly through countries in South and Central America and
West Nile virus, encephalitis, and chikungunya, depending on the spe-
infected millions of people. Adults who contract the virus may develop
cies.2 The most dangerous species, Aedes aegypti, can transmit dengue,
a fever, rash, headache, and other tolerable symptoms which usually
Zika, malaria, and chikungunya to humans. In 2015, malaria infected
resolve within 7-­10 days. However, the virus poses a serious risk to
214 million people and killed 438,000, mostly children living in Africa.3
fetuses. Infection with Zika during pregnancy is associated with an
increased risk of birth defects, including microcephaly, a condition in
which the infant’s head and brain are significantly smaller than
World Health Organization. 2016. Vector-­borne disease. Available at: http://www.who.int/
mediacentre/factsheets/fs387/en/ [Accessed 6 December 2016].
Centers for Disease Control and Prevention. 2016. Other mosquito-­borne diseases. Available
at: http://www.cdc.gov/niosh/topics/outdoor/mosquito-borne/other.html [Accessed 22
November 2016].
Centers for Disease Control and Prevention. 2016. Malaria. Available at: https://www.cdc.
gov/malaria/ [Accessed: 22 November 2016].
Developing World Bioeth. 2018;18:135–143.
Centers for Disease Control and Prevention. 2016. Dengue, epidemiology. Available at:
https://www.cdc.gov/dengue/epidemiology/index.html [Accessed 22 November 2016].
Johansson MA, Mier-­y-­Teran-­Romero L, Reefhuis J, Gilboa SM & Hills SL. Zika and the risk
of microcephaly. N Engl J Med. 2016;375(1):1-­4.
© 2017 John Wiley & Sons Ltd
In the last decade, scientists have been working on ways of using ge-
Each approach has benefits and risks.14 The benefit of the first ap-
netic engineering to prevent mosquito-­borne diseases.6 Two different
proach is that it can reduce populations of disease vectors, which can
strategies have received the most attention. The first involves introducing
decrease the likelihood that human beings will contract those diseases.15
mutations into male mosquitos which overproduce a protein that causes
For years, people have used pesticides to control mosquito populations,
toxicity and results in premature death of offspring, unless they are ex-
but mosquitoes have become resistant to many of the chemicals cur-
posed to the antibiotic tetracycline, which inactivates the mutations.
rently being used.16 Also, pesticides can have adverse effects on human
Genetically modified (GM) males are released into the wild, where they
health and non-­human species, such as birds, fish, aquatic animals, earth-
mate with females. Because the offspring die before they can reproduce,
worms, and bees.17 One of the risks of the first approach is that it could
the population decreases. The GM mosquito is not likely to become es-
significantly reduce populations of targeted mosquitoes, which could
tablished in the wild, due to its lethal mutation. GM males must be rein-
disrupt the food web,18 because mosquitoes, in their larval or adult
troduced periodically to keep the population in check. The biotechnology
forms, are a primary food source for various species of fish, aquatic in-
company Oxitec has tested this method on Aedes aegypti mosquitoes at
sects, flying insects, birds, amphibians, reptiles, and bats and they are also
several sites around the world, including the Cayman Islands, Panama,
pollinators.19 However, this point is contested and some ecologists argue
Malaysia, and Brazil.7 Field tests have produced an 80-­95% decline in
that the food web would eventually adjust to the eradication of a mos-
Aedes aegypti populations.8 According to Oxitec, the release of its GM
quito species.20
mosquitoes resulted in a 91% decline in dengue fever cases in Brazil’s
Eldorado district and a 52% reduction in the Piracicaba district.9
A benefit of the second approach is that it can increase disease-­
resistance among targeted mosquitoes, which can decrease the likeli-
The second strategy involves genetically modifying mosquitoes to
hood that humans will contract those diseases from mosquitoes.21 A
resist targeted diseases or render them incapable of transmitting those
risk of this approach is that the pathogen carried by the mosquitoes
diseases.10 To implement this strategy, researchers introduce disease-­
might evolve so that it can overcome the disease-­resistance genes.22
resistance genes into mosquitoes and release them into the wild. To
The evolved pathogen might be more difficult to control than the pre-
promote rapid proliferation of the mutation in the population, the
vious version.23 Another risk is that this approach might make tar-
disease-­resistance genes are attached to genes (known as gene drive
geted mosquitoes more susceptible to carrying other diseases that
systems) which distort Mendelian inheritance so that the mutations
can infect human beings.24 A third risk of this approach is that the
increase in the population irrespective of the effects of natural selec-
gene drive system might move from the targeted species and incor-
This second strategy, unlike the first,
porate into the genomes of other species via horizontal gene trans-
can lead to permanent genetic changes in the mosquito population.12
tion or random genetic drift.
fer,25 with unpredictable effects on the environment and public
So far, this strategy has only been tested in the laboratory.
Levy S. Mosquito modifications: new approaches to controlling malaria. BioScience.
2007;57(10):816-­821; Netburn D. Scientists aim to fight malaria with genetically engineered
mosquitoes. Los Angeles Times, 25 November 2015. Available at: http://www.latimes.com/science/sciencenow/la-sci-sn-genetically-engineered-mosquitoes-malaria-20151121-story.html
[Accessed 22 November 2016]; Servick K. Winged warriors. Science 2016;354(6309):164-­167;
LaFrance A. Genetically modified mosquitoes: what could possibly go wrong? The Atlantic
Monthly, April 26, 2016. Available at: http://www.theatlantic.com/technology/archive/2016/04/
genetically-modified-mosquitoes-zika/479793/ [Accessed 22 November 2016].
Servick 2016, op. cit., note 6; Gorman K, Young J, Pineda L, Márquez R, Sosa N, Bernal D,
Torres R, Soto Y, Lacroix R, Naish N, Kaiser P, Tepedino K, Philips G, Kosmann C & Cáceres L.
Short-­term suppression of Aedes aegypti using genetic control does not facilitate Aedes
albopictus. Pest Manag Sci. 2016;72(3):618-­628.
Harris AF, Nimmo D, McKemey AR, Kelly N, Scaife S, Donnelly CA, Beech C, Petrie WD, &
Alphey L. Field performance of engineered male mosquitoes. Nat Biotechnol.
2011;29(11):1034-­1037; Carvalho DO, McKemey AR, Garziera L, Lacroix R, Donnelly CA,
Alphey L, Malavasi A & Capurro ML. Suppression of a field population of Aedes aegypti in
Brazil by sustained release of transgenic male mosquitoes. PLoS Negl Trop Dis.
2015;9(7):e0003864; LaFrance, op. cit., note 6.
Oxitec. 2016a. Press release, 14 July 2016: Dengue fever cases drop 91% in neighbourhood
of Piracicaba, Brazil, where Oxitec’s Friendly™ Aedes were released. Available at: http://
www.oxitec.com/dengue-fever-cases-drop-91-percent-neighbourhood-piracicaba-brazil-oxitecs-friendly-aedes-released/ [Accessed: 28 November 2016].
World Health Organization. 2014. Guidance Framework for Testing of Genetically Modified Mos­
quitoes. Geneva, Switzerland: World Health Organization. Available at: http://www.who.int/tdr/
publications/year/2014/Guidance_framework_mosquitoes.pdf [Accessed 23 November 2016].
Sinkins SP & Gould F. Gene drive systems for insect disease vectors. Nat Rev Genet
National Academy of Sciences. 2016. Gene Drives on the Horizon: Advancing Science,
Navigating Uncertainty, and Aligning Research with Public Values. Washington, DC: National
Academies Press. Available at: https://www.nap.edu/catalog/23405/gene-drives-on-the-horizon-advancing-science-navigating-uncertainty-and [Accessed 17 December 17, 2016].
Main D. 2015. Researchers genetically modify mosquitoes to be malaria-­resistant. Newsweek,
28 November 2015. Available at: http://www.newsweek.com/2015/12/11/researchers-genetically-modify-mosquitoes-be-malaria-resistant-398998.html. [Accessed November 22, 2016].
For a comprehensive review of the benefits and risks of releasing GM mosquitoes in the
wild, World Health Organization 2014, op. cit., note 10; Boëte C, ed. 2006. Genetically
Modified Mosquitoes for Malaria Control. Austin, TX: Landes Bioscience.
Macer D 2003. Ethical, Legal, and Social Issues in Genetically Modified Disease Vectors. Geneva,
Switzerland: World Health Organization. Available at: http://www.who.int/tdr/publications/
documents/seb_topic1.pdf [Accessed 25 November 2016]; Macer D. Ethical, legal and social
issues of genetically modifying insect vectors for public health. Insect Biochem Mole Biol.
World Health Organization 2014, op. cit., note 10.
Fang J. 2010. Ecology: a world without mosquitoes, Nature. 2010;466(7305):432-­434.
World Health Organization 2014, op. cit., note 10.
Horizontal gene transfer is a natural process in which viruses or other pathogens transfer
genes between organisms. For example, a retrovirus that infects an organism could incorporate
some of the organism’s DNA into its genome and then transfer it to another organism that it
infects. Scientists estimate that 5-­8% of the human genome consists of DNA sequences
acquired from viruses. See Krishnapillai VJ. Horizontal gene transfer. J Genetics. 1996;75(2):219-­
232; Drake N. Our inner viruses: 40 million years in the making. National Geographic, 1 February
2015. Available at: http://phenomena.nationalgeographic.com/2015/02/01/our-inner-virusesforty-million-years-in-the-making/ [Accessed 25 November 2016].
World Health Organization 2014, op. cit., note 10; National Academy of Sciences 2016,
op. cit., note 12.
Obtaining the support of the local community is an essential legal,
While we sometimes refer to communities in in terms of their com-
ethical, and practical requirement for conducting GM mosquito field
mon cultural, ethnic, sexual, political, or religious characteristics, e.g.
trials.27 Researchers cannot legally conduct field trials in many coun-
the Lesbian, Gay, Bisexual, Transgender, Queer community or the
tries unless they first obtain approvals from national and local author-
African American community,33 when we are thinking about commu-
ities, such as environmental or public health agencies.
For example,
nity engagement in GM mosquito field trials, it is appropriate to focus
researchers for proposed field trials in Florida needed to obtain ap-
on geographic communities, since individuals living at or near a release
proval from the Food and Drug Administration and the Monroe County
site will face the direct risks related to the experiment and reap the
Mosquito Control District (see discussion of community engagement
potential benefits.34 However, it is still important to appreciate the
cases below). Since legal requirements tend to be procedural and for-
social, economic, ethnic, and cultural diversity among people living in
malistic, this paper will focus on ethical requirements. From an ethical
an area where mosquitoes may be released.35
perspective, the principles of autonomy and justice require that people
While individuals living outside of the site, such as environmental
who are likely to be impacted by a proposed public health research
activists, may have political interests which could be impacted by a
project or intervention should have meaningful input into decision-­
field trial, it is impractical to target these groups for community en-
It also makes little practical sense
gagement, because one would need to interact with an indeterminate
to conduct a GM mosquito field trial if it is likely to meet with stiff re-
number of people and canvass their views. Moreover, one might argue
making related to the intervention.
sistance from the local community.30
that it would be unfair to give outsiders substantial input into such
While there is widespread agreement concerning the importance
decisions, since their opinions might diverge from community’s. For
of community engagement in public health research, there is less
example, suppose that members of a local community favor a field trial
agreement about how to do this effectively, especially given public
to help prevent a mosquito-­borne disease that is causing them con-
opposition to genetically modified organisms (GMOs) in many coun-
siderable hardship. One might argue that it would be unfair to allow
tries.31 In this article, I will examine the ethical foundations of obtain-
outsiders (such as environmental interest groups) to prevent the trial
ing local support for field trials of GM mosquitoes, describe some
from occurring, since those in the local community will have the most
standards for effective community engagement, and draw some con-
direct stake in the field trial. Likewise, it would also be unfair to allow
clusions from actual cases involving community engagement.
outsiders to impose a field trial on a local community if most members
of that community oppose it.
However, even though outside activists should not be targeted for
community engagement, their views should still be considered and accounted for because members of the local community may be aware
of and sympathetic to their views. Also, as we shall see below, it is
Before exploring ethics of community engagement in field trials of GM
important to understand how outside interest groups may impact local
mosquitoes, it is important to indicate what I mean by “community
decision-­making, because these groups may try to influence local com-
engagement.” A “community” is commonly defined as “a social group
munities and public health officials.
of any size whose members reside in a specific locality, share govern-
To “engage” has many different common meanings, including “to
occupy the attention or efforts of…secure for aid, employment, use…
ment, and often have a common cultural and historical heritage.”
World Health Organization 2014, op. cit., note 10; Macer D. 2006. Ethics and community
engagement for GM insect vector release. In: Boëte C, ed., Genetically Modified Mosquitoes for
Malaria Control. Austin, TX: Landes Bioscience: 152-­165; Lavery JV, Harrington LC & Scott
TW. Ethical, social, and cultural considerations for site selection for research with genetically
modified mosquitoes. Am J Trop Med Hyg. 2008;79(3):312-­318; Lavery JV, Tinadana PO,
Scott TW, Harrington LC, Ramsey JM, Ytuarte-­Nuñez C & James AA. Towards a framework
for community engagement in global health research. Trends Parasitol. 2010;26(6):279-­283.
Macer 2005, op. cit., note 15; Ostera GR & Gostin LO. Biosafety concerns involving genetically modified mosquitoes to combat malaria and dengue in developing countries. JAMA.
Shrader-­Frechette KS. 2002. Environmental Justice: Creating Equity, Reclaiming Democracy.
New York: Oxford University Press; Resnik DB. 2012. Environmental Health Ethics. New York:
Cambridge University Press.
Lavery et al 2008, op. cit., note 29.
Lavery et al 2010, op. cit., note 29; Tindana PO, Singh JA, Tracy CS, Upshur RE, Daar AS,
Singer PA, Frohlich J & Lavery JV. Grand challenges in global health: community engagement
in research in developing countries. PLoS Med. 2007;4(9):e273; McNaughton D. The importance of long-­term social research in enabling participation and developing engagement strategies for new dengue control technologies. PLoS Negl Trop Dis. 2012;6(8):e1785; Kolopack
PA, Parsons JA & Lavery JV. What makes community engagement effective?: Lessons from
the Eliminate Dengue Program in Queensland Australia. PLoS Negl Trop Dis.
Dictionary.com. 2016. Community. Available at: http://www.dictionary.com/browse/community?s=t [Accessed: 30 November 2016].
attract…bind…enter into conflict with.”36 None of these capture what
scientists, scholars, government agencies, and policymakers typically
have in mind when they talk about engaging communities in public
health research. Community engagement is sometimes characterized
as “informing” or “consulting with” the community but community
members who are likely to be impacted by proposed public health
­research projects (or interventions) usually want to be more than just
passive receptors of information: they also want to be actively ­involved
in decision-­making concerning those projects.37 Thus, I will define
community engagement as a partnership between public health researchers (or officials) and community members that includes the
Ross LF, Loup A, Nelson RM, Botkin JR, Kost R, Smith GR Jr & Gehlert S. Human subjects
protections in community-­engaged research: a research ethics framework. J Empir Res Hum
Res Ethics. 2010;5(1):5-­17.
Weijer C & Emanuel EJ. Ethics. Protecting communities in biomedical research. Science.
Lavery et al 2010, op. cit., note 29.
Dictionary.com. 2016b. Engage. Available at: http://www.dictionary.com/browse/
engage?s=ts [Accessed 1 December 2016].
Lavery et al 2010, op. cit., note 29.
exchange of information, ideas, and opinions; mutual respect for values and interests; and shared decision-­making.
Someone might object that obtaining consent from the commu-
For a decision to be
nity rather than from each individual living in it violates the rights of
shared, both partners must agree to it. Thus, a proposed project or in-
those who do not agree with the proposed project or intervention. For
tervention that impacts that local community should not occur unless
example, suppose that a county agency is planning to build a public
the community agrees to it (see discussion of community consent
hospital to serve its population and that voters have approved a bond
measure to fund it. However, some people who are living near the pro-
Engaging the community concerning proposed public health re-
posed site oppose the plan because it will increase traffic, pollution,
search projects or interventions is important for respecting the auton-
and noise levels. Should these opponents of the hospital be allowed
omy of the people living within a targeted area.39 The right to make
to stand in the way of a project intended to improve the health of the
autonomous decisions relating to one’s health, well-­being, life plans,
community, which has been approved by the majority?
and conduct is a widely accepted principle in biomedical ethics, juris-
The issue of how to respect minority rights involves political and
prudence, and public policy.40 One way of respecting autonomy is to
moral questions which extend beyond the scope of the present inquiry.
allow people to decide whether they will be exposed to certain types
For the purposes of this paper, I will follow Gutmann and Thompson’s
Since field trials of GM mosquitoes pose risks to community
account of minority rights in democratic societies.45 According to
members, they should be able to decide whether the benefits of the
Gutmann and Thompson, majority rule is a legitimate method for mak-
of risks.
trials, such as prevention of mosquito-­borne illnesses, are worth the
ing public decisions in democratic societies because it treats all voting
risks. However, since it is often not possible to obtain consent from
members as having equal political standing. Since each citizen has one
each individual living in a highly populated area targeted for research
vote and all votes are equal, and the option with the most votes should
project or intervention, consent from the community often may need
win. However, there should be limits on majority rule to protect some
to suffice.42
basic rights and liberties possessed by all citizens, such as freedom of
What does it mean for a community to “consent” to a public health
expression, freedom of religion, legal due process, property rights, and
research project or intervention? This is a difficult question to answer,
so on. A law approved by the majority should not be able to strip people
because we usually think of consent as applying to individuals, not
of these basic rights and liberties.46 Also, democratic decision-­making
communities.43 Since consent is a form of decision-­making, commu-
should include strategies for reaching out to all citizens, especially racial
nity consent can be equated with the political process that a commu-
or ethnic minorities or socioeconomically disadvantaged groups, to en-
nity normally uses to make choices pertaining to issues affecting its
sure that they have the opportunity for meaningful input into public
members. These processes may vary, depending on the nature of the
decision-­making (see discussion of inclusiveness below).47
community. For a community in the US, consent may take place by
Although individual consent is not always required to implement
means of voting on referenda or decision-­making by elected officials.
public health interventions or research projects that can significantly
In a village in Africa, tribal leaders may make decisions for the commu-
benefit the community,48 it is required when researchers intend to inter-
nity. I will not examine these political processes in significant detail in
act with and/or collect biological samples or private data from human
this article, but I will assume that the community where a GM mos-
subjects.49 Well-­established regulations, guidelines, and ethics codes re-
quito field trial may occur has a legitimate political process for making
quire that investigators obtain informed consent from individuals before
enrolling them in research. Studies should also be approved by ethics
committees which oversee research involving human subjects.50 GM
Lavery et al 2010, op. cit., note 29; Macer 2006, op. cit., note 29; Tindana et al 2007, op. cit.,
note 33; Ross et al 2010, op. cit., note 35; O’Fallon LR & Dearry A. Community-­based participatory research as a tool to advance environmental health sciences. Environ Health Perspect.
2002;110(Suppl 2):155-­159; National Institute of Environmental Health Sciences. 2016.
Community engagement and research translation. Available at: https://www.niehs.nih.gov/
research/supported/centers/srp/outreach/index.cfm [Accessed: 13 December 2016]. Haire
BG, Kaldor JM. Communities need to be equal partners in determining whether research is
acceptable. J Med Ethics 2016 [published online 3Aug 2016].
Dickert NW & Sugarman J. Ethical goals of community consultation in research. Am J Public
Health. 2005;95(7):1123-­1127; Macer 2006, op. cit., note 29; Council for International
Organizations of Medical Sciences. 2016. International Ethical Guidelines for Health-­Related
Research Involving Humans. Geneva, Switzerland: Council for International Organizations of
Medical Sciences. Available at: http://www.cioms.ch [Accessed 6 December 2016].
Beauchamp T, Childress J. 2001. Principles of Biomedical Ethics, 5th ed. New York: Oxford
University Press.
Weijer and Emanuel 2000, op. cit., note 36; Gbadegesin S & Wendler D. Protecting communities in health research from exploitation. Bioethics. 2006;20(5):248-­253; Resnik 2012,
op. cit., note 31.
Macer 2006, op. cit., note 29; World Health Organization 2014, op. cit., note 10; Resnik DB.
Ethical issues in field trials of genetically modified disease-­resistant mosquitoes. Dev World
Bioeth. 2014;14(1):37-­46.
mosquito field trials that perform interventions on or collect private data
or biological samples from human research subjects should include provisions for securing appropriate regulatory approvals and obtaining informed consent from individuals.51 However, GM mosquito field trials
need not involve human research subjects, since researchers could test
hypotheses using data from public health agencies (e.g. disease prevalence) or by measuring changes in mosquito populations. For example,
Gutmann A & Thompson D. 1996. Democracy and Disagreement. Cambridge, MA: Harvard
University Press.
Ibid. See also Rawls J. 2005. Political Liberalism, 2nd ed. New York: Columbia University
Gutmann & Thompson 1996, op. cit., note 47.
Kass NE. An ethics
Macer 2005, op. cit., note 15; Resnik 2014, op. cit. note 44.
Juengst ET. Groups as gatekeepers to genomic research: conceptually confusing, morally
hazardous, and practically useless. Kennedy Inst Ethics J. 1998;8(2):183-­200.
World Health Organization 2014, op. cit., note 10.
Emanuel EJ, Wendler D & Grady C. What makes clinical research ethical? JAMA.
Resnik 2014, op. cit. note 44.
Oxitec’s studies have collected data on Aedes aegypti populations and
• Timeliness: Community engagement should begin very early in the
the prevalence of mosquito-­borne diseases, but they have not obtained
planning process to give community members enough time to pro-
samples or private data from human subjects.52 However, since it may
cess information, ask questions, discuss the study with their neigh-
not always be obvious that studies do not involve human subjects, researchers conducting field trials of GM mosquitoes should consult with
bors and friends, and so on.
• Consent: The community should have the right to give its per-
local ethics committees to ensure that human subjects review is not
mission, consent, or approval; studies should not occur without
community consent. Engaging the community early in the process
Community engagement can also be viewed as a mechanism for
can help assure residents that their wishes will be honored and
promoting environmental justice.53 The environmental justice move-
that the study or project is not a fait accompli. Since researchers
ment in the US emerged in the 1980s when minority communities ob-
(and their sponsoring organizations) have more power and influ-
jected to the placement of waste sites in their neighborhoods without
ence than community members, they have an obligation assure
their input or approval.54 They argued that they were being unfairly ex-
community members that they are partners in the decision-mak-
posed to environmental risks without sufficient compensating benefits
ing process and their voices matter. To do this, researchers should
or meaningful involvement in decision-­making. The US Environmental
engage in or provide a robust deliberative process where the pros
Protection Agency applies principles of environmental justice to its reg-
and cons of the proposal are fully explored to facilitate informed
ulatory decision-­making.55 Although researchers are not seeking to en-
gage communities to mobilize protests of their work, effective
• Information sharing: Researchers, public health officials, and com-
community engagement can reduce the odds of this happening by giv-
munity members should share relevant information and knowledge
ing community members meaningful involvement in decision-­making.
with each other. Researchers and public health officials should
Fairness in decision related to environmental exposures can be un-
provide information about the nature and purpose of intervention
derstood in relation to outcomes or decision-­making processes.56 An
or project, its risks and benefits, other available options for deal-
outcome is fair if it leads to a just (or fair) distribution of benefits and
ing with the problem, funding sources, and regulatory approvals.
risks. For a field trial of GM mosquitoes to be fair in this sense, com-
Community members should communicate their needs, interests,
munity members should not be unduly burdened with risks without
and concerns to researchers or officials. Researchers and officials
compensating benefits. A careful evaluation of the benefits and risks
should also share the results of the study with community mem-
of a field trial, as well as how these may impact different members of
bers when it is completed as well as any new information related
the community, can help ensure that the trial meets outcome-­based
to their health and welfare. Since researchers and public health of-
criteria of fairness. A process is fair if affected stakeholders have the
ficials have much more knowledge and expertise concerning pro-
opportunity for meaningful input into decision-­making.57 Input is
posed projects or interventions than community members, their
meaningful if it can substantially affect the outcome of the decision
obligations to share and explain information are much greater.
(see discussions of consent, information sharing, and responsiveness
Researchers should describe scientific concepts in lay language and
below). Effective community engagement can help to ensure the GM
mosquito field trials meet process-­based standards of environmental
justice (see discussion in the next two sections).
provide supporting documents and materials.
• Transparency: Information sharing should be honest and open;
researchers and officials should not hide important information
from community members before, during, or after the intervention
Several research groups have developed some guidelines for community engagement related to public health research.58 Although these
researchers focus on different aspects of community engagement,
they agree upon some common standards:
Servick 2016, op. cit., note 6.
Shrader-­Frechette 2002, op. cit., note 31.
Resnik 2012, op cit., note 31.
Environmental Protection Agency. 2016. Environmental justice. Available at: https://www.
epa.gov/environmentaljustice [Accessed 19 December 2016].
Rawls J. 1971. A Theory of Justice. Cambridge, MA: Harvard University Press; Daniels N.
2008. Just Health: Meeting Health Needs Fairly. Cambridge, UK: Cambridge University Press.
or project. Information relevant to the study or project should be
available on publicly accessible websites.
• Responsiveness: Researchers and officials should actively listen
to community members and respond to their questions and comments. They should be available to meet with community members
at a mutually convenient time and place. Researchers should also be
willing to revise their objectives, procedures, or research designs in
response community concerns, or abandon them if the community
does not accept them.
• Mutual understanding: Researchers, officials, and community members should seek to understand each other’s point of view concerning the proposed intervention or project. Researchers should make
special efforts to understand why community members oppose a
project or intervention.
• Respectfulness: Researchers, officials, and community members
should respect each other’s values, opinions, attitudes, and be-
liefs, even when they disagree. Researchers should not belittle
Shrader-­Frechette 2002, op. cit., note 31.
Lavery et al 2010, op. cit., note 29; Tindana et al 2007, op. cit., note 33; Kolopack et al 2015,
op. cit., note 33; Ross et al, op. cit., note 35.
or denigrate community beliefs, opinions, or attitudes, such as
philosophical opposition to GMOs (see discussion below), even if
proposed field trial in local newspapers and solicited comments from
they view them as irrational or unscientific.
the public and non-­governmental environmental organizations.
• Inclusiveness: Everyone in the community should have an oppor-
Malaysian officials also distributed posters (in four languages) an-
tunity to participate in the decision-making process regardless of
nouncing the proposed field trial and sought input from local councils
income, education, race, ethnicity, gender, or religion, and efforts
and community leaders. Malaysian officials approved the field trial
should be made to reach out to socioeconomically disadvantaged
only after reviewing safety and efficacy data presented by Oxitec re-
members of the community and minorities.
searchers and addressing public comments and concerns. The
Malaysian Biosafety Act requires public consultation prior to any re-
In the next two sections of this article, I will describe the community
lease of GM organisms in wild.67 In 2015, the Malaysian government
engagement activities in several field trials of GM mosquitoes a draw
decided not to move forward with widespread release of GM mosqui-
some conclusions from these efforts.
toes, due to concerns about cost-­effectiveness.68
In Brazil, Oxitec researchers conducted field trials of GM Aedes
aegypti mosquitoes in 2011 to help reduce the incidence of dengue
fever. They obtained approvals from the Brazilian National Biosafety
Technical Commission in 2010 to import the GM mosquitoes and designate five sites for potential field trials.69 Local public health authori-
Oxitec’s first field trial of its GM Aedes aegypti mosquitoes took place
ties and community leaders also consented to the project. Public
At the
engagement took place via announcements in the media (including
time of the release, the country had no regulations concerning the
social media), distribution of posters and leaflets; meetings with com-
in an isolated area of the Cayman Islands in 2009 and 2010.
release of GM organisms into the wild. Although Oxitec researchers
munity members, and presentations at schools. The project also em-
obtained approval for the trial from country’s Mosquito Research and
ployed technicians to go door-­to-­door to answer questions from
Control Unit, they neither consulted with nor obtained consent from
residents and learn more about their opinions and concerns.70
the local community.
Critics argued that the local community should
Members of affected communities expressed strong support for the
have been involved in the decision-­making.61 Although the second
field trials.71 It is worth noting, however, that Brazil, like Malaysia, has
field trial included more community engagement,62 critics have com-
not yet approved widespread release of GM mosquitoes.
Following an outbreak of dengue fever in Key West, Florida in
Opponents of the release claimed that Oxitec had not provided
2010, the Florida Keys Mosquito Control District publicly announced it
enough information to the community and had not addressed their
was considering a proposal to release Oxitec’s GM mosquitoes. In June
questions, fears, and concerns.64 Despite these complaints, Oxitec
2012, researchers surveyed 400 residents of Monroe County, Florida
plained that the community engagement was inadequate.
researchers released thousands of GM mosquitoes in the West Bay
concerning their opinions about the proposed field trial. 51.1% of re-
area in July 2016 to help the country deal with its dengue fever and
spondents had heard about it. Among those who already knew about
Zika epidemics.65
the proposed trial, 9.7% were strongly opposed, 8.2% were opposed,
In December 2010, Oxitec researchers released 6000 GM mosqui-
25.1% were neutral, 22.1% were supportive, and 34.9% were strongly
toes in an uninhabited forest in Malaysia after extensive community
supportive.72 After the survey was conducted, the Florida Keys
Malaysia’s Department of Biosafety announced the
Mosquito Control District engaged the community in various ways,
such as making public announcements in various media, delivering pre-
Subramaniam TS, Lee HL, Ahmad NW & Murad S. Genetically modified mosquito: the
Malaysian public engagement experience. Biotechnol J. 2012;7(11):1323-­1327.
Reeves RG, Denton JA, Santucci F, Bryk J & Reed FA. Scientific standards and the regulation
of genetically modified insects. PLoS Negl Trop Dis. 2012;6(1):e1502.
Enserink M. GM mosquito trial alarms opponents, strains ties in Gates-­funded project.
Science. 2010;330(6007):1030-­1031. Kolopack et al 2015, op. cit., note 33.
sentations to various local audiences, and holding public meetings.73
Public perceptions of the proposed trials began to change, however,
as many residents expressed concerns about the potential public health
and environmental risks of releasing GM mosquitoes into the wild.74
Subramaniam et al 2012, op. cit., note 61.
Oxitec. 2016. Caymans. Available at: http://www.oxitec.com/programmes/cayman/
[Accessed 29 November 2016].
Ragoonath R. Bush: halt genetically modified mosquito release. The Cayman Reporter, 14
June 14 2016. Available at: http://www.caymanreporter.com/2016/06/14/bush-halt-genetically-modified-mosquito-release/ [Accessed 5 December 2016].
Jukam K. thousands of genetically modified mosquitoes released. Cayman Compass, 28 July
2016. Available at: https://www.caymancompass.com/2016/07/28/thousands-of-genetically-modified-mosquitoes-released/ [Accessed 19 December 2016].
Lacroix R, McKemey AR, Raduan N, Kwee Wee L, Hong Ming W, Guat Ney T, Rahidah AAS,
Salman S, Subramaniam S, Nordin O, Hanum ATN, Angamuthu C, Marlina Mansor S, Lees RS,
Naish N, Scaife S, Gray P, Labbé G, Beech C, Nimmo D, Alphey L, Vasan SS, Han Lim L, Wasi
AN & Murad S. Open field release of genetically engineered sterile male Aedes aegypti in
Malaysia. PLoS One. 2012;7(8):e42771.
Fong LF. GM Mosquito project shelved. The Star Online, 6 March 2015. Available at: http://
www.thestar.com.my/news/nation/2015/03/06/gm-mosquito-project-shelved-plan-notcost-effective-for-implementation-says-health-dg/ [Accessed 11 February 2017].
Carvalho et al 2015, op. cit., note 8.
Resnik 2014, op. cit. note 44.
Ernst KC, Haenchen S, Dickinson K, Doyle MS, Walker K, Monaghan AJ & Hayden MH.
Awareness and support of release of genetically modified “sterile” mosquitoes, Key West,
Florida, USA. Emerg Infect Dis. 2015;21(2):320-­324.
Brown KV. Genetically modified mosquitoes could wipe out the world’s most deadly
viruses. If we let them. Fusion, 19 September 2016. Available at: http://fusion.net/
story/347298/oxitec-genetically-modified-mosquitoes/ [Accessed 24 November 2016].
Monroe County resident Mila de Mier collected over 170,000 online
voted against allowing the field trials to take place in their community.
signatures on a petition opposing the release of the mosquitoes. The
However, Monroe County voters passed a referendum to approve the
petition cited concerns that radically decreasing the population of Aedes
field trials (Key Haven in located in Monroe County).83 Florida resi-
aegypti mosquitoes could destabilize the ecosystem by threatening bat
dents also voted in favor of allowing the field trials to occur in the state
populations or could increase mosquito species that carry a more viru-
during the general election. On November 19, the Monroe County
lent form of dengue or some other disease.
It is important to mention,
Mosquito Control District approved the field trials, which could begin
however, that since the population of Key Haven is just over 32,000,76
in 2017.84 Since residents of Key Haven have voted against these tri-
most of signers of the petition came from outside the community.
als, they will must take place in a different part of Monroe County.
Key West physician John Morris III circulated a letter expressing the
concern that the mosquitoes could carry antibiotic-­resistant bacteria,
due to exposure to tetracycline and petitioned Oxitec to release infor-
mation about antibiotic resistance in its mosquitoes.77 In response to
this request, Oxitec researchers said that they had thoroughly studied
The publicly available information for the field trials of GM mosquitos
the issue and that the risk of the mosquitoes infecting the human pop-
at these four sites supports following conclusions concerning com-
ulation with antibiotic-­resistant bacteria was negligible.78
munity engagement activities.
Rumors with no basis in scientific fact began to circulate.79 Some
First, the inaugural field trial of GM mosquitoes in the Cayman
people claimed that recent Zika outbreaks came from Oxitec’s GM
Islands clearly did not meet most of the standards for community en-
mosquitoes [recent outbreaks did not start in the areas where the field
gagement described above, since there was no community engage-
trials took place], and some feared that a bite from one of Oxitec’ mos-
ment prior to initiating the study. The Mosquito Research and Control
quitoes could make a child sterile [the mosquitoes are males, which
Unit, not the community, consented to the release. It also appears that
don’t bite]. Distrust of the federal government, biotechnology compa-
the other standards, such as information sharing, responsiveness, un-
nies, GMOs, and scientists also played a role in turning the tide against
derstanding, and so on, also were not met. Although the second field
the field trials.80 A survey of Key Haven residents conducted in 2015
trial included more community consultation than the first, critics ar-
found that most had a negative opinion of the field trials. Opponents
gued that community consultation was still deficient.85 Community
of the trials were concerned about the impacts of the mosquitoes on
consultation in the second field trial may not have met several stan-
public health and the environment.
In July 2016, the US Food and Drug Administration approved
dards, including information sharing, transparency, responsiveness,
understanding, and respect.
Oxitec’s plans to conduct field trials of GM Aedes aegypti mosquitoes
Second, community engagement in the Brazilian field trials ap-
in Key Haven, Florida, concluding that the mosquitoes did not pose a
pears to have been outstanding. The community engagement efforts
threat to public health or the environment.82 Residents of Key Haven
in Brazil are especially noteworthy for including door-­to-­door question and answer sessions. Visiting the homes of community members
de Meir M. 2016. Say no to genetically modified mosquitoes release in the Florida Keys.
Available at: https://www.change.org/p/say-no-to-genetically-modified-mosquitoes-release-in-the-florida-keys [Accessed 30 November 2016].
At Point Homes. 2016. Key Haven. Available at: http://www.point2homes.com/US/
Neighborhood/FL/Key-West/Key-Haven-Demographics.html [Accessed 13 December
Atkins K. Doctor wants nose swabs to monitor mosquito release. The Miami Herald, 19
September 2016. Available at: http://www.miamiherald.com/news/local/community/florida-keys/article102690147.html [Accessed 5 December 2016].
Unger S. Oxitec: drug resistant bacteria not a threat. Keysnews.com, 17 October 2016.
Available at: http://keysnews.com/node/78398 [Accessed 5 December 2016].
Brown 2016, op. cit., note 76.
Alverez L. In Florida keys, some worry about ‘science and government’ more than Zika. New
York Times, 24 August 2016: A9; Glenza J. Zika virus: Floridians fear ‘Pandora’s box’ of genetically altered mosquitos. The Guardian, 14 August 2016. Available at: https://www.theguardian.com/us-news/2016/aug/14/florida-keys-zika-virus-genetically-modified-mosquitoes
[Accessed 29 November 2016].
Adalja A, Sell TK, McGinty M & Boddie C. Genetically modified (GM) mosquito use to
reduce mosquito-­transmitted disease in the US: a community opinion survey. PLoS Curr. 2016
May 25;8. pii.
Rutkin A. GM mosquitoes approved for field trial release in Florida. New Scientist, 22
November 2016. Available at: https://www.newscientist.com/article/2113627-gm-mosquitoes-approved-for-field-trial-release-in-florida/ [Accessed: 23 November 2016]; Food and Drug
Administration. 2016. Preliminary Finding of No Significant Impact (FONSI) In Support of an
Investigational Field Trial of OX513A Aedes aegypti Mosquitoes. Available at: at: http://www.
GeneticallyEngineeredAnimals/UCM487379.pdf [Accessed 24 November 2016].
helped promote inclusiveness, responsiveness, respectfulness, understanding, and information sharing. The Brazilian trials also appear
to have met other standards, such as timeliness, consent, and transparency. Given these impressive efforts to engage the community, it
should come as little surprise that the local population was very receptive to the GM mosquito field trials. However, it is worth noting
that the outcome is not what made community engagement effective.
Community engagement would have been effective even if the local
population had rejected the field trials, based on the extraordinary efforts the researchers made to consult with, inform, understand, and
respect the community.
Third, in the Florida Keys researchers appear to have met most of
the standards for effective community engagement, even though the
field trials met with substantial resistance. The researchers informed
the community, answered questions, attempted to understand their
views, and included them in decision-­making. While community members expressed concerns about some risks with a sound basis in scientific fact, it appears that misinformation about the risks of the trials
Rutkin 2016, op. cit., note 84.
Ragoonath 2016, op. cit., note 65.
also played an important role in shaping community attitudes and
Public opposition to GMOs stands in sharp contrast to scientific
perceptions. It is not clear whether the researchers sought to correct
enthusiasm for genetic engineering of organisms as a tool for advanc-
these misperceptions or whether they understood the impact of false
ing scientific knowledge pertaining to human health and disease, man-
beliefs on community attitudes toward the trial.
ufacturing biologics and biofuels, increasing crop yields, and reducing
The researchers may have also not understood the impact of some
the use of pesticides. Many scientists view the public’s negative atti-
of the values that shaped the community’s decision-­making, such as
tudes toward GMOs as irrational and ignorant, because numerous
general opposition to GMOs, and distrust of biotechnology compa-
studies have shown GM foods are just as safe to eat as non-­GM foods
nies, scientists, and the federal government. The Florida Keys case
and that GM crops pose minimal risks to the environment.92 In 2016,
illustrates some of the difficulties researchers are likely to encounter
over one hundred Nobel Prize winners signed a letter to Greenpeace
when seeking permission from communities to conduct field trials of
International criticizing organization’s stance against GMOs as anti-­
GM mosquitoes.
scientific and harmful to scientific progress and human health.93
Fourth, additional research is needed on the effectiveness of dif-
Although researchers may be frustrated with public opposition to
ferent methods of engaging communities in field trials of GM mosqui-
GMOs, they should still try to understand and address it. Indeed, pub-
toes.86 Researchers should survey members of the local population
lic distrust of GMOs makes effective community engagement for field
before and after initiating community engagement activities to learn
trials of GM mosquitoes especially important. Researchers who are
more about their attitudes toward and perceptions of the decision-­
seeking to conduct field trials of GM mosquitoes should be prepared
making process. They should also conduct interviews with community
to discuss the benefits and risks of these studies with the local com-
members to explore their concerns, attitudes, perceptions, and opin-
munity and to respond to questions and concerns they have about
ions in greater depth. Articles reporting the results of field trials of GM
GMOs in a manner that respects their opinions, beliefs, values, and
mosquitoes should include detailed descriptions of regulatory approv-
attitudes. Additional research on how to respond to public skepticism
als and community engagement activities.
concerning GMOs may provide researchers and public health officials
Fifth, controversies concerning GMOs are likely to continue to impact community decisions concerning field trials of GM mosquitoes.87
with knowledge they can utilize in engaging communities and selecting potential sites for release of GM mosquitoes.94
Although the US has approved many different GMOs for use in agriculture and the production of biopharmaceuticals and biofuels, public
opposition to GMOs is significant, especially in Europe.88 The cultiva-
tion of GM crops has met with little resistance in the developing nations of Argentina, Brazil, China and India, but in Mozambique,
Effective community engagement is an important legal, ethical, and
Namibia, and Zambia public opposition has been strong.89 As seen
practical prerequisite for conducting field trials of GM mosquitoes.
above, public concerns about GMOs played a significant role in Key
Researchers who are planning to conduct field trials of GM mosqui-
Haven’s decision to reject the field trial of GM mosquitoes. Anti-­GMO
toes should develop a robust community engagement strategy that
activists have also opposed field trials of Oxitec’s mosquitoes in Brazil,
meets widely recognized standards for seeking approval from the
the Cayman Islands, and Malaysia.90 Much of the opposition to GM
affected population, such as timeliness, consent, information sharing,
mosquitoes has come from environmental activists who reside outside
transparency, understanding, responsiveness, mutual understanding,
of the areas impacted by the field trials. Environmental groups, such as
inclusiveness, and respect. Additional research on how to conduct
Friends of the Earth, Greenpeace International, and Organic
effective community engagement and respond to public skepticism of
Consumers Association have also mounted global campaigns against
GMOs can provide researchers and public health officials with knowl-
GM foods, crops, plants, and animals.91
edge they can utilize in planning field trials of GM mosquitoes and
selecting sites for potential release of these organisms.
Lavery et al 2010, op. cit., note 29; McNaughton 2012, op. cit., note 33.
Knols BG, Bossin HC, Mukabana WR & Robinson AS. Transgenic mosquitoes and the fight
against malaria: managing technology push in a turbulent GMO world. Am J Trop Med Hyg.
2007;77(6 Suppl):232-­242.
Macer 2006, op. cit., note 26; Herring RJ. Science and society: Opposition to transgenic technologies: ideology, interests and collective action frames. Nat Rev Genet. 2008;9:458-­463; Lucht
JM. Public acceptance of plant biotechnology and GM crops. Viruses. 2015;7(8):4254–4281.
Resnik 2012, op. cit., note 31.
Rueda M. Genetically modified mosquitoes could wipe out the world’s most deadly viruses.
If we let them. Fusion, 19 September 2016. Available at: http://fusion.net/story/347298/
oxitec-genetically-modified-mosquitoes/ [Accessed 11 February 2017].
Friends of the Earth. Genetic engineering. Available at: http://www.foe.org/projects/
food-and-technology/genetic-engineering [Accessed 13 February 2017]; Greenpeace
International. What’s wrong with genetic engineering (GE)? Available at: http://www.greenpeace.org/international/en/campaigns/agriculture/problem/genetic-engineering/ [Accessed
13 February 2017]; Organic Consumers Association. Genetic engineering. Available at: https://
www.organicconsumers.org/categories/genetic-engineering [Accessed 13 February 2017].
Release of GMOs into the wild may play an increasingly important
role in preventing some types of vector-­borne diseases.95 Although
current research has focused on mosquito vectors of disease, researchers have proposed genetically modifying mice so that they resist
Lyme disease.96 Other potential targets include: black flies
National Research Council. Genetically Engineered Crops: Experiences and Prospects.
Washington, DC: National Academies Press, 2016.
Achenbach J. 107 Nobel laureates sign letter blasting Greenpeace over GMOs. Washington
Post, 30 June 2016. Available at: https://www.washingtonpost.com/news/speaking-ofscience/wp/2016/06/29/more-than-100-nobel-laureates-take-on-greenpeace-overgmo-stance/?utm_term=.8ff6c86a1979 [Accessed 13 February 2017].
Macer 2006, op. cit., note 29.
World Health Organization 2014, op. cit., note 10.
Harmon A. Fighting Lyme disease in the genes of Nantucket’s mice. New York Times, 7 June
(Onchocerciasis or river blindness), aquatic snails (Schistosomiasis),
Tsetse flies (African sleeping sickness), and Triatomine bugs (Chagas
disease). However, for research programs involving the genetic modification of disease vectors to move forward, they must have public
acceptance and support, which cannot be achieved without effective
community engagement.
This research was supported by the Intramural Program of the
National Institute for Environmental Health Sciences (NIEHS),
National Institutes of Health (NIH). It does not represent the views of
the NIEHS, NIH, or US government. I am grateful to Symma Finn for
helpful comments.
No conflicts declared.
David B. Resnik is a bioethicist at the National Institute of
Environmental Health Sciences in North Carolina, USA. He holds
a PhD in philosophy from the University of North Carolina, Chapel
Hill, and a JD from the Concord University School of Law in Los
How to cite this article: Resnik DB. Ethics of community
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Field Trials of Genetically Modified Mosquitoes and
Public Health Ethics
David B. Resnik
To cite this article: David B. Resnik (2017) Field Trials of Genetically Modified
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Jonas, H. 1966. The phenomenon of life: Toward a philosophical biology.
New York, NY: Harper and Row.
Singer, P., and J. Mason. 2007. The ethics of what we eat: Why our food
choices matter. Emmaus, PA: Rodale Press.
Lee, L. M. 2017. A bridge back to the future: Public health ethics,
bioethics, and environmental ethics. American Journal of Bioethics
17 (9):5–12.
Thompson, P. B. 2015. From world hunger to food sovereignty:
Food ethics and human development. Journal of Global Ethics
Field Trials of Genetically Modified
Mosquitoes and Public Health Ethics
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David B. Resnik, National Institutes of Health
Lisa Lee’s (2017) target article “A Bridge Back to the
Future: Public Health Ethics, Bioethics, and Environmental
Ethics” presents a compelling case for using a public
health ethics framework for reconnecting biomedical
ethics and environmental ethics. She describes how biomedical ethics and environmental ethics have drifted apart
since Van Rensselaer Potter characterized bioethics as a
global discipline in the 1970s that addresses ethical dilemmas in medicine, public health, and the environment. She
argues that public health ethics can serve as a bridge back
to Potter’s vision of an inclusive bioethics because it deals
with health at individual, community, and environmental
Elsewhere (e.g., Resnik 2009; 2012), I have argued for
basically the same thesis that Lee defends in her article.
Accordingly, my goal in this commentary is not to criticize
Lee’s viewpoint but to provide additional evidence for it
by discussing an example that illustrates the need for a bioethical perspective that addresses individual, community,
and environmental concerns. The example I have in mind
is the use of genetically modified (GM) mosquitoes to control mosquito-borne diseases, such as malaria, dengue
fever, and the Zika infection (Resnik 2014; 2017).
Mosquito-borne illnesses are a serious public health
problem, especially in developing countries. Malaria kills
more than 400,000 people per year, mostly children living
in Africa, and 20,000 people die annually from the hemorrhagic fever caused by the dengue virus (World Health
Organization 2014). In 2015, millions of people in Central
and South America contracted the Zika virus. Although
most adults only develop a mild fever, rash, and headache
from a Zika infection, the virus poses a significant threat to
fetuses and can increase this risk of birth defects, including
microcephaly (Resnik 2012; 2017).
Since the beginning of this century, researchers have
been developing genetically modified mosquitoes to help
prevent the spread of mosquito-borne diseases. One of the
reasons why researchers have undertaken this task is that
other methods of controlling mosquito populations have
significant disadvantages (Macer 2005; World Health
Organization 2014). Pesticides, for example, can pose risks
to human health and to nonhuman species (such as some
species of birds, insects, and fish). Also, some species of
mosquitoes are becoming resistant to pesticides. Eliminating mosquito breeding grounds (such as wetlands and
ponds) can disrupt the ecosystem and threaten biodiversity (Resnik 2012).
The two approaches to producing GM mosquitoes
that have gained the most attention are (1) modifying
male mosquitoes so that they cannot produce viable offspring, and (2) modifying male and female mosquitoes
so that they resist certain diseases or are incapable of
transmitting them (World Health Organization 2014;
Servick 2016). Scientists working for the biotechnology
company Oxitec have tested the first approach in field
trials involving the release of thousands of mosquitoes
into the wild; the second approach has only been tested
in laboratory settings (Resnik 2017). Oxitec’s genetically
modified Anopheles aegypti1 male mosquitoes have a
mutation that causes larvae to die unless they are
exposed to the antibiotic tetracycline. The GM males
mate with the females in the wild but do not produce
viable offspring. Because the GM mosquitoes are not
viable, researchers must periodically reintroduce GM
males to keep the population in check. Oxitec has
tested this approach in parts of Brazil, the Cayman
Islands, and Malaysia. The Food and Drug Administration and the Monroe County, Florida, Mosquito Control
District have approved field trials of Oxitec’s mosquitoes, which have not taken place as of the writing of
this commentary (Resnik 2017). Field trials of Oxitec’s
mosquitoes have reduced Anopheles aegypti mosquito
1. This mosquito species can carry dengue, malaria, Zika, and yellow fever.
This article is not subject to U.S. copyright law
Address correspondence to David B. Resnik, NIEHS/NIH, Mail Drop CU 03, Box 12233, Research Triangle Park, NC 27709, USA. E-mail:
24 ajob
September, Volume 17, Number 9, 2017
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Public Health Ethics Bridge
populations 80–95% and dengue fever cases by as much
as 91% (Carvalho et al. 2015; Oxitec 2016).
Both approaches can produce different benefits and
risks for individuals, communities, and the environment.
A benefit of the first approach for individuals and communities is that it can reduce the prevalence of mosquitoborne diseases by controlling mosquito populations with
introducing pesticides into the environment. Since male
mosquitoes do not bite, this approach poses no risk of
infection from a GM mosquito bite. A potential environmental risk of this approach is that it could disrupt the
food web by drastically reducing or eliminating the local
population of Anopheles aegypti mosquitoes, which are an
important source of food for amphibians, bats, birds, fish,
insects, and reptiles. However, it possible that these species could adjust to loss of this food source and that other
mosquito species would fill the ecological niche vacated
by Anopheles aegypti (Macer 2005; World Health Organization 2014).
A benefit of the second approach for individuals and
communities is that it could reduce the prevalence of
mosquito-borne diseases by making mosquitoes resistant
to those diseases or incapable of transmitting them. A
potential risk for individuals and communities is that the
genetic modification might not work as intended and
could theoretically increase the prevalence of some types
of mosquito-borne diseases. For example, a genetic modification might promote malaria resistance but increase
yellow fever susceptibility. A potential environmental
risk is that the gene drive2 mechanism used to increase
the prevalence of targeted genes in the population might
be transmitted to other species by viruses, with unpredictable effects on human health and the environment (World
Health Organization 2014; National Academy of Sciences
Both approaches raise significant ethical issues at the
level of the individual, community, and environment,
such as (Macer 2005; Resnik 2012; 2017; World Health
Organization 2014):
Individual consent: Should individuals have the right to
decide whether they will be exposed to GM mosquitoes?
How should such a right be balanced against the
community’s interests in promoting public health?
Should individual consent be required only for people
who will be subjects of research studies related to a field
Community consent: Should the affected community
have the right to approve or disapprove a field trial of
GM mosquitoes? How should researchers or public
health officials engage the local community? Should
2. A gene drive mutation distorts Mendelian inheritance so that it
increases in prevalence in the population irrespective of the effects
of natural selection or random drift (National Academy of Sciences 2016). Genes linked to these mutations will also increase in
September, Volume 17, Number 9, 2017
outside groups (such as organizations opposed to genetically modified organisms) be allowed to prevent the
community from implementing a strategy to promote
the health of its members?
Public health benefits and risks: What are the public
health benefits and risks of field trials of GM mosquitoes?
How should benefits and risks be compared?
Environmental risks: What are the potential environmental impacts of a field trial of GM mosquitoes? How
should these impacts be evaluated? Should public health
be promoted at the expense of the environment? Does
introducing GM mosquitoes into the wild set a dangerous precedent for environmental policy?
As one can see from this list of questions, the issues
raised by field trials of GM mosquitoes affect individuals,
communities, and the environment and cannot be
addressed by a decision-making method that focuses
solely on clinical, research, or environmental ethics. To
adequately address these issues, one must employ a more
comprehensive framework, such as public health ethics or
environmental health ethics, which encompasses these different ways of thinking about ethical dilemmas related to
human health and environment. I applaud Dr. Lee for her
efforts to move bioethics in this direction.
This research was supported, in part, by the National Institute of Environmental Health Sciences (NIEHS), National
Institutes of Health (NIH). It does not represent the views
of the NIEHS, NIH, or the U.S. federal government. &
Carvalho, D. O., A. R. McKemey, L. Garziera, et al. 2015. Suppression of a field population of Aedes aegypti in Brazil by sustained
release of transgenic male mosquitoes. PLoS Neglected Tropical Diseases 9 (7):e0003864.
Lee, L. M. 2017. A bridge back to the future: Public health ethics,
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Environmental Neuroethics: Bridging
Environmental Ethics and Mental Health
Adam J. Shriver, University of British Columbia
Laura Y. Cabrera, Michigan State University and University of British Columbia
Judy Illes, University of British Columbia
As noted by Lee (2017), this is a time of unprecedented
human influence on global ecosystems. In the 1960s, scientists proposed the term Anthropocene to refer to the epoch
during which human activity became the dominant influence on the climate and environment. Scholars are still
debating when the Anthropocene epoch began, but regardless of the starting date, it is clear that anthropogenic influences on the environment are not merely continuing, but
in fact accelerating. In turn, the changes humans have
induced in the environment are reverberating through
sometimes subtle but frequently profound environmental
effects on human health. We agree with Lee that these
effects challenge society to grapple with ethical perspectives that take into account the value of ecosystems, of
other animals, and of current and future human populations. We build here on Lee’s proposal by highlighting one
particular area at the intersection of environmental ethics
and bioethics that is in need of further research: environmental neuroethics (Illes, Davidson, and Matthews 2014;
Cabrera et al. 2016).
Environmental neuroethics examines the many ways
in which anthropogenic influences on the environment
affect brain health and mental well-being. It builds upon
the field of neuroethics that situates ethical, legal, policy
and social considerations alongside technological developments in the neurosciences. The term “neuroethics” was
initially used by William Safire to refer to ethical issues
associated with the “treatment and enhancement of the
human brain” (Marcus 2002), but the field has expanded
in scope as it has become increasingly clear that the changing understanding of the brain is having a profound influence on many aspects of human life. As such, the field of
neuroethics is responsive to the ways in which an evolving
understanding of the brain interacts with the transformative processes shaping the future. There is little doubt,
moreover, that the impact that humans are having on the
environment is one of those transformative processes of
our time. Discussions of the ethical and societal consequences of environmental change for brain and mental
health have thus far been limited, but given the vulnerability of the central nervous system to environmental factors,
the time is now for the field of public health to embrace the
We consider two contemporary examples of importance to public health to highlight the ethical challenges
raised by environmental impacts on brain and mental
health: pesticides and exposure to lead. It has long been
known that pesticides can have detrimental effects on
wildlife, can be toxic for nontarget plants and animals, and
thereby can adversely impact nearby and downstream ecosystems. The consumption of pesticides can also have
adverse effects on human health and, particularly important for our purposes, has been associated with brain
changes related to autism, aging, and neurodegeneration
(Pearson et al. 2016).
The potential adverse effects of pesticides on brain
health raise several important neuroethics challenges
(Cabrera 2017). The neurotoxic effects of pesticides are particularly pronounced on various vulnerable populations.
Some pesticides can cross the blood–brain barrier and
damage the brains of fetuses. Prenatal pesticide exposure
has been associated with working memory deficits, IQ
reduction, and decreased behavioral competence in children. Increased exposure risks continue throughout childhood, as the developing nervous system is particularly
prone to disruption. These challenges are further
Address correspondence to Adam J. Shriver, University of British Columbia, Maurice W. Young Centre for Applied Ethics, 227 – 6356
Agricultural Road, Vancouver, BC, V6T 1Z4, Canada. E-mail: ashriver@mail.med.upenn.edu
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September, Volume 17, Number 9, 2017
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