Ethics of community engagement in field trials of genetically modified mosquitoes

Abstract

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.

1 ∣. INTRODUCTION

Vector-borne illnesses account for 17% of all infectious diseases worldwide and cause one million deaths each year, most of which occur in developing nations.¹ The most dangerous disease vectors by far are mosquitoes, which can carry malaria, dengue, Zika, yellow fever, West Nile virus, encephalitis, and chikungunya, depending on the species.² The most dangerous species, Aedes aegypti, can transmit dengue, Zika, malaria, and chikungunya to humans. In 2015, malaria infected 214 million people and killed 438,000, mostly children living in Africa.³ Between 50 and 100 million people contract dengue annually and about 22,000 die from the hemorrhagic fever caused by the virus. Areas at the highest risk for dengue are developing nations in Africa, South and Central America, Southeast Asia, and the Pacific Islands.⁴ In 2015, Zika reemerged as a serious public health threat. The disease spread rapidly through countries in South and Central America and infected millions of people. Adults who contract the virus may develop a fever, rash, headache, and other tolerable symptoms which usually resolve within 7-10 days. However, the virus poses a serious risk to 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 normal.⁵

In the last decade, scientists have been working on ways of using genetic engineering to prevent mosquito-borne diseases.⁶ Two different strategies have received the most attention. The first involves introducing mutations into male mosquitos which overproduce a protein that causes toxicity and results in premature death of offspring, unless they are exposed to the antibiotic tetracycline, which inactivates the mutations. Genetically modified (GM) males are released into the wild, where they mate with females. Because the offspring die before they can reproduce, the population decreases. The GM mosquito is not likely to become established in the wild, due to its lethal mutation. GM males must be re-introduced periodically to keep the population in check. The biotechnology company Oxitec has tested this method on Aedes aegypti mosquitoes at several sites around the world, including the Cayman Islands, Panama, Malaysia, and Brazil.⁷ Field tests have produced an 80-95% decline in Aedes aegypti populations.⁸ According to Oxitec, the release of its GM mosquitoes resulted in a 91% decline in dengue fever cases in Brazil’s Eldorado district and a 52% reduction in the Piracicaba district.⁹

The second strategy involves genetically modifying mosquitoes to resist targeted diseases or render them incapable of transmitting those diseases.¹⁰ To implement this strategy, researchers introduce disease-resistance genes into mosquitoes and release them into the wild. To promote rapid proliferation of the mutation in the population, the disease-resistance genes are attached to genes (known as gene drive systems) which distort Mendelian inheritance so that the mutations increase in the population irrespective of the effects of natural selection or random genetic drift.¹¹ This second strategy, unlike the first, can lead to permanent genetic changes in the mosquito population.¹² So far, this strategy has only been tested in the laboratory.¹³

Each approach has benefits and risks.¹⁴ The benefit of the first approach is that it can reduce populations of disease vectors, which can decrease the likelihood that human beings will contract those diseases.¹⁵ For years, people have used pesticides to control mosquito populations, but mosquitoes have become resistant to many of the chemicals currently being used.¹⁶ Also, pesticides can have adverse effects on human health and non-human species, such as birds, fish, aquatic animals, earth-worms, and bees.¹⁷ One of the risks of the first approach is that it could significantly reduce populations of targeted mosquitoes, which could disrupt the food web,¹⁸ because mosquitoes, in their larval or adult forms, are a primary food source for various species of fish, aquatic insects, flying insects, birds, amphibians, reptiles, and bats and they are also pollinators.¹⁹ However, this point is contested and some ecologists argue that the food web would eventually adjust to the eradication of a mosquito species.²⁰

A benefit of the second approach is that it can increase disease-resistance among targeted mosquitoes, which can decrease the likelihood that humans will contract those diseases from mosquitoes.²¹ A risk of this approach is that the pathogen carried by the mosquitoes might evolve so that it can overcome the disease-resistance genes.²² The evolved pathogen might be more difficult to control than the previous version.²³ Another risk is that this approach might make targeted mosquitoes more susceptible to carrying other diseases that can infect human beings.²⁴ A third risk of this approach is that the gene drive system might move from the targeted species and incorporate into the genomes of other species via horizontal gene transfer,²⁵ with unpredictable effects on the environment and public health.²⁶

Obtaining the support of the local community is an essential legal, ethical, and practical requirement for conducting GM mosquito field trials.²⁷ Researchers cannot legally conduct field trials in many countries unless they first obtain approvals from national and local authorities, such as environmental or public health agencies.²⁸ For example, researchers for proposed field trials in Florida needed to obtain approval from the Food and Drug Administration and the Monroe County Mosquito Control District (see discussion of community engagement cases below). Since legal requirements tend to be procedural and formalistic, this paper will focus on ethical requirements. From an ethical perspective, the principles of autonomy and justice require that people who are likely to be impacted by a proposed public health research project or intervention should have meaningful input into decision-making related to the intervention.²⁹ It also makes little practical sense to conduct a GM mosquito field trial if it is likely to meet with stiff resistance from the local community.³⁰

While there is widespread agreement concerning the importance of community engagement in public health research, there is less agreement about how to do this effectively, especially given public opposition to genetically modified organisms (GMOs) in many countries.³¹ In this article, I will examine the ethical foundations of obtaining local support for field trials of GM mosquitoes, describe some standards for effective community engagement, and draw some conclusions from actual cases involving community engagement.

2 ∣. COMMUNITY ENGAGEMENT IN PUBLIC HEALTH RESEARCH

Before exploring ethics of community engagement in field trials of GM mosquitoes, it is important to indicate what I mean by “community engagement.” A “community” is commonly defined as “a social group of any size whose members reside in a specific locality, share government, and often have a common cultural and historical heritage.”³² While we sometimes refer to communities in in terms of their common cultural, ethnic, sexual, political, or religious characteristics, e.g. the Lesbian, Gay, Bisexual, Transgender, Queer community or the African American community,³³ when we are thinking about community engagement in GM mosquito field trials, it is appropriate to focus on geographic communities, since individuals living at or near a release site will face the direct risks related to the experiment and reap the potential benefits.³⁴ However, it is still important to appreciate the social, economic, ethnic, and cultural diversity among people living in an area where mosquitoes may be released.³⁵

While individuals living outside of the site, such as environmental activists, may have political interests which could be impacted by a field trial, it is impractical to target these groups for community engagement, because one would need to interact with an indeterminate number of people and canvass their views. Moreover, one might argue that it would be unfair to give outsiders substantial input into such decisions, since their opinions might diverge from community’s. For example, suppose that members of a local community favor a field trial to help prevent a mosquito-borne disease that is causing them considerable hardship. One might argue that it would be unfair to allow outsiders (such as environmental interest groups) to prevent the trial from occurring, since those in the local community will have the most direct stake in the field trial. Likewise, it would also be unfair to allow 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 important to understand how outside interest groups may impact local decision-making, because these groups may try to influence local communities and public health officials.

To “engage” has many different common meanings, including “to occupy the attention or efforts of…secure for aid, employment, use…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 exchange of information, ideas, and opinions; mutual respect for values and interests; and shared decision-making.³⁸ For a decision to be shared, both partners must agree to it. Thus, a proposed project or intervention that impacts that local community should not occur unless the community agrees to it (see discussion of community consent below).

Engaging the community concerning proposed public health research projects or interventions is important for respecting the autonomy of the people living within a targeted area.³⁹ The right to make autonomous decisions relating to one’s health, well-being, life plans, and conduct is a widely accepted principle in biomedical ethics, jurisprudence, and public policy.⁴⁰ One way of respecting autonomy is to allow people to decide whether they will be exposed to certain types of risks.⁴¹ Since field trials of GM mosquitoes pose risks to community members, they should be able to decide whether the benefits of the trials, such as prevention of mosquito-borne illnesses, are worth the risks. However, since it is often not possible to obtain consent from each individual living in a highly populated area targeted for research project or intervention, consent from the community often may need to suffice.⁴²

What does it mean for a community to “consent” to a public health research project or intervention? This is a difficult question to answer, because we usually think of consent as applying to individuals, not communities.⁴³ Since consent is a form of decision-making, community consent can be equated with the political process that a community normally uses to make choices pertaining to issues affecting its members. These processes may vary, depending on the nature of the community. For a community in the US, consent may take place by means of voting on referenda or decision-making by elected officials. In a village in Africa, tribal leaders may make decisions for the community. I will not examine these political processes in significant detail in this article, but I will assume that the community where a GM mosquito field trial may occur has a legitimate political process for making decisions.⁴⁴

Someone might object that obtaining consent from the community rather than from each individual living in it violates the rights of those who do not agree with the proposed project or intervention. For example, suppose that a county agency is planning to build a public hospital to serve its population and that voters have approved a bond measure to fund it. However, some people who are living near the proposed site oppose the plan because it will increase traffic, pollution, and noise levels. Should these opponents of the hospital be allowed to stand in the way of a project intended to improve the health of the community, which has been approved by the majority?

The issue of how to respect minority rights involves political and moral questions which extend beyond the scope of the present inquiry. For the purposes of this paper, I will follow Gutmann and Thompson’s account of minority rights in democratic societies.⁴⁵ According to Gutmann and Thompson, majority rule is a legitimate method for making public decisions in democratic societies because it treats all voting members as having equal political standing. Since each citizen has one vote and all votes are equal, and the option with the most votes should win. However, there should be limits on majority rule to protect some basic rights and liberties possessed by all citizens, such as freedom of expression, freedom of religion, legal due process, property rights, and so on. A law approved by the majority should not be able to strip people of these basic rights and liberties.⁴⁶ Also, democratic decision-making should include strategies for reaching out to all citizens, especially racial or ethnic minorities or socioeconomically disadvantaged groups, to ensure that they have the opportunity for meaningful input into public decision-making (see discussion of inclusiveness below).⁴⁷

Although individual consent is not always required to implement public health interventions or research projects that can significantly benefit the community,⁴⁸ it is required when researchers intend to interact with and/or collect biological samples or private data from human subjects.⁴⁹ Well-established regulations, guidelines, and ethics codes require 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 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, Oxitec’s studies have collected data on Aedes aegypti populations and the prevalence of mosquito-borne diseases, but they have not obtained samples or private data from human subjects.⁵² However, since it may not always be obvious that studies do not involve human subjects, researchers conducting field trials of GM mosquitoes should consult with local ethics committees to ensure that human subjects review is not required.

Community engagement can also be viewed as a mechanism for promoting environmental justice.⁵³ The environmental justice movement in the US emerged in the 1980s when minority communities objected to the placement of waste sites in their neighborhoods without their input or approval.⁵⁴ They argued that they were being unfairly exposed to environmental risks without sufficient compensating benefits or meaningful involvement in decision-making. The US Environmental Protection Agency applies principles of environmental justice to its regulatory decision-making.⁵⁵ Although researchers are not seeking to engage communities to mobilize protests of their work, effective community engagement can reduce the odds of this happening by giving community members meaningful involvement in decision-making.

Fairness in decision related to environmental exposures can be understood in relation to outcomes or decision-making processes.⁵⁶ An outcome is fair if it leads to a just (or fair) distribution of benefits and risks. For a field trial of GM mosquitoes to be fair in this sense, community members should not be unduly burdened with risks without compensating benefits. A careful evaluation of the benefits and risks of a field trial, as well as how these may impact different members of the community, can help ensure that the trial meets outcome-based criteria of fairness. A process is fair if affected stakeholders have the opportunity for meaningful input into decision-making.⁵⁷ Input is meaningful if it can substantially affect the outcome of the decision (see discussions of consent, information sharing, and responsiveness 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).

3 ∣. ETHICAL GUIDELINES FOR COMMUNITY ENGAGEMENT

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:

• Timeliness: Community engagement should begin very early in the planning process to give community members enough time to process information, ask questions, discuss the study with their neighbors and friends, and so on.

• Consent: The community should have the right to give its permission, consent, or approval; studies should not occur without community consent. Engaging the community early in the process can help assure residents that their wishes will be honored and that the study or project is not a fait accompli. Since researchers (and their sponsoring organizations) have more power and influence than community members, they have an obligation assure community members that they are partners in the decision-making process and their voices matter. To do this, researchers should engage in or provide a robust deliberative process where the pros and cons of the proposal are fully explored to facilitate informed decision-making.

• Information sharing: Researchers, public health officials, and community members should share relevant information and knowledge with each other. Researchers and public health officials should provide information about the nature and purpose of intervention or project, its risks and benefits, other available options for dealing with the problem, funding sources, and regulatory approvals. Community members should communicate their needs, interests, and concerns to researchers or officials. Researchers and officials should also share the results of the study with community members when it is completed as well as any new information related to their health and welfare. Since researchers and public health officials have much more knowledge and expertise concerning proposed projects or interventions than community members, their obligations to share and explain information are much greater. Researchers should describe scientific concepts in lay language and 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 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 beliefs, even when they disagree. Researchers should not belittle or denigrate community beliefs, opinions, or attitudes, such as philosophical opposition to GMOs (see discussion below), even if they view them as irrational or unscientific.

• Inclusiveness: Everyone in the community should have an opportunity to participate in the decision-making process regardless of income, education, race, ethnicity, gender, or religion, and efforts should be made to reach out to socioeconomically disadvantaged members of the community and minorities.

In the next two sections of this article, I will describe the community engagement activities in several field trials of GM mosquitoes a draw some conclusions from these efforts.

4 ∣. COMMUNITY ENGAGEMENT IN FIELD TRIALS OF GM MOSQUITOES

Oxitec’s first field trial of its GM Aedes aegypti mosquitoes took place in an isolated area of the Cayman Islands in 2009 and 2010.⁵⁹ At the time of the release, the country had no regulations concerning the release of GM organisms into the wild. Although Oxitec researchers obtained approval for the trial from country’s Mosquito Research and Control Unit, they neither consulted with nor obtained consent from the local community.⁶⁰ Critics argued that the local community should have been involved in the decision-making.⁶¹ Although the second field trial included more community engagement,⁶² critics have complained that the community engagement was inadequate.⁶³ Opponents of the release claimed that Oxitec had not provided enough information to the community and had not addressed their questions, fears, and concerns.⁶⁴ Despite these complaints, Oxitec researchers released thousands of GM mosquitoes in the West Bay area in July 2016 to help the country deal with its dengue fever and Zika epidemics.⁶⁵

In December 2010, Oxitec researchers released 6000 GM mosquitoes in an uninhabited forest in Malaysia after extensive community engagement.⁶⁶ Malaysia’s Department of Biosafety announced the proposed field trial in local newspapers and solicited comments from the public and non-governmental environmental organizations. Malaysian officials also distributed posters (in four languages) announcing the proposed field trial and sought input from local councils and community leaders. Malaysian officials approved the field trial only after reviewing safety and efficacy data presented by Oxitec researchers and addressing public comments and concerns. The Malaysian Biosafety Act requires public consultation prior to any release of GM organisms in wild.⁶⁷ In 2015, the Malaysian government decided not to move forward with widespread release of GM mosquitoes, 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 authorities and community leaders also consented to the project. Public engagement took place via announcements in the media (including social media), distribution of posters and leaflets; meetings with community members, and presentations at schools. The project also employed technicians to go door-to-door to answer questions from residents and learn more about their opinions and concerns.⁷⁰ Members of affected communities expressed strong support for the field trials.⁷¹ It is worth noting, however, that Brazil, like Malaysia, has not yet approved widespread release of GM mosquitoes.

Following an outbreak of dengue fever in Key West, Florida in 2010, the Florida Keys Mosquito Control District publicly announced it was considering a proposal to release Oxitec’s GM mosquitoes. In June 2012, researchers surveyed 400 residents of Monroe County, Florida concerning their opinions about the proposed field trial. 51.1% of respondents had heard about it. Among those who already knew about the proposed trial, 9.7% were strongly opposed, 8.2% were opposed, 25.1% were neutral, 22.1% were supportive, and 34.9% were strongly supportive.⁷² After the survey was conducted, the Florida Keys Mosquito Control District engaged the community in various ways, such as making public announcements in various media, delivering presentations 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 Monroe County resident Mila de Mier collected over 170,000 online signatures on a petition opposing the release of the mosquitoes. The petition cited concerns that radically decreasing the population of Aedes aegypti mosquitoes could destabilize the ecosystem by threatening bat populations or could increase mosquito species that carry a more virulent form of dengue or some other disease.⁷⁵ It is important to mention, however, that since the population of Key Haven is just over 32,000,⁷⁶ most of signers of the petition came from outside the community.

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 information about antibiotic resistance in its mosquitoes.⁷⁷ In response to this request, Oxitec researchers said that they had thoroughly studied the issue and that the risk of the mosquitoes infecting the human population with antibiotic-resistant bacteria was negligible.⁷⁸

Rumors with no basis in scientific fact began to circulate.⁷⁹ Some people claimed that recent Zika outbreaks came from Oxitec’s GM mosquitoes [recent outbreaks did not start in the areas where the field trials took place], and some feared that a bite from one of Oxitec’ mosquitoes could make a child sterile [the mosquitoes are males, which don’t bite]. Distrust of the federal government, biotechnology companies, GMOs, and scientists also played a role in turning the tide against the field trials.⁸⁰ A survey of Key Haven residents conducted in 2015 found that most had a negative opinion of the field trials. Opponents of the trials were concerned about the impacts of the mosquitoes on public health and the environment.⁸¹

In July 2016, the US Food and Drug Administration approved Oxitec’s plans to conduct field trials of GM Aedes aegypti mosquitoes in Key Haven, Florida, concluding that the mosquitoes did not pose a threat to public health or the environment.⁸² Residents of Key Haven voted against allowing the field trials to take place in their community. However, Monroe County voters passed a referendum to approve the field trials (Key Haven in located in Monroe County).⁸³ Florida residents also voted in favor of allowing the field trials to occur in the state during the general election. On November 19, the Monroe County Mosquito Control District approved the field trials, which could begin in 2017.⁸⁴ Since residents of Key Haven have voted against these trials, they will must take place in a different part of Monroe County.

5 ∣. DISCUSSION

The publicly available information for the field trials of GM mosquitos at these four sites supports following conclusions concerning community engagement activities.

First, the inaugural field trial of GM mosquitoes in the Cayman Islands clearly did not meet most of the standards for community engagement described above, since there was no community engagement prior to initiating the study. The Mosquito Research and Control Unit, not the community, consented to the release. It also appears that the other standards, such as information sharing, responsiveness, understanding, and so on, also were not met. Although the second field trial included more community consultation than the first, critics argued that community consultation was still deficient.⁸⁵ Community consultation in the second field trial may not have met several standards, including information sharing, transparency, responsiveness, understanding, and respect.

Second, community engagement in the Brazilian field trials appears to have been outstanding. The community engagement efforts in Brazil are especially noteworthy for including door-to-door question and answer sessions. Visiting the homes of community members 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 also played an important role in shaping community attitudes and perceptions. It is not clear whether the researchers sought to correct these misperceptions or whether they understood the impact of false beliefs on community attitudes toward the trial.

The researchers may have also not understood the impact of some of the values that shaped the community’s decision-making, such as general opposition to GMOs, and distrust of biotechnology companies, scientists, and the federal government. The Florida Keys case illustrates some of the difficulties researchers are likely to encounter when seeking permission from communities to conduct field trials of GM mosquitoes.

Fourth, additional research is needed on the effectiveness of different methods of engaging communities in field trials of GM mosquitoes.⁸⁶ Researchers should survey members of the local population before and after initiating community engagement activities to learn more about their attitudes toward and perceptions of the decision-making process. They should also conduct interviews with community members to explore their concerns, attitudes, perceptions, and opinions in greater depth. Articles reporting the results of field trials of GM mosquitoes should include detailed descriptions of regulatory approvals and community engagement activities.

Fifth, controversies concerning GMOs are likely to continue to impact community decisions concerning field trials of GM mosquitoes.⁸⁷ 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 cultivation of GM crops has met with little resistance in the developing nations of Argentina, Brazil, China and India, but in Mozambique, Namibia, and Zambia public opposition has been strong.⁸⁹ As seen above, public concerns about GMOs played a significant role in Key Haven’s decision to reject the field trial of GM mosquitoes. Anti-GMO activists have also opposed field trials of Oxitec’s mosquitoes in Brazil, the Cayman Islands, and Malaysia.⁹⁰ Much of the opposition to GM mosquitoes has come from environmental activists who reside outside of the areas impacted by the field trials. Environmental groups, such as Friends of the Earth, Greenpeace International, and Organic Consumers Association have also mounted global campaigns against GM foods, crops, plants, and animals.⁹¹

Public opposition to GMOs stands in sharp contrast to scientific enthusiasm for genetic engineering of organisms as a tool for advancing scientific knowledge pertaining to human health and disease, manufacturing biologics and biofuels, increasing crop yields, and reducing the use of pesticides. Many scientists view the public’s negative attitudes toward GMOs as irrational and ignorant, because numerous studies have shown GM foods are just as safe to eat as non-GM foods and that GM crops pose minimal risks to the environment.⁹² In 2016, over one hundred Nobel Prize winners signed a letter to Greenpeace International criticizing organization’s stance against GMOs as anti-scientific and harmful to scientific progress and human health.⁹³

Although researchers may be frustrated with public opposition to GMOs, they should still try to understand and address it. Indeed, public distrust of GMOs makes effective community engagement for field trials of GM mosquitoes especially important. Researchers who are seeking to conduct field trials of GM mosquitoes should be prepared to discuss the benefits and risks of these studies with the local community and to respond to questions and concerns they have about GMOs in a manner that respects their opinions, beliefs, values, and attitudes. Additional research on how to respond to public skepticism concerning GMOs may provide researchers and public health officials with knowledge they can utilize in engaging communities and selecting potential sites for release of GM mosquitoes.⁹⁴

6 ∣. CONCLUSION

Effective community engagement is an important legal, ethical, and practical prerequisite for conducting field trials of GM mosquitoes. Researchers who are planning to conduct field trials of GM mosquitoes 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 respect. Additional research on how to conduct effective community engagement and respond to public skepticism of GMOs can provide researchers and public health officials with knowledge they can utilize in planning field trials of GM mosquitoes and selecting sites for potential release of these organisms.

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 (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.

Biography

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 Angeles.