Table 3.

Some considerations for ecological confinement

Consideration	Island	Mainland
Efficacy	Possibility of less complex mosquito population genetics, less polymorphism, may increase chances of initial establishment	Easier to obtain conditions for realistic prediction of establishment and spread rate comparable to those necessary for testing epidemiological efficacy
	May provide a simpler mosquito population structure less generalizable to mainland settings
	Lower potential for inward migration of wild-type mosquitoes may increase ability to detect establishment and spread
Containment	Genetic evidence for some degree of isolation may simplify monitoring	Difficult to define boundaries and thus to control diffusion
	Boat or air traffic to and from islands may complicate detection of escapes	Any road or river traffic in the area could increase emigration potential
Monitoring	Depending on size, may facilitate intense monitoring	May require monitoring over larger area
Engagement	Malaria elimination may be achievable using conventional methods, decreasing willingness to try a novel strategy	Malaria elimination likely to require new tools, simplifying explanation of potential benefit for public health
	Depending on location, may be less likely to have local scientific leadership and champion for the technology	More likely to have research infrastructure, local scientific leadership, and champion
Regulatory issues	Regional approval desirable in the absence of guaranteed confinement	Regional approval highly relevant
	Depending on degree of isolation, may have special biodiversity considerations