Malaria is preventable and curable, yet nearly half the world’s population remains at risk of catching the mosquito-borne disease. In Africa, which accounted for 95% of the 247 million global cases in 2021, bed nets and indoor spraying of insecticide are the primary tools to curb infections. New vaccines are also being aimed at preventing transmission in young children, who are among the most at risk of dying from the illness. Entrepreneur Arnon Houri-Yafin says policymakers should pursue an additional approach: Stop the bugs from reproducing in the first place.
Houri-Yafin is the founder of Zzapp Malaria, a startup based in Tel Aviv that has created a tool that uses satellite imagery to identify water bodies in which malaria-carrying mosquitoes reproduce and to predict where new water sources will form. Zzapp’s mobile application then helps field workers find water sources they can treat with a biological control—a bacterium called Bacillus thuringiensis subspecies israelensis (Bti)—that targets the larvae of mosquitoes, gnats and black flies and is not toxic to other insects, humans and animals.
While other antimalarial efforts are effective at reducing infections, they don’t attempt to stem the problem at its source, Houri-Yafin says. Referring to the treatment of water bodies, he says: “We believe this is the only way to eliminate the disease.” At about $1 per person annually in an urban setting, Zzapp’s solution has a cost comparable to that of bed nets, he says.
By 2030, the World Health Organization aims to reduce both the incidence of malaria and mortality from the disease by 90%, as well as to eliminate it in 35 countries and prevent its resurgence in places that are currently free of it. Progress was hampered by the Covid-19 pandemic, which disrupted prevention and treatment efforts. Other challenges are the parasite’s increasing resistance to widely used drugs and insecticides and the threat that climate change will push transmission from mostly tropical areas into new regions.
Zzapp says it has run trials of its approach in São Tomé and Príncipe, an island nation off Africa’s west coast, and in five east African countries. After treating almost 13,000 water bodies in São Tomé and Príncipe, the mosquito population dropped 75% and malaria cases halved, according to Zzapp.
The company is a spinoff of Israeli blood test startup Sight Diagnostics. About $3 million in prize money from artificial intelligence startup competitions has helped fund Zzapp’s operations, and the Bill & Melinda Gates Foundation covered the costs of its trial in Zanzibar and awarded Zzapp an additional $70,000.
Treating water sources to halt the development of malaria-carrying insects isn’t new. It was successful in some areas of Brazil decades ago and was used in Israel to eradicate the disease by the 1960s. But the WHO recommends going after mosquito breeding sites only when they are “few, fixed and findable,” says Basil Brooke, the head of the vector control reference laboratory at South Africa’s National Institute for Communicable Diseases (NICD). “That’s those that lend themselves to treatment because they are big enough, but not too big.”
As Africa’s population rapidly increases—it’s expected to almost double by 2050—more people will live closer together in villages, towns and cities. Malaria control experts have identified that one way to prevent mosquitoes from breeding is to limit open bodies of water near communities, Brooke says, calling urban planning “quite an important feature” of disease prevention.
Houri-Yafin says that Zzapp’s water identification and treatment, which must be done weekly, can work in both urban and rural settings. But he says that countries may be daunted by logistical challenges and elect to apply the method only around populated areas.
Gaining community acceptance for the use of larvicides could be another hurdle, says Jaishree Raman, the head of the NICD’s laboratory for antimalarial resistance monitoring. “If you are wanting to use larvicides, especially in urban areas, you have to have community buy-in,” Raman says. “Whether the water is for drinking or animal use, you definitely have to have very good community engagement prior, during and after treating the water.”
Zzapp is currently in talks with officials in Mozambique and Ghana about potential contracts; if finalized, they would constitute its first significant paid work, Houri-Yafin says. “It’ll be an opportunity to save so many lives,” he says. “Mozambique is one of the leading countries in terms of malaria per capita—in terms of not only mortality but also morbidity.”
SOURCE: Bloomberg
