Da Tanzania er mit hjemland bør jeg byde Jer velkommen igen. Tak, fordi I kom.
I guess because I'm from Tanzania I have a responsibility to welcome all of you once again. Thank you for coming.
Før vi begynder - hvor mange af jer har været ofre for insektet her? Undskyld på vegne af alle myggefangere.
So, first of all, before we start, how many of you in the audience have been in the past a victim of this bug here? We apologize on behalf of all the mosquito catchers.
(Latter)
(Laughter)
Mine damer og herrer, forestil jer at blive bidt af syv inficerede myg om dagen. Det er 2.555 inficerede myggebid årligt. Da jeg gik på universitetet, flyttede jeg til Kilombero floddalen i den sydøstlige del af Tanzania. Det var historisk et af de mest malariainficerede områder i verden dengang. Livet var svært der. I de sene stadier viser malaria sig som ekstreme anfald, der lokalt kaldes "degedege". Det har dræbt både kvinder og mænd, voksne og børn, uden nåde.
Ladies and gentlemen, imagine getting seven infectious mosquito bites every day. That's 2,555 infectious bites every year. When I was in college, I moved to the Kilombero River valley in the southeastern part of Tanzania. This is historically one of the most malarious zones in the world at that time. Life here was difficult. In its later stages malaria manifested with extreme seizures locally known as degedege. It's killed both women and men, adults and children, without mercy.
Min institution, Ifakara Health Institute, blev grundlagt i denne dal i 1950'erne for at afhjælpe presserende helbredsbehov i lokalsamfundene. Faktisk er "Ifakara" navnet på et sted, hvor man går hen for at dø, og det afspejler, hvordan livet plejede at være her i dagene før et organiseret offentligt sundhedsvæsen. Da jeg flyttede hertil var min primære rolle at anslå, hvor ofte malaria blev overført mellem landsbyerne, og hvilke myg, der bar sygdommen.
My home institution, Ifakara Health Institute, began in this valley in the 1950s to address priority health needs for the local communities. In fact, the name Ifakara refers to a place you go to die, which is a reflection of what life used to be here in the days before organized public health care. When I first moved here, my primary role was to estimate how much malaria transmission was going on across the villages and which mosquitoes were transmitting the disease.
Min kollega og jeg rejste 30 km syd for Ifakara by, over floden. Hver aften tog vi ind til landsbyerne med lommelygter og hæverter. Vi rullede buksebenene op og ventede på de myg, der kom for at bide os, så vi kunne indsamle dem for at se, om de var malariabærere.
So my colleague and myself came 30 kilometers south of Ifakara town across the river. Every evening we went into the villages with flashlights and siphons. We rolled up our trousers, and waited for mosquitoes that were coming to bite us so we could collect them to check if they were carrying malaria.
(Latter)
(Laughter)
Min kollega og jeg udvalgte et hus. Vi var både inde og ude og byttede position hver halve time Dét gjorde vi i 12 timer hver nat 24 nætter i træk. Vi sov fire timer hver morgen, og arbejdede resten af dagen med at sortere myg, bestemme dem og kappe hovederne af dem, så laboratoriet kunne analysere dem for tegn på, at de bar malariaparasitter i munddelene. Herved fandt vi ikke bare ud af, hvor udbredt malaria var, men også hvilke myg, der bar malariaen. Vi fandt også ud af, om malariaen mest var inden for eller uden for husene.
My colleague and myself selected a household, and we started inside and outside, swapping positions every half hour. And we did this for 12 hours every night for 24 consecutive nights. We slept for four hours every morning and worked the rest of the day, sorting mosquitoes, identifying them and chopping off their heads so they could be analyzed in the lab to check if they were carrying malaria parasites in their blood mouthparts. This way we were able to not only know how much malaria was going on here but also which mosquitoes were carrying this malaria. We were also able to know whether malaria was mostly inside houses or outside houses.
Mine damer og herrer, jeg lever stadig af at fange myg. Jeg gør det mest for at forbedre folks tilværelse Nogen kalder den verdens farligste dyr hvilket desværre er sandt. Men hvad ved vi egentlig om myg? Det viser sig at være meget lidt. Det bedste værn vi vi øjeblikket har mod malaria er giftbehandlede sengenet. Vi ved nu, at der i hele Afrika er udbredt resistens mod insektgifte. Disse insektgifte, af typen "pyrethroider", bruges på sengenettene. Vi ved nu, at sengenettene beskytter mod bid, men kun dræber en brøkdel af de myg, de burde. Det betyder, at vi skal gøre mere for at nå nulpunktet Det er vores ansvar.
Today, ladies and gentlemen, I still catch mosquitoes for a living. But I do this mostly to improve people's lives and well-being. This has been called by some people the most dangerous animal on earth -- which unfortunately is true. But what do we really know about mosquitoes? It turns out we actually know very little. Consider the fact that at the moment our best practice against malaria are bednets -- insecticide treated bednets. We know now that across Africa you have widespread resistance to insecticides. And these are the same insecticides, the pyrethroid class, that are put on these bednets. We know now that these bednets protect you from bites but only minimally kill the mosquitoes that they should. What it means is that we've got to do more to be able to get to zero. And that's part of our duty.
På Ifakara Health Institute fokuserer vi på myggens biologi for at finde nye muligheder. Nye tilgange. Nye måder at udvikle nye løsninger, som f.eks. kan bruges sammen med sengenettene for at nå til nul. Jeg viser et par eksempler på ting, mine kolleger og jeg arbejder med.
At Ifakara Health Institute we focus very much on the biology of the mosquito, and we try to do this so we can identify new opportunities. A new approach. New ways to try and get new options that we can use together with things such as bednets to be able to get to zero. And I'm going to share with you a few examples of the things that my colleagues and myself do.
For eksempel: Myg yngler i små vandpytter, som er svære at finde - de kan være spredt i landsbyerne, og kan være så små som hovspor. De kan være lige bag dit hus, eller langt derfra. Hvis man vil kontrollere antallet af myggelarver, kan det være temmelig svært at finde dem. Det, mine kolleger og jeg vil gøre, er et forsøg på at bruge myggene til at bære insektgiftene fra et bestemt sted til deres ynglepladser så æggene ikke overlever.
Take this, for example. Mosquitoes breed in small pools of water. Not all of them are easy to find -- they can be scattered across villages, they can be as small as hoofprints. They can be behind your house or far from your house. And so, if you wanted to control mosquito larvae, it can actually be quite difficult to get them. What my colleagues and I have decided to do is to think about what if we used mosquitoes themselves to carry the insecticides from a place of our choice to their own breeding habitats so that whichever eggs they lay there shall not survive.
Dette er Dickson Lwetoijera. Han er min kollega, der styrer dette tiltag i Ifakara. Han har vist hvordan man lokker myggene til det sted de normalt suger blod Her får de en dosis sterilisation eller gift, som bæres med retur til ynglestedet og dræber afkommet. Vi har vist, at det fungerer og dræber bestande meget hurtigt. Det er smukt.
This is Dickson Lwetoijera. This is my colleague who runs this show at Ifakara. And he has demonstrated cleverly that you can actually get mosquitoes to come to the place where they normally come to get blood to pick up a dose of sterilants or insecticide, carry this back to their own breeding habitat and kill all their progeny. And we have demonstrated that you can do this and crush populations very, very rapidly. This is beautiful.
Dette er vores mygge-by. Det er den største myggefarm i verden, til brug for malariaforskning. Her har vi store selvbærende kolonier af malariamyg som vi opretholder. De er naturligvis ikke smittebærere. De tillader os at afprøve nye metoder og øjeblikkeligt teste dem, hurtigt, og se, om vi kan dræbe eller kontrollere bestandene. Mine kolleger har påvist, at hvis vi blot har to-tre steder, hvorfra myggene kan hente disse giftige væsker, så kan vi dræbe kolonierne på kun tre måneder. Vi kalder det "autodisseminering".
This is our mosquito city. It is the largest mosquito farm available in the world for malaria research. Here we have large-scale self-sustaining colonies of malaria mosquitoes that we rear in these facilities. Of course, they are disease-free. But what these systems allow us to do is to introduce new tools and test them immediately, very quickly, and see if we can crush these populations or control them in some way. And my colleagues have demonstrated that if you just put two or three positions where mosquitoes can go pick up these lethal substances, we can crush these colonies in just three months. That's autodissemination, as we call it.
Men tænk, hvis vi kunne bruge myggenes forplantning til at kontrollere dem? Først må jeg fortælle, at myg normalt yngler i sværme. Han-myg samles normalt gruppevis i horisonten efter solnedgang. Hannerne danser og hunnerne flyver ind i dansen og vælger en han-myg, som regel ham, de synes er flottest. De klumper sig sammen og falder til jorden. Hvis man ser dette, er det smukt. Det er et fantastisk fænomen. Her bliver vores mygge-indsamling spændende. Når vi går på rov i sumpe ved landsbyerne ser vi, at vandet ofte samler sig de samme steder dagligt, ugentligt, månedligt, år efter år. Myggene begynder på det samme tidspunkt, på de samme steder. Hvad betyder det? Det betyder, at hvis vi kortlægger disse steder i landsbyerne, kan vi faktisk udrydde disse bestande med ét slag. Sådan, bombesprøjte eller tilintetgøre dem. Det forsøger vi at gøre gennem unge mænd og kvinder i landsbyerne. Vi organiserer grupperne, lærer dem at identificere sværmene, og sprøjte dem ihjel. Mine kolleger og jeg mener, at vi har en ny mulighed for at fjerne myg fra dalen.
But what if we could use the mosquitoes' sexual behavior to also control them? So, first of all I would like to tell you that actually mosquitoes mate in what we call swarms. Male mosquitoes usually congregate in clusters around the horizon, usually after sunset. The males go there for a dance, the females fly into that dance and select a male mosquito of their choice, usually the best-looking male in their view. They clump together and fall down onto the floor. If you watch this, it's beautiful. It's a fantastic phenomenon. This is where our mosquito-catching work gets really interesting. What we have seen, when we go swarm hunting in the villages, is that these swarm locations tend to be at exactly the same location every day, every week, every month, year in, year out. They start at exactly the same time of the evening, and they are at exactly the same locations. What does this tell us? It means that if we can map all these locations across villages, we could actually crush these populations by just a single blow. Kind of, you know, bomb-spray them or nuke them out. And that is what we try to do with young men and women across the villages. We organize these crews, teach them how to identify the swarms, and spray them out. My colleagues and I believe we have a new window to get mosquitoes out of the valley.
Men det, at myg suger menneskeblod gør dem til verdens farligste dyr. Der foregår således: Myg kan lugte dig. De har udviklet utrolige sanseorganer. De kan lugte op til 100m. Og når de nærmer sig, kan de kende forskel på to familiemedlemmer. De ved hvem du er, baseret på det, du udskiller med din ånde, hud, sved og lugt. I Ifakara har vi fundet ud af hvad det er ved din hud, krop, sved eller ånde, som myggene synes om. Da vi havde fundet ud af det, blandede vi en væske, en blanding af kunstige stoffer som minder om det, din krop udskiller. Vi lavede en syntetisk blanding, der tiltrak 3-5 gange flere myg, end mennesker gør. Hvad kan dette bruges til? Man sætter en fælde, lokker myg til, og dræber dem. Man kan også bruge det til overvågning. På Ifakara ønsker vi at vide mere om myggens biologi for at kontrollere de sygdomme foruden malaria, som myg er bærere af. For eksempel dengue feber, chikungunya og zika virus. Derfor har mine kolleger f.eks. set på det faktum at nogle myg helst stikker i benene. Vi har derfor udviklet sandaler med myggebalsam, som turister og lokale kan have på. Så bliver man ikke bidt, men har konstant beskyttelse, indtil du kravler under dit sengenet.
But perhaps the fact that mosquitoes eat blood, human blood, is the reason they are the most dangerous animal on earth. But think about it this way -- mosquitoes actually smell you. And they have developed incredible sensory organs. They can smell from as far sometimes as 100 meters away. And when they get closer, they can even tell the difference between two family members. They know who you are based on what you produce from your breath, skin, sweat and body odor. What we have done at Ifakara is to identify what it is in your skin, your body, your sweat or your breath that these mosquitoes like. Once we identified these substances, we created a concoction, kind of a mixture, a blend of synthetic substances that are reminiscent of what you produce from your body. And we made a synthetic blend that was attracting three to five times more mosquitoes than a human being. What can you do with this? You put in a trap, lure a lot of mosquitoes and you kill them, right? And of course, you can also use it for surveillance. At Ifakara we wish to expand our knowledge on the biology of the mosquito; to control many other diseases, including, of course, the malaria, but also those other diseases that mosquitoes transmit like dengue, Chikungunya and Zika virus. And this is why my colleagues, for example -- we have looked at the fact that some mosquitoes like to bite you on the leg region. And we've now created these mosquito repellent sandals that tourists and locals can wear when they're coming. And you don't get bitten -- this gives you 'round the clock protection until the time you go under your bednet.
(Klapsalve)
(Applause)
Mit had-kærlighedsforhold til myg fortsætter.
My love-hate relationship with mosquitoes continues.
(Latter)
(Laughter)
Og det vil sandsynligvis fortsætte længe endnu. Det er OK. Verdenssundhedsorganisationen (WHO) har som mål at udrydde malaria i 35 lande. Den afrikanske Union har som mål at udslette malaria fra kontinentet inden 2013. På Ifakara står vi bag disse målsætninger. Vi har samlet en gruppe unge forskere, mænd og kvinder, som kæmper for målene, og som ønsker at samarbejde for at nå dem. De gør, hvad de kan for at få det til at lykkes. Og vi støtter dem. Vi er her for at sikre, at disse drømme opfyldes.
And it's going to go a long way, I can see. But that's OK. WHO has set a goal of 2030 to eliminate malaria from 35 countries. The African Union has set a goal of 2030 to eliminate malaria from the continent. At Ifakara we are firmly behind these goals. And we've put together a cohort of young scientists, male and female, who are champions, who are interested in coming together to make this vision come true. They do what they can to make it work. And we are supporting them. We are here to make sure that these dreams come true.
Mine damer og herrer, selv om det ikke sker i vores levetid, selv om det ikke sker før du og jeg går bort, er jeg sikker på at vore børn arver en verden fri for malariabærende myg og fri for malaria. Mange tak, mine damer og herrer.
Ladies and gentlemen, even if it doesn't happen in our lifetime, even if it doesn't happen before you and me go away, I believe that your child and my child shall inherit a world free of malaria transmitting mosquitoes and free of malaria. Thank you very much, ladies and gentlemen.
(Klapsalve)
(Applause)
Mange tak.
Thank you.
Kelo Kubu: Godt, Fredros. Lad os tale om CRISPR et øjeblik.
Kelo Kubu: OK, Fredros. Let's talk about CRISPR for a bit.
(Latter)
(Laughter)
Det har taget verden med storm, og lover at udrette utrolige ting. Hvad synes du om, at forskere bruger CRISPR til at dræbe myg?
It's taken the world by storm, it promises to do amazing things. What do you think of scientists using CRISPR to kill off mosquitoes?
Fredros Okumu: Lad os begynde med, hvad problemet er. For det første taler vi om en sygdom, der stadig dræber; det nyeste tal fra Verdenssudhedsorganisationen er 429.000 mennesker. De fleste er afrikanske børn. Vi har selvfølgelig gjort fremskridt, der er lande, der har opnået 50-60% mindre malaria. Men vi er nødt til at gøre mere for at nå til nul. Man har allerede bevist princippet bag teknikker for genetiske ændringer - såsom CRISPR - og deres brug til effektivt at ændre myg, så de enten ikke bærer malaria - hvilket kaldes populationsændringer - eller udryddes, kaldet populationshæmning. Dette er bevist i laboratorier.
Fredros Okumu: To answer this question, let's start from what the problem is. First of all, we're talking about a disease that still kills -- according to the latest figures we have from WHO -- 429,000 people. Most of these are African children. Of course, we've made progress, there are countries that have achieved up to 50-60 percent reduction in malaria burden. But we still have to do more to get to zero. There is already proof of principle that gene-editing techniques, such as CRISPR, can be used effectively to transform mosquitoes so that either they do not transmit malaria -- we call this population alteration -- or that they no longer exist, population suppression. This is already proven in the lab.
Der er også modeller, der viser, at selv om man udsætter bare et lille antal genetisk ændrede myg, så vil man meget hurtigt opnå udslettelse. Redskaber som CRISPR er reelle muligheder - gode muligheder for meget virksomme indsatser - som kan bruges i tilgift til vores andre redskaber for at nå til nul. Det er vigtigt. Folk spørger os altid - det er et almindeligt spørgsmål, så du stiller det sikkert også - "Hvad så, hvis vi udsletter myg?"
There is also modeling work that has demonstrated that even if you were to release just a small number of these genetically modified mosquitoes, that you can actually achieve elimination very, very quickly. So, CRISPR and tools like this offer us some real opportunities -- real-life opportunities to have high-impact interventions that we can use in addition to what we have now to eventually go to zero. This is important. Now, of course people always ask us -- which is a common question, I guess you're going to ask this as well -- "What happens if you eliminate mosquitoes?"
KK: Så spørger jeg ikke, svar bare.
KK: I won't ask then, you answer.
FO: OK. Jeg vil blot minde mine kolleger om, at vi har 3.500 myggearter i verden. Måske flere. Cirka 400 af dem er Anopheles, og kun cirka 70 af disse kan bære malaria. I Afrika skal vi håndtere 3-4 af disse, som bærer cika 99% af al malaria. Hvis vi anvendte genetiske ændringer såsom CRISPR, hvis vi brugte genændringer til at kontrollere malaria, ville vi kun rette det mod 1-2 arter. Det ser jeg intet diversitetsproblem ved. Det er min personlige holdning. Det synes jeg er i orden. Husk, i øvrigt, at i alle årene, hvor vi har forsøgt at udrydde disse myg ved at sprøjte dem - vores kolleger i Amerika har sprøjtet dem - virkelig sprøjtebombet for at fjerne dem fra landsbyerne. I Afrika sprøjter vi mest i husholdningen. Alt dette er for at dræbe myg. Så det er intet problem at have et nyt redskab.
FO: OK. In respect to this, I would just like to remind my colleagues that we have 3,500 mosquito species in this world. Maybe more than that. About 400 of these are Anophelenes, and only about 70 of them have any capacity to transmit malaria. In Africa, we're having to deal with three or four of these as the major guys. They carry most -- like 99 percent of all the malaria we have. If we were to go out with gene editing like CRISPR, if we were to go out with gene drives to control malaria, we would be going after only one or two. I don't see a diversity problem with that. But that's personal view. I think it's OK. And remember, by the way, all these years we've been trying to eliminate these mosquitoes effectively by spraying them -- our colleagues in America have sprayed with -- really bomb-spraying these insects out of the villages. In Africa we do a lot of household spraying. All these are aimed solely at killing the mosquitoes. So there's really no problem if we had a new tool.
Alligevel må jeg sige, at vi skal udvise stor ansvarlighed. Der er reguleringer og vi må samarbejde med myndighederne og sikre, at alt bliver gjort rigtigt, ansvarligt, og vi må foretage uafhængige risikovurderinger for at sikre, at alle disse processer ikke falder i de forkerte hænder. Mange tak.
But having said that, I have to say we also have to be very, very responsible here. So there's the regulatory side, and we have to partner with our regulators and make sure that everything that we do is done correctly, is done responsibly and that we also have to do independent risk assessments, to just make sure that all these processes do not fall into the wrong hands. Thank you very much.
KK: Mange tak.
KK: Thank you.
(Klapsalve)
(Applause)