Putting evolution in elimination: Winning our ongoing battle with evolving malaria mosquitoes and parasites

Abstract

Since 2000, the world has made significant progress in reducing malaria morbidity and mortality, and several countries in Africa, South America and South‐East Asia are working hard to eliminate the disease. These elimination efforts continue to rely heavily on antimalarial drugs and insecticide‐based interventions, which remain the cornerstones of malaria treatment and prevention. However, resistance has emerged against nearly every antimalarial drug and insecticide that is available. In this review we discuss the evolutionary consequences of the way we currently implement antimalarial interventions, which is leading to resistance and may ultimately lead to control failure, but also how evolutionary principles can be applied to extend the lifespan of current and novel interventions. A greater understanding of the general evolutionary principles that are at the core of emerging resistance is urgently needed if we are to develop improved resistance management strategies with the ultimate goal to achieve a malaria‐free world.

Transmission traits of malaria parasites within the mosquito: Genetic variation, phenotypic plasticity, and consequences for control

“…Ongoing control efforts, relying mostly on antimalarial drugs and insecticide‐based interventions such as long‐lasting insecticidal nets and indoor residual spraying against mosquito vectors, have reduced malaria transmission (Bhatt et al., ). However, these interventions have selected for drug and insecticide resistance which could jeopardize control efforts (Huijben & Paaijmans, ; Sternberg & Thomas, ).…”

Impact of sublethal pyrethroid exposure on resistant Anopheles gambiae mosquitoes’ fitness

“…This effect can be explained through a resources based tradeoff between fecundity and survival [28] as the over-production of detoxifying enzymes triggered upon exposure to insecticide is probably associated with energetic cost, which impacts the resource available for egg laying. Such a regulation would indicates a high adaptative cost related to insecticide resistance [29], which have been already demonstrated in previous studies [30][31][32][33][34]. The low rate of egg laying would logically be translated epidemiologically into a decrease in vector density and a thus decrease in transmission.…”

Core Principles for Evolutionary Medicine

“…Despite these insights, a fully sophisticated evolutionary approach to antibiotic resistance is still developing; the word 'evolution' is avoided in many medical articles (Antonovics et al 2007). If new strategies to combat infection are to be found, they will need to rely on more sophisticated evolutionary models (Pepper 2008;Vale et al 2016;Huijben and Paaijmans 2017). Even such basic questions as whether it is wise to continue antibiotics for a full 10-day course remain controversial (Read et al 2011;Day and Read 2016;Bouglé et al 2017) but increasingly studied, with longer courses now recognised as usually unnecessary (Uranga et al 2016).…”