PHILADELPHIA, PENNSYLVANIA—Ivermectin, the 30-year-old antiparasitic drug whose discovery was honored with a Nobel Prize last month, may have another trick up its sleeve: killing mosquitoes. A new study in Burkina Faso suggests that mass-administering ivermectin to people may kill or weaken the mosquitoes feeding on them, and thus make a dent in malaria transmission.
Ivermectin is best known for killing roundworms, including the ones that cause river blindness and the leading cause of elephantiasis. But researchers have known for decades that the drug also kills insects if they ingest it. Brian Foy, a medical entomologist at Colorado State University, Fort Collins, believes that makes it a prime candidate in the fight against malaria. If enough people in an area have ivermectin in their blood, says Foy, some of the female mosquitoes that bite them will die, whereas others will be too weakened to pass on the malaria parasite. Foy has shown in lab studies that the approach holds promise, and co-founded a research network last year to study the concept further.
To show that ivermectin actually has an impact on malaria in the field, Foy teamed up with Roch Dabiré, a researcher at the Institute of Health Studies in Bobo-Dioulasso, Burkina Faso. The scientists went to eight villages near the town of Diébougou, in the southwest of the country. At the start of the trial, in July, the population of all villages received one dose of ivermectin and another drug, albendazole; this standard combination is given twice yearly around Burkina Faso to control elephantiasis and soil-transmitted worms.
In four of the villages, this was followed by ivermectin tablets every 3 weeks for the entire population except pregnant women and children under 90 centimeters tall, who may be at higher risk of side effects. The four other villages served as controls; they received no drugs after the first dose.
The trial is still ongoing and will conclude in November. But an interim analysis presented today by Foy and Dabiré at the annual meeting of the American Society of Tropical Medicine and Hygiene suggests that the drug is already having an impact. Among children under the age of 5—the group at the highest risk of severe disease and death from malaria—there were 16% fewer cases in the villages that received ivermectin at 3-week intervals. That translates to 94 cases averted so far this season in the four villages.
The full results will take some time to analyze, and the study will need to be repeated at a larger scale to see if the findings hold up, Dabiré says. If they do, ivermectin could be another weapon in the antimalaria arsenal, Foy says. He adds that it wouldn’t replace other measures, such as insecticide-treated bed nets.
It’s an interesting approach that should be explored further, says Michel Boussinesq, who studies ivermectin at the Institute of Research for Development in Montpellier, France. But the need to give ivermectin every 3 weeks could be a logistical problem, he says. Boussinesq and his colleagues are working on an ivermectin implant for animals that instead releases the drug slowly and offers long-term protection.
Such implants aren’t likely to be acceptable for use in humans, Foy says—but he points out that ivermectin would only be given during the rainy season, when malaria mosquitoes are active. The season lasts about 6 months in the region where the study took place and even less than that farther north, in the Sahel region. “I think that’s feasible,” Foy says.
Willem Takken, a medical entomologist at Wageningen University and Research Centre in the Netherlands, sees another, fundamental problem: Mosquitoes have developed resistance against almost any chemical that humans have thrown at them. He says that’s bound to happen with ivermectin, too. That’s why, despite the encouraging data, “I find it hard to get enthusiastic about this,” Takken says. He believes that nonchemical approaches, such as mosquito traps or bacteria that render mosquitoes unable to transmit pathogens, hold more long-term promise.