Table 2 Quotations that illustrate theme 2

2

Identifying and weighing alternatives

Comparing GDTs to conventional strategies

2A

Conventional strategies are harmful, underlining the need for an alternative strategy

R18: “Our current [anti-malarial] tools, they do have a negative effect. We treat it as being the status quo and so therefore we don’t measure the negative effects, but every pesticide we use on an environment still has a negative, [whichever] we choose. You should compare like with like, but it’s very infrequent that people compare like to like, we have a much greater fear of the new and the novel, as opposed to the cost that we are having already (..) Let’s not say our [anti-malarial] tools are currently not teratogenic or highly problematic to human health”

2B

Conventional strategies are inadequate, underlining the need for an alternative strategy

R5: “The tools we have are good because they’ve saved lives but they’re not perfect or sufficient. Which is why we need something new and this could be it.”

2C

GDTs are complimentary to conventional strategies

R14: “it doesn’t take anything away from what we are already doing. (..) it adds to all of the different interventions. (..) Even if they were around the corner, even if they got used and even if they were being successfully used, don’t stop the other interventions. You’d be mad to do that”

Comparing GDTs to systematic changes to global health, political and agricultural systems

2D

Agricultural change is needed to solve the problem of agricultural pests

R11: Like if you want to use [gene drives] in agriculture, what does that mean? Are we going to eliminate pests, so called pests, that actually are there because of the way we have chosen to do agriculture, which has proven to be a real problem for the climate, as well as for biodiversity?”

2E

Health care and political change is needed to target vector-borne disease

R16: “I would say at many places it’s mainly a political thing. If you have like [a] good water system, good hospitals, good access to treatment; that would make that the malaria issue is much less problematic”

Exhausting alternatives and feasibility of alternatives

2F

Questioning whether conventional strategies have been exhausted

R29: “You can look at countries like Paraguay and a number of other countries that have recently been declared as malaria-free, and there’s a lot of really wonderful studies as to what they did. I mean, there are so many approaches from the policy level to the grassroots level and education; so many different strategies and tactics that all need to be implemented”

2G

Changes in global health care, political and agricultural systems not feasible

R18: “You would need to spend a crazy amount of money in the sites where we work to be able to reach the social determinants of health high enough to stop malaria transmission, it would be huge, it’s unattainable”

2H

Difficulty in deciding what should be taken as a given or as changeable

R6: “This is the very hard thing in this area, is to say what to keep fixed”