“Malaria, one of the most ancient and deadly diseases of humankind, can and should be eradicated before the middle of the 21st century,” kicks off the introduction to a new report by the internationally acclaimed medical journal, The Lancet.

It is a claim the peer-reviewed report’s authors — 41 of the world’s leading malariologists, biomedical scientists, economists, and health policy experts — acknowledge as “bold,” before outlining exactly how the 86 remaining countries with endemic malaria can achieve ridding themselves of the disease within one generation.

India is one such country. With the fourth-highest number of malaria cases in the world, India is likely to be one of the focal points of this effort. It’s a unique battleground; while in most of the 86 malaria-endemic countries, malaria is a rural disease, in India, malaria is harbored in urban centers, which proffer “water storage containers, wells, gutters, and construction sites” — ideal breeding grounds for Anopheles stephensi, the mosquito responsible for most of the country’s malaria transmissions. For example, 71% of all malaria cases in Tamil Nadu in 2017 occurred in Chennai.

Some recommendations for India are common to many developing countries where malaria is endemic and where public health systems are weak, such as strengthening the regulation of, and cooperation with, the private health care system. This would improve data collection and allow for improved targeting of eradication efforts, since “under [current health care system] conditions, malaria and other diseases are commonly misdiagnosed, incorrectly treated, and unreported.” While gains can be made here, India is actually ahead of the curve on this one; the National Strategic Plan for Malaria Elimination, launched in 2017, aims to scale up diagnostic testing, treatment, and surveillance, and improve the drug and diagnostics supply chain, training of community workers, and distribution of bed nets, according to a Hindustan Times report last year.

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But these measures, while successful in decreasing India’s number of malaria infections and deaths, will only go so far. They are generalized improvements aimed at controlling infection, improving diagnosis and treatment, and targeting efforts — not eradication. This is why The Lancet report also offers a unique recommendation to eliminate the disease, taking into account India’s increasingly urbanized malaria scenario: gene drives. Gene drives involve genetically modifying mosquitos — either to become resistant to infection by P falciparum, the parasite that causes malaria, or to produce male offspring only, as female mosquitos are the only ones who bite and thus transfer the parasite. They are a promising measure in the fight to eradicate malaria, and Target Malaria, a non-profit research consortium, is developing one of these gene drives, which offers “the potential to address urban malaria in India,” the report notes.

But gene drives are a controversial step; tweaking the DNA of a living organism — with the goal of reproduction to spread that tweaked DNA until it becomes the organism’s norm — is a fraught topic. Gene drives may be the most promising method of eradicating malaria from an urban environment, but they will undoubtedly set off a vast ethical debate about their deployment — especially given the country’s debate over genetically modified crops and distrust of Western-developed technologies, like vaccines.

“There are no regulators that have handled this before,” Jonathan Kayondo, a Target Malaria researcher, told a Vox reporter in 2018.

In light of that, according to a 2018 Vox report on gene drives (which is worth a read in its entirety), Target Malaria is currently working with Burkina Faso — the country with the second-highest per capita incidence of malaria, according to The Lancet report — to release mosquitos genetically modified to be sterile; these mosquitos will do nothing to stop the spread of malaria, but are intended as an initial show of good faith and no harm that will dispel myths about genetically modified organisms and build public support for a future gene drive.

But the thing about genetically modifying a species is that it’s difficult to limit or predict, just as a species of millions, maybe billions, in the wild is difficult to limit or predict. As the Vox article points out, “A Burkina Faso field trial absolutely will not remain a Burkina Faso field trial. A Burkina Faso field trial isn’t even a field trial at all. It could eventually result in continent-wide deployment of the technology.”

All of this is to say gene drives are an opportunity for India in more ways than one — a chance to eliminate malaria as a scourage of its population, and a chance to be a leader within an unprecedented ethical debate.