The environmental impact of a malaria clinical trial in Mali: Life cycle assessment reveals high emissions due to international travel and local electricity use and identifies opportunities for sustainable improvement

Merel Smit , Almahamoudou Mahamar, Emma Kooistra, Kjerstin Lanke, Koualy Sanogo, Patrick Wilikpan Okedy, Mohamed A. Yehia, Chris Drakeley, Hugo Touw, Will Stone, Alassane Dicko, Teun Bousema , Tim Stobernack

Climate change may be the single largest threat facing humanity and ecosystems, necessitating decarbonization across all sectors, including healthcare and academia. With the aim of informing and supporting sustainable research practices, we performed a life cycle assessment of a clinical trial conducted in Mali. The trial involved 80 malaria-infected participants in Ouélessébougou who were treated with antimalarials and followed for 28 days to determine their clinical and transmission-blocking efficacy. Data on consumables, transportation, travel, and electricity use were collected in Mali and the Netherlands, where additional laboratory analyses and sample storage occurred. Data were analysed using the ReCiPe 2016 method for midpoint impact assessment. The trial involved 3 intercontinental shipments of materials and samples, 59,900 km of travel by research staff, and ~55 kg of plastics. Trial conduct and reporting resulted in 20.5 metric tonnes of CO2-equivalent (CO2e) emissions. Major contributors were international travel (50%), electricity in Mali (28%), and air-transportation (14%). Laboratory consumables, while contributing up to 22% of the trial’s impact on land and water use, were less important sources of emissions (2% of CO2e). Whereas the electricity mix in Mali, ~60% fossil-fuel-based, was disadvantageous for the carbon footprint, laboratory analyses in the Netherlands benefited from 100% wind energy, resulting in a minor overall contribution to emissions (<1%). We observed no loss in stability of parasite genetic material (mRNA) in protective buffers when stored for 12 months at -20°C, compared to conventional -70°C. These results form a foundation for improving the environmental sustainability of clinical trials in Africa. Switching to energy-efficient equipment settings could reduce electricity consumption by over 30%. Implementing solar panels in the Mali laboratory would reduce CO2e emissions by 28%. Immediate CO2e reductions can be achieved through online conference attendance and alternative sample transportation, which would contribute an additional 10% CO2e reduction.