Malaria in the 21st century

Tonight’s lectures on malaria, presented by the Oxford Global Health Group, demonstrated once more the kind of opportunity that is being missed with regards to global development. According to the World Health Organization (WHO), one million people per year die from the parasite. In addition, the direct economic costs imposed exceed $12B a year: a figure agreed upon by the two scientists and the representative from GlaxoSmithKline. By contrast, the WHO estimate for the cost of controlling malaria globally is just $3.2B a year. While money alone can’t solve so complex a problem, the gap between what is possible and what is being done remains unacceptable.

Like HIV/AIDS, while efforts are being made to find an effective vaccine, the state of affairs at the moment includes treatment and prevention measures. As Adrian Hill – the Director of Oxford’s Jenner Institute – discussed, there has never been an effective vaccine developed against any human parasitic illness, and the incredible complexity of the malarial life cycle and the long period of endemic coexistence between people, mosquitos, and parasites makes it a task of fiendish difficulty. That doesn’t mean that a vaccine is impossible. Indeed, Dr. Hill stressed how two moderately effective vaccines based on different approaches could combine into a single highly effective treatment. What it does mean is that the existence of effective mitigation mechanisms like pesticide-coated bednets and combination anti-malarial therapies should be focused upon.

I was pleased to learn that Oxford is presently the only organization in the world that is carrying out any level of clinical trial for vaccines addressing tuberculosis, HIV/AIDS, and malaria. Each has an enormous global toll, in terms of lives lost and societies disrupted, and all are well within the present financial means of the world to reduce in significance enormously. When the constant refrain is that official development assistance gets spirited off by corrupt governments and into foreign bank accounts and BMWs, the case for funding large-scale research into the development and cost-reduction of medical responses to devastating illnesses of the poor world is clear and compelling.

The comparison everybody makes is with arms expenditures. That’s fair enough. Discretionary spending on armaments in the 2004 American federal budget was $399B. Three times more was spent on just missile defence than would cover the WHO’s estimated cost for global malarial control. $1.2B was allocated just for the V-22 Osprey aircraft: a design that many, even within the Air Force, consider hopelessly flawed and too dangerous to ever put into operation.

Though of another way, Canada’s GDP is about $1000B. The WHO estimate is therefore just 0.32% of the GDP of a single, relatively unpopulous, member of the rich country club. If anything, the global experience of smallpox and polio has shown that bold and properly funded global health strategies can yield fantastic returns. The chance to capitalize on that potential for AIDS, malaria, and TB is sitting right there for us to grasp.

The latest offence in the global fight against malaria: Build a better mosquito.

Scientists have developed the first genetically modified mosquito (GMM) that is completely immune to the disease the insects so efficiently spread. An estimated 250 million people worldwide contract the deadly blood-borne disease a year; one million of them die.

The GMM mosquitoes will still bite; they just won’t leave behind the malaria-causing parasite, called Plasmodium.

“Hopefully, down the road this will play a part in controlling malaria,” says lead researcher, entomologist Michael Riehle. The research was published Thursday afternoon in the journal Public Library of Science Pathogens.

Although releasing the new mosquito into the wild is a long way off, Dr. Riehle says that given the drawbacks of other malaria-fighters, especially the mosquito’s growing resistance to various insecticides and vaccines, it is a method worth investigating.

“Malaria is a very smart parasite and our best efforts haven’t done much to reduce the impact of it. That’s why we have to keep trying these different approaches, to find something that works.”

While previous research has been able to create mosquitoes that are 97 per cent resistant to malaria, that’s just not enough, Dr. Riehle says.

LONDON – The world’s first potential malaria vaccine proved only 30 per cent effective in African babies in a crucial trial, calling into question whether it can be a useful weapon in the fight against the deadly disease.

The surprisingly poor result for the vaccine, which GlaxoSmithKline has been developing for three decades, leaves several years of work ahead before a protective malaria shot could be ready for countries that desperately need one.

On November 15th the Global Fund’s board said it would end a controversial pilot scheme for treating malaria. Discussions about this scheme began in 2002. The malaria parasite had long developed ways to fend off one type of drug, chloroquine, and doctors feared it would increasingly resist artemisinin, a newer treatment. After much deliberation a committee at America’s Institute of Medicine proposed a new way to supply artemisinin-based combination therapies (ACTs). A funding agency could negotiate prices with drug manufacturers and subsidise the medicine at the local level. The ACTs would be available at public facilities and sold by tiny drug shops, in many villages the only source of medicine. Use of older drugs would drop. The Global Fund introduced the Affordable Medicines Facility-malaria (AMFm) in seven African countries and Cambodia in 2010. To date it has spent $463m on the programme.

Malaria vaccinesThe long war
A new vaccine will help, but will not defeat malaria

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A clinical trial at 11 sites in seven African countries shows RTS,S does indeed protect against malaria. But it does not work as well as researchers had hoped. The recent data show the effect 18 months after vaccination. In children (aged five to 17 months when vaccinated) it reduced the number of cases by 46%. In infants (aged six to 12 weeks) it reduced them by 27%. And its effect seems to wane. Earlier results showed efficacies after one year of 56% in children and 31% in infants.