Malaria in the 21st century

Painting in Magdalen CollegeTonight’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.

Author: Milan

In the spring of 2005, I graduated from the University of British Columbia with a degree in International Relations and a general focus in the area of environmental politics. In the fall of 2005, I began reading for an M.Phil in IR at Wadham College, Oxford. Outside school, I am very interested in photography, writing, and the outdoors. I am writing this blog to keep in touch with friends and family around the world, provide a more personal view of graduate student life in Oxford, and pass on some lessons I've learned here.

24 thoughts on “Malaria in the 21st century”

  1. Note to self: write a post soon about why the argument that children saved from malaria will just go on to starve is a profoundly fallacious one.

  3. Pingback: a sibilant intake of breath » Blog Archive » Positive externalities and the environment

  4. Genetically altered mosquito may spell end of malaria

    Scientists develop new mosquito that is completely immune to the disease the insects spread

    Tralee Pearce

    From Friday’s Globe and Mail Published on Thursday, Jul. 15, 2010 5:00PM EDT Last updated on Friday, Jul. 16, 2010 9:58AM EDT

    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.

  5. Setback for first malaria vaccine in African trial

    By Kate Kelland and Ben Hirschler

    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.

  6. By most measures the millennia-long fight against malaria has now had enormous success. Between 2000 and 2010 malaria rates plunged by more than 50% in 43 countries. But questions remain how best to stamp out the disease.

    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.

  7. Malaria vaccines
    The long war
    A new vaccine will help, but will not defeat malaria

    …

    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.

  9. ‘Milestone’ for child malaria vaccine

    By Smitha Mundasad
    Health reporter, BBC News

    Reporting in PLOS Medicine, researchers found that for every 1,000 children who received the vaccine, an average of 800 cases of illness could be prevented.

    And in continuing trials it went on to provide protection some 18 months after the injections were given.

    Manufacturers GSK have now applied for regulatory approval – making this the first vaccine to reach this step.

  10. Malaria, too, has been beaten back in the past 15 years, but could stage a resurgence. A vaccine is already in use in several countries, but its efficacy is limited and it is not yet clear how much use it will be in the poorest countries. Drug companies and research foundations are working to develop better ones, but success is some way off. In the meantime, drug-resistant strains could evolve and spread. Without continuing research into new insecticides to use with bednets, says Mr Gates, deaths from malaria could rise again, as high as 1m a year.

  11. The parasite was once endemic throughout Europe, not just in southern countries like Greece but as far north as Finland. In Italy in the late 19th century it used to kill 15,000 people each year. But by the end of the last century public-health programmes had rid the continent of the disease. Today, even in Africa and Asia, the war on malaria is going well: between 2000 and 2015, the World Health Organisation reported a 37% drop in the global incidence rate, and a 60% fall in the death toll.

    One might thus think that in Switzerland, of all places, doctors would have little need for anti-malarial treatments. Yet data from the Swiss public health department (BAG) show that annual cases of P. vivax have recently jumped, from under 200 in the mid-2000s to 250-400 for the past four years. Similar increases in malaria have been recorded in Germany, France and Sweden, according to the European Centre for Disease Control (ECDC). Almost all of the Swiss cases since the start of the migrant crisis in 2014 have been refugees from Eritrea.

  12. In 1960 George Craig, an American entomologist, suggested that such subversive genes might be a way of controlling the populations of disease-carrying mosquitoes, for example by making them more likely to have male offspring than female ones. In 2003 Austin Burt, at Imperial College, described how a gene drive that could cut a place for itself in a chromosome and copy itself into the resulting gap could, in the right circumstances, drive a species to extinction.

    A fascinating idea, but one hard to put into practice—until, in 2012, a powerful new gene-editing tool called crispr-Cas9 became available. Gene drives based on crispr-Cas9 could easily be engineered to target specific bits of the chromosome and insert themselves seamlessly into the gap, thus ensuring that every gamete gets a copy (see diagram). By 2016, gene drives had been created in yeast, fruitflies and two species of mosquito. In work published in the journal Nature Biotechnology in September, Andrea Crisanti, Mr Burt and colleagues at Imperial showed that one of their gene drives could drive a small, caged population of the mosquito Anopheles gambiae to extinction—the first time a gene drive had shown itself capable of doing this. The next step is to try this in a larger caged population.

  23. A new malaria vaccine shows promising results
    If further tests remain successful, it could be deployed in the field as soon as 2023

    …

    Most diseases that used to kill children in large numbers have succumbed to vaccines. Malaria is an exception. In 2020 it killed 640,000 people, mostly African children under five years old. Scientists have not ignored the scourge: the first candidate vaccine trial took place in the 1940s; more than a hundred jabs have been in development since.

    …

    The latest results are from a trial in Burkina Faso, where almost half of people get malaria each year.

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