OBSTACLES TO EFFECTIVE CONTROL
A. WEAK POLITICAL
FACT is that foresight and compassion are no match for politics
and profits in setting priorities for disease research. When
malaria comes here, we'll seriously get to work on it. But sadly,
not until then."
Daniel S. Greenberg
in The Washington Post (1998)
- There is the healthy,
wealthy world; and the ill, poor nowhere. In sub-Saharan Africa
alone, malaria destroys 76% more years of productive life
than do all cancers in all economically developed countries.
Yet the US spends fifty times as much on cancer research as
malaria research. This is typical: in Canada, the difference
- Vanquishing malaria
is like fitting together a puzzle. First you lay out the pieces:
talking about the problem; training scientists and doctors;
providing research funding. Then you build the edges: introducing
control measures to the field; teaching communities to use
them; studying how the disease fights back against control;
designing new drugs and vaccines. Then you fill the center:
testing new drugs and vaccines; sharing those that work. The
last piece makes a picture of health. But it takes political
will, in the beginning, to open the puzzle box!
- Africa is asking
for that political will; is anyone listening? In 1997, the
53 African heads of state passed a resolution at the Organization
of African Unity, to ask for help against malaria. Without
scientific tools themselves, African countries must rely on
developed countries to hear their plea.
- With a commitment,
disease control is possible. Politicians acted to eradicate
smallpox from the face of the earth for about $300 million.
In a campaign of less than a decade, 97% of cases of guinea
worm were eliminated it will be driven extinct within five
years. In just one day in 1997, India vaccinated 130 million
children against polio. Similar "vaccination days", paid for
by governments, the WHO and groups like the Rotary Club, will
destroy this killer of children by the year 2000..
SOURCES: World Bank;
Wellcome Trust; Medical Research Council (Canada); Organization
of African Unity; Carter Center; Rotary International.
B. THE LOOMING
CRISIS OF DRUG RESISTANCE
IS EMERGING AND SPREADING faster than new drugs can be developed...Given
the speed with which parasites are becoming resistant and the
length of time required to develop new drugs (even accelerated
development takes 5 to 10 years from discovery to clinic), we
face a looming crisis: multidrug-resistant malaria with no safe,
effective alternatives for treatment. This problem exists today
in Southeast Asia and will occur in most other malaria-endemic
areas within the next decade."
of Technology, Technology Review (1997)
"NOT A SINGLE
major Western pharmaceutical company is now developing new drugs
Institute of Medicine
of the National Academy of Sciences of the United States (1997)
- The "good" strains
of malaria are difficult to treat; the "bad" ones are impossible.
Careless drug use has caused malaria parasites to evolve survival
strategies against drugs. In most areas, malaria parasites
resist at least one drug. In others, they resist all known
drugs. There are no failsafe treatments a state of affairs
not known since the discovery of quinine in the 17th century.
- Malaria prevention
is also in jeopardy. Travelers to malarious areas take antimalarial
drugs to avoid getting the disease, but the parasite can resist
prophylactic drugs too. There is no prescription that guarantees
a traveler absolute safety from malaria.
- Things are getting
worse, not better. Today, only government and university labs
do malaria drug research, on a budget under that of the 1980s.
The US military has invented most of the drugs used in the
last 50 years, yet its drug research program advances on just
$5 million a year, and even this is threatened by cuts.
SOURCES: WHO; Journal
of the American Medical Association; New Scientist;
C. THE QUEST
FOR A VACCINE
"...A VACCINE that
can prevent illness and death of malaria could be one of the
most important advances in medicine, with the potential for
improving the lives of hundreds of millions of people." [emphasis
"IN SPITE OF GROWING
SCIENTIFIC OPTIMISM, the pace of vaccine development appears
to be slowing because of diminishing public funds, fragmented
public sector efforts, and limited interest within the vaccine
Both from Institute
of Medicine of the National Academy of Sciences (1996)
* * *
FINDING A CHEAP,
EFFECTIVE MALARIA VACCINE IS THE HOLY GRAIL OF RESEARCH. Unlike
drugs that prevent or treat the disease only so long as they
are taken, vaccines confer enduring, even life-long, immunity
to disease. If a good vaccine is distributed widely enough,
it is even possible to forever wipe the disease from the face
of the earth.
- Researchers have
yet to develop a successful malaria vaccine in humans, although
they have succeeded in immunizing many types of animals, from
rats to monkeys. The last step is proving elusive, even though
studies over 20 years ago proved that humans can be successfully
immunized in the laboratory.
- The barriers to
vaccine development are not so much technical as financial.
Although eight clinical trials are now underway globally,
many other candidate vaccines are kept out of trials because
research funding is so petty. US military scientists alone
possesses a half dozen candidate vaccines ready for human
testing, but with a budget of just $4 million a year, they
cannot do the job. European, Australian and South American
labs are in a similar bind.
Today; Military Infectious Diseases Research Program, US
Department of Defence; New York Times; Nature.
D. POOR COORDINATION
"THE URGENT NEED
is to put malaria on the scientific, media and political agenda,
and in particular to identify it as a priority for research,
both in the developed North and in those areas of the South
where the disease is endemic... We recognize that the control
of malaria in Africa will require a long-term collaboration
between scientists in the North and South...[and] commitments
from the industrialized countries to funding, and from African
leaders to support scientist and health and research infrastructures
in their countries."
of seven countries, the World Bank, the World Health Organization,
Organization of African Unity, and the Wellcome Trust (1997)
NO ONE COUNTRY WILL
SOLVE MALARIA. A disease endemic to 100 countries needs multilateral
effort to conquer. Rich states must give of their funds and
technological expertise; poor states must supply facilities
and cooperate, especially in field research.
- The Multilateral
Initiative on Malaria (MIM) began as a joint African-American-European
project that brought together representatives from thirty-seven
countries, three charities and three intergovernmental agencies
in Senegal in 1997. Despite a plea for joint action to save
lives in Africa, countries have so far responded with token
funding donations, no where near the hundred's of millions of
dollars now needed and which could become available with a serious
of Medicine, National Academy of Sciences (USA); Ralph Nader;
World Health Organization.