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From Boston Globe


Malaria Resists Treatment and Cure

DATELINE: October 25, 1999, Monday, City Edition

SECTION: SCIENCE & TECHNOLOGY; Pg. F3 BYLINE: By Barbara Borst, Globe Correspondent

For years, Dr. Dyann Wirth and Dr. Evan Lee have been fighting a war with blunted weapons - a war that kills at least one million people annually, most of them children in Africa.

The enemy - malaria - is devious. The battlefield is worldwide, from Wirth's office at the Harvard School of Public Health to the refugee camps where Lee, an East Boston physician, has worked in Africa. Last week the international group through which Lee donates his time, Doctors Without Borders, was awarded the Nobel Peace Prize for its humanitarian work in areas of the world where disaster, be it war, famine or epidemic, strikes.

The old weapons against malaria are failing; the parasite is increasingly resistant to insecticides and to the major drugs used to fight it, including the once reliable chloroquine. The disease has shown a remarkable capacity for variation and mutation, making it difficult to treat and control. While a single case of measles grants the sufferer lifelong immunity from the disease, even multiple bouts of malaria produce only partial immunity.

Malaria is transmitted by the Anopheles mosquito. The insect carries the parasite, Plasmodium, from one person to another; the disease reproduces in the liver and then invades red blood cells. In mild cases, malaria causes recurrent fever and chills; in severe ones, it causes anemia, weakness, coma or death.

Many pharmaceutical companies have dropped out of tropical disease research because there is little chance of recouping their investment in impoverished countries, where people are too poor to buy the drugs without government assistance.

The best approach to eradicating or limiting malaria is a vaccine, say experts, but few companies have an incentive to invest in one. Wirth, director of the Harvard Malaria Initiative at the Harvard School of Public Health, believes "there has to be a new paradigm of governments getting involved" in providing incentives for companies to work on drug or vaccine development.

Until that happens, the World Health Organization has taken the reigns with its Roll Back Malaria campaign, begun last year, which is attacking the disease on several fronts. Earlier this month, WHO said it would help provide 60 million African families with insecticide-treated mosquito nets over the next five years. Studies have shown that the treated nets can reduce malaria deaths by 25 percent.

The Roll Back Malaria campaign is unique in the realm of disease control, say experts, both for its global scale and for the diversity of partners engaged in a single coordinated effort. The campaign brings together academic researchers, pharmaceutical companies, government and private donors, international agencies, health officials from developing countries, and humanitarian relief groups.

It links basic research, such as that done by Wirth, director of the Harvard Malaria Initiative, with emergency services, such as that provided by Lee and other physicians.

Lee, who practices at the East Boston Neighborhood Health Center, worked in the Somali refugee camps of eastern Kenya for Doctors Without Borders. The most common diseases he treated were diarrhea, respiratory tract infections, and malaria. Many people had deadly combinations of malnutrition and parasitic infections.

"We needed a wider arsenal of weapons," he recalls. Like other relief workers, he lived with "a kind of contradiction" that is emblematic of malaria generally: he was protected by prophylactic medications, bed nets treated with insecticide, and an adequate diet, none of which the refugees have access to in their daily lives.

Wirth sees an urgent need for the development of better medications, since she does not expect an effective vaccine to be in the pipeline anytime soon.

She surveyed 20 major pharmaceutical companies and found only two involved in malaria research: one had an anti-malarial medicine in the final stages of development and another was working on a vaccine and combinations of existing drugs.

Malaria kills about 1.1 million people worldwide each year, about 1 million of them in Africa. The overwhelming majority of them are children under five; indeed, one of every four childhood deaths in African is due to malaria.

People living in malarial areas may endure an infectious bite every night; they may have chronic anemia, immune system suppression, and vulnerability to countless other maladies. Children may suffer 10 to 20 bouts of malaria before the age of five; if they survive into adulthood, they often gain partial immunity that reduces the severity of the disease but does not prevent subsequent infections.

"Malaria is very much a development issue, not just a health issue," says Dr. Kamini Mendis, a WHO malaria specialist in Geneva. In addition to time lost from work and school, the disease discourages outside investment because companies hesitate to send representatives to malarial regions.

"Malaria may thus be a cause, and not just a consequence, of underdevelopment," according to WHO's 1999 World Health Report.

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