News Article
From Boston Globe
HEADLINE:
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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