Malaria Aid, Research Ramp Up to Tackle Africa Crisis

Stefan Lovgren
for National Geographic News
July 21, 2005
More than a million people die of malaria each year, 90 percent of them in Africa. Seventy percent of the victims are children under the age of five.

Now, after paying relatively scant attention to the disease for decades, the international community is showing renewed resolve to combat malaria.

At the G8 summit in Scotland earlier this month, leaders of the world's richest nations vowed to dramatically boost aid for malaria control in Africa. In the U.S. before the summit, the Bush administration pledged 1.2 billion U.S. dollars in malaria aid over the next five years.

The money is targeted at both preventing and treating malaria, using methods ranging from insecticide-treated mosquito nets to antimalaria drug therapies.

The goal, however, is to develop an effective malaria vaccine. None has yet been found, but several new initiatives are underway. One experimental vaccine, tested last year in Mozambique, proved effective at protecting as much as 50 percent of children against the disease for six months.

"Things have really changed," said Brian Greenwood, director of the Malaria Centre at the London School of Hygiene and Tropical Medicine in England. "The disease has long been ignored, but it is definitely getting more attention."

Greatest Killer

Most malaria infections in Africa are caused by a parasite called Plasmodium falciparum, which carries the most life-threatening form of the disease. It is transmitted from person to person through the bite of a mosquito. Africa is the home to the most deadly species of mosquito, Anopheles gambiae, which transmits the parasite.

Malaria causes persistent fever, severe pain in the joints, and anemia—a deficiency in red blood cells—because the parasites use red blood cells to reproduce.

The disease was essentially wiped out decades ago in temperate regions. The introduction of the cheap, antimalarial drug chloroquine in the 1940s led to a dramatic decrease in malaria in Africa as well.

In the 1970s, however, malaria made a comeback in Africa after the falciparum parasite developed a resistance to chloroquine. Since then, the epidemic has spiraled out of control.

"In Africa the situation has not improved in the last 20 years," Greenwood said. "In some areas it has gotten worse, and that's associated with chloroquine resistance."

There are now up to 500 million malaria cases each year, the vast majority of them in Africa. Only a small proportion of infections are fatal, but children under five and pregnant women are particularly vulnerable. Malaria is the single largest killer of young children in Africa.

Bed Nets

Malaria is relatively easy to prevent. But many poor African countries lack the infrastructure and other resources necessary to fight the disease.

Insecticide-treated bed nets may be the cheapest and most effective tools for preventing the spread of malaria. Experts say malaria infections can be cut at least in half with the use of bed nets, since mosquitoes generally bite at night.

Still, bed nets are not widely used, mainly because of their cost and the difficulties in getting them to remote areas.

However, campaigns to distribute mosquito nets to rural areas have generated some successes. In December of last year, the UN-backed Roll Back Malaria Global Partnership combined a measles immunization campaign with the distribution of insecticide-treated nets in Togo.

As a result, 98 percent of households in Togo with children under the age of five now own at least one treated net.

"If you have a combination of political will, money, health care personnel on the ground, and the commodities you need, you can achieve swift and sharp reductions in malaria's toll," said Judith Mandelbaum-Schmid, a spokesperson for the Roll Back Malaria program in Geneva, Switzerland.

Drug resistance is another challenge. The parasite continuously mutates, making itself resistant to malaria drugs. Resistance to the drug that replaced cholorquine as the most frequent treatment is already common in eastern and southern Africa.

Meanwhile, new drugs called artemisinins, which are derived from a Chinese herb, have proved to be highly effective, and there are no signs of resistance to them yet.

But artemisinins cost several times as much as existing drugs and are not easy to produce.

New Vaccines

The goal of the international antimalaria effort is to develop a vaccine. This has proved difficult, despite decades of research.

"While vaccines against diseases like measles and polio offer lifelong immunity, malaria is different," said Louis Miller, a malaria expert at the National Institute of Allergy and Infectious Diseases in Rockville, Maryland.

"People are repeatedly infected [with malaria over] their whole lifetime," Miller said. "The challenge is not to eliminate infection but to reduce disease. It's a completely different concept in vaccine development."

Several new initiatives have shown great promise, including a vaccine developed in a partnership between the pharmaceutical company GlaxoSmithKline and the U.S. Army.

The vaccine attacks the parasite that causes malaria as it passes through the human liver.

"The parasite is quite good at eluding the immune system," said Col. Gray Heppner, malaria researcher at the Walter Reed Army Institute of Research in Silver Spring, Maryland. "It hides out in immunologically privileged places, and it constantly changes its shape."

The vaccine was tested on more than 2,000 children in Mozambique. The results, which were published last year, show that the vaccine protected 30 to 58 percent of children against the disease for at least six months.

"The point of the vaccine is to elicit a powerful immune response that effectively attacks its Achilles heel," Heppner said.

Experts warn, however, that a commercially available vaccine is still many years away.

"It takes a long time to do testing," Louis Miller said. "We have to make sure we don't put kids at risk. … If we have any impact in the next 10 or 20 years, that would be wonderful."

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