Can you name the disease that infects half a billion people at any given moment and kills a child every thirty seconds? You're probably thinking AIDS, tuberculosis, or even dysentery, but the correct answer is malaria. This ancient scourge kills well over a million people per year, most are children under the age of five. In a special VOA series, reporter Mike Osborne examines the current state of malaria research and treatment.
For 14 years Dr. David Stevens practiced medicine at a small mission hospital in the African bush. During the rainy season mosquitoes would swarm and his wards would fill with malaria patients.
"I think one of the pictures imprinted in my mind is walking into the man's medical ward one day, and listening to this sound," he recalls. "And as I went to the back of the ward, here's a man who has blackwater fever - severe cerebral malaria - so bad that his chills that he's having are actually moving the bed across the floor. And the sound I heard was the bed scraping as his shakes, actually walked it out, into the middle of the room."
Dr. Stevens' battle against malaria turned personal the year his parents came to Kenya for a visit. His father contracted the disease during the trip but didn't show symptoms until he returned home. His family physician missed the diagnosis.
"And he went to the hospital and he said, 'I'm not leaving till you check me for malaria,' and they did and found out that he had a 30 percent parasite rate in his blood. They called the Centers for Disease Control and they said, 'How old is he?' They said, '65," and they said, 'He's dead. He'll never leave the hospital.'"
Dr. Steven's father died a week later. His case is tragic but hardly surprising. Few American doctors have ever seen a case of malaria. The disease was eliminated in the industrialized nations 50 years ago. But as the recent SARS scare has clearly shown, an epidemic is just one patient, just one plane ride away. Few anti-malarial drugs have been developed since World War II and there are now strains of the disease resistant to every known cure.
"The drugs that were developed just after the war, in particular, chloraquine, sulfadoxin, perimethamin, the parasite has developed resistance to these drugs," points out Robert Ridley who works in the Tropical Disease Program at the World Health Organization in Geneva.
"We have had some drugs for several years now to treat the disease," he adds. "Going way back to the 17th century, indeed, quinine was identified as a potential cure for the disease. But one of the challenges has been to identify potential new treatments."
A challenge made more difficult, Mr. Ridley explains, by malaria's unusually complex pathology.
"The disease is caused by a parasite, which is transmitted through a mosquito bite," he said. "The parasite travels through the blood to the liver, where it replicates, and then having multiplied many, many thousand-fold, it bursts into the blood system, and starts to basically destroy your red blood cells. And that destruction of the red blood cells gives rise to shivers, shakes, and can lead ultimately to death if not treated."
Malaria is a serious problem throughout Southeast and South Central Asia as well as much of South and Central America. But the vast majority of deaths occur in Africa.
"There are well over a million deaths each year caused by the disease. About 90-95 percent of those deaths occur in sub-Saharan Africa. And about 90-95 percent of those deaths are in young children under five years of age. And also pregnant women are particularly susceptible to the disease."
In economic terms malaria costs Africa $12 billion a year in lost revenue. On average, 40 percent of all hospital admissions on the continent are due to malaria. Although that represents a huge potential market, the unlikelihood of any significant return on the investment keeps new drugs from being developed. There's little need for them in the developed nations and third world patients can't afford the high cost of new medicines.
"I surveyed the major pharmaceutical companies in the U.S. and Europe, asking them about their involvement in tropical disease drug and vaccine development," says Dyann Wirth, a professor at the Harvard School of Public Health and director of the Harvard Malaria Initiative.
"With the exception of two companies, in the 1997 survey, and one company in the 2001 survey, most reported little interest, in fact, no interest, in drugs for malaria and other parasitic diseases," she said. "And so, the difficulty is finding a way to discover and develop such drugs through a novel or innovative use of industrial partners or through the public sector."
Happily, Dr. Wirth and her fellow malaria researchers around the world have done just that. They've initiated a level of collaborative effort rarely seen in the extremely competitive field of drug research. The result is a surprising number of original projects, several of which may even lead to a malaria vaccine. It's a development that Dr. David Stevens says is long overdue.
"I have some hope that we are making some progress, and I think we are getting smarter about groups coming together and attacking this problem," he emphasizes. "Somebody needs to take the bull by the horns and help people who are terribly suffering because of this illness."
A suffering so pervasive in Africa that 10 children died during the time it took to read this report.
In future stories in this series, we'll look at what's being done for those most vulnerable to malaria, children under five and expectant mothers. We'll also look at a few of the more innovative malaria research projects and the technological innovations that make them possible. Perhaps most importantly, we'll look at some of the unusual partnerships driving malaria research forward at surprising speed.