The mosquito-borne parasitic infection called malaria may not get as much press as some better known diseases, but it kills millions each year and infects hundreds of millions more. In fact, malaria joins AIDS and tuberculosis as the world's top three deadliest infectious diseases. In this final report in our series, Mike Osborne looks at the collaborative efforts pushing malaria research forward.
For 14 years, David Stevens served on the front lines in the war on malaria. He practiced bush medicine at a mission hospital in Kenya.
"I think one of the pictures that will be indelibly imprinted in my mind is when we had 482 patients in a 135-bed hospital, and there were literally two and three patients in a bed."
Dr. Stevens has long since returned to the United States and now serves as president of the 17,000-member Christian Medical and Dental Association. But even in an organization so large, he's one of the few doctors to ever see a case of malaria, and therein lies the problem.
"If we'd poured a quarter of the money into malaria that we've poured into diseases that are common in this part of the world heart disease for example or high cholesterol - we could have controlled if not cured the malaria problem," he said. "Unfortunately, this disease is endemic in countries where there is little economic potential for drug companies and they basically look at the bottom line."
Ironically, this lack of drug company interest may have actually encouraged recent advances in research. Dyann Wirth, Director of the Harvard University Malaria Initiative, notes that because the malaria research community is so small, it's developed a degree of cooperation that's rare in such a competitive business.
"That's not to say that there isn't good scientific competition, but I think we all see the larger purpose," she said. "That is, we really need to solve this problem and there's really room for almost everyone to participate."
One of the earliest cooperative ventures, Dr. Wirth recalls, was the creation of a team to sequence the entire genetic structure of both the malaria parasite and the mosquito that carries it.
"To the credit of all those involved everyone kept their eye on the goal of getting the sequence, because we knew that would open up, you know, enormous opportunity," she said.
Nirbhay Kumar and his colleagues at Baltimore's John's Hopkins University are among those taking advantage of that enormous opportunity. His team is searching the now published malaria parasite's genetic structure, looking for places a vaccine might deliver a killing blow.
"In particular we are using an approach based on a fairly new concept in the last five years or so. It's called DNA vaccine concept, where basically, if you know the target antigens that you think will be effective as vaccines, you can use them in the form of DNA and use DNA to immunize people or animals… what we are doing right now," explained Mr. Kumar.
A second, perhaps even more novel cooperative approach is what scientists call "piggyback" research. Dr. Voorhis and his colleagues, who study malaria for the University of Washington's School of Medicine, have recently identified a number of drugs developed for cancer treatment that show promise as anti-malarial medications.
"That tremendous effort, you know, hundreds to even thousands of chemist years is very difficult to do outside of the pharmaceutical industry. So if we can piggyback on to that effort, use that kind of accumulated knowledge to get new malaria drugs from other targets that they've been looking at we are so much further ahead," said Dr. Voorhis.
One of the best-known malaria collaborations is a Geneva-based organization called the Medicines for Malaria Venture, led by Dr. Chris Henschell.
"We actually sort of broker in all of the organizations that have the know how, the necessary staff, the necessary facilities and we put together the project and we partially fund them. That partial funding is enough to bring in other organizations like pharmaceutical companies who normally wouldn't do this because they would simply be losing money," explains Dr. Chris Henschell.
The Malaria Venture's most recent project helped Hong Kong University researchers bring to market one of the most promising anti-malarial drugs in some time: a new medication based on a traditional Chinese cure. An Indian drug company has been awarded production rights and will be able to distribute the new medicine cheaply enough to make a real impact in places like Africa where malaria kills so many.