In the developed world, parents worry when their children get the flu. In Africa the concern is malaria. And the threat is deadly. Malaria is the number one cause of death for children under age five in Africa. Microsoft billionaire Bill Gates has funded programs to fight malaria since 1999. Now, he has donated an additional $100 million to develop a malaria vaccine.
Global health is a top priority of the Bill & Melinda Gates Foundation and malaria is a current focus. For Foundation infectious disease director Regina Rabinovich, the battle against malaria is personal.
"It felt foolish but I probably had one infected mosquito bite right here," she said. "I mean, really. One infected mosquito bite."
Doctor Rabinovich contracted malaria on a research trip to Gambia. The experience helped her realize the devastation of the disease across Africa.
"And if you think about an entire community where a proportion is ill, a proportion has died and a proportion are feeling the impact and are going to get infected again, you can then understand why malaria by itself has such a profound economic impact on the ability of Africa to really take advantage of economic development," said Ms. Rabinovich.
Over the past four years, the Gates Foundation has donated close to $300 million to fight malaria in Africa. The money pays for treatment and medications for children already infected. But most of the funding goes to development of a permanent solution: a vaccine.
"Vaccines are the most effective public health intervention known. And so when we think about actually trying to prevent disease rather than to treat it once people have it, vaccines are really the answer for that," said Melinda Moore, who directs the Gates Foundation-funded Malaria Vaccine Initiative.
"Malaria is a complicated disease," she explained. "When we apply the things we know to do now, bed nets, drugs, other kinds of control measures, we still end up with over a million kids a year dying of malaria. We need something that will actually give us that sustained impact on this disease. And vaccines do that."
But developing a vaccine is not easy. Research and development costs are high, and Doctor Moree points out that pharmaceutical companies have little incentive to create a vaccine for poor countries.
"For industry when they're looking at a [financial] return, malaria and these other diseases like that don't seem to promise them the same kind of returns as products that will be used in the developed world," continued Ms. Moore. "And so part of what we do then is to work with companies and provide incentives to them. Which sometimes is technical expertise, oftentimes is money."
Pharmacy giant Glaxo-Smith Klein, for example, has been working on a malaria vaccine for more than 20 years. The new money provided by the Gates Foundation will set up the infrastructure to mass-produce the vaccine if it proves successful in field trials.
The Malaria Vaccine Initiative also brings together companies, scientists and laboratories that might not otherwise coordinate their work, in order to accelerate vaccine development. One of those partners is the United States Army. Doctor Gray Heppner, who is with the Walter Reed Army Institute of Research in Maryland, explains that malaria has been a major problem for the military, most recently in Liberia, where this summer, 80 U.S. Marines contracted a drug-resistant strain of the disease.
"And what's remarkable is that most of the people affected were there for less than 12 days which really to my mind illustrates why we need a malaria vaccine," he said.
The military has been working on a malaria vaccine for 50 years. So far, the effort has been unsuccessful. Doctor Heppner says that's because scientists must combat one of the most formidable organisms in nature: a parasite which has evolved with mankind since the beginning of civilization.
"If you think about it there are very few parasites in nature that actually infect liver cells and are able to hide there and develop undisturbed," said Dr. Heppner. "So we're trying to train the immune system to recognize a very difficult-to-see target and effectively eliminate it."
The Gates Foundation is funding nine different malaria vaccine projects. Scientists estimate it will be a decade or more until a proven malaria vaccine will be available to the children of Africa. But there is a sense of urgency, because of malarial drug resistance. For example, chloroquine was the most used anti-malarial drug for decades. It is no longer effective against the parasite in Africa. Medications created just fifteen years ago are no longer effective in other regions, especially South East Asia. Still, Regina Rabinovich with the Gates Foundation is cautiously optimistic that advances can be made against malaria.
"Do I think that we're going to solve all the problems of malaria in the next decade? No. I'm fairly sure we're not," she said. "Can we make important advances with availability of improved drugs? Absolutely. Will we see a malaria vaccine in my lifetime? It better be there."
Field trials of two malaria vaccines are underway in Africa. Scientists involved say there's no shortage of volunteers who don't want to see another generation plagued by the disease.