Wednesday, Jul 9, 2008
With fears mounting that global climate change may cause the dreaded disease to spread, scientists turn their attention to vaccine research.
Dec 15, 2000 | Regina Rabinovich recently returned from her first trip to Africa as director of a $50 million campaign to create a vaccine against the planet's most insidious parasite. One night shortly thereafter, she woke up feverish at 2 a.m. in the Washington home she shares with her husband, a pediatrician, and three children.
"I was burning up," she recalls. "Naturally, with two doctors in the house we didn't have a thermometer, so I went to the E.R. I was 105."
The diagnosis was malaria -- the disease that had brought Rabinovich to Africa in the first place. She'd taken antimalarial pills before leaving on her tour of six villages along the Gambia River, but evidently that was not enough to prevent the mosquito-borne bug from colonizing in her bloodstream.
Rabinovich cycled through cascades of fever and shaking, burning and cold for a few days before returning home from the hospital. She had undergone her rite of passage as a malaria researcher with the Malaria Vaccine Initiative, created earlier this year by the Bill and Melinda Gates Foundation.
During the Vietnam War, in response to the more than 100,000 cases of malaria recorded among American troops, the United States invested significant funds for development of antimalarial drugs. In the decades since then, however, malaria research has been a disheartening, underfunded field -- despite the fact that the parasite is the No. 1 killer of children in Africa, claiming more than 1 million victims a year, and causes illness in 400 million people annually worldwide.
Once the U.S. military managed to control the disease among its troops, the failure of a United Nations-backed global antimalarial campaign around the same time -- stymied by stubborn mosquitoes and parasites and a lack of resources -- caused a decline in Western interest in the disease. U.S. and European governments spent less than $50 million annually on malaria research while drug-resistant strains of malaria proliferated in Africa.
Poverty and disorganization have frustrated African efforts to control malaria's spread with low-tech means -- such as spreading oil on stagnant ponds where mosquitoes breed and distributing window screens and bed nets. And until recently, few pharmaceutical companies had shown much interest in what may be the most promising solution -- a vaccine.
As it happens, though, Rabinovich may be a harbinger of a change in that picture. She was a prominent public health official at the National Institute of Allergy and Infectious Diseases before being named in December 1999 to head the private malaria initiative, part of a $1 billion philanthropic investment by the Gates Foundation for development of vaccines for the Third World. Her group plans to create partnerships with universities and private companies that commit to creating a malaria vaccine.
The Gates Foundation's spending on malaria follows upon big investments over the past few years by the National Institutes of Health, the World Health Organization and Britain's Wellcome Fund, with total spending from all sources totaling $100 million or more. What's more, the World Bank has pledged up to $500 million in interest-free loans to African countries for malaria prevention and control. And the lame-duck Congress could add to its appropriations a $1 billion tax credit program -- pushed by the Clinton administration and based on a proposal by Harvard professors Jeffrey Sachs and Michael Kremer -- to encourage spending on malaria research by the pharmaceutical industry.
Money has begun flowing into this fight for two reasons. Public health officials are worried about drug-resistant strains of the parasite that are on the rise around the world, and they are encouraged by the emergence of several promising antimalarial vaccines, which need big cash infusions to move forward.
But when both houses of Congress approved a $50 million U.S. Agency for International Development program to combat malaria on Oct. 26, another factor was at play: the self-interested inclination to do something about malaria before global climate change brings a "third-world disease" to our doorstep.
"As we know from our experience with the West Nile virus," said Rep. Barbara Lee, D-Calif., during floor debate on the bill, "if we do not act quickly to break the back of a disease abroad, the inevitable result is outbreaks of the disease here in the United States."
Global climate change does seem to be bringing more mosquito-borne diseases to this country. Scientists speculate that an errant mosquito that somehow traveled to the United States in the belly of a plane may have caused New York's 1999 outbreak of the occasionally deadly West Nile virus. By this fall the germ -- which spreads from mammals and birds to mosquitoes and back again -- had established itself all along the East Coast, prompting spraying campaigns in places as far south as the Washington suburbs. Scientists believe that the West Nile virus is here to stay, and will probably spread across the entire country within a few years.
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