Bringing World Diseases Home


Vol. 14 •Issue 20 • Page 28
Bringing World Diseases Home * Bringing World Diseases Home

Researchers Combat Malaria, Grapple with Medical Access Issues

By Shawn M. Proctor

During the Spanish-American War, more than five soldiers died from disease for every one who perished from wounds, according to the Office of the U.S. Surgeon General. During that time, one of the biggest killers was malaria, spread by mosquitoes in the tropical region. To help limit the numbers of deaths, the U.S. adopted preventive measures like mosquito eradication and devised medical treatments which helped.

Despite mammoth efforts, malaria still claims millions of deaths each year, and age-old treatments like the antimalarial quinine are still not universally available. Citizens of developed countries are not immune either, especially those of travel abroad, who sometimes bring the disease home with them.

“The enormous burden of malaria and the disparity in global malaria research efforts is the rationale for the Multilateral Initiative on Malaria (MIM) and the reason why U.S., European, and African scientists have joined together [to fight it]” said Gerald T. Keusch, MD, associate director for International Research at the National Institutes of Health. The goals are outlined in an NIH supplemental report titled “The Intolerable Burden of Malaria: A New Look at the Numbers.”

“With new data, this landmark supplement highlights the many burdens caused by malaria,” he said. “It is essential that its full burden on societies and families be measured both epidemiologically and economically,” he said.

Although the mantra of one million annual malaria-related deaths has been cited by scientists for years, this estimate has gone underexamined in regard to its accuracy, clinical components and economic implications, Keusch said. The new supplement estimates up to 2.7 million people die annually from malaria, and over 85 percent of the malaria-induced childhood deaths are due to anemia, low birth weight and hypoglycemia.

GROWING RISK TO WORLD POPULATION

MIM reports up to 900 million acute febrile episodes occur annually in African children under the age of five living in malaria-endemic regions, and this number will double by 2020 if effective control interventions are not implemented. This is notable, according to Keusch, because high fevers and febrile convulsions in infants and children can retard brain development, often resulting in impairments in high-order cognitive functions.

Help might be on the way, according to National Institute of Allergy and Infectious Diseases (NIAID). That agency recently announced a $9 million award had been given to help reveal the genetic secrets of malaria. “This initiative will give us the pieces to an incredibly complex puzzle,” says NIAID director Anthony S. Fauci, MD.

Through the grant to Celera Genomics Group, NIAID has expanded its efforts to determine the genetic blueprint of Anopheles gambiae, a mosquito species that transmits the malaria parasite to people. As part of an international consortium of researchers and genome sequencing centers, Celera scientists will help sequence the mosquito genome and make the information freely available to the scientific community, hopefully by this spring. “By analyzing and comparing the genomes, researchers will have a wealth of new information for understanding malaria and how it is spread for use in developing new tools to help reduce its devastating impact,” said Fauci.

Once completed, it will be assembled by combining the data with information generated at Genoscope. The Anopheles sequencing consortium will then begin the process of annotating the genome, identifying individual genes and placing them in order along the insect’s chromosomes. The ultimate goal is to begin conceiving possible genetically based treatments.

But even should the treatments be available in the future, there is no guarantee they will be available to everyone. Paul Farmer, MD, PhD, of Harvard Medical School, asserts unequal access to medical treatments around the world is troubling. In a recent editorial in the New England Journal of Medicine (NEJM) titled “The Major Diseases in the World Ð To Treat or Not to Treat?” he raises questions about the provision of care not only for diseases like malaria but also TB and more. “Excellence without equity looms as the chief human-rights dilemma of health care in the 21st century,” he wrote. “The more effective the treatment, the greater the injustice meted out to those who do not have access to care.”

You can reach Shawn M. Proctor at sproctor@merion.com.

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