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Symptoms of malaria include fever, headache and vomiting, usually within 10 to 15 days of being bitten by an infected mosquito. Left untreated, malaria interrupts the blood supply to vital organs, in severe cases resulting in coma and death.
There’s cyclical interest in eradicating malaria, which has effectively been eliminated from temperate regions of the globe. But the last full-scale push to wipe out the disease was a World Health Organization campaign following World War II. Experts theorized that DDT spray could kill the mosquitoes that carry the parasite while chloroquine tablets could treat those already affected by the disease. After 15 years of concerted effort, it was clear the plan was a failure
“Since then,” Lum said, “it’s been the ugly stepchild of public health because this massive effort had been tried and it had failed.”
Small-scale initiatives have since met with some success. For instance, malaria was recently eliminated from an island in Vanuatu with a population of about 600 using nothing more than existing tools and about $10 per person. The whole population — not just the symptomatic children, who are usually the most likely to be treated — had to be given medication once a week for 2.5 mosquito life cycles, or about nine weeks.
What stands in the way of repeating this achievement in the South Pacific across the globe?
From Lum’s perspective, it’s largely an issue of health-care infrastructure. “On paper, it’s easy,” he said. “There are no ‘black boxes’ in the technology, but there are a lot of logistical hurdles. There’s a big gap between knowing how to do it and actually implementing it.”
It’s as easy — and as hard — as answering this question: How do you find everyone every week and ensure they take the medicine?
“It’s kind of a Catch-22,” Lum said. “If you knew how to find everybody, and you knew how to talk to everybody, it wouldn’t be a problem because you would have the basic health-care infrastructure. When you don’t have that, it remains a problem.”
Lum doesn’t hold out much hope for a new super-drug, either. “One of the problems with designing drugs for malaria is that there’s not much profit in it,” he said. “The people who need these medicines don’t have any money. If they could afford $2 a week to save their child, then they could afford to have basic health-care infrastructure. There’s not a big purse to entice these pharmaceutical companies into pushing the envelope of drug development.”
That brings us back to chloroquine, which costs pennies per dose and was once incredibly effective. Lum wonders if a higher dose of chloroquine could be the answer, or perhaps periodically removing the drug from use and allowing susceptibility to recover. In any event, he hopes finding out more about the malaria parasite’s basic biology as it pertains to drug resistance will offer some insights.
“Arguably, malaria has killed more people in human history than anything else,” he said. He still believes we can win the war.
— Rachel Coker
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