Four dollars a day to keep P. falciparum away: A privileged guy’s musings on malaria

In 2017, mosquitos, whether they were conscious of it or not, were responsible for the deaths of nearly half a million people[1]. That’s 20 times the number of people who lost their lives in armed conflicts around the world in the same year. About 20 times the number of people killed by terrorism throughout the world a few years back[2]. And of these 435,000 people who are at the mercy of the ongoing mosquito massacre, the African continent carries the highest burden. In 2017, the region was home to over 90% of all malaria cases and 93% of malaria deaths. Children under 5 years are the most vulnerable group affected by malaria; in 2017, children in this age range accounted for 61% (266 000) of all malaria deaths worldwide[3]. However, not all cases result in fatalities but the total number of confirmed cases is still staggering. In 2016 alone, there were an estimated 216 million cases of malaria worldwide, although down by nearly 20 million compared with the 237 million cases reported in 2010[4].

But while we are quick to cast stones, malaria is an interesting and complex beast; we blame the mosquito while in fact, its only sin is being the carrier. But still, we have to try and swat the messenger. Around 10,000 years ago, Malaria made the jump from animals to humans. All the cycle needed was a dense population of humans to keep the parasite moving and alive — cue the agricultural revolution and humans beginning to reside in more densely populated agricultural based settlements. So, while we may think that the disease is hundreds of thousands of years old, ground breaking work tracking the disease’s origins has revealed that the most deadly strain of the disease, P. falciparum, came from a single bite, only some thousands of years ago. Meanwhile, Gorillas have hosted the parasite in their bodies for a lot longer than humans and seem to have built up an immunity. This is something that is worth studying to help in the development of the global battle against the disease[5].

Malaria medications have done a good job in slowing the transmission risk, for residents of, and visitors to, endemic areas — areas where around 3 billion people carry on with their daily lives with the looming threat of contracting the disease. The discovery of Quinine, the active ingredient in the bark from the Cinchona tree, is considered one of the most ground breaking medical discoveries ever since it marked the first successful use of chemical compound to treat an infectious disease. As early as the 1600’s the “sacred bark” was ground up and used to treat and hopefully, prevent, malaria. In the 1820’s, quinine was extracted from the bark, isolated and named. It became the gold standard treatment until a hundred years later when new and more effective remedies were created[6].

Today, the main forms of Malaria prophylactics are Atovaquone/Proguanil (brand name Malarone), Doxycycline, Mefloquine (brand name Lariam) and Chloroquine (brand name Avloclor). Some are more effective than others in certain regions around the world, some cost substantially more than others, some have been known to cause grim side effects, things like nightmares, sweating, and constant nausea. However, all have proven themselves worthy additions to help decrease the risk of transmission in all endemic countries around the globe.

And in most regards, surely the possible side effects are worth it. Evidence suggests that malaria doles out huge financial costs to individuals, societies and governments. At the individual level, things such as the purchase of drugs for treating malaria; expenses for travel to, and treatment at, dispensaries and clinics; lost days of work; absence from school; expenses for burial in case of deaths. On the societal and governmental side, costs include things such as the supply and staffing of health facilities; purchase of drugs and supplies; public health interventions against malaria; lost days of work with resulting loss of income; and lost opportunities for joint economic ventures, investment and tourism. Such estimated direct costs are at least 12 billion USD per year. The cost in lost economic growth is many times more than the direct cost number[7].

During my time living and working in Haiti, some of my friends used to tell me when I asked about malaria and their risk that “Jezi pwotoge mwen” (Jesus protects me). Well, if Jesus comes in the form of treated bed nets and malaria prophylactics, then hell yes he does. While I appreciate their faith in the divine, I’d stick to taking my pills daily, feeling mostly protected while I swatted morning mosquitos who mustered their forces from around pools of standing rain puddles, or slightly less protected, but still out of the danger zone while I cursed evening mosquitos that snuck in under my bed net.

I’m writing this article because I’m currently in East Africa in the rainy season, surrounded by the threat of Malaria around many corners. And I’ve got my two kids with me and I love them more than my own life. But I’m also writing this article because there is breaking news in the global fight against malaria, a battle that currently demands a cool 2.5 billion USD per annum. And globally, we’ve been chopping this kind of cash for years and are still technically losing. So, I’m sharing a message of hope from the front lines.

This past April saw the launch of the first ever malaria vaccine in a pilot trial in Malawi. Two weeks ago, the vaccine RTS,S, has now been rolled out in three countries. Ghana and Kenya have joined Malawi in running pilot trials on this ground-breaking treatment. But this is no flash in the pan. RTS, S, has been in development for 30 years.

In clinical trials, the vaccine was found to prevent approximately 4 in 10 malaria cases, including 3 in 10 cases of life-threatening severe malaria[8]. You don’t have to understand biostatistics to see that these numbers make more trials worthy of investment and consideration. The vaccine will be given to infants at age six months, seven months, nine months and 24 months[9]. The fact is that this vaccine holds great potential to help reduce the overall global disease burden of malaria.

I’m hopeful that these trials will show incredible results and lead towards much wider implementation. Economic development is partly contingent upon bolstering health outcomes and reducing huge, ongoing economic expenditures on diseases like this. Maybe within the next ten years, the total number of malaria cases will start to really fall as a result of this vaccine roll out. The next generation need not inherit this disease burden and have to bear its social and economic costs as they seeks to invent, inspire and innovate. All the privileged, conspiracy theorists who think that this is some kind of cash grab by pharmaceutical companies can actually refrain from commenting. This is not for you if you live in a country where a few mosquito bites at the lakeside cabin are a mere annoyance. This is life saving technology that if shown to be effective, made equitably available and some of the difficult delivery logistics can be overcome, tens of millions of people will line up for and will benefit from in the years ahead. This is nothing short of the latest, high tech weapon in a global battle that in the year 2020 we really shouldn’t be losing.

While there are still additional concerns that impact the fight against malaria, things such as the lack of sustainable and predictable international and domestic funding, conflict in malaria endemic zones, changing climate patterns, the emergence of parasite resistance to antimalarial medicines and mosquito resistance to insecticides[10], this vaccine is still history in the making.

Until then, I totally recognize my privilege and the fact that I can pay $16 a day to protect my family (to the best of my ability) from the smallest harbinger of one of the biggest killers on the planet. I know it’s a huge luxury and every single morning when I swallow that pill I remember it and am grateful.

Dr. Chris Hergesheimer is a sociologist moonlighting as an economic developer, traveller, writer and thinker. He thinks a lot about development, technology, culture, community, travel, money, family, food, globalization, and the environment.

[1] https://www.who.int/news-room/fact-sheets/detail/malaria

[2] http://visionofhumanity.org/app/uploads/2017/11/Global-Terrorism-Index-2017.pdf

[3] https://www.who.int/news-room/fact-sheets/detail/malaria

[4] https://www.who.int/malaria/media/world-malaria-report-2017/en/

[5] http://www.bbc.com/earth/story/20160324-how-our-deadliest-disease-infected-us

[6] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3121651/

[7] https://www.cdc.gov/malaria/malaria_worldwide/impact.html

[8] https://www.who.int/news-room/detail/23-04-2019-malaria-vaccine-pilot-launched-in-malawi

[9] https://www.businessdailyafrica.com/news/Kenya-becomes-third-country-in-Africa/539546-5271754-14opeey/index.html

[10] https://www.who.int/malaria/media/world-malaria-report-2017/en/