We now have an effective vaccine for Malaria
reuters.com
reuters.com
Not home yet or I'd likely have more to say.
Home now. Reading the article. First thoughts:
* This is a vaccine for P. falciparum, which is the nasty form that you really don't want. Good.
* Funding comes from GSK and the Bill and Melinda Gates Foundation
* These are interim results, looking at the older kids (5mo and up) in a 2-prong study (the younger kids haven't all hit the 12mo-duration milestone needed per protocol so this largely ignores them so far with more to come later). Caution. (Because there was no clear rationale given for why this is being reported now, in pieces.)
* Treated kids had higher incidence of meningitis. Caution.
* Treated kids had higher risk of febrile seizures. Caution.
* Generally, few deaths, so these kids seem to be well looked-after in this trial. Appropriate.
So far, so good. Interested to see the final Phase 3 results and to see how this holds up in Phase 4/postmarketing.
Regarding efficacy, it is definitely low compared to many modern vaccines which are in the 90+ range. But my understanding is that this is much higher than previous malaria vaccines. If the numbers are really true, then they could possibly save hundreds of thousands of lives per year despite the relatively low efficacy. And it should be a first foothold in terms of making immunologic progress against Plasmodium.
If this doesn't deserve a Nobel I'm not sure what does. Bravo Joe Cohen.
Worldwide it was estimated in 2004 that 1.2 million people were killed and 50 million more were injured in motor vehicle collisions.[1]
It is estimated that malaria causes 250 million cases of fever and approximately one million deaths annually. [2]
If we focus on the 800 million people in Sub-Saharan Africa where 90% of malaria cases occur, a rough estimate would be:
If we assume that Africa's traffic accident rate is the same as the world rate (it's not - I see that it's higher when I examine a few countries in this table[3]), it would be 141,000 deaths from traffic accidents and more than 5.9 million injuries from traffic accidents. The world death rate from traffic accidents is 20.8. I'll arbitrarily pick Zimbabwe's 27.5 to be representative of the region so the numbers should be 32% higher. That would be 186,000 deaths and more than 7.8 million injuries.
Taking 90% of the world malaria numbers, there are 900,000 deaths and 30 million cases of fever from malaria in Sub-Saharan Africa.
So if you're one of the 800 million people in that region, you're 4.8 times more likely to die from malaria than a traffic accident and 3.8 times more likely to get a fever from malaria than be injured in a traffic accident.
[1] http://en.wikipedia.org/wiki/Traffic_collision#Epidemiology
[2] http://en.wikipedia.org/wiki/Malaria#Epidemiology
[3] http://en.wikipedia.org/wiki/List_of_countries_by_traffic-re...
If you contract malaria you suffer from it for life, and you become a carrier so that mosquitos can pass it on from you to others.
Most people who contract malaria don't die from it, but you do get VERY sick. It's an incurable disease that comes back year after year for the rest of your life.
This is not true.
My wife is Nigerian. She had malaria a number of times as a child. So did all her sisters. So did the rest of her family. Luckily for them they are from a privileged family that could easily afford proper treatment. None of them have had recurrences in the 10+ years since they moved to the UK.
Some forms of malaria can recur. It is not a given that it will. Recurrence happens when the malaria continues to infect the liver after the symptoms subside. However it can be eradicated from the liver too with primaquine to take care of the liver combined with chloroquine and ACT for the primary infection.
The problem with Malaria is not that it isn't treatable, but that it 1) infects so many that it's pretty much inevitable that some people don't get treatment in time, and 2) that it mostly affect people in areas that are poor enough for people to have problems getting treatment, 3) because of the scale of the problem there is a very real ongoing concern about drug resistance.
For a lot of poor people, though, in practice you are right in that many won't be able to get a proper combination therapy and will keep getting their blood reinfected from their liver.
I've had malaria once, but I've never been injured in an automobile crash. Luckily I was able to avoid malaria for 25 years by living in Los Angeles (I got it on a trip through the jungle in the Philippines), but for people living in tropical climates where malaria is more common, this may not be an option.
This is quite wrong. About 15 years ago I went on a trip up the Rio Negro in Brazil. My wife and daughters had taken the standard preventative medicines, but they all came down with a drug resistant form. I escaped because I took a low dosage antibiotic. Their treatment was complicated because the disease didnt manifest itself for 2-3 months, not the normal < 30 days. Also malaria runs in a cycle of 2 weeks or so. It could be detected (then?) only when they were too sick to go to the hospital. When they felt well enough to go to the hospital it had retreated to the liver and wasnt detectable.
> Its incurable
Not true at all, but the treatment (at the time) required a two drug phased treatment. First the active disease needed to be cleared from the system. Then the reservoir in the liver needed to be killed. They had a drug resistant strain which required strain specific treatment. Treatment in Brazil was complicated because the drugs were OTC and most people treated themselves without a doctor's supervision, leading to the drug resistant strains.
For example, initiatives to dig wells in various African countries have turned out to result in other problems. Some nomadic cultures began staying put, and then they started overusing all the other resources. The scarcity of water was a control in itself, limiting how long groups stayed in a given area. Removal of that control has led to desertification of areas surrounding the wells. And it also brought disparate groups into contact with each other for longer periods of time, which led to more disease outbreaks. Nomadic groups had fewer and briefer encounters with others before, limiting the spread of disease from one group to another.
Another example is the grave humanitarian crisis in Somalia. Hundreds of thousands of people are expected to starve to death in the next few months. Due to raging conflicts, humanitarian aid cannot be effectively distributed.
However, even if the crisis could temporarily be averted, the problem with food aid is it undermines any possibility of local production. Farmers can't compete with free food dumped on the market, so they stop farming. Not being self-sufficient, now you're looking at not only providing aid, but ever-increasing aid as the population grows, which means if you stop for any reason -- including civil war flaring up again -- now even more people die: the ones you saved, and the children they have had in the interim.
See http://www.spiegel.de/international/spiegel/0,1518,363663,00...
Cultures with high child mortality compensate by having high numbers of children. Once you get rid of the main causes of child mortality, you have to either stop having so many kids, or dramatically increase food production. Otherwise curing Malaria can result later in all the problems that accompany a lack of resources: bigger famines, increased civil strife and warfare.
There will very likely be issues like you describe, but they should run their course and go away so long as outsiders don't try to meddle too much.
Unlike accelerated disease propegation between nomadic tribes, the problem of having extra people is one of the better problems to have.
Much as what happened in Europe, this tends to self-regulate over a few generations: high natality is a requirement in high-death and low-income situations, where you need many children to have some survive (and help you in old age), and children are hands that can work and provide wealth.
As mortality decreases you need less children as they'll pretty much all survive, and as wealth increases you want less children because raising them to your society's standards gets more expensive and there's a much bigger investment in each child.
Of course there will be 2-3 generations with high natality and low mortality, and an explosion of younger generations (likely leading to a few revolutions). But there's little you can do about that in the short term.
I cannot fathom why someone would be against curing malaria. Bring on the faminines or civil wars. We shouldn't keep the Africans down. Africa already has civil wars & famines, we shouldn't sacrifice the little black kids aswell.
Aid like this needs to happen through buying the food locally, or as close to it as possible.
I think you'd get the most long-term benefit from enforcing peace on the roads and at the refugee camps, then giving the refugees money - ever more until it's worth it for independents to deliver food.
Initially this would result in the same rush of foreign food which would otherwise put local farmers out of business, but instead of the aid being foreign food which displaces local food production, it's foreign money - which will buy local food with preference because it's cheaper. Local farmers could command any price - just short of that of shipping food across the world under military convoy, and would make a fortune. This would build local food production, not ruin it.
Combine prevention like this Malaria vaccine with rapid detection from these guys and you've got a nice one-two punch capable of fending of a whole host of things that are unnecessarily taking lives.
http://www.reuters.com/video/2011/02/15/us-company-says-rapi...
Natural immunity to malaria is often limited to the local variant -- go a couple hundred miles, and you have no resistance at all. Vaccines rely on the body's natural immune system, so it is nearly impossible to create a single vaccine that is effective across the world.
For this reason, I'm highly skeptical that this initial test result will hold up with broader trials. BTW my spouse is a malariologist, formerly at WHO, and I've been a witness to much of the fight against malaria over the years.
http://www.who.int/malaria/publications/atoz/meeting_briefin...
From what i read elsewhere it works almost like a magic without producing resistance, and i'm wondering what would be the first hand account of a practitioner.
The main problem is that cheap medications are often out of date or have improper dosage. Also, people stop taking medication when they feel better, but before the parasite is eliminated. The result is resistant parasites survive the treatment, and then spread.
We have maybe a decade of artemisin usability in the hottest areas. Could be more or less depending on how efficient public health practices are. But no way is it a permanent cure.
http://www.who.int/malaria/diagnosis_treatment/arcp/en/index... http://mango.ctegd.uga.edu/jkissingLab/
It all starts with what Malaria has evolved to do. The lifecycle of malaria requires both a mosquito and a human. It gets into a female mosquito, hangs out in her gut until she bites a human, jumps into the human and hangs out there for a while mucking about, and then jumps back to a different mosquito.
If malaria straight-up killed its host, it wouldn't transmit itself on to the next one. This means malaria must be really good at two things: keeping its host walking around and going undetected for as long as possible. It has lots of tricks it uses to stay under the radar. This all makes sense because the longer it can stay in the host, the more likely it'll get picked up by something else. Think of malaria like a spy that's infiltrated your population. You know one of your civilians is killing the others, but you can't figure out who.
It's also important to know HOW vaccinations work. There are four golden strategies used today:
- Put a dead bugger in the body.
- Put a neutered bugger in the body.
- Put the bugger's coat (a virus-like particle) in the body.
- Put the bugger's perfume (a protein marker) in the body.
All four of these strategies work the same way. Your body recognizes an intruder and teaches itself how to eliminate the threat.
We've established that malaria is good at going undetected. This renders the first two strategies ineffective. Even if we did introduce dead/neutered malaria into the body, the body will still have a hard time finding it when real Malaria enters the system.
We can't use the third strategy because Malaria isn't a virus. That leaves us with only one option: a perfume (subunit) vaccine.
A subunit vaccine is a vaccine where you take the perfume of a bugger and give it to the body saying "Anything that smells like this, you should probably deal with". These are difficult vaccines to put together. Proteins, like perfume, are a carefully constructed thing and are hard to perfectly replicate. Plus, given their complex nature, the body can get confused and build ineffective defenses since it's only given a protein to work with.
On top of all this, the malaria bugger goes through three different stages of its life while in the human body. If you target it late stage, you'll prevent further transmission but the human could still die. You want to target it early stage, preventing transmission AND protecting the human from symptoms. Unfortunately, your body only has 5 minutes from being bitten to to find the bugger and kick its ass before he effectively vanishes from sight.
So where does that leave us? We have a spy entering our country. We are already doing everything we can to destroy his transit before he enters our borders (spraying with DEET to kill mosquitos). We need to catch him before he masquerades as a citizen, otherwise we will never find him. So our only option is to look for signs of a spy and ruthlessly eliminate anything that fits the bill.
That's what RTS,S/AS01 does. In the 80s we were able to produce a protein from the malaria sporozoite (the first stage inside the human body) to get a small level of immunity in humans. The problem since then has been ramping up the immune response. The body needs to act fast (within 5 minutes of being infected) and with extreme prejudice (wiping out the sporozoites) off of very little training (a single sporozoite protein). Vetting this vaccination is also tricky, since it requires human field testing in Africa.
In other words, this vaccine is the culmination of 50 years of dedication, research, and hard work. It's also a miracle of modern science. Most importantly, it will save a LOT of human lives.
You sure did an excellent job there.
Quick question: is there an issue with resistance when it comes to vaccinations? I understand the problem with creating better combative medicines is working out how to attack the critters before they produce resistance. Either way, it sounds like a profound breakthrough for affected countries.
The only real problem will be price. GSK will want a lot of money, and most malaria-affected countries are poor. Chances are that the "developed world" will have to step in and sponsor vaccination programs to the tune of billions, making (mostly African and South-Asian) countries even more dependent on them that they are now. Some of them had just managed to get rid of old debts, and now they'll have to make new ones. I expect the debate on pharmaceutical patents will flare up again.
But it'll all be worth it.
http://www.guernicamag.com/features/2273/pogue_1_15_11
I found it fascinating, as someone with the intent of (eventually) studying disease ecology, in particular, that of malaria in West Africa. It's a thoughtful and well argued essay, but not in the end entirely convincing to me. But it deserves to be more widely distributed, I think.
PS: Thanks to Instapaper, which made retrieving this article a matter of seconds. Interesting how one's expectations of the rate of information retrieval have evolved, speaking as a 40-yr old who well remembers waiting around weeks at times for books or journals to be delivered to the Reg.
Medically there's a tone of what-doesn't-kill-you-makes-you-stronger, which is kind of bullshit. Malaria might not kill native adults very often, but it is not harmless.
And economically, the argument is similarly patronizing. After going on about the native immunity many people have, it then talks about how economic disruption is causing migrations, leading to people (not just whites) who don't have the immunity to be exposed. The response: people should stay in their place. That the prerequisite for solving any problem is to revert to traditional structures and strengthen those structures (the same basic argument is made about poverty and many other African problems). The idea that Africans may in fact wish to have control of their own personal destiny is disregarded -- that if conditions were better, if economic forces were less manipulative, people might still want to migrate, because the drive to better one's life persists even when life is okay.
But in medical research have to try new things, adquire new knowledge, evaluate that new knowledge with all your previous researchs and don't quit your objective despite of failing for years... so yeah, i think the parent comment was talking about _that_ kind of dedication.
EDIT: missing word
Poor people die from it all the time. Wealthier people mistake it for a cold and die. It is also about as common as a cold here, so a lot of productivity is lost. Not to mention the huge amounts of money being spent on health care.
It is not a coincidence that the worst hit countries are the poorest, people can't afford treatment and the costs for the societies might actually keep many African countries in poverty.
Not to mention how inconvenient it is to not be able to sit outdoors at night, making sure your house is sealed off and spraying with poisonous insect repellants all the time.
The 5% profits over costs is promising, even if it leaves some wiggle room.
(No, I'm not a nutcase, but, yes, this really is Vaccine Damage Awareness Month. 'Tis the season to kill people by demonizing an extremely safe form of preventative treatment by spreading baseless rumors to sow irrational fear.)
GSK has a mixed history when it comes to stuff like this, let's hope they do the right thing here. I note they didn't say the doses will cost at most 'x' (which they should have a pretty good idea of by now).
if GSK didn't pay for those, the malaria vaccine wouldn't exist; those are real costs that GSK paid. if they were always compensated on certain drugs only based on cost of manufacturing, they would simply never research those drugs.
Worse, I wouldn't even be sure they can economically mass-produce it yet, and the ramp-up could be a major PITA. The final trial was 16,000 vaccines, the WHO says there are 250 million cases every year. They're going to need tens of millions of doses before a blip even registers. And somebody's gonna have to distribute and administer this stuff.
That is really cool for Joe Cohen. Way to go.
And they are only taking 5% profit over "costs" which sounds promising.
The last few years have been success after success with the Global Fund and the Gates Foundation pouring in money.
To continue your HIV/AIDS analogy, we know that people are taking more risks due to availability of HIV/AIDS meds. I don't think that means we should stop HIV/AIDS meds. We should still produce them and sell them.
And I got malaria anyway.
Do you mean cancer isn't caused by a pathogen? Because that isn't true for some cancers, and there are suggestions that all cancers are caused by viruses.
And cancer vaccines do exist, but they need to be individually created for each case.
Certainly it can't be true that all cancers are caused by viruses, can it? For instance, some cancers are caused by radiation.
I guess not all are caused, but perhaps I can rephrase as all can be caused? It's only suggestions that this is the case, but it's not actually known yet. I certainly don't know.
This: http://en.wikipedia.org/wiki/Cancer_Virus#Viral says that 12% of cancers are caused by viruses. The true number may be a lot higher since more viruses are being discovered all the time. But even 12% is a lot if someone were able to make a vaccine for them.
From a practical point of view what would you call an agent which stimulates the immune system to attack cancerous cells?
I struggle with such usage of the words, perhaps as I tend to use "malaise" in place of "disease" for anything not caused by a pathogen.
If we are to get deeper into the book definition, so long as you can stimulate production of antibodies that identify cancer cells, you have made a vaccine.
"PROVENGE is the only FDA-approved autologous cellular immunotherapy indicated for the treatment of asymptomatic or minimally symptomatic metastatic castrate resistant (hormone refractory) prostate cancer. PROVENGE is designed to work differently from hormone therapy or chemotherapy. By stimulating the natural ability of your body’s immune cells to target and attack advanced prostate cancer, PROVENGE may help you live longer."
1: http://news.ycombinator.com/item?id=3043065 2: http://www.nature.com/news/2010/100721/full/466432a.html
Is that what we are calling 'effective vaccine'?
It's a major achievement, but if this is 'effective vaccine' then we already have an 'effective cure' to a number of cancers as well. A bit link baity.
Vaccines in general are 90%+ (sometimes 100%). (See polio or hepatitis for examples).
Those that argue herd immunity - go and read it... all of the thresholds are > 50%
This is categorically not 'effective', a breakthrough, yes. But it won't get rid of malaria.
In order to have a malaria epidemic, Alice needs to be bitten by a malaria carrying mosquito. Alice needs to become ill and have a large number of juvenile parasites in her blood. She then needs to be bitten by another mosquito. This parasites becomes adults in the mosquito's gut and the mosquito then needs to bite Bob and infect him.
A vaccine that reduces the chances of an infected individual becoming ill effectively reduces the reproduction rate of malaria.
In a vaccinated area, one would expect to see reductions in the number of infected people during the high season by potentially an order of magnitude.
This is a sarcastic reference to anti-measles vaccine activists.
That is all.
But I seriously don't want anyone imagining I think vaccines cause autism.
Isn't overpopulation the biggest challenge we are facing right now?
Who is working on this problem?
(if someone I care about was ill from Malaria, I would be happy to be able to cure that person, but my belief about overpopulation remains)
Japan has actually been paying couples to have kids to stave off population decline.
I would have thought other factors like lack of contraception and education would be more correlated.
If infant mortality is high then they will likely decide to have many children to make their bet more safe. If they have girls and the local custom centers around having sons then that too might work as a reason to get more children, and the reverse will be true in places where large dowries are paid for daughters.
Having many children is also seen as a sign of affluence or blessing.
Lack of education and contraception are factors in the developed world too, people that have lower levels of education tend to have their first children at a younger age and tend to have more of them as well (both due to starting younger and due to not being able to accurately gauge the impact of having children on their lives).
I'm sorry you got downvoted, overpopulation (or simply the problem of how to match our numbers to the available resources without drastic measures or apocalyptic events) is a subject that requires one to face some harsh realities and ask some very tough questions.
Is there anyone working on the overpopulation problem? This problem is the root to many other symptoms.
I am not speaking about terrorism or single child policy that didn't seem to work well in China. Is there any other suggestions out there?
The aging of the population is a different issue to the overpopulation issue. You could get 100% young population and still have a overpopulation problem.
Thanks Jarek.
That in turn causes people to be less productive, which in turn means they have less surplus available for things like education.
This causes areas with malaria to forever be stuck in a primitive state of development. Cure malaria and things may change a lot.
I never considered people who tried to cure malaria would do it for any other reasons that the deaths it causes. The productivity loss could be another worthy cause.
I still believe people who are after a cure mainly do it to prevent the deaths it causes. Wikipedia reports that Malaria is responsible for "2.23% of deaths worldwide" which is not negligible.
http://en.wikipedia.org/wiki/Demographic_transition
Sorry for the wikipedia link, but it is not a half bad article on the subject and it was easy to find. Basically, this theory suggests that increased income per capita is correlated with a decrease in a country's fertility rate.
There are arguments on both sides regarding the flow of causality, but if you wanted to know what was being done to address the challenge of overpopulation then that article above is a good starting point for your own inquiries.
(Also, just as a side note, it is probably the case that you were down-voted for being off-topic and not due to some overwhelming sentimentality. Maybe if you want to talk about overpopulation you should have written a blog post and posted it up, I bet that would have probably got a much better reception.)
I didn't think the topic of overpopulation was that far from finding a vaccine to a top disease.
I thoroughly enjoyed the replies I got so far so the few karma points I lost were definitely worth it.
But the you realize, that China and India have very few really old people. Now that they have decent medical treatment, the older Chinese and Indians live longer, pushing the population up. But they aren't having any babies, so in the long term we might not be growing like lemmings.
So you look at the fertility rate:
http://en.wikipedia.org/wiki/List_of_countries_and_territori...
For China, it's 1.54, and it's 2.6 for India. Anything under 2 (plus a bit for the ones who don't reach fertility) means a declining population, in the long term.
As far as I can tell, "health" isn't keeping up with "life", so we are screwed, just the other way around.
But now we also have to divine the state of robotics and AI, say 100 years out, and my brain begins to strangle itself.
I fear it has a lot to do with which populations tend to be most heavily hit.
You could have asked me if I felt the same way about cancer and heart disease and I could have answered that no matter what disease is the cure for (or who it is for), the question of overpopulation remains.
I'm trying to provoke some thought. What you say when directly asked is less interesting to me than how you and others respond upon seeing stories like this one, without being otherwise prompted.
The position is utter shit on numerous levels.