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The Hope of a Vaccine

June 30, 2005

In a room in a Seattle office building, behind what seems like enough safeguards to protect the occupants of a nuclear submarine, anopheles mosquitoes dine on Special K and the occasional malaria-infected mouse.

Researcher Stefan Kappe of the Seattle Biomedical Research Institute is harvesting parasites from their salivary glands in a quest to create something new: a malaria vaccine. He is getting tantalizingly close. By injecting mice with genetically modified parasites, he and his team have produced a colony of rodents that is immune to malaria.

If they can do the same for humans, it could mean the end of one of the deadliest plagues mankind has ever known. Or it could just be a waste of time, money and brainpower. We won't know for at least a decade.

That's the problem with drug and vaccine research: It's very, very slow, and often even the most promising ideas hit dead ends. Time is the enemy for malaria victims. In Africa, a child dies of the disease, by the most modest estimates, every 30 seconds. In the years or decades it might take to produce a working vaccine, malaria will reap corpses by the millions -- 1 million to 3 million a year.

It's possible to slash the time frame, and the deaths, if leading industrialized nations pay more attention. President Bush is expected to make an announcement about Washington's commitment to the war on malaria as early as today. We can only hope he builds on the plan proposed by Gordon Brown, Britain's chancellor of the exchequer, to give commercial biotechnology firms an incentive to create vaccines for diseases such as malaria and HIV. The plan was endorsed in principle this month by the finance ministers of the Group of 8, the club of wealthy nations whose leaders meet starting Wednesday in Gleneagles, Scotland. But that was the easy part; none of the G-8 members have yet been asked to put up any money to pay for it. The price tag will be in the billions -- yet it's a bargain given both the humanitarian and economic benefits.

The Key to Prevention

There are a lot of weapons in the fight against malaria, all of which are either being misused or underfunded. Bed nets and insecticides go after the mosquitoes that spread the disease. A new generation of drugs targets the parasite after the victim is bitten and can even help stave off an infection. But you could blanket the continent with bed nets, blast whole villages with insecticide and deliver cheap drugs by the trainload without eradicating malaria in sub-Saharan Africa. Hot weather and unique breeds of malaria-carrying mosquitoes create a cycle of infection that is impossible to break. The only way to stamp out malaria in Africa is with an effective vaccine.

Scientists have come a long way toward producing one. Kappe isn't the only researcher with a promising start. He's in a friendly competition with a colleague at the SBRI, Patrick Duffy, who is testing a vaccine in Tanzania aimed at a vicious strain of malaria that attacks pregnant women and their unborn children.

Other important efforts are underway around the world. The one that provides the best hope for the near future is a compound now known mainly by the initials RTS,S (a recombinant protein that will get a catchier name if it ever becomes a marketable vaccine). The compound's history gives a telling look into how market forces -- or rather the lack of those forces -- delay progress on a malaria vaccine.

Research on RTS,S was started almost two decades ago by London-based drug company GlaxoSmithKline. By the late 1990s, researchers had produced a vaccine that was protecting lab volunteers from malaria. But the program was slated to be cut in 1999 because Glaxo officials couldn't see a viable market for it.

That's precisely why few biotech companies make vaccines for Third World diseases such as malaria. The research commitment behind a new drug or vaccine is vast -- it can take from seven to 20 years to produce one, at a cost of up to $1 billion. Further, because many leads don't pan out, drug companies take a risk every time they fund research into a new product. The only way to make the kind of profits sought by drug companies is to focus on ailments for which people with money are willing to pay a hefty premium.

Ninety percent of those who die of malaria live in sub-Saharan Africa, and most are children under 5. Their parents make on average less than $1 a day. That's not a market that promises much of a return on investment for Big Pharma, which is why out of 1,233 drugs licensed worldwide between 1975 and 1997, just 13 were for tropical diseases -- and five of those were for veterinary purposes.

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