NextBillion - An Initiative of the William Davidson Institute at the University of Michigan

Wednesday, February 11, 2015

Tucked away in a few rooms within the Alexandria Life Science and Translational Research Center in Rockville, Maryland, is a 48-member biotechnology company pursuing a singular obsession to eradicate one of the greatest global health challenges in history, malaria. “We’re swinging for the knockout,” says Dr. Stephen Hoffman, who founded Sanaria in 2003. “This is not to take anything away from the incredibly successful work others are doing to distribute bed nets, create educational programs to increase malaria literacy or discover better methods to deliver existing antimalarials. Those efforts are vitally important. But we’re searching for the one blow that will finally end humanity’s fight against this ancient disease: a vaccine.”

Malaria has plagued humankind for more than 4,000 years, causing every second human death since the Middle Ages. There has never been an effective vaccine against malaria or any other human parasite, mostly because they tend to be very complex, single-celled organisms (malaria, sleeping sickness,Leishmania) or complex multicellular organisms, like the worms that cause lymphatic filariasis and schistosomiasis.

Moreover, according to the Entomological Society of America, malaria has been exercising its evolutionary flexibility in various vertebrates (likely including the dinosaurs) for over 100 million years. This means malaria is uniquely adept at survival, including becoming resistant to all of the methods we use to combat it. Resistance has been reported against quinine, chloroquine, mefloquine, pyrimethamine-sulfadoxine and ACTs (artemisinin-based combination therapies, the current front-line malaria treatment). Mosquitoes carrying malaria have even circumvented the bed nets by feeding earlier in the evening, catching people before they retire for the night.

The illness is rampant: The World Health Organization reported that there were 198 million cases of malaria in 2013. Luckily, only about one in every 330 of these cases leads to death. In large part, this is due to the fact that many of those who live in the most malaria-stricken parts of the world—sub-Saharan Africa and Southeast Asia—have developed a natural immunity.

But naturally acquired malaria immunity comes at a great cost. “Kids in high-malaria-transmission areas get infected almost every day, yet it takes three years for them to become partially immune,” says Dr. Arjen Dondorp, deputy director and head of malaria research at the Mahidol-Oxford Tropical Medicine Research Unit in Bangkok. Many of these children die and all will become sick—even after developing immunity.

The silver bullet would provide this same type of immunity but without all the illnesses along the way. To date, that solution has been incredibly elusive, and excitement over a potential malaria vaccine is hard-won. When I asked Nick Day, a professor of tropical medicine at Oxford University, if more money spent on combating malaria should go toward vaccine development, he told me, “Billions have been spent in malaria vaccine research over the years, with very little to show for it.”