Focus 580; The Battle Against Malaria

And this is focused 580 on telephone talk program my name is David Inge. Good morning to you Welcome back to our number two of our show in this part of focus 580 will be talking about the battle against malaria. And we have as our guest this morning Robert Desa Wittes he is a leading authority in the area of tropical medicine and we'll be talking about a book that he wrote that takes a look at the battle against malaria. His book is entitled The malaria capers. It was published last fall by W. W. and Norton Malaria is a disease that has been with us for a long time. In fact some very old medical texts describe the symptoms of malaria very well and here we're talking about records that go back to a couple of thousand years B.C. the modern age for researchers of malaria came in the late 1800s when the cause was identified and also the method of the spreading of the disease by the an awful mosquito by the 50s. There was a great deal of optimism of that malaria could be controlled possibly even stamped out altogether through the use of the drugs that

were available to treat malaria and also through the use of the insecticide DDT to get rid of the mosquitoes that spread the disease. However now that optimism has faded and in fact as our guest writes in his book. We must remind ourselves that malaria by sheer numbers remains the most important disease of humans 100 to 200 million cases every year that bring death to 1 to 2 million people. Why it is that malaria has been so difficult to stamp out is the topic of the book the malaria capers and we'll be talking this morning about that with our guest Robert guess which makes his home in Honolulu where he holds a double appointment as Professor of tropical medicine and medical microbiology and Professor He's also professor of Public Health at the University of Hawaii and he is joining us by telephone this morning as we talk. You certainly are. You folks are listening should feel free to call in if you have questions. 3 3 3 WRAL is our

local number that's 3 3 3 9 4 5 5. We also have a toll free line that once good anywhere you can hear us. And that is eight hundred eight hundred to 2 2 9 4 5 5 3 3 3 W I L L and eight hundred to two to WY allow those of the numbers Professor death. Hello. Good morning. Good morning. Thank you very much for talking with us today we appreciate it. Perhaps we might just talk generally a little bit about a malaria. Because I think probably many of the people listening to us won't know very much about it other than it is a disease that you associate with tropical areas and probably there will be a lot of people who will know that it is spread by the mosquito but maybe you could just give us a thumbnail sketch of the disease and what it's all about. Well actually it's a number of disease malaria. Consider that for malaria parasites at bat. We're also libel

to be occasionally expection species that I carry by monkeys and can be given a mad but the fourth species plasmodium. Oh Larry I only 5 facts and falciparum of these only falciparum is the true killer. Dr X can make you feel. So terrible that it indeed you feel that you are in mortal danger. All of them are carried by various species of being an awfully mosquito and have a sexual development in the mosquito that takes about 14 to 20 days depending upon temperature and speak a very complex cycle within the mosquito. As mosquito bites human the parasite heads is the blood and very quickly goes to the liver

where it may remain for several weeks. It's a quiescent period 5 x and valley malaria at some of these stages remain dormant. Word was called the whites weeping stages and they can be activated back to life. What do infections up to five years later falciparum malaria invades it a prodigious fashion and are left unchecked in humans. He didn't mean a logically very good human trap which killed it. My particular interest dragon lady. It can overwhelm us. Different ways affect different organs but most notably the great one and that that's the 50 minute

lecture on the life cycle without it and several that are so tall I just have a compulsion to go through life cycles in a very you know fashion. Well you know I think it's it's important to understand at least a little bit about the complexity of the lifecycle of the organism or organisms that cause malaria because one of the stories that you tell in the book is the effort to develop a vaccine and which has has not proven successful perhaps for a number of reasons that we can go into but I suppose the one thing that has frustrated researchers is the fact that it is a very complex the life cycle of this organism is very complex and if you were going to develop a vaccine you couldn't just have one you would have to have a different vaccine for every stage in the life cycle and would somehow have to be able to

give them all to an individual to really make sure that you were going to provide them with immunity at least now that's my understanding. Well that's that's some of the crowd could see even more complex in that each stage of a life cycle sport result. The city stage could be decided today. Where does they go through to successively the bacteriologists and the biologists have a relatively simple bacteria is a bacteria bacteria viruses virus lives but as I said a malaria parasite goes through all of the successive stages and each stage is profoundly different in its antigenic constitution and we don't know within this very complex Constitution which parts of which segments of which proteins which didn't actually maybe antigenic which may induce protective immunity to

complicate this even for the malaria has lived in even that species has it. Enormous diversity. We know its influence. Voices antigenic shift gender change and malaria from locale to locale and can be very very different a person who grows up in one village and is protected develops in a very expensive way to its health finally develops an immunity. If he goes to a village maybe 20 miles away much of that immunity is laws. It's not quite as dire as the African patents which change to China code every three days but it's it's bad enough to make it a very frustrating attempt for researches about this fact. However they may have

focused in the wrong way because I believe that the object of the game is interruption of transmission. If we try to make a vaccine that gets the trades elements possibly we might be successful. The story of the effort to develop a vaccine has some elements of its scientific misconduct. To be to be kind and perhaps perhaps fraud is really the word to one ought to use. Can you tell some of that story. Well I might first of all I must say that there are lodge numbers dedicated completely ethical scientists polluting the United States who have who are have been and

are you asleep you gauged in a search for a vaccine. The difficulty I think arose at some 25 years ago when when all the money that ate ID Americans. A bit today development agency had had I think was a billion dollars that they put in over about 10 15 years. The grand scheme of eradicating the area went up sales. They were looking to cover their dairy as a credible technical fashion and they were sold on the idea that a vaccine might be possible by a by name Sylvan. Paul Silverman is an old friend of Biden God mostly on

Henman and he felt that indeed it was possible to immunize against malaria and all the time to spill day I'd be lucky here. You've never been in the research business you don't know how Dick that the idea of a malaria vaccine should be. But it's it's kind of like I don't get high hopes that one day Id then did was to pay for it. They're almost their entire resources started a whole research program without benefit of professionals. Against the advice of professionals without benefit of leadership by professionals and they went ahead and they got partial mean ization with rabbit what we would consider a dirty vaccine by by today's standards in rhesus monkey but the monkey malaria.

Well not what they had to do even to get that kind of chemical boost which was so savage that it could never be used in a human it would never fight as we humans this fall for a tragedy. Well in the end that was dropped but the program wasn't dropped at that at this time. Biotechnology and all its attractions ended at that picture and they said people said we could make it. Banksy and indeed from New York University they came in with the spore result vaccine which in turn entirely synthetic came out of the shelf and protected by protected bout 1 out of an eye in human beings and that one human or several humans developed an allergic reaction. But the press and they when everybody went to the press and said the vaccines around the corner at this

time they got a nother leader the first manager from eight left. He was an entomologist not an immunologist. They got another entomologist. I think it's background change direction was the agricultural entomologist and he ran this thing like the galley liter of the vaccine Gallo right. Unfortunately he was old so turned out to be rather crooked he established his own dummy companies for buying monkeys from South America which he explained had to be used as a model and in the end he was indicted pled guilty and was sentenced to six months. Something like this. This was the leader of the whole scheme. Maybe Mayawati was doing the original charge with

sexual harassment charge but he was also doing they made him chief of everything including his own Sippy became a zome superior and he had a favored few people who would be searched his network of researchers when the reviews came and said look this is. Bad research he would say it's wonderful research and he funded them holds up at least two of those. If you were accused of taking money respect from Illinois Illinois who was in the area and has either been convicted or pled guilty and watched the DP I'm sorry to say who was from Hawaii and he after two and a half years is still awaiting trial for

trial. Oh I get the feeling something like a hundred thirty five. After I get that exact set in various fiscal manipulations. But that's still under the you know it's still on the subject you see I suppose. That trial and its revelation be about shortly. Meanwhile risk goes on with AI this their aim to maintain the program and nothing nothing has come out of this except that possibly a lot of mischief in some ways because they keep going to what they had kept going to the press making announcement that the vaccine is around the corner. Got it got them and said you know let's give it up why we spending all this money to spray and give drugs you know a vaccine is around the corner and gave up on it when I

bought a new CD. That's. It's an intriguing story with you but you actually have a complete update lation that many companies went up. Nothing like this is that happened in science and certainly nothing happened like malaria where there have been better arguments between people and clashes but never that it think that well and what's particularly I think said just underscore the point you made is that it resulted the result one of the results was that as you say people said well any day now we're going to have a vaccine which meant that money that had been going into efforts to to spray to get rid of the mosquitoes and to make sure that there is at least treatment for people were using the drugs we have available that that kind of treatment was abandoned people say well we don't need to do this anymore

because next week we're going to have a vaccine. And so so the vaccine never comes. We stop doing the things we could do and apparently that has really resulted in a in an increasing number of people who have had the disease. And we've lost balance in our researches. Oh and I and the raft and the basket you know and all Mum's all those. All those golden eggs are gone mostly in one basket and the some of the more practical or other approaches balanced approaches were abandoned as very little money for relatively few third world research and we've been seduced completely. I don't mean I don't mind being partially seduced you know like The Cure.

By the tech not by high tech outside research must always go on but it must be balanced by by attending the kind of development or actual need of people living in villages and I know when I even suggested this in my book and I have a cold for abandonment of all this. Back. From Cambridge with Nobel laureate kind of technology ended up I think you'd like but ended up. Which he thought I was attacking. Oh research that was corrupt. Oh the book I did a search about the controversy in the community which I think thank you as well.

Well we have some people to talk with and let me reintroduce our guest but with the morning for this part of the morning we're talking with Robert Desa wittes. He is a leading researcher of tropical diseases and has been doing that work for several decades now and he is a currently a professor of Tropical Medicine and Public Health at University of Hawaii and is author of a book you might want to take a look at if this subject interests you the book is entitled The malaria capers. And it was published last fall by W. W. Norton so you should be able to find it. It is about the effort to. And treat malaria. Here we have several people lined up with questions so why let's do that will start with our toll free line. Hello back good morning. Can you hear me. Yes. Oh good I have a baby throw you on a limb. OK I have a basic question for some years now in fact we live about 40 miles from the station where you're talking and for some years we have had to report on and polite as and when they

give out the information we do we try to do what they tell us we should do. We burn. We cannot during the evening went out to people we prefer to be outdoors in the summertime because we are pretty good at cooped up in the winter. But we like to work in our yard we like to be in our yard. And we've done everything we could I'd I hope to cut down on water we keep hearing there are beds firmly on except one there and you know and we try to drain off our runoff as best we can. And I've what I followed all the rules. How serious is this and do we really need to worry about it in this particular area. If so do we need to take a question. Well that's a little plot for malaria it's mosquito borne but I think in your area it's a cubic spline Speedo and region. I think large water stands they say I'm not of I probably just don't know too much about

your particular situation. I think you're doing everything you can but I know the last two years have been terrible people have come on and I think you know very big and strong I have primary director yeah. I think we're getting a greenhouse effect possibly and things are indeed changing. My wife and I were in the highlands of heat in New Guinea and they were having malaria rights there which they never had before and they described it to the higher temperatures and so things indeed may be changing as far as the mosquito goes. You're doing everything you can watch right. You're covering yourself. I would you know. It's just you when you're outside the peak biting I was probably which surround you might ask your local entomologist about the behavior of that MIT particular object or it's because you've got to remember each vector is genetically

sort of controlled by a tiny few cells that a cold spray into a very selective type of behavior which bites when it bites when it flies. That's it's like where it plays. Thanks that you might call them up and say watch it biting time by time. When are we at risk. Well I think I'm Tamar just writes a damn doms. I mean it may be we have to keep in mind I had put out such wonderful information on to one who we need to watch out for especially the sleeping fictive types. I don't recall her mentioning a malaria type of mosquito in this scenario but since things are changing. And I think a lot of people are beginning to realize how severe rapid change we've had in one last community. I think none of us really know exactly well the changes would be for all mosquitoes not only the malaria mosquitoes which exist but a kind of potential

vectors did exist. Larry it would be America great American disease until the 40s actually date I think went right up in southern Ohio in agreement. But that's all gone now. But for your own personal safety for encephalitis for the viral and satellite which I think is to explore in your area. So I I if you out an at risk expose possibly go on to some of the pellets which lasts 45 60 minutes something like that. We have used our finest and I buy big buckets of the canola and we bring up and down I think I think it's safe. You sound safe. OK well I thank you for the call. Let's go on here we'll talk with a caller next line number two.

Hello. Hello yes I have a question concerning the safety of the immunization procedure for young children I'm planning a trip to West Africa and member with two young children one of whom will be under one year and I was just concerned about the safety of the treatment that you have to undergo before going to live with every country to prevent malaria. There you are there you want to speak to your physicians for your general immunization. Yellow fever which I think is all right sir. Keep it at 0 0 and all the other shots. There is a certain physicians infectious disease physicians. And you may well want to consult a good travel medicine clinic describes you are a real problem will be you know a very young child preventing malaria in every area.

Drug addicted to drugs. Hill days. And my children were raised in West Africa. They spelled it perfectly healthy. But we were able to give them their early chloroquine in fact that is all denied us. Now depending where you were all of virtually all of West Africa even in the city now it has become have become malarious. So and children you know are extremely vulnerable and the children become comatose die or fall apart very quickly. They don't separate malaria which is the major species in West Africa buybacks that exist there. So you've got to be careful. I think you would have to make sure your child first of all sleeps

under a good mosquito net and possibly spray the net with a knockdown spray before sleeping. Well again as a prophylactic again you should consult your either at the CDC or. Problem medicine clinic and I had the experience so far has been good using meth flow quick or by trade area. As a as a prophylactic. Jerry how long are you going to be there. Probably a month. My husband is African and I'm white so I was concerned about that because one of our children is heterozygous for Mychal Bell which I heard sometimes or may give me an immunity to malaria but that's probably not something that should count higher.

No no no they get malaria. Sickle cell phone heterozygotes get malaria but they don't die of it or they can but they usually don't. It slows the growth of the parasite but is not entirely protected. And particularly young very young cats. So I would keep the child under age it's not very even pregnant. That would be I'm sure you could buy one there and good knock down spray and possibly go to prophylactic on the advice of. The trap. That's what I. Kind of OK thank you very much. Thanks Nicole. Let's go and talk with somebody else would lie number one tell you there is an X that I want a definite remedy for this

in a book by a Canadian. It's only good for Craig and that to Cal you the dress shirt you want. OK first the phone number that don't cost a lot to call they are the one that I can't for over three. OK. Thank you guys. 3 0 7 7 0. And they I guess it is. Well hell when Kid Rock can and the only thing back. Back. I'm a coward. One comma. Wrong route to. Those are two in Canada. There are a lot. Could one have to be out there the first say the top field. Oh f i

l d. Alberta Canada. How about that. They have numbers in America. Oh. OK try our oh ok. And we're keeping three people. OK. 2 4 0 3 6 6 2 3 0 7 7. Thank you very much. OK well if that's something people want to investigate they can do that just to talk for a moment about treatment for for a long time. There was only one drug for treating malaria and that was quinine and had been in use had been known for for quite a long time it's something that's derived from the bark of a tree

grows in South America. It worked pretty well although there were some some side effects and. I think probably people were glad when and I think it was in the 1930s there started to be synthetic drugs chloroquine one that you mentioned was was one of them and I think probably still it is fairly widely used although I gather that there has not really been very much research aimed at trying to find better anti-malarial drugs. Why is that why don't we have better drugs. Well it's the church drugs in some ways is very prickly very expensive. One tries to make it logical drug but we don't know that much about the biochemistry really a parasite of. So one makes thousands of formulation during World War

Two. Larry it was supremely important problem the United States Commission looking for a drug problem and correctly something like 20 20 20. That's not normal for today because of that great expense. In some ways that have a shot approach to this as well. Drug companies. Just aren't interested in drugs for poor people and people who live affected by malaria. The great number is where you could sell watch amounts of drugs poor they don't they can't pay a dollar a pill but that's the per capita cost for health for the whole years.

So modern drug companies no longer stared by colonial governments in their need to keep the locals healthy and the Ministry of Health. They have virtually stopped all old research. Droughts for tropical heat. You get one one coming to the fore. But even these are not the license or not. I beguile way it's wrong. Tedious expensive process. Being licensed in the United States and many of the tropical countries wrongly feel it's not good enough. Like I hate that rock I think it confused. So that's essentially what's happened there. The interest in drive as God can still stop cold is the idea that we're putting billions into research. But but in

a place like that let's talk with some other people who are listening here. Line 3 would be our next caller. Hello good morning i want to ask about public help. But what you were just talking about. The idea that the over use of common drugs in the tropics. I get the pharmaceuticals are quite happy to sell. So not really why you know a lot of the. Advocacy is lost because of some of these treatments have been used you know why do you attribute. I'm not completely sure that this is the way you give I don't take it the way you produce drug resistance in animal models. Probably be true. Maybe a simple selection process over a period no drive even how carefully being used is eventually going to be free.

I really don't know I don't think that enough research is done nevertheless. What had happened after the malaria campaign fails that the way to go in the World Health Organization particulate said Now we must go to a different way. We must go to primary health care and where this is. Working today many parts of the world by a small aid post maybe 10 drugs in virtually every village that he knows are orderly. Everybody comes with a fever get to floor when two aspirin and is sent home. And it works in some ways it saves people even with marginally drugs It's strange we never get well actually value added but it doesn't save people.

Makes it rather sticky crowd but it was worth it. There is indeed a great deal of drug use but it does have it as well. Village setting. Any comment on the strategy. The former Nicaraguan government the public health. Plan where they actually just gave anti-malaria was out of the same time and waited long enough that it was a period of a life of. Had a lapse by twice or something like that so that they were no better than actually eradicated. Parasite as a vector so that to date up was malaria but by the fact that they're not doing as much in that regard. Well the fact is you're always going to be that the idea is transferred transmitted at any rate. If you've got a kind of sterile population it

it's OK to have mosquito beds. There's nothing wrong with that as long as the not carrying any and I dare say we looked around we probably met a potentially dangerous and after the fact is that they did at every TV age. It was too cheap for America but it is in many many parts of our country so. What I think they try to do is give very special drugs you know way to kill off sexual stages in the blood and meet a very special right and kind of sterilized population and retrieves transmission or interrupt training suspension. It was a good idea and possibly the Nicaraguan government.

And dictatorial governments and do that when you try to impose mass inoculations bash chemotherapy. Upon a population I am very very. It is very very different. People like Hashem. They don't want to clean up the swamp they don't want to take rugby all the time. And as I understand it much of that malaria is have me back again. If they don't clean up everything. But again they got a bit of it got a bit of rest a lot of ways in which they were great. I wanted to check one thing if I could about maybe an apocryphal story about Silverman when he was here in Augusta this far back in the late 60s. But he was very sure that he had the malarial vaccine. You know if you just do the research and supposedly had

a conversation with Indira Gandhi and said. Well I would continue my research and if you introduce a family planning program and she felt she couldn't I couldn't do it and he said well do some other research I got this from an research assistant from him so it's probably apocryphal but it brings up the whole issue of the family planning in the tropics. And that's are things I never heard anything like that. Yeah yeah. I've been trying to trace a dad I called wire until when I was writing the book Absalom thing like you guys want. Roger Altman from the New York Times the medical writer there because I had somewhere stuck in the back of my mind that there was a New York Times article back in very early 70s late 60s which said

we would not undertake a malaria control program in countries that didn't have a good family planning. I think as an explanation a background explanation in these countries malaria very often directly or indirectly will kill 40 percent of the children and the very slow development of immunity allows people to develop a functional kind immunity when they reach working age. It's not sterile but it is functional. They don't come down with medical attacks. So what malaria had done in a potentially burgeoning population malaria was the bait. Great control birth control program. It killed babies. So. What I had said and what the great fear had always been even

today King in The Lancet said because this is the new bed net program which seems to be working. Pregnant bed head we got to be very careful because again we can have a population explosion. Player on Avatar. Paul Silverman who is an old Indian friend of mine. We actually both did doctorates at the same time he lived in London and when I interviewed him about never told me about that story he told me he thought he had a vaccine that was ready to be tested in Brazil and that the oil embargo came on and they stopped all the research that vaccine would now never be used in humans would be considered too dirty impurity. Some red cell material in it. I fight with that

but that's the way of the world now and in the backseat. So I will never know and I certainly will ask about it next. Thank you. Let's go I have a caller here on the toll free line. Hello Yes good morning. During World War 2 I was stationed in Lee New Guinea and the Japanese had put off peak wind and so the Army had added green tablets are you familiar with those. Oh very much so. We all took turns yellow eyeballs solidarity yellow haired girl in a turn yellow but it could have prevented people from getting malaria and why why did they quit using that over there Nguyen in the countries that they have a lot of malaria. Well out of Britain had had problems it turned yellow which are guys it was medically acceptable it had certain side effects one of which occasionally true of people

psychotic which is not exactly a mild side effect but I never knew of any other menorah put that ever got it and I was valued for over 200 but it did happen at about that same time. Clark when Which what. Much more active was introduced and superseded rightly so at a bed and then when chloroquine became when drug strains became existed for work when they found that they were also prone to resist the added brain as well. So out of Britain but never. We never took attic added up again as a dandy area now of course I know I know over a period of time of cause a ring you know the years I understand that through all that that isn't true it isn't true I have a slight buzz myself from taking back

you know what you people use it for in this country. When you go to take an examination they can do you use that to prevent examination jitters hit or you weren't edited. Yeah well it affects the brains of some sugar this is one of the problems in giving it to people with very high malaria is. You are acutely Gail he has it quick and get it. Because. You can be changed. I could do to make it.

A little. Boring. For Ian. Healy. Oh would it be. Political. Well it's economic in the fact that when people get rich enough to scream that out we did in the United States malaria. Rich people don't have malaria. They go to a country that day where people will villages will Bill. Anti-malarial houses a long ways off but

we had a little tear from Shell Oil Company and in the literature said that mosquito doesn't fly over 200 feet unless it is driven by the wind and we assist spray all around our company area a mixture of kerosene and motor oil. After every rain and we controlled a mosquito so that we didn't even have mosquitoes. That's a hold. That's a whole other approach. But the fact is each Miskito is very very different in the way it will breed and the way it flies. Every strong fly is and with the wind can be carried out on play in ultimate. It's read in very small collections Water Street. Oh yeah. Even to an animal that stops you have a little puddle of water. But if you want to control mosquitoes here in your yard and you have a say

or a baron or anything that holds water all you do is just drop about half a teaspoon of vegetable oil in it. Oh it's great that's the way that's the old fashioned and very effective way of controlling rate barrel breeding and even upon breeding mosquitoes you think you like diesel oil it works very very well. Well you can use RAW which is biodegradable. That's right. Thank you. OK we're coming down here to the point we only have about a minute. There is one thing that I wanted to have you talk a little bit about perhaps we haven't got enough time but that is the why why it is that the spraying efforts that were undertaken by World Health Organization say in the late 50s into the 60s didn't really do what they hoped that they would do the effort to go in there and you had to use I guess the chemical they use mostly was DDT to spray to kill them ski those wonderful chemicals.

Nothing like this have been developed again. In fact it was somewhat difficult to get the agricultural people to get used discriminately in Speedos. It very quickly became resistant physiologically and behaviorally resistant. And then of course the people who developed this program didn't realize the great diversity of mosquito behavior and I would say that mosquitoes which get outdoors which would not were not affected by the kind of household spraying program that was formulated was the whole basis of the strategy of the global eradication scheme so bad biology in some ways a faulty biology. Well mixed with intemperate use I think I. Well we will have to stop at this point because we're at the end of the time I will recommend people if they'd like to read more on the topic. They can take a look at the book it's

entitled The malaria capers and it's published by Norton by W. W. Norton and it's by Robert Desa what's in the book was published last fall. Well Professor dissuades thank you very much for talking with us. My great pleasure. Thank you.