The Dr. Ruth of Malaria Research

She’s the Dr. Ruth of malaria research. She’s short, has meticulously coifed gray hair, and speaks with a thick accent. But she’s no parvenu of mosquito mating habits.

Ruth Nussenzweig, trained in Brazil, long at New York University, published her first paper on the microbiology of parasites in 1954. She and her husband Victor outlined the path to an X-ray attenuated antimalaria vaccine in Nature in 1967. In the 1970s, she helped discover the parasite’s cloaking protein, which GlaxoSmithKline is using to make a malaria vaccine now in clinical trials.

And as she stepped away from the podium Friday at the launch of the Sanaria, Inc. manufacturing facility in Rockville, Md., the 20 staffers who will make an X-ray attenuated vaccine that could go into human clinical trials as soon as next year, along with the 200 public health officials, scientists and dignitaries who’d come to cheer them on, gave her a standing ovation, not so much for anything she’s done lately, but for having carried the torch through the long, dark night when there was no money in the field of malaria vaccine research.

That’s no longer the case, thanks to the generosity of the Bill and Melinda Gates Foundation. John McNeil, director of research at the Foundation-supported PATH Malaria Vaccine Initiative, told the crowd that not only are there two vaccines in or heading for clinical trials, but his group is funding researchers who have at least three more promising candidates in their labs.

Financial largesse can be a mixed blessing, of course, and the malariologists of the world can be excused if they are feeling a bit of pressure. At a forum held earlier this month in Seattle, the computer mogul-turned-philanthropist told his grant recipients that malaria’s eradication – a goal not articulated in global health circles since the 1970s – was back on the agenda. “I’m optimistic that we can make this disease history,” he said.

A vaccine isn’t needed to make major inroads against the disease, which strikes an estimated half billion people a year and kills one to two million, mostly children in sub-Saharan Africa. Mass distribution of insecticide-treated bednets, selective use of indoor spraying, and widespread deployment of artemisinin-combination therapy – the most effective new drug to come along in half a century – could go a long way towards eliminating the disease in countries where public health systems are effective at deploying these strategies.

But eradicate the disease where grinding poverty, corrupt governments and endless civil strife are endemic? That’s where the PATH-MVI research program, based on the pioneering work of Ruth Nussenzweig, is seen as crucial. “How do we contain disease in low-infrastructure settings,” asked Kent Campbell, a senior epidemiologist with the group. “Vaccines.”

Leave it to the one African on the podium to warn about the limits of technology in conquering this age-old scourge. “How many infectious diseases have we eradicated,” asked Adel Mahmoud, an Egyptian-born infectious disease researcher who served as president of Merck’s vaccine unit from 1999 to 2005 and is now a professor at Princeton University. The answer to his rhetorical question is one – smallpox – and researchers have repeatedly shown that only its limited scale in the general population made it an ideal target for isolation and elimination. “We have been warned not to use that as a model,” he said.

Given the technical difficulties of producing a successful vaccine of any type, the odds against developing a vaccine that provides immunity against a complex and adaptable organism that is old as mankind itself are huge. And even if the researchers succeed, the roadblocks to getting it massively deployed are enormous.

But the richest man in the world has thrown down the gauntlet, and backed it with his money. Eradication of malaria is back on the global public health agenda after a two-generation absence. Ruth Nussenzweig, her head barely able to reach the microphone, said only that she was “happy to be able to play a small part.”

Posted by gooznews at October 27, 2007 01:07 PM