Seeing the Past and Future of Malaria Research
On April 25, World Malaria Day 2014 will be celebrated around the world with activities that highlight advances in the field of malaria research and reinvigorate ourselves for the challenges that remain.
Malaria has been with us for most of recorded history. Chinese writing on malaria goes back to 2700 B.C., and Eber's papyrus describes it in 1550 B.C. Despite much progress in disease prevention and treatment over the last several decades, malaria continues to threaten the lives of millions of children and adults and hamper economic development.
For the U.S. military, as far back as 1775, George Washington had to expend his very limited monetary resources to purchase quinine for the treatment of malaria in the Revolutionary Army. During the Civil War, 50 percent of Caucasian troops and a staggering 80 percent of African-American troops contracted malaria annually. Conflicts within the last century continue to highlight the threat of malaria to our troops with World War II, Vietnam, and even recently in Afghanistan. Malaria can have a significant operational impact: in 2003 a military peacekeeping operation in Liberia failed due to 80 cases of malaria in 220 Marines within the first few weeks of the mission.
The Walter Reed Army Institute of Research has been engaged in the battle against malaria since its establishment. Assigned to the newly opened Army Medical School in 1893, Maj. Walter Reed was instrumental in defining the concept of mosquitoes and disease transmission. In Reed's case, it was the disease yellow fever, but this idea allowed William C. Gorgas to abate the transmission of yellow fever and malaria in the construction of the Panama Canal.
The first synthetic antimalarial, atabrine, was developed through the coordinated activities of the Allied medical forces, and this set the stage for WRAIR's later involvement in antimalarial drug development. The Experimental Therapeutics branch of WRAIR remains the only sustained drug development program in the Department of Defense, and this group has the distinct honor of initiating or being involved in virtually every antimalarial drug available for fighting malaria since WWII.
The Malaria Vaccine branch of WRAIR in collaboration with GlaxoSmithKline developed what is currently the world's leading malaria vaccine, RTS,S, the first candidate malaria vaccine to demonstrate that protection is possible. The Entomology branch of WRAIR has worked quietly and diligently on personal protective measures to prevent not only malaria, but other insect-borne diseases as well.
Despite these successful research efforts, there is much to be done. Conservative estimates suggest that over 3.3 billion people remain at risk for the malaria worldwide, with over 200 million cases every year and with over 650,000 deaths (of which over 85 percent are children). Resistance threatens the use of all current drugs used to treat malaria'the parasite will likely continue to find ways to defeat any new drugs discovered for malaria treatment. While vaccines show promise, it will likely be years before we have a licensed vaccine that can protect both the military and public health. As new pesticides to control mosquitoes often suffer from the same resistance problems seen in drugs to control the parasite, we need to continue working on the next generation of personal protective measures. And, like most tropical diseases, malaria is a disease that is tied to poverty and social disruption, which will continue to remain a pervasive problem globally.
As this World Malaria Day is celebrated, we have many reasons to be proud. Military medicine has made significant advances in malaria prevention, control, diagnosis, and treatment, and over the last 100 years, the U.S. military has been a global leader in this fight. However, this is a fight that must be sustained. On this World Malaria Day 2014, we are reminded of the long road ahead of us, and remain steadfast in our resolve to overcome this global health threat.