Rip Ballou's world began to blur around the edges as he stood among the croquet wickets, sipping home-brewed beer at a friend's lawn party. He should have expected it. Two weeks earlier, he'd agreed to let infected mosquitoes land on his arm and fill their bellies with his blood.
The five other volunteers were already sick, but the 34-year-old physician still hoped he would be protected. Ballou and a team of Army scientists had devoted years to making a vaccine against malaria, and the young officer had eagerly volunteered to serve as one of the first guinea pigs.
Maybe it was the beer, he told his wife, as she drove them back to their Wheaton home that day in 1987. Maybe it was too much sun. Then a tremor shook his body, and he resigned himself to the truth. The vaccine had failed. Instead of defeating one of man's oldest foes, Ballou knew the organism had beaten him.
Malaria is a ferocious predator, each year claiming more than 1.1 million lives. In Africa, it kills enough children every day to fill 100 kindergarten classes. Once subdued in much of the world, malaria has rebounded and today infects up to a half-billion people a year. It has surfaced in recent years in southern Europe and Russia, where it was routed almost 40 years ago. As air travel draws the world closer together, experts increasingly fear malaria outbreaks in the United States.
Rich nations and the pharmaceutical industry pay little attention to the disease, which mainly strikes poor countries. But for nearly a century, a few scientists have dreamed of vanquishing malaria with a vaccine.
The more they discovered about the organism, though, the more it seemed to mock them. It was as if the parasite possessed a malignant intelligence, a deep understanding of the human body and its defenses.
Like the scientists before them, Ballou and his colleagues at the Walter Reed Army Institute of Research in Washington came to respect their slippery adversary. Sometimes, they doubted it could ever be conquered. For years, they struggled along on a threadbare budget, working in obscurity, enduring repeated frustrations.
Finally, last year, they could claim some success. For a short time, they protected hundreds of people from malaria in Africa, proving that a vaccine was at least possible. More work would be needed, they knew, more money and luck. But Ballou and his team had come closer than anyone before to creating the ultimate weapon against the disease.
After that first discouraging trial 13 years ago, the Walter Reed scientists learned to build on their failure. Back at the lab, they began asking themselves: What had gone wrong? Why had the vaccine failed? Most important, how could they beat malaria the next time?
One out of five
After the "Long Rains" raked the ragged fields along Kenya's coast, the fever returned to claim its melancholy harvest.
Ria Sulubu lay in a hospital ward in the town of Kilifi last summer, his soft brown skin shining against the white sheet. The 3-year-old panted. A desk lamp warmed him. His tiny fists clenched and unclenched, his eyes darting fitfully. Others in the cramped ward coughed or moaned.
In some villages in sub-Saharan Africa, malaria kills one out of five children before their fifth birthday. Unlike many other infectious diseases, malaria confers only limited immunity. Small children can contract malaria 30 or 40 times. Even if the disease doesn't kill them, it can cause severe brain damage or make them vulnerable to other infections. Some might be stricken with Burkitt's lymphoma, a cancer that causes balloon-shaped tumors on the face and abdomen.
Ria suffered from a severe complication called cerebral malaria. For 10 days, seizures jolted his brain. Scribbled in pencil, his medical chart for June 25 records more than a dozen episodes: 5:05 a.m., 6:10 a.m., 6:18 a.m., 6:36 a.m., 6:48 a.m. and so on. If doctors couldn't stop them, Ria would die.
Two weeks earlier, Ria had been bitten by a female mosquito, seeking the nourishment of human blood before she laid her eggs. Maybe Ria felt the insect puncture his skin as he played in the red earth outside his mother's mud-wattle house. Maybe the bite came while he was sleeping with his two sisters on their bed.
The insect's saliva carried Plasmodium falciparum, one of four species of the malaria parasite and the one responsible for almost all the deaths.
Eyelash-shaped parasites slipped through Ria's skin and into his blood. Within minutes, each parasite wiggled into a liver cell and adopted a beady shape, like a fish egg. They poked out a chemical net to snare nutrients from the blood.
Over the next 10 days, the parasites changed form, gorged and created tens of thousands of offspring. Leaving the liver, they invaded red blood cells, shifted shape again to fool the body's defenses, and multiplied. Every 48 hours, new parasites burst in unison from their host blood cells and swarmed into fresh cells.
With each eruption, the parasites created showers of cellular debris. That provoked Ria's immune system to pump out chemicals called cytokines, causing shattering chills, fevers and pain. Ria may have felt as though his muscles were pricked by needles, his head as though it were split in a vise.
His body's thermostat rose from 98.6 degrees Fahrenheit to over 105. Though Ria lived on the Equator, he would have felt as though he were freezing. His body ordered his muscles to shiver, generating heat through friction. This is called rigor, pronounced RYE-gore, and it is the defining symptom of a malaria infection.
A roller coaster of chills and fevers followed. Every two days, the parasites increased tenfold. In a week, Ria's blood was loaded with tens of millions of them.
Ria's fever soared, and he became listless and weak. His mother, Fatuma, carried him to a private health clinic and paid about $3.60 -- a day's pay for her husband -- for what probably was chloroquine.
Twenty years ago, the drug would have cured malaria in East Africa. Because local strains are increasingly resistant to chloroquine, it didn't help Ria. (Several drugs are still effective and might have cured him, but they are more expensive and often not available in rural areas.)
By the next day, he didn't have enough healthy blood cells left to deliver oxygen through his body. The boy gasped for breath. Soon, some of his organs began to fail. The spleen normally flushes out infected cells, but falciparum dodges this defense by anchoring itself to the blood vessels. The parasites began to clog the capillaries in Ria's brain, and he fell into a coma.
Fatuma propped up her son in a plastic tub and poured water over his head, but she couldn't stir him. So she bundled the boy up and carried him several miles to the coastal highway, where she caught a bus to Kilifi.
A doctor sent him to the hospital's intensive care unit, a building with eight metal frame beds, a hole in the floor for a toilet, and not much else. It was one of the worst malaria seasons in memory. So many children were sick, they crowded three to a bed.
Fighting the seizures
There, seizures jolted Ria, shocking the delicate circuitry of his brain. Twice, doctors tried to halt the seizures by injecting him with Valium, with no effect.
Desperate, Dr. Faith Osier, a 27-year-old Kenyan doctor, tried another drug, which didn't work either. Finally, she injected Ria with her most powerful remedy, phenobarbital. The drug might have killed him, but the seizures could destroy his brain. After 65 recorded seizures, Ria's siege ended.
Fatuma was murmuring to her son a few days later when Ria turned to listen. He was coming out of his coma. But, she realized, he couldn't sit up or talk. And the seizures had left him blind.
Fatuma's prominent cheekbones glistened with perspiration, her eyes sagged with fatigue. Nervously, she fingered the hospital smock that replaced her soiled clothes. She had spent a week by Ria's bed, sitting on a stool or sleeping on the concrete floor. "Now I want to take him home," she said.
Dr. James Berkley, a young British-born physician, stood across the room and flipped through the boy's chart. "Given the level of severity, he will not recover," he said quietly. "That's about as bad as malaria gets. In some ways, it's a worse outcome than dying."
Fatuma washed Ria and put on her tribal dress, a pink and yellow print. Slung in a cloth on her back, Ria stared blankly. How, his mother was asked, will she cope once she gets him home?
Fatuma's exhausted face hardened. Finally, she whispered: "The baby is OK now." And she turned to leave.
The ancient Hindus crowned malaria "King of Diseases." The Chinese called it "Mother of Fevers." After evolving more than a million years ago in Africa, it crept across the world and arrived in the Americas shortly after Columbus. Outbreaks once occurred as far north as Long Island Sound and the Great Lakes.
For centuries, physicians blamed malaria on vapors drifting off rotting vegetation. (Malaria comes from the Italian for "bad air.") Then in 1880, a French army doctor in Algiers put the blood of a feverish soldier under his microscope and saw a wiggling form. Soon after, British and Italian scientists discovered that malaria was spread by female Anopheles mosquitoes, found all over the world.
The hunt for a vaccine began. Developed in the 18th century by British physician Edward Jenner, vaccines are the most successful medical strategy ever devised. Today, more than two dozen exist. They have wiped out smallpox and brought measles and polio to the brink of extinction.
By staging a kind of mock infection, vaccines train the body to recognize and attack an invading pathogen. They work by enlisting the immune system's major forces -- mainly antibodies, particles that stick to invaders, immobilizing them in the blood.
Traditionally, vaccines are aimed at viruses or bacteria. Malaria is a more complicated organism, commonly called a parasite, that acts more like a cunning predator than a brainless microbe. There has never been a successful vaccine against any parasite.
Scientists quickly discovered how difficult it would be to create a human vaccine. Unlike bacteria, they discovered, malaria parasites couldn't be grown in the lab. Because human malaria can't infect animals, there was no safe way to test vaccines.
So researchers tried making vaccines against animal malarias, but that didn't work either. In the mid-1940s, a New York City health department scientist developed a monkey vaccine, but it was toxic.
No ethical scientist would test such a dangerous vaccine on humans. But in Nazi Germany, Dr. Claus Karl Schilling injected inmates at the Dachau concentration camp with experimental formulas, killing more than 400. He was hanged for his crimes.
After World War II, scientists abandoned malaria vaccine research in favor of public health measures. The World Health Organization set out in the 1950s to eradicate the disease using two chemicals: DDT, which killed mosquitoes, and chloroquine, an anti-malarial wonder drug captured from the Vichy French.
Within a few years, the effort collapsed. A few hardy parasites and insects survived every onslaught, and their offspring inherited genes for resistance. Malaria crept back and then attacked with renewed savagery.
By 1963, drug-resistant strains of malaria infected American soldiers in Vietnam. Sri Lanka, which had only 16 cases of malaria in the 1960s, saw a half-million in the 1980s. In Peru, the number rose 2,500 percent from 1992 to 1997. In Tajikistan, a former Soviet republic, cases jumped from 616 in 1993 to 30,000 in 1997.
Even Europe and North America, where draining swamps and spraying pesticides had eliminated malaria by the 1940s, became vulnerable.
Infected mosquitoes stowed away on jets have caused cases of "airport malaria" recently near Paris, Luxembourg and London. And malaria slips into the United States through 1,200 infected travelers a year, each a walking incubator of the parasite.
If an infected person is bitten by a mosquito, and that mosquito bites someone else, an outbreak can begin. Locally transmitted cases of malaria are rare in this country, but they happen. That's probably how two Long Island boys were sickened at a Scout camp last summer and why a Virginia woman nearly died the summer before.
Doctors at a Fredericksburg hospital were stumped in July 1998 when paramedics brought in Shirley Walker, who was feverish and increasingly incoherent. The 63-year-old Colonial Beach housewife had collapsed outside her bedroom.
Finally, lab technicians took a second look at a sample of her blood and found Plasmodium falciparum -- the same deadly species that infected Ria Sulubu.
It was the first falciparum infection in Virginia in 50 years. How had it happened? Walker didn't live near an airport and hadn't been farther than a mall in Waldorf, Md., in months.
A team from the U.S. Centers for Disease Control and Prevention in Atlanta hunted mosquitoes in the woods behind Walker's home. None carried the parasite. They drew blood from migrants from Mexico and the Caribbean working in area nurseries and wineries. They weren't infected. The mystery of Shirley Walker's illness was never solved.
Searching for a malaria vaccine demanded discipline and perseverance. It was a role, it seemed, that Rip Ballou had prepared for all his life.
Born in Fort Campbell, Ky., Ballou is descended from three generations of Army officers. Ballou Sr., a colonel, had nine sons, and he imposed a quasi-military discipline on them.
Each boy was responsible for the behavior of his next younger sibling. In any dispute, the older son was assumed to be at fault. Infractions drew corporal punishment. W. Ripley Ballou Jr., known as Rip, was his father's second-in-command. Ballou Sr. dreamed of sending his eldest son to West Point, where Rip's grandfather and great-grandfather had gone. (Poor eyesight disqualified Ballou Sr.) Rip had the grades.
"That was an unwritten rule in our household," brother John Ballou says. "You're a good student or you're a waste of time." Rip's brothers include another doctor, two lawyers, an electrical engineer, an environmental scientist, an art teacher and two computer software entrepreneurs.
Rip arrived at West Point in 1969, the summer of Woodstock. Plebe year was called "Beast Barracks," a punishing rite of passage mixing military training and ritual harassment. Ballou excelled, but regarded the hazing as a distraction, the war in Vietnam -- where many Point graduates were headed -- as a mistake.
While Ballou guarded the academy gates one day, protesters put a flower in his rifle barrel. He thought: "I agree with them." After his first year, he quit.
Ballou approached major decisions methodically. At Georgia Tech in Atlanta, he needed a major. The first listing in his catalog was Aeronautical Engineering. He studied that for three months, until he decided there were too many mathematical formulas to memorize. The second major was Applied Biology. That one stuck.
Once committed to a goal, Ballou was seldom diverted. His father told him he would know instantly when he met the woman he would marry. "Sure, right," Rip thought. "My old man talking."
But when Ruth Wallace, a high school senior, visited his roommate one day, Rip was smitten. "I didn't know her name, but I knew it was her," he said. At first she thought he was crazy, but they were married 18 months later.
Unable to pay for medical school, Ballou reluctantly accepted a military scholarship that committed him to four years of service. As a resident at the Walter Reed hospital in 1981, Ballou was required to spend a year in the lab. At the Army Institute of Research, one of the world's leading centers for tropical medicine, he extracted and analyzed blood from rodents. He hated it. After a few months, he protested.
"I can't take this anymore," Ballou recalls telling his boss. "I spent eight years learning to be a doctor and I'm screwing around with mice." The lab chief offered him another job. Would Ballou like to make a vaccine against malaria?
It was an ambitious goal, but Ballou knew there would be little glory in its pursuit.
Infectious disease was considered a backwater of research; most microbes were thought to have been conquered. Few scientists back then realized that malaria was resurging. The first AIDS cases were surfacing. Drug-resistant tuberculosis was about to become a global scourge.
Pharmaceutical companies were more interested in drugs for heart disease and cancer, the chronic ailments of industrial nations. Increasingly, they raced to find profitable treatments for baldness, "social anxiety" and allergies to pets.
They spent little effort on the infections killing the world's poor. Only 13 out of 1,223 new medicines marketed by major drug companies between 1975 and 1997 could be used for tropical diseases, according to Doctors Without Borders.
Even the military neglected malaria, though it can be as lethal as an enemy's bullet. A third of U.S. peacekeepers were sickened in Somalia. If America sent troops to Southeast Asia today, "you would have enormous casualties and deaths from malaria," says Amir Attaran, a health policy expert at Harvard's Kennedy School of Government.
Yet in recent years the Pentagon spent only about $5 million annually on malaria vaccine research -- a tenth of what it spent last year on Viagra, the anti-impotence drug, for troops.
Ballou and his colleagues at Walter Reed, named after the Army scientist who established that mosquitoes spread yellow fever, labored in labs that were exotically decrepit. Water pipes broke, flooding offices. Manure from monkey cages would sometimes leak from sewer pipes and bubble out of sinks. Dusty marble hallways telescoped into tunnels choked by file cabinets and refrigerators with peeling biohazard stickers.
Committed to the goal
The researchers didn't care. They felt they were closing in on a goal sought by generations of scientists. "There was this constant sense of enthusiasm, that if we worked hard enough and fast enough, we could have an effective malaria vaccine," recalled Dr. Wayne T. Hockmeyer, who headed the effort.
The Army built on the work of Dr. Ruth Nussenzweig of New York University, who in the 1960s immunized mice with parasites weakened by radiation so they couldn't cause disease.
Dr. David F. Clyde of the University of Maryland proved those methods worked in tests on prisoners at the Men's House of Correction in Jessup in the 1970s. ("G.Z.," a Baltimore longshoreman who killed a man in a bar fight, might have been the first human ever immunized against malaria.)
But Clyde couldn't make a practical vaccine. He had taken malaria-carrying mosquitoes, exposed them to X-rays and let them feed on the inmate volunteers. Separating parasites from the mosquitoes was impossible, and a vaccine contaminated with mosquito parts could be lethal.
Nussenzweig found a protein that stuck out of the coating of the invasive stage of the parasite, called the sporozoite. The protein seemed to rouse the body's defenses, like the battle flag of an attacking army.
Walter Reed researchers tried to fabricate the chemical flag. But it fell into pieces in the test tube. So they hunted for smaller, more stable bits of the protein that could be copied, yet still prod the immune system to react. After more than a year, they succeeded.
The Army hoped to attack the parasite right after it entered its victim. Researchers half-jokingly called this "the Star Wars strategy." To work, the vaccine would have to wipe out all dozen or so invading parasites in the few minutes before they reached the liver. If even one slipped by, it would swiftly change form, multiply and cause full-blown illness.
Crafting a vaccine in the lab was only a start. It would have to be tested by exposing people to the parasite. Scientists call this a "challenge," and Ballou was put in charge.
"It was always clear that Rip had the most leadership skills," said Dr. Jeffrey Chulay, a former Walter Reed scientist. Ballou's manner was reserved but intense. Even superiors were intimidated by his cobalt-steel stare.
As they solved one problem after another, the Army scientists grew confident. In those early, heady days, Ballou recalled, Army brass visited the researchers regularly; a general even sent his Blackhawk helicopter to whisk them to a meeting. Drug executives courted the Walter Reed team.
In April 1987, Ballou and the other volunteers -- all military scientists -- were inoculated. Weeks later, they let infected mosquitoes bite them. Ten days later, two fell ill. A third followed. Soon, Ballou was thrashing in his bed. The next day, a fifth volunteer began shaking uncontrollably as he lectured on malaria in San Diego. A Washington Post headline summed it up: "Malaria Vaccine Bites Dust."
In science, failure separates the plausible from the real, the intriguing from the true. The trick, Ballou said, is to learn something from failure, to listen to what it tells you.
Five volunteers fell ill, but one -- Dr. Daniel M. Gordon -- did not. Gordon might have been a fluke, but later tests showed the vaccine pushed his antibody levels higher than anyone else's. If the vaccine could protect one person, the Army scientists asked, why couldn't it be made to protect everyone else?
The Walter Reed scientists knew then that they had only one choice: to test version after version of the vaccine until they hit on one that worked.
It would be like trying to guess the combination to a safe. They could have all the numbers wrong or be just a digit off on a single number, but the safe would remain locked. They wouldn't even know how close they had come.
"There's no guarantee we'll find an answer," Ballou said. "There's no guarantee of anything but disappointment."
In 1990, Ballou took over the program. He scrounged, begging other Pentagon managers for money to supplement the few million he was given each year. (By contrast, a drug company might spend $500 million on a vaccine.) He had to compete against a rival Navy program with a different vaccine strategy. "We had to fight for every dollar that we got," Ballou said.
He turned an old Army lab in Montgomery County into a vaccine manufacturing plant. And he scoured the ranks of military doctors and scientists for converts to his cause.
One of the first was Dr. D. Gray Heppner, a square-jawed physician who was impressed with Walter Reed's frontal assault on malaria. "They had a plan to attack the parasite by the most expedient means," Hepp-ner said.
Like some of the other recruits, Heppner was more spit- and-polish than Ballou. Where Ballou might slouch into the lab in an olive T-shirt, like Alan Alda in a "MASH" episode, Heppner's uniform was pressed and his shoes shined. He placed a shotput ball from a military contest on top of his coffee cup and stuck "MALARIA" license tags on his minivan.
The longer Ballou worked on malaria, the more personal his quest became. During a trip to Gambia, in West Africa, Ballou visited a couple who had just lost their child. They grasped his hands, their faces strained by grief. Sometimes, callous Westerners assume that losing a child isn't as hard for people in poor countries. "Children die there all the time," they'll say. It made Ballou sick to remember such talk.
"Here I was in this one-room house, with a bed, a few chairs and a couple of calendars on the wall," Ballou recalled. "And I realized that this was all these people had. This child was obviously an incredibly important part of their lives."
Malaria claimed more lives every year, but in the early 1990s the Army's vaccine program appeared stalled. Every vaccine Ballou and his team tested fizzled. The original vaccine failed in field trials in Thailand and Kenya. New versions that linked the malaria parasite with other microbes to spur the immune system flopped. Each blind alley consumed millions of dollars and years of work. Colleagues began to have doubts.
"You guys still working on that sporozoite vaccine?" one scientist asked Ballou. Others would ask pointedly: "Why are you still working on this?"
"It's the only thing that has worked so far," Ballou would say.
But the "Star Wars strategy" didn't work all that well. What they needed, Ballou's researchers believed, was to attack the parasite at several points in its life cycle, not just the first. If the vaccine failed against one stage, it might still work against another. So Army scientists loaded a new vaccine with fragments torn from seven of malaria's stages. "It was so beautiful," said David Lanar, the biologist who led the effort.
When the vaccine was tested on 30 volunteers, 29 got malaria. In the jargon of researchers, the formula was "water." They were stunned. How could a vaccine with multiple weapons be less effective than one with a single weapon?
"Why has this parasite survived for millions of years?" said Dr. Christian F. Ockenhouse, a Walter Reed scientist. "It doesn't want to make things easy."
By the mid-1990s, Pentagon officials began to question whether the vaccine effort was worthwhile. SmithKline Beecham PLC, Walter Reed's only real ally in industry, also wavered, researchers said. Ballou lobbied hard to keep the company from dropping out. First hired to make batches of vaccine, the company had become the Army's partner -- spending an estimated $5 million to $10 million. In exchange, the company demanded all commercial rights .
SmithKline describes its efforts as an act of charity. "We're never going to get a return because nobody is going to have the money for buying these vaccines," says Dr. Jean-Pierre Garnier, the company's chief operating officer.
But some scientists say there is another reason the drug maker is involved: an AIDS vaccine, which could find a lucrative market in Western nations. The key to preventing AIDS might be adjuvants -- compounds that boost the immune system. Because volunteers can't be deliberately exposed to AIDS, malaria vaccines are a surrogate for testing adjuvants.
Dr. Joe Cohen, a SmithKline researcher in Belgium, grew interested in a new adjuvant derived from the bark of a South American tree. He and Walter Reed researchers added it to yet another version of the sporozoite vaccine.
Walter Reed rounded up volunteers, including David Armstrong, a 30-year-old Defense Department employee. "Down the road this was probably going to save someone's life," he said.
After being inoculated, Armstrong went to Walter Reed on a summer day in 1996, laid his arm on a table and watched five mosquitoes feed. Each bite, he said, felt like a pinprick. Two weeks later he and six others gathered in a rundown Silver Spring motel.
One volunteer developed chills and a fever, and was treated with drugs. The others waited, but none fell ill.
The Army researchers were elated. Colleagues called to congratulate them. When the New England Journal of Medicine published the paper in January 1997, reporters clamored for interviews.
Ballou, though, did not celebrate. Even at home, he was cautious, telling his wife not to read too much into the results.
"The first vaccine failed so miserably, that's always been in the back of their minds," Ruth Ballou said. "You can't get excited about these things."
Still, Ballou couldn't help feeling heartened. Maybe they were on the threshold of success. Maybe, he thought, they had outwitted the parasite at last.
On the banks of the Gambia River in West Africa, doctors working with Walter Reed and SmithKline bounced down dirt roads in a Land Rover. They passed 6-foot termite mounds and the bloated trunks of baobab trees.
In the fall of 1998, they inoculated 306 men in villages near the dusty port city of Basse. Half received a placebo, half the Army vaccine that researchers hoped would block the fevers that smolder in the savanna.
The doctors tracked their volunteers for months, taking blood samples and looking for signs of illness. But no one knew whether the vaccine worked until last July, after Ballou and his team arrived at SmithKline Beecham's gleaming offices in Rixensart, Belgium.
As a statistician summarized the data, the numbers sounded grim at first. At the end of the five-month study, there were almost as many cases of malaria among those who got the vaccine as among those who didn't.
But as Ballou scanned the columns of figures, he discovered they were hiding something. For the first eight weeks, the vaccine had reduced cases of malaria by almost two-thirds. And among those who got sick, there were significantly fewer cases -- 40 percent -- of severe infection.
To many of malaria's victims, Ballou knew, that could mean the difference between life and death.
Everyone in the room understood that the vaccine needed more tinkering and testing. Its effect faded far too quickly. But it had worked. Eleven years earlier, the Walter Reed doctors had protected a single scientist in Washington. Now, they had for a time protected scores of men in the African bush.
"It was a landmark that broke through the skepticism," said Dr. Philip Russell, a Johns Hopkins vaccine expert. Until Walter Reed's work, many scientists still suspected a malaria vaccine was an illusory goal, said Dr. Adrian Hill of Oxford University, a leading malaria researcher. The Gambia trial, he said, "has provided proof the whole thing is doable."
Always the reluctant soldier, Ballou had thought for years about retiring from the Army. He was offered a job ten years ago that would have made him rich, but he couldn't bring himself to leave. "I had unfinished business with malaria," he said.
After Gambia, he was ready to go. While the vaccine wasn't the final triumph he had struggled for, he could still feel some measure of satisfaction. He had taken on a force of nature and revived interest in one of medicine's oldest quests.
Western governments and public health groups are taking up the cause. Perhaps it is the fear that malaria might return to the developed world. Perhaps it's no longer possible to ignore the unnecessary deaths of millions. Whatever the reasons, the pursuit of a malaria is no longer a lonely one.
In the past year, the National Institutes of Health and the U.S. Centers for Disease Control and Prevention have raised spending significantly on malaria research. The Gates Foundation, funded by Microsoft billionaire Bill Gates, pledged $50 million last year to create malaria vaccines. Other labs are planning trials of Walter Reed's vaccine in the coming months; SmithKline plans to test it in children in Gambia this fall.
At the White House, President Clinton gathered the leaders of the world's pharmaceutical industry in March, exhorting them to battle malaria and other scourges of the developing world. And last month Dr. Jean Stephenne, a top SmithKline executive, surprised scientists at an NIH conference with a prediction that would have sounded preposterous just two years ago. By the end of this decade, he said, the world could finally have a malaria vaccine.
A matter of time
Springtime came as it always has to Kilifi. First, the April rains tap on the broad banana and palm leaves, the corrugated tin roofs. Then the Long Rains rattle steadily. The skies weld shut, becoming a seamless lid of steel.
When puddles shimmer in the pink light of the setting sun, swarms of female Anopheles mosquitoes begin their nightly hunt for blood. Anxious mothers struggle into town, carrying their sick children like sacks of rice. At the hospital, listless toddlers crowd the unit's beds.
Usually, the mothers sit stoically, with blank expressions, as their children are poked with needles and transfused with blood. No tears stain their faces. "I think most people who bring their kids here expect them to die," said James Berkley, the young British doctor. "Anything else is a bonus."
For now, malaria remains as certain as the seasons, as predictable as the waves that wash Kilifi's shore. But a vaccine could stop the ageless cycle of disease. It could break the fever.Copyright © 2015, Los Angeles Times