* This is a vaccine for P. falciparum, which is the nasty form that you really don't want. Good.
* Funding comes from GSK and the Bill and Melinda Gates Foundation
* These are interim results, looking at the older kids (5mo and up) in a 2-prong study (the younger kids haven't all hit the 12mo-duration milestone needed per protocol so this largely ignores them so far with more to come later). Caution. (Because there was no clear rationale given for why this is being reported now, in pieces.)
* Treated kids had higher incidence of meningitis. Caution.
* Treated kids had higher risk of febrile seizures. Caution.
* Generally, few deaths, so these kids seem to be well looked-after in this trial. Appropriate.
So far, so good. Interested to see the final Phase 3 results and to see how this holds up in Phase 4/postmarketing.
Phase 3 is basically the definitive clinical trial. Phase 4 is essentially keeping track of what happens after your drug comes onto market. Once all of the results are in, that paper will likely become the definitive paper on this particular drug (again, it's a bit weird that they did this prelim analysis without a clearly stated reason). So Phase 3 is the real deal in terms of winning approval to market the drug.
Regarding efficacy, it is definitely low compared to many modern vaccines which are in the 90+ range. But my understanding is that this is much higher than previous malaria vaccines. If the numbers are really true, then they could possibly save hundreds of thousands of lives per year despite the relatively low efficacy. And it should be a first foothold in terms of making immunologic progress against Plasmodium.
I am not an epidemiologist, so I cannot answer your question directly. However, I do know that most vaccines are not 100% protection. The goal is to reach herd immunity. This is also the reason why the recent anti-vax movement is so dangerous. Even if your kid gets vaccinated, if the rest of his/her classmates do not there is still a risk of him/her catching the disease in question.
As someone who worked in the development world for a year, I can honestly say that if this vaccine pans out, it would be the biggest development in recent history and would change the livelihoods of so many individuals and families.
If this doesn't deserve a Nobel I'm not sure what does. Bravo Joe Cohen.
You could also look at Microsoft's history and declare that if it hadn't been for the widespread adoption of the internet then the Gates Foundation would be even richer than it is now.
Considering an enormous amount of business (you know where food, supplies, etc. comes from) is now facilitated with the Internet, I don't think this is true, especially because they won't see a vaccine for a very long time. The chance of getting the disease is also low, probably not substantially more than getting injured in an automobile crash.
> The chance of getting the disease is also low, probably not substantially more than getting injured in an automobile crash.
Worldwide it was estimated in 2004 that 1.2 million people were killed and 50 million more were injured in motor vehicle collisions.[1]
It is estimated that malaria causes 250 million cases of fever and approximately one million deaths annually. [2]
If we focus on the 800 million people in Sub-Saharan Africa where 90% of malaria cases occur, a rough estimate would be:
If we assume that Africa's traffic accident rate is the same as the world rate (it's not - I see that it's higher when I examine a few countries in this table[3]), it would be 141,000 deaths from traffic accidents and more than 5.9 million injuries from traffic accidents. The world death rate from traffic accidents is 20.8. I'll arbitrarily pick Zimbabwe's 27.5 to be representative of the region so the numbers should be 32% higher. That would be 186,000 deaths and more than 7.8 million injuries.
Taking 90% of the world malaria numbers, there are 900,000 deaths and 30 million cases of fever from malaria in Sub-Saharan Africa.
So if you're one of the 800 million people in that region, you're 4.8 times more likely to die from malaria than a traffic accident and 3.8 times more likely to get a fever from malaria than be injured in a traffic accident.
If you contract malaria you suffer from it for life, and you become a carrier so that mosquitos can pass it on from you to others.
Most people who contract malaria don't die from it, but you do get VERY sick. It's an incurable disease that comes back year after year for the rest of your life.
> It's an incurable disease that comes back year after year for the rest of your life.
This is not true.
My wife is Nigerian. She had malaria a number of times as a child. So did all her sisters. So did the rest of her family. Luckily for them they are from a privileged family that could easily afford proper treatment. None of them have had recurrences in the 10+ years since they moved to the UK.
Some forms of malaria can recur. It is not a given that it will. Recurrence happens when the malaria continues to infect the liver after the symptoms subside. However it can be eradicated from the liver too with primaquine to take care of the liver combined with chloroquine and ACT for the primary infection.
The problem with Malaria is not that it isn't treatable, but that it 1) infects so many that it's pretty much inevitable that some people don't get treatment in time, and 2) that it mostly affect people in areas that are poor enough for people to have problems getting treatment, 3) because of the scale of the problem there is a very real ongoing concern about drug resistance.
For a lot of poor people, though, in practice you are right in that many won't be able to get a proper combination therapy and will keep getting their blood reinfected from their liver.
This is quite wrong. About 15 years ago I went on a trip up the Rio Negro in Brazil. My wife and daughters had taken the standard preventative medicines, but they all came down with a drug resistant form. I escaped because I took a low dosage antibiotic. Their treatment was complicated because the disease didnt manifest itself for 2-3 months, not the normal < 30 days. Also malaria runs in a cycle of 2 weeks or so. It could be detected (then?) only when they were too sick to go to the hospital. When they felt well enough to go to the hospital it had retreated to the liver and wasnt detectable.
> Its incurable
Not true at all, but the treatment (at the time) required a two drug phased treatment. First the active disease needed to be cleared from the system. Then the reservoir in the liver needed to be killed. They had a drug resistant strain which required strain specific treatment. Treatment in Brazil was complicated because the drugs were OTC and most people treated themselves without a doctor's supervision, leading to the drug resistant strains.
The chance of getting the disease is also low, probably not substantially more than getting injured in an automobile crash.
I've had malaria once, but I've never been injured in an automobile crash. Luckily I was able to avoid malaria for 25 years by living in Los Angeles (I got it on a trip through the jungle in the Philippines), but for people living in tropical climates where malaria is more common, this may not be an option.
Completely agree. It's a major accomplishment, and if confirmed, will change the world. In my mind, it goes along with another fascinating development Reuters covered a while back having to do with rapid detection of micro-organisms. These guys say they've brought detection times of tuberculosis from 21 days to 4 days, e.coli from 24 hours down to 4 hours, and similar decreases in detection of a wide variety of other microorganisms using a very cost-effective technique well suited for developing nations where price is a major issue.
Combine prevention like this Malaria vaccine with rapid detection from these guys and you've got a nice one-two punch capable of fending of a whole host of things that are unnecessarily taking lives.
The real trick is that the existing cultures themselves will have to quickly reconfigure so that this doesn't simply shift the problem laterally.
For example, initiatives to dig wells in various African countries have turned out to result in other problems. Some nomadic cultures began staying put, and then they started overusing all the other resources. The scarcity of water was a control in itself, limiting how long groups stayed in a given area. Removal of that control has led to desertification of areas surrounding the wells. And it also brought disparate groups into contact with each other for longer periods of time, which led to more disease outbreaks. Nomadic groups had fewer and briefer encounters with others before, limiting the spread of disease from one group to another.
Another example is the grave humanitarian crisis in Somalia. Hundreds of thousands of people are expected to starve to death in the next few months. Due to raging conflicts, humanitarian aid cannot be effectively distributed.
However, even if the crisis could temporarily be averted, the problem with food aid is it undermines any possibility of local production. Farmers can't compete with free food dumped on the market, so they stop farming. Not being self-sufficient, now you're looking at not only providing aid, but ever-increasing aid as the population grows, which means if you stop for any reason -- including civil war flaring up again -- now even more people die: the ones you saved, and the children they have had in the interim.
Cultures with high child mortality compensate by having high numbers of children. Once you get rid of the main causes of child mortality, you have to either stop having so many kids, or dramatically increase food production. Otherwise curing Malaria can result later in all the problems that accompany a lack of resources: bigger famines, increased civil strife and warfare.
> Once you get rid of the main causes of child mortality, you have to either stop having so many kids, or dramatically increase food production. Otherwise curing Malaria can result later in all the problems that accompany a lack of resources: bigger famines, increased civil strife and warfare.
Much as what happened in Europe, this tends to self-regulate over a few generations: high natality is a requirement in high-death and low-income situations, where you need many children to have some survive (and help you in old age), and children are hands that can work and provide wealth.
As mortality decreases you need less children as they'll pretty much all survive, and as wealth increases you want less children because raising them to your society's standards gets more expensive and there's a much bigger investment in each child.
Of course there will be 2-3 generations with high natality and low mortality, and an explosion of younger generations (likely leading to a few revolutions). But there's little you can do about that in the short term.
Yes - see Germany, Italy, Singapore and Japan for high life expectancy and low birth rate. Interestingly, children also become less affordable, as opposed to just less financially necessary.
Regarding cultures with high child mortality and the effects of vaccine: http://www.ted.com/talks/hans_rosling_shows_the_best_stats_y...
If these cultures can focus on development instead of battling sickness the surprising fact is that the earth population actually will stop growing...
Humanity is still an animal race. Our birth rates still self-regulate. If children stop dying in Africa, people will in time stop having as many children.
There will very likely be issues like you describe, but they should run their course and go away so long as outsiders don't try to meddle too much.
Unlike accelerated disease propegation between nomadic tribes, the problem of having extra people is one of the better problems to have.
Otherwise curing Malaria can result later in all the problems that accompany a lack of resources: bigger famines, increased civil strife and warfare.
I cannot fathom why someone would be against curing malaria. Bring on the faminines or civil wars. We shouldn't keep the Africans down. Africa already has civil wars & famines, we shouldn't sacrifice the little black kids aswell.
I didn't read this into seven_stones' post. We should eradicate Malaria, of course, but we should also plan for the consequences of eradicating it - intensify investment in modernizing agriculture, education and getting ready for a few famines and revolutions (and the resulting deaths) too if all else fails.
> However, even if the crisis could temporarily be averted, the problem with food aid is it undermines any possibility of local production. Farmers can't compete with free food dumped on the market, so they stop farming.
Aid like this needs to happen through buying the food locally, or as close to it as possible.
I think you'd get the most long-term benefit from enforcing peace on the roads and at the refugee camps, then giving the refugees money - ever more until it's worth it for independents to deliver food.
Initially this would result in the same rush of foreign food which would otherwise put local farmers out of business, but instead of the aid being foreign food which displaces local food production, it's foreign money - which will buy local food with preference because it's cheaper. Local farmers could command any price - just short of that of shipping food across the world under military convoy, and would make a fortune. This would build local food production, not ruin it.
The USDA has been piloting a food aid program for a few years that procures food locally. I think an independent study on the program is due next year.
Most vaccines are against viruses and bacteria. Malaria is a more complicated organism, a protist with many local varieties, and a tremendous ability to evolve around vaccines and medications in general.
Natural immunity to malaria is often limited to the local variant -- go a couple hundred miles, and you have no resistance at all. Vaccines rely on the body's natural immune system, so it is nearly impossible to create a single vaccine that is effective across the world.
For this reason, I'm highly skeptical that this initial test result will hold up with broader trials. BTW my spouse is a malariologist, formerly at WHO, and I've been a witness to much of the fight against malaria over the years.
From what i read elsewhere it works almost like a magic without producing resistance, and i'm wondering what would be the first hand account of a practitioner.
There's already artemisinin resistance starting in several places around the world, especially the Thai-Cambodia border, a very chaotic area with high endemic malaria.
The main problem is that cheap medications are often out of date or have improper dosage. Also, people stop taking medication when they feel better, but before the parasite is eliminated. The result is resistant parasites survive the treatment, and then spread.
We have maybe a decade of artemisin usability in the hottest areas. Could be more or less depending on how efficient public health practices are. But no way is it a permanent cure.
The artemisinin resistance is very scary. Cambodia is where Chloroquine resistance developed, which has since spread to Africa. If artemisinin resistance were to become widespread too, it would be a disaster. Containing it is a very tough problem, but there are efforts underway to try. One of the members of my lab is traveling to the area soon to test a new screening method.
thanks, i see. With developing resistance and being cheap, i wonder whether the artemisinin would fall off the radar of the industry - i mean it has shown good cancer cell killing efficiency and selectivity in tissue samples and mice, yet i haven't heard about serious research beyond that.
Smallpox was eliminated through a vaccine campaign. Resistance against vaccines is generally different from resistance from treatments. For example, since vaccines are in place pre-infection, the amount of target microbes in the body at time of action is pretty low, giving a much higher chance of killing them all. Treatment is usually given after infection, where there will be a large amount of target microbes. This will substantially increase the probability some critter surviving with more resistance genes and then passing them on.
There's a lot of complexity here I'm going to attempt to simplify. Apologies in advance if I glossed over any important details.
It all starts with what Malaria has evolved to do. The lifecycle of malaria requires both a mosquito and a human. It gets into a female mosquito, hangs out in her gut until she bites a human, jumps into the human and hangs out there for a while mucking about, and then jumps back to a different mosquito.
If malaria straight-up killed its host, it wouldn't transmit itself on to the next one. This means malaria must be really good at two things: keeping its host walking around and going undetected for as long as possible. It has lots of tricks it uses to stay under the radar. This all makes sense because the longer it can stay in the host, the more likely it'll get picked up by something else. Think of malaria like a spy that's infiltrated your population. You know one of your civilians is killing the others, but you can't figure out who.
It's also important to know HOW vaccinations work. There are four golden strategies used today:
- Put a dead bugger in the body.
- Put a neutered bugger in the body.
- Put the bugger's coat (a virus-like particle) in the body.
- Put the bugger's perfume (a protein marker) in the body.
All four of these strategies work the same way. Your body recognizes an intruder and teaches itself how to eliminate the threat.
We've established that malaria is good at going undetected. This renders the first two strategies ineffective. Even if we did introduce dead/neutered malaria into the body, the body will still have a hard time finding it when real Malaria enters the system.
We can't use the third strategy because Malaria isn't a virus. That leaves us with only one option: a perfume (subunit) vaccine.
A subunit vaccine is a vaccine where you take the perfume of a bugger and give it to the body saying "Anything that smells like this, you should probably deal with". These are difficult vaccines to put together. Proteins, like perfume, are a carefully constructed thing and are hard to perfectly replicate. Plus, given their complex nature, the body can get confused and build ineffective defenses since it's only given a protein to work with.
On top of all this, the malaria bugger goes through three different stages of its life while in the human body. If you target it late stage, you'll prevent further transmission but the human could still die. You want to target it early stage, preventing transmission AND protecting the human from symptoms. Unfortunately, your body only has 5 minutes from being bitten to to find the bugger and kick its ass before he effectively vanishes from sight.
So where does that leave us? We have a spy entering our country. We are already doing everything we can to destroy his transit before he enters our borders (spraying with DEET to kill mosquitos). We need to catch him before he masquerades as a citizen, otherwise we will never find him. So our only option is to look for signs of a spy and ruthlessly eliminate anything that fits the bill.
That's what RTS,S/AS01 does. In the 80s we were able to produce a protein from the malaria sporozoite (the first stage inside the human body) to get a small level of immunity in humans. The problem since then has been ramping up the immune response. The body needs to act fast (within 5 minutes of being infected) and with extreme prejudice (wiping out the sporozoites) off of very little training (a single sporozoite protein). Vetting this vaccination is also tricky, since it requires human field testing in Africa.
In other words, this vaccine is the culmination of 50 years of dedication, research, and hard work. It's also a miracle of modern science. Most importantly, it will save a LOT of human lives.
Many thanks for the explanation. You sound like a teacher; I feel like I've really learned something this morning.
Quick question: is there an issue with resistance when it comes to vaccinations? I understand the problem with creating better combative medicines is working out how to attack the critters before they produce resistance. Either way, it sounds like a profound breakthrough for affected countries.
Most diseases on the same scale as malaria were effectively wiped out by vaccination, because social pressure to get rid of them was tremendously high. The same would probably apply with malaria: vaccination programs would be so immediate and massive to give it very little chance of mutating quick enough to maintain the current (massive) level of infection. Even a reduction of 70 or 80% would make an incredible difference.
The only real problem will be price. GSK will want a lot of money, and most malaria-affected countries are poor. Chances are that the "developed world" will have to step in and sponsor vaccination programs to the tune of billions, making (mostly African and South-Asian) countries even more dependent on them that they are now. Some of them had just managed to get rid of old debts, and now they'll have to make new ones. I expect the debate on pharmaceutical patents will flare up again.
For starters surviving malaria does not prevent you from getting it again. So a vaccine has to be more effective in creating an immune response than the actual parasite.
I'd like to recommend (without endorsing the opinions therein) this contrarian article I read about malaria, poverty, and Western attitudes towards Africa:
I found it fascinating, as someone with the intent of (eventually) studying disease ecology, in particular, that of malaria in West Africa. It's a thoughtful and well argued essay, but not in the end entirely convincing to me. But it deserves to be more widely distributed, I think.
PS: Thanks to Instapaper, which made retrieving this article a matter of seconds. Interesting how one's expectations of the rate of information retrieval have evolved, speaking as a 40-yr old who well remembers waiting around weeks at times for books or journals to be delivered to the Reg.
I think there's something very patronizing and morally inconsistent about the kind of argument that is described in that article. Underlying its argument is a belief that the lives of all the people who die aren't important, that these deaths are somehow the proper and natural balance. In some ways it may echo the cultures themselves; when life is precarious and lost for no outward reason (such as by a disease like malaria) then individual life loses some of its meaning, people value not only each other but even themselves less.
Medically there's a tone of what-doesn't-kill-you-makes-you-stronger, which is kind of bullshit. Malaria might not kill native adults very often, but it is not harmless.
And economically, the argument is similarly patronizing. After going on about the native immunity many people have, it then talks about how economic disruption is causing migrations, leading to people (not just whites) who don't have the immunity to be exposed. The response: people should stay in their place. That the prerequisite for solving any problem is to revert to traditional structures and strengthen those structures (the same basic argument is made about poverty and many other African problems). The idea that Africans may in fact wish to have control of their own personal destiny is disregarded -- that if conditions were better, if economic forces were less manipulative, people might still want to migrate, because the drive to better one's life persists even when life is okay.
I don't disagree. But I think the correlation between urbanization and malaria is one that would be very interesting to analyze, particularly where rural people are primarily cattle herders (and as such have beef for the Anopheles to feed on).
Repetitive mundane task surely can be called "dedication"...
But in medical research have to try new things, adquire new knowledge, evaluate that new knowledge with all your previous researchs and don't quit your objective despite of failing for years... so yeah, i think the parent comment was talking about _that_ kind of dedication.
As somebody who lives in Africa (Ghana), I cannot overstate how important this could be. I hate malaria on so many levels.
Poor people die from it all the time. Wealthier people mistake it for a cold and die. It is also about as common as a cold here, so a lot of productivity is lost. Not to mention the huge amounts of money being spent on health care.
It is not a coincidence that the worst hit countries are the poorest, people can't afford treatment and the costs for the societies might actually keep many African countries in poverty.
Not to mention how inconvenient it is to not be able to sit outdoors at night, making sure your house is sealed off and spraying with poisonous insect repellants all the time.
This is fantastic news. However, the vaccine won't be in production and available till 2015. Nearly 1 million people die every year from it; which means, about 1.5 million lives could be saved if the vaccine were in production today. I know it can't happen overnight, but still: 4 years?
Large-scale production will take a while, and they might be trying to make it even more effective. The article mentioned it halves the risk of malaria in African children, which is huge, but this progress could perhaps be taken even further.
It says "by 2015". If they mean it, that's more like 3 years. These kinds of reviews move at a snail's pace.
Worse, I wouldn't even be sure they can economically mass-produce it yet, and the ramp-up could be a major PITA. The final trial was 16,000 vaccines, the WHO says there are 250 million cases every year. They're going to need tens of millions of doses before a blip even registers. And somebody's gonna have to distribute and administer this stuff.
Really? I'm bet it has to do with further testing. You could give a little bit of credit to GlaxoSmithKline for working on this for 24 years. This isn't exactly a good example of "big pharma" greed.
If it was indeed made by GlaxoSmithKline, then this is a good example of "big pharma" greed. Only, in this case, "big pharma" greed might end up saving millions of lives.
That all depends on the price. If the price is reasonable then fine. But typically big pharma that gets a lock-in on 'life' is anything but reasonable in their pricing, after all, what's the value of a human life.
The 5% profits over costs is promising, even if it leaves some wiggle room.
I've seen the Moving Goalposts enough in the past. You're probably one of the ones who argued that Big Pharma would never allow the discovering of a vaccine because vaccines aren't profitable enough. Today must not have been a good day for you.
October is Vaccine Damage Awareness Month. If Big Pharma is doing this, it must be because it will cause Vaccine Damage.
(No, I'm not a nutcase, but, yes, this really is Vaccine Damage Awareness Month. 'Tis the season to kill people by demonizing an extremely safe form of preventative treatment by spreading baseless rumors to sow irrational fear.)
They've mentioned that their goal is to make 5% profit above the cost. Even at 20%, it seems reasonable for something that took about 24 years to create. Hopefully they'll stick by their word.
Let's hope they start with the actual costs of manufacturing, and not tack on 24 years of research and the cost of large scale clinical trials.
GSK has a mixed history when it comes to stuff like this, let's hope they do the right thing here. I note they didn't say the doses will cost at most 'x' (which they should have a pretty good idea of by now).
why would you not tack on 24 years of research and the cost or large scale clinical trials?
if GSK didn't pay for those, the malaria vaccine wouldn't exist; those are real costs that GSK paid. if they were always compensated on certain drugs only based on cost of manufacturing, they would simply never research those drugs.
As I get older, I think more and more about my work being impactful on the lives of others. Not higher performance, better UI, greater convenience or less cost; rather, something that positively improves the lives of others.
While this vaccine is an important development, there's still a lot of work to be done. If you'd like to develop free, publicly available tools that help researchers improve treatments for malaria and other parasites, send a resume to jobs AT apidb DOT org. We need not only people with bioinformatics backgrounds but also web developers to help us improve resources like the malaria genome database, http://plasmodb.org/
I'm a programmer with an extreme interest in disease ecology (in particular, that of malaria). Please email me at my profile address and let me know if there's anything I can do to help.
This could have adverse effects, similar to medication agains HIV/AIDS. People will get a vaccine and reduce their efforts of protection against Malaria by mosquito nets and other means. I hope that will not happen.
I doubt people will back off of malaria at this point in the past it seems like once it starts getting under control in a region it keeps going down. There is a lot of anti-malaria momentum building up with awareness and malaria education only increasing.
The last few years have been success after success with the Global Fund and the Gates Foundation pouring in money.
To continue your HIV/AIDS analogy, we know that people are taking more risks due to availability of HIV/AIDS meds. I don't think that means we should stop HIV/AIDS meds. We should still produce them and sell them.
When I lived in Cambodia, even when I was in areas where malaria was not common I still used a mosquito net every night, because being bitten by several thousand mosquitoes is not conducive to sound sleep.
There are always going to be Darwin Award candidates, and they're always going to take any form of risk mitigation as an invitation to engage in riskier behavior, whether it's a vaccine or an air bag.
I hope that the discovery of vaccines like this increase in frequency over time. I'm not sure if that IS the case, but I'd really like it to be so that one day soon AIDS and Cancer are as benign as Polio.
Do you mean cancer isn't caused by a pathogen? Because that isn't true for some cancers, and there are suggestions that all cancers are caused by viruses.
And cancer vaccines do exist, but they need to be individually created for each case.
I guess not all are caused, but perhaps I can rephrase as all can be caused? It's only suggestions that this is the case, but it's not actually known yet. I certainly don't know.
This: http://en.wikipedia.org/wiki/Cancer_Virus#Viral says that 12% of cancers are caused by viruses. The true number may be a lot higher since more viruses are being discovered all the time. But even 12% is a lot if someone were able to make a vaccine for them.
From a definitional point of view, according to google define:cancer, cancer is - "The disease caused by an uncontrolled division of abnormal cells in a part of the body."
From a practical point of view what would you call an agent which stimulates the immune system to attack cancerous cells?
Hmm... You are correct, the book definitions seem to indicate cancer is a disease, and that you could vaccinate against cancer.
I struggle with such usage of the words, perhaps as I tend to use "malaise" in place of "disease" for anything not caused by a pathogen.
If we are to get deeper into the book definition, so long as you can stimulate production of antibodies that identify cancer cells, you have made a vaccine.
I've heard people call Dendreon's new prostate cancer therapy, Provenge, a "vaccine". Interestingly, the official website doesn't mention it, but the description of it does sound sort of vaccine-like in a lot of ways:
"PROVENGE is the only FDA-approved autologous cellular immunotherapy indicated for the treatment of asymptomatic or minimally symptomatic metastatic castrate resistant (hormone refractory) prostate cancer. PROVENGE is designed to work differently from hormone therapy or chemotherapy. By stimulating the natural ability of your body’s immune cells to target and attack advanced prostate cancer, PROVENGE may help you live longer."
It sounds like this vaccine should be combined with some of the mosquito eradication methods highlighted in a recent HN link [1]. One commenter there ("Ox12") pointed to an article in Nature which argues the reduction in mosquito population would likely not be problematic.
It's a major achievement, but if this is 'effective vaccine' then we already have an 'effective cure' to a number of cancers as well. A bit link baity.
The thing to remember about malaria is that is an infectious disease.
In order to have a malaria epidemic, Alice needs to be bitten by a malaria carrying mosquito. Alice needs to become ill and have a large number of juvenile parasites in her blood. She then needs to be bitten by another mosquito. This parasites becomes adults in the mosquito's gut and the mosquito then needs to bite Bob and infect him.
A vaccine that reduces the chances of an infected individual becoming ill effectively reduces the reproduction rate of malaria.
In a vaccinated area, one would expect to see reductions in the number of infected people during the high season by potentially an order of magnitude.
Malaria can survive in cattle, not just humans. Mosquitoes bite infected cows (which don't necessarily have symptoms), then bite humans. It's not like most infections diseases, which can be entirely eradicated just by vaccinating a critical number of people.
This is one of the reasons that malaria incidence goes down as the number of cattle being raised goes up. Anopheles is happy to take a blood meal from a beef rather than a human.
Do you have a source for this? I find this weird. Wouldn't more food for Anopheles increase their population and hence the risk for humans to get bitten?
Yes, that is an effective vaccine. A vaccine does not necessarily confer 100% protection against a disease. Comparing "effective vaccine" to "effective cure" is nonsensical.
Overpopulation is a hard problem. There are complex socioeconomic reasons for why some countries have higher fertility rates than others. This is a heavily studied topic in health economics, but I am unwell right now and do not feel like digging through research papers. Instead, I will point you to a wikipedia article that talks about one (popular with economists) take on overpopulation:
Sorry for the wikipedia link, but it is not a half bad article on the subject and it was easy to find. Basically, this theory suggests that increased income per capita is correlated with a decrease in a country's fertility rate.
There are arguments on both sides regarding the flow of causality, but if you wanted to know what was being done to address the challenge of overpopulation then that article above is a good starting point for your own inquiries.
(Also, just as a side note, it is probably the case that you were down-voted for being off-topic and not due to some overwhelming sentimentality. Maybe if you want to talk about overpopulation you should have written a blog post and posted it up, I bet that would have probably got a much better reception.)
You can subtract death rate from birth rate, and the world looks screwed. For China, this is (13.1 - 7.1) per 1000. For India, it's (21.76 - 6.23) per 1000. So for the world's middle class, that's about 2% population growth per year. Yikes.
But the you realize, that China and India have very few really old people. Now that they have decent medical treatment, the older Chinese and Indians live longer, pushing the population up. But they aren't having any babies, so in the long term we might not be growing like lemmings.
For China, it's 1.54, and it's 2.6 for India. Anything under 2 (plus a bit for the ones who don't reach fertility) means a declining population, in the long term.
Actually, areas with higher life expectancies generally have much, much lower birth rates, in part because you don't have to worry about having half your kids die off.
Japan has actually been paying couples to have kids to stave off population decline.
I never considered people who tried to cure malaria would do it for any other reasons that the deaths it causes. The productivity loss could be another worthy cause.
I still believe people who are after a cure mainly do it to prevent the deaths it causes. Wikipedia reports that Malaria is responsible for "2.23% of deaths worldwide" which is not negligible.
Why is it that these sorts of arguments always seem to pop up in discussions about malaria and HIV, but never in articles about cancer, and heart disease?
I fear it has a lot to do with which populations tend to be most heavily hit.
It's not unheard of to die of cancer or heart disease before having children, but it's uncommon enough (even compared to accidents and suicide) that I wouldn't expect them to affect the size of the next generation. Malaria kills a lot of kids, which is to say there are a lot of potential parents that are going to be saved in places with overtaxed food and water supplies.
You could have asked me if I felt the same way about cancer and heart disease and I could have answered that no matter what disease is the cure for (or who it is for), the question of overpopulation remains.
I'm trying to provoke some thought. What you say when directly asked is less interesting to me than how you and others respond upon seeing stories like this one, without being otherwise prompted.
It depends. In countries with a lack of social security and pensions people tend to look on their children as providers.
If infant mortality is high then they will likely decide to have many children to make their bet more safe. If they have girls and the local custom centers around having sons then that too might work as a reason to get more children, and the reverse will be true in places where large dowries are paid for daughters.
Having many children is also seen as a sign of affluence or blessing.
Lack of education and contraception are factors in the developed world too, people that have lower levels of education tend to have their first children at a younger age and tend to have more of them as well (both due to starting younger and due to not being able to accurately gauge the impact of having children on their lives).
I'm sorry you got downvoted, overpopulation (or simply the problem of how to match our numbers to the available resources without drastic measures or apocalyptic events) is a subject that requires one to face some harsh realities and ask some very tough questions.
Please go over the superficial outrage feeling. I know that it is more popular to celebrate saving lives but I still would like to discuss this question:
Is there anyone working on the overpopulation problem? This problem is the root to many other symptoms.
I am not speaking about terrorism or single child policy that didn't seem to work well in China. Is there any other suggestions out there?
I agree that better living standards has a correlation with lower birth rate. And if we look at Europe decreasing population, it may actually be the answer.
"Not enough young" is only a problem because of the number of "Older people".
The aging of the population is a different issue to the overpopulation issue. You could get 100% young population and still have a overpopulation problem.
Not home yet or I'd likely have more to say.
Home now. Reading the article. First thoughts:
* This is a vaccine for P. falciparum, which is the nasty form that you really don't want. Good.
* Funding comes from GSK and the Bill and Melinda Gates Foundation
* These are interim results, looking at the older kids (5mo and up) in a 2-prong study (the younger kids haven't all hit the 12mo-duration milestone needed per protocol so this largely ignores them so far with more to come later). Caution. (Because there was no clear rationale given for why this is being reported now, in pieces.)
* Treated kids had higher incidence of meningitis. Caution.
* Treated kids had higher risk of febrile seizures. Caution.
* Generally, few deaths, so these kids seem to be well looked-after in this trial. Appropriate.
So far, so good. Interested to see the final Phase 3 results and to see how this holds up in Phase 4/postmarketing.