Prevention and Treatment of Malaria

Although malaria has been proven to be both preventable and curable, it still stands as one of the top killers of African children, at a rate of two children per minute. In Masterson’s words, malaria is a societal condition that is dependent on four aspects: the number of infected people, the volume of biting mosquitoes, the extent to which those mosquitoes procreate, and the extent to which those mosquitoes prefer human blood. In 1939 and 1942, the United States and Germany launched their respective malaria projects to combat the microbes for war purposes. Both nations aimed to formulate a “magic bullet” that would eradicate malaria and prevent soldiers from succumbing to the furnace-hot fevers. The campaign ushered in an extensive battle that intertwined molecular malarial research, ethical issues concerning test subjects, and efficient methods to improve public health.

While Bayer’s skilled chemists attempted to create a magic bullet to fight malaria, other scientists sought to understand the underlying mechanism of malaria infections. They discovered that the species of malaria were unique to their own geographic regions of people and mosquitoes. According to many biological historians, “trade, especially the slave trade, allowed these microbes to spread across the globe” (Masterson, 17). In 1880, Alphonse Laveran, a French army doctor who examined the fresh blood of infected but alive soldiers, unknowingly captured the sexual stage of falciparum.

Although he was unaware of the explanation at the time, Laveran witnessed gametocytes, of which he noted as “large microbes the size of the red blood cells,” that had swum to the soldier’s surface tissue to be ingested by mosquitoes. In 1897, W. G. MacCullum noticed the parasites in the blood of a sick crow fusing into an egg sac (Masterson, 21). The first-year student at Johns Hopkins University’s medical school, in his paper presented to the British Association for the Advance of Science, suggested that this might be the methodology for which malaria parasites procreate after being consumed by mosquitoes. Julius Wagner von Jauregg was a psychiatrist engrossed in utilizing infectious diseases, especially malaria, to cure different forms of mental illness. Surrounded by ethical issues, his numerous experiments enabled him to differentiate between P. falciparum and P. vivax. He recognized that falciparum was deadly and advocated for the use of vivax for malaria therapy. He also instructed other asylum doctors to use infected blood, instead of infected mosquitoes, for the therapy. He explained that the mosquitoes introduce sporozoites into the body, which could lead to relapses as P. vivax had a dormant liver stage and can reactivate after a period of time without any precursor symptom (Masterson, 63). By using infected blood, however, syphilitics are only exposed to a onetime fever attack. After a myriad of experiments in the form of basic science research, the puzzle of the malaria parasite life cycle was slowly being assembled.

As briefly mentioned in the previous paragraph, Jauregg was an ambitious psychiatrist who wanted to cure insanity. While it was evident that he had the best interests of the syphilitics in mind, his strategy to heal them through the exploitation of infectious diseases did not align with the ethical guidelines. Jauregg believed that high fevers had the potential to cure dementia. Upon seeing the symptoms of a malaria infection, he decided to use his respected syphilitics as test subjects to explore “the therapeutic value of malaria inoculation in the treatment for dementia paralytica” (Karamanou et al.). In one experiment, Jauregg injected malaria-infected blood into a syphilis stage actor, whose blood was then introduced into eight other syphilis patients. The psychiatrist reported one death, two admissions to the asylum, four cases of relapses, and two successfully cured individuals of dementia (Masterson, 39). While his discovery earned him a Nobel Prize award, his use of syphilis patients eventually led to ethical objections that viewed him as a potential murderer. To make matters worse, Claus Schilling disobeyed Jauregg’s suggestions and employed nonsyphilitics, in the 1930’s, to induce immunity against malarial parasites, including the fatal falciparum (Masterson, 101). Similarly, G. Robert Coatney, in the 1940’s, covertly used inmates to test anti-malaria drugs (Masterson, 232). While human subjects did yield accurate and better results, both scientists violated the ethical guidelines as well as “a moral responsibility to protect all research participants from harm” (McLeod).

The struggle to formulate a “magic bullet” proved to be laborious as each proposed drug had its own impediment. For example, atabrine worked against the blood-destroying stage of the microbes, preventing the trigger of severe symptoms. However, as shown in several autopsies, “atabrine had caused toxic shock to the liver” (Masterson, 260). Sontochin proved to be “eight times better than quinine at clearing the parasites” and was “less toxic than atabrine” (Masterson, 265). However, it was patented by Winthrop Chemical Company and conflicted international diplomacy. Primaquine eliminated the liver-stage parasites as well as the sexual-stage parasites with little side effects. However, people with the G6PD deficiency, mostly those from regions with malaria, cannot take this drug (Masterson, 330). Recognizing the trouble of perfecting a treatment plan, some medical doctors turned to prevention to reduce malaria outbreaks and improve public health. The most notable example was Gorgas’s and Dr. Darling’s efforts to solve the malaria problem during the construction of the Panama Canal. Laborers were trained to “build screen rooms for the sick, construct new mosquito-proof buildings, and spray kerosene on breeding grounds” (Masterson, 24). The strategies allowed workers to stay healthy enough to complete the engineering feat. Such was Lowell’s approach in lowering malaria transmission in Pan Am. In addition to draining swamps and poisoning ponds with Paris Green, Lowell also instructed malaria orientation courses to restrain the men of Pan Am from risking the disease simply for sexual pleasures (Masterson, 140). During his work in Africa, malaria transmission dropped nearly 50% in Pan Am employees and nearly 100% at Accra and Fisherman’s Lake. Perhaps prevention is more efficient at dwindling malaria epidemics than treatment.