World’s first malaria vaccine can save thousands of children lives
One of the world's deadliest diseases, malaria takes the life of a child every two minutes.
- Malaria, one of the world's deadliest diseases, kills 435,000 people a year, most of them children in Sub-Saharan Africa.
- Three African countries are set to receive the world's first malaria vaccine this week as part of a WHO pilot program.
- The vaccine has the potential to save the lives of hundreds of thousands of children worldwide.
The 20th century has seen some truly profound advances in human medicine. We now produce clean water and uncontaminated food at unprecedented levels. We've eradicated smallpox and rinderpest — the former having been one of history's deadliest diseases, the latter having caused widespread, depopulating famine — and we're close to eradicating deadly, debilitating diseases such as polio, yaws, and rabies.
But some medical leaps have been more elusive. One of the most devastating has been our inability to find a cure for malaria.
Malaria is among the world's deadliest diseases. It kills 435,000 people worldwide every year, the vast majority in Sub-Saharan Africa. Ninety percent of all malaria-related deaths occur in Africa, and children under the age of five are its most likely victims. In fact, every tenth child death in 2016 was the result of malaria.
But that tragic paradigm may be changing soon. The World Health Organization has launched a pilot program for the world's first malaria vaccine, a change that's been three decades in the making.
Countering the malaria epidemic
Image source: CDC / Wikimedia Commons
The malaria vaccine pilot program will launch in Malawi this week. In 2016, the country suffered 45 malaria-related deaths per 100,000 people. In the coming weeks, Ghana and Kenya will introduce the vaccine as well. In 2016, these countries suffered 69 and 11 deaths per 100,000 respectively.
The vaccine, called RTS,S, will be administered in a regimen of four doses. The first three will be given to children between five and nine months of age. The final dose will be provided around the children's second birthday. The program aims to vaccinate around 360,000 children per year across the three countries. It will focus on areas with moderate-to-high malaria transmission rates in the hopes of maximizing the impact.
"Malaria is a constant threat in the African communities where this vaccine will be given. The poorest children suffer the most and are at highest risk of death," Dr Matshidiso Moeti, WHO Regional Director for Africa, said in a statement. "We know the power of vaccines to prevent killer diseases and reach children, including those who may not have immediate access to the doctors, nurses and health facilities they need to save them when severe illness comes."
WHO's press statement notes that the pilot program is a global partnership. It has brought together a range of in-country and international partners to coordinate with the ministries of health in the three pilot countries. GSK, the vaccine's developer and manufacturer, will donate 10 million doses.
"This is a day to celebrate as we begin to learn more about what this tool can do to change the trajectory of malaria through childhood vaccination," Moeti added.
Difficulties in eradicating malaria
However, the vaccine is not a silver bullet aimed at ending the malaria epidemic. RTS,S does not have a 100 percent success rate, offering only partial protection. In clinical trials, it prevented approximately 4 in 10 malaria cases (3 in 10 for life-threatening malaria).
As such, WHO is presenting the vaccine as a "complementary malaria control tool." The vaccine paired and supported by other preventative measures, including bed nets, indoor insecticides, and antimalarial treatments.
"It's a difficult disease to deal with. The tools we have are modestly effective but drugs and insecticides wear out — after 10, 20 years mosquitoes become resistant. There's a real concern that in 2020s, [cases] are going to jump back up again," said Adrian Hill, a professor of human genetics and director of the Jenner Institute at the University of Oxford, told CNN.
Malaria has proven difficult to eradicate because of its nature. The disease is caused by a parasite of the genus Plasmodium. Its life cycle is split between a sexual stage in its mosquito hosts and an asexual stage in human hosts. When a mosquito bites an infected human, it contracts the disease from that person's red blood cells.
When it bites another person, the mosquito transmits the disease to a new host. The infected patient develops a fever, chills, headaches, and other flu-like symptoms. If untreated, it can develop into severe malaria, where the symptoms can manifest into anemia, organ failure, and neurological abnormalities. Any mosquito that bites this person has the chance to then pass on the disease further.
The difficulty in preventing mosquito bites, the insect's growing resistance to insecticides, and changes the parasite undergoes during its life cycle, all contribute the difficulties on controlling and containing malaria in the world's poorest countries.
Developing sustainable change
Graph showing the percentage of global malaria deaths per world region. Africa accounts for 90 percent of deaths resulting from the disease. (Source: Our World in Data)
WHO's Sustainable Development Goals are 17 directives comprising 169 targets. The ultimate aim is to advance peace and prosperity for all people.
The program's third directive is to ensure health and well-being for all people of all ages. Among its targets are the end of the AIDS, tuberculosis, and malaria epidemics by 2030 and the reduction of mortality for children under 5 to as few as 25 per 1,000 live births worldwide.
Despite the difficulties still ahead, any substantial reduction in malaria deaths is a welcome change and a significant step in achieving this goal.
Thanks to this vaccine, hundreds of thousands of children will likely avoid a crippling, painful death. Communities in some of the world's poorest regions will be given a chance to better stabilize and grow. And the pilot may help scientist develop better strategies for future endeavors.
The vaccine's development came at an auspicious moment, too. Malaria cases began to rise in 2017, after nearly two decades of decline.
"The malaria vaccine is an exciting innovation that complements the global health community's efforts to end the malaria epidemic," Lelio Marmora, executive director of Unitaid, said. "It is also a shining example of the kind of inter-agency coordination that we need. We look forward to learning how the vaccine can be integrated for greatest impact into our work."
The Lumina Foundation lays out steps for increasing access to quality post-secondary education credentials.
- America's post-high school education landscape was not created with the modern student in mind. Today, clear and flexible pathways are necessary to help individuals access education that can help them lead a better life.
- Elizabeth Garlow explains the Lumina Foundation's strategy to create a post-secondary education system that works for all students. This includes credential recognition, affordability, a more competency-based system, and quality assurance.
- Systemic historic factors have contributed to inequality in the education system. Lumina aims to close those gaps in educational attainment.
- In 2019, Lumina Foundation and Big Think teamed up to create the Lumina Prize, a search to find the most innovative and scalable ideas in post-secondary education. You can see the winners of the Lumina Prize here – congratulations to PeerForward and Greater Commons!
French newspapers report that the trial hasn't lived up to expectations.
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- French newspapers report that the trial hasn't lived up to expectations.
- Solar panel "paved" roadways are proving to be inefficient and too expensive.
During World War II, the U.S. incarcerated over 100,000 Japanese Americans in concentration camps throughout the West.
- Now that the issue of concentration camps in the U.S. has once again reared its head, it can be beneficial to recall the last time such camps were employed in the U.S.
- After Pearl Harbor, the U.S. incarcerated over 100,000 Japanese Americans in camps, ostensibly for national security purposes.
- In truth, the incarceration was primarily motivated by racism. What was life like in the U.S.'s concentration camps?
On February 19, 1942, President Roosevelt issued Executive Order 9066, which authorized and directed military commanders "to prescribe military areas … from which any or all persons may be excluded, and with respect to which, the right of any person to enter, remain in, or leave shall be subject to whatever restrictions the Secretary of War or the appropriate Military Commander may impose in his discretion." Under the authority of this executive order, roughly 112,000 men, women, and children of Japanese descent — nearly two-thirds of which were American citizens — were detained in concentration camps.
How did the camps get their start?
With the benefit of a nearly 80-year perspective, it's clear that the internment of Japanese Americans was racially motivated. In response to Japan's growing military power in the buildup to World War II, President Roosevelt commissioned two reports to determine whether it would be necessary to intern Japanese Americans should conflict break out between Japan and the U.S. Neither's conclusions supported the plan, with one even going so far as to "certify a remarkable, even extraordinary degree of loyalty among this generally suspect ethnic group." But of course, the Pearl Harbor attacks proved to be far more persuasive than these reports.
Pearl Harbor turned simmering resentment against the Japanese to a full boil, putting pressure on the Roosevelt administration to intern Japanese Americans. Lieutenant General John DeWitt, who would become the administrator of the internment program, testified to Congress
"I don't want any of them here. They are a dangerous element. There is no way to determine their loyalty... It makes no difference whether he is an American citizen, he is still a Japanese. American citizenship does not necessarily determine loyalty... But we must worry about the Japanese all the time until he is wiped off the map."
DeWitt's position was backed up by a number of pre-existing anti-immigrant groups based out of the West Coast, such as the Joint Immigration Committee and the Native Sons and Daughters of the Golden West. For many, the war simply served as an excuse to get rid of Japanese Americans. In an interview with the Saturday Evening Post, Austin Anson, the managing secretary of the Salinas Vegetable Grower-Shipper Administration, said:
"We're charged with wanting to get rid of the Japs for selfish reasons. We do. It's a question of whether the White man lives on the Pacific Coast or the brown men. ... If all the Japs were removed tomorrow, we'd never miss them in two weeks because the White farmers can take over and produce everything the Jap grows. And we do not want them back when the war ends, either."
Ironically for Anson, the mass deportation of Japanese Americans under Executive Order 9066 meant there was a significant shortage of agricultural labor. Many Caucasians left to fight the war, so the U.S. signed an agreement with Mexico to permit the immigration of several million Mexicans agricultural workers under the so-called bracero program.
Life in the camps
Hulton Archive/Getty Images
Circa 1943: Aerial view of a Japanese American relocation center in Amache, Colorado, during World War II. Each family was provided with a space 20 by 25 ft. The barracks were set in blocks and each block was provided with a community bath house and mess hall.
For the most part, Japanese Americans remained stoic in the face of their incarceration. The phrase shikata ga nai was frequently invoked — the phrase roughly translates to "it cannot be helped," which, for many, represents the perceived attitude of the Japanese people to withstand suffering that's out of their control.
Initially, most Japanese Americans were sent to temporary assembly centers, typically located at fairgrounds or racetracks. These were hastily constructed barracks, where prisoners were often packed into tight quarters and made to use toilets that were little more than pits in the ground. From here, they were relocated to more permanent camps — replete with barbed wire and armed guards — in remote, isolated places across the seven states of California, Arizona, Colorado, Wyoming, Idaho, Utah, and Arkansas.
Many of these camps, also known as War Relocation Centers, were little better than the temporary assembly centers. One report described the buildings as "tar paper-covered barracks of simple frame construction without plumbing or cooking facilities of any kind." Again, overcrowding was common.
As a result, disease became a major concern, including dysentery, malaria, and tuberculosis. This was problematic due to the chronic shortage of medical professionals and supplies, an issue that was not helped by the War Relocation Authority's decision to cap Japanese American medical professional's pay at $20 a month (about $315 in 2019 dollars), while Caucasian workers had no such restriction. As a comparison, Caucasian nurses earned $150 ($2,361) a month in one camp.
The U.S. government also administered loyalty questionnaires to incarcerated Japanese Americans with the ultimate goal of seeing whether they could be used as soldiers and to segregate "loyal" citizens from "disloyal" ones. The questionnaires often asked whether they would be willing to join the military and if they would completely renounce their loyalty to Japan. Due to fears of being drafted, general confusion, and justified anger at the U.S. government, thousands of Japanese Americans "failed" the loyalty questionnaire and were sent to the concentration camp at Tule Lake. When Roosevelt later signed a bill that would permit Japanese Americans to renounce their citizenship, 98 percent of the 5,589 who did were located at Tule Lake. Some apologists cite this an example of genuine disloyalty towards the U.S., but this argument clearly ignores the gross violation of Japanese Americans' rights. Later, it became clear that many of these renunciations had been made under duress, and nearly all of those who had renounced their citizenship sought to gain it back.
Since many children lived in the camps, they came equipped with schools. Of course, these schools weren't ideal — student-teacher ratios reached as high as 48:1, and supplies were limited. The irony of learning about American history and ideals was not lost on the students, one of whom wrote in an essay --
"They, the first generation [of Japanese immigrants], without the least knowledge of the English language nor the new surroundings, came to this land with the American pioneering spirit of resettling. ...Though undergoing many hardships, they did reach their goal only to be resettled by the order of evacuation under the emergency for our protection and public security."
Potentially the best part of life in the camps — and the best way for determined prisoners to demonstrate their fundamental American-ness — was playing baseball. One camp even featured nearly 100 baseball teams. Former prisoner Herb Kurima recalled the importance of baseball in their lives in an interview with Christian Science Monitor. "I wanted our fathers, who worked so hard, to have a chance to see a ball game," he said. "Over half the camp used to come out to watch. It was the only enjoyment in the camps."
When the camps finally closed in 1945, the lives of the incarcerated Japanese Americans had been totally upended. Some were repatriated to Japan, while others settled in whichever part of the country they had been arbitrarily placed in. Those who wished to return to the West Coast were given $25 and a train ticket, but few had anything to return to. Many had sold their property to predatory buyers prior to being incarcerated, while theft had wiped out whatever else they had left behind. Many, many years later, the 1988 Civil Liberties Act mandated that each surviving victim be paid $20,000, though that seems like a small fine to pay for irrevocably changing the courses of more than 100,000 lives.