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Have We Defeated Malaria?

The roll-out of a new affordable vaccine, combined with breakthroughs in the genetic modification of mosquitos, means that a world free of malaria is "finally within sight," Adar Poonawalla, chief executive of India-based drugs manufacturer the Serum Institute, has said.

Malaria is caused by a parasite carried by some types of mosquito, and is prevalent in tropical climates. Although the vast majority of people infected with malaria recover, the disease can be deadly, especially among small children. A commonly repeated claim is that half of all the human beings who have ever existed on Earth have been killed by malaria – equivalent to around 54.5 billion people.

Today malaria is responsible for the deaths of more than 600,000 people a year, according to a 2022 report from the World Health Organization (WHO). Of those, 95% of these occur in Africa, and 80% of victims are under the age of five.

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Following decades of research and development, this month babies in the Ivory Coast and South Sudan became the first to receive a dose of the R21 vaccine, hailed as a game-changer by scientists who believe it could see the complete eradication of malaria within a decade.

How does the new vaccine work?

Developed by the Jenner Institute at Oxford University, R21 targets the first stage of the parasite's life cycle before it gets to the liver, and is combined with an immune-boosting agent, or adjuvant, made by the US company Novavax.

Trials have shown it to be 79% effective at preventing the disease in young people, and its production capacity and low price give it a "huge advantage" over the only other malaria vaccine, RTS,S, which was released earlier this year, The Times reported. At around $4 (£3.10) a dose of R21 is less than half the cost of its rival, and the Serum Institute, which manufactures the vaccine, claims it could produce 100 million doses a year.

"Cost is absolutely the key question", said Poonawalla. "If this was a $10 vaccine, just forget it, you wouldn't be able to reach the kind of countries we have because the budgets just wouldn't allow it. We've spent so many years – blood, sweat and money – developing this with Oxford. After all this effort and going through the regulatory process, we're finally here. This is a great moment."

Having launched in the Ivory Coast and South Sudan, targeted at children under three, the vaccine roll-out will expand to a further 15 countries in Africa – including the Central African Republic, Democratic Republic of Congo, Ghana, Mozambique, Uganda and Nigeria – by the end of the year, with another 15 African nations due to follow.

While children are the focus, trials are also set to start for pregnant women – another at-risk group – before being expanded to other adults, with the potential of becoming a travellers' vaccine within a few years. Efforts are also under way to develop a variant of the vaccine to combat a different strain of malaria that's common in India and South America.

What else is being done?

The WHO Global Malaria Programme goal is to reduce cases of malaria by 90% before 2030.

Measures in place to achieve this include the "early detection and diagnosis of malaria cases", said Al Jazeera, as well as the mass distribution of affordable vaccines, "the use of insecticide-treated nets and indoor residual spraying", as well as building awareness and expanding necessary health facilities in affected areas.

In May, the BBC reported that tens of thousands of genetically modified mosquitos had been released in Djibouti in an effort to stop the spread of an invasive species that transmits malaria.

The "friendly non-biting male Anopheles stephensi mosquitos" were developed by Oxitec, a UK-based biotechnology company, and carry a gene that "kills female offspring before they reach maturity". This is crucial, said the broadcaster, as "only female mosquitos bite and transmit malaria and other viral diseases."

Despite huge strides made in recent years the WHO warned that some challenges remain. "Countries, sub-national areas and communities are situated at different points along the path towards malaria elimination, and their rate of progress will differ depending on the level of investment, biological determinants (related to the affected populations, the parasites and the vectors), environmental factors, strength of health systems, and social, demographic, political and economic realities," it said in a recent report.

Nevertheless, the WHO remains optimistic that its ambitious objectives can be met, going so far as to classify malaria as being in the "final stage" of elimination.

"I think the whole thing is doable, not in the next five years, but maybe in the next 10," said Sir Adrian Hill, director of the Jenner Institute at Oxford, adding that for the first time in history, "eradication is beginning to look really credible".

BT Fined £17.5m Over 999 Call 'network Fault'

BT has been fined £17.5m over network disruption that affected 14,000 emergency calls and led to an "unacceptable risk".

Ofcom, the telecoms regulator, said the penalty was linked to a network fault on Sunday 25 June last year.

The disruption lasted for more than 10 hours.

It judged that while emergency services found no evidence of serious harm to the members of the public using the 999 emergency and 112 service during the disruption, there were a number of failures in BT's handling of the situation.

Money latest:Most parents worried they can't afford a summer holiday

"We found that BT did not have sufficient warning systems in place for when this kind of incident occurs, nor did it have adequate procedures for promptly assessing the severity, impact and likely cause of any such incident or for identifying mitigating actions," Ofcom said.

"We also found that BT's disaster recovery platform had insufficient capacity and functionality to deal with a level of demand that might reasonably be expected.

Why Are Treatments That Were Developed For Malaria Now Used For Lupus?

Most physicians with experience in lupus agree that antimalarial treatments such as hydroxychloroquine (Plaquenil), chloroquine (Aralen) or quinicrine (Atabrine) should be used long-term, year-after-year, in all lupus patients who can tolerate them. Why?

The answer is that these drugs have a range of effects on people, so what they do for malaria is not necessarily the same as what they do for lupus. And yet, there are similarities.

How chloroquine treats malaria

Malaria is caused by a parasite, usually found in tropical regions, that infects humans after they have been bitten by a mosquito. This parasite is transmitted directly from the saliva of the mosquito into the bloodstream of a person who has been bitten. Under the microscope a malaria parasite can actually be seen literally crawling inside of people's red blood cells.

In order to survive, the malaria parasite has to break down a part of the red blood cell called hemoglobin, but this results in toxic by-products which need to be processed and contained by the malaria parasite. The malaria parasite has a little digestive pouch inside it, rather like a primitive stomach, that turns the toxic products into crystals. This provides a way to contain them and keep them from harming the parasite. Chloroquine stops this from happening and even binds directly to the toxic product to disrupt and break up the malaria invader.

All cells, whether parasitic or human, must break down and recycle substances that come in from the blood stream in order to survive. Just like a malaria parasite, the specialized proteins that work for human cells are stored in little acid filled protective pouches inside the cell called lysosomes. Antimalarials go directly into these lysosomes and decrease the acid levels in there that the digestive proteins require in order to work best. In doing so, antimalarials can really gum up some critical activities of hyperactive immune cells.

How chloroquine inhibits overactive immune cells

Our DNA is the blueprint for every protein in the body. Thymine is one of the building blocks of DNA and is needed to replenish new cells all over the body and to build the armies of immune cells we need to fight disease (which are the same cells that we wish would calm down a little in lupus). Chloroquine inhibits the ability of cells to take in and process thymine. This may keep immune cells from regenerating out of control.

As you can see, when you put any substance into a cell it has complicated chemical processes in place to break it down, use some of it for nutrition, recycle parts of it, and dispose of the waste. This is true whether the cell is a parasite trying to survive by eating human red blood cells, or a human cell. Human cells have a big job to do because we humans are complicated beings. We must deal with hostile invaders (bacteria, viruses, parasites), as well as the good (or bad) things that we put into our bodies on purpose, in the form of food and medicine.

What is hydroxychloroquine?

Some of the breakdown products of medicines also are useful as treatments, even without giving the "parent" drug initially. Hydroxychloroquine (Plaquenil) is a breakdown product of chloroquine, and is, in fact, the most common antimalarial given to treat lupus.

How hydroxychloroquine works to fight lupus

Hydroxychloroquine has a number of effects on the immune system. Recently, hydroxychloroquine has been found to interfere in the internal communications of an immune cell, by inhibiting important proteins that recognize danger signals (either from infectious invaders or from byproducts of lupus inflammation). These proteins, which hydroxychloroquine inhibits, are called Toll-Like Receptors. When they are stimulated, the body makes a lot of a protein called type one interferon. Interferon can be very helpful if you are trying to fight off a virus, but it can cause a great deal of trouble in lupus by stimulating a vicious, self-perpetuating circle of inflammation. By inhibiting the production of interferon just enough (but not too much) a proper balance might be found between protecting the body from lupus flares and protecting the body from viruses.

Hydroxychloroquine is probably only a weak inhibitor of Toll-Like Receptors. Some potentially stronger biologic drugs, which target the specific Toll-Like Receptors that are acting up in lupus, are currently in the early stages of being studied.

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