- The Washington Times - Sunday, July 20, 2003

MAE SOT, Thailand — Hopes are rising on the front line of the global battle against malaria, with a recent experiment in western Thailand nearly halving the disease’s mortality rate, and a major breakthrough by British researchers announced this spring.

The disease, which is preventable and curable, kills more than 1 million people a year — 90 percent of them in Africa.

From July 2001 to September last year, the provincial health office in Thailand’s western Tak province, which borders Burma, ran an experiment aimed at controlling the malaria endemic to the area.

It resulted in a 30 percent drop in the number of cases caused by Plasmodium falciparum — a blood parasite transmitted to people by mosquitoes — which is the most dangerous of the four forms of malaria and is frequently resistant to drugs.

The number of cases in the area fell to 43,000 during the period, compared with 62,000 from the same period a year earlier, and the number of deaths dropped 42 percent, with 36 fatalities compared with 62 the previous year.

“This initiative to control malaria is a world first under these study conditions,” said Francois Nosten, director of the Thai research center Shoklo Malaria Research Unit (SMRU) and overseer of the experiment’s results.

The experiment was based on two principles: early detection of the disease by a network of 100 specially trained villagers, and the use of a cocktail of drugs to which the falciparum parasite is not resistant.

“Before, malaria was in all the surrounding area,” said Somrak Kaewsorm, 18, who was one of the villagers on the network. “Now, it has dropped a lot.”

In the small village of Doi Hin Kiu, just a few miles from the Burmese border, he built a hut where he received four or five patients a day.

With a sterilized needle, he would prick the finger of the patient and deposit a drop of blood onto a slide to test for falciparum malaria. In 10 minutes, the results were known.

“If it was a case of malaria but was not severe, the villager treated the patient” with the necessary drugs, said Dr. Supakit Sirilak, who directed the initiative.

Patients were given a cocktail of two drugs in a formula that reduced the resistance of the parasite to the drugs — one of the biggest challenges in treating the disease.

Pharmaceutical companies, however, have not plunged research dollars into developing new antimalarial drugs as the market is considered unprofitable.

The cocktail was developed by the SMRU after 20 years of research in the refugee camps of Tak province, home to thousands of people from Burma. Now, just 0.5 percent of doctor’s visits in the camps relate to malaria, compared with 30 percent before the combination of drugs was introduced.

The villagers working in the initiative, financed with a $4.7 million grant from the Bill and Melinda Gates Foundation, were paid $36 to $61 per month each.

Meanwhile, a team of British researchers who worked with the Biotec Institute in Bangkok announced in April that they had identified the element in the makeup of the malaria parasite that enabled it to become resistant to new treatments quickly.

“We can now use this protein structure to design a new generation of drugs which makes it possible to overcome resistant strains of malaria,” said professor Malcolm Walkinshaw of Edinburgh University’s Institute of Cell and Molecular Biology.

The findings, published in the journal Nature Structural Biology, could have a major effect on treatment for the disease.

“People have studied this protein for a long time, but until now, no one has been able to determine its detailed structure. This is a real breakthrough,” Mr. Walkinshaw said.

The British development as well as the success of the Thai drug cocktail show the potential to combat malaria’s resistance challenge.

“We have arrived at the end of reserves of new medicines,” Mr. Nosten said.

“We have shown that it is possible to reduce malaria. What is missing are the means to do so and the political will,” he said.

To eradicate the disease globally, however, it would be necessary to multiply a hundredfold the money currently spent, Mr. Nosten estimates.

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