[e-drug] Malaria: the terrorist's friend

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E-drug: Malaria: the terrorist's friend
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By AMIR ATTARAN
[copied as fair use. BS]

New York Times September 25, 2003

CAMBRIDGE, Mass.  When the United States Marine Corps went ashore in 
Liberia in August, it discovered an enemy that had no ties to the 
various factions in the civil war there. More than 50 of the 225 
service members, roughly a quarter, who landed in Liberia last month 
were hospitalized because of a longtime scourge of mankind: malaria.

This figure reveals a troubling gap in the military's preparations 
for dealing with unrest and terrorism overseas. Existing medicines 
for malaria are so ineffective or have such unpleasant side effects 
that they offer little real protection, yet many of the places 
terrorists could hide are rife with the disease.

The Department of Defense knows that malaria - which causes fever, 
and if untreated, anemia and death - is a threat. In Liberia, the 
marines were armed with the best malaria medicines, mosquito 
repellents and antimosquito suits that the Pentagon's money could 
buy. Since the Vietnam War, when malaria was the most common cause of 
hospitalization after combat wounds, commanders have known that 
soldiers in the tropics are vulnerable. A malaria epidemic during the 
Somalia deployment in the early 1990's reinforced this lesson. Yet 
little has been done despite scientists' warnings and abundant 
evidence that existing medicines are near the end of their useful 
life because drug-resistant strains of malaria have emerged.

Although the Army has the world's most successful malaria drug 
laboratory - the Walter Reed Army Institute of Research has 
discovered three of the five most effective drugs since World War II 
- the Department of Defense allocates it only $8 million a year. 
Other contributions raise the institute's budget to $13 million.

These sums are woefully inadequate. If a terrorist group had a weapon 
that would hospitalize 25 percent of American soldiers within weeks, 
wouldn't the Pentagon spend more than $8 million a year to defend 
against it?

The malaria cases in Liberia provide a lesson to any budding 
terrorist: base yourself in a tropical country with lots of deadly 
Plasmodium falciparum malaria. If you recruit locals to your cause, 
their acquired immunity will keep them relatively safe. And if 
America sends troops, they'll soon be too incapacitated to do much.

In a world where terrorists are as mobile as the soldiers pursuing 
them, America can hardly afford to declare some places off limits. 
Yet our troops' vulnerability to malaria is so great, as the Liberia 
deployment proves, that we may have to do just that, even when they 
are protected by the latest technology.

What is needed is a crash program of malaria drug development. The 
announcement this week by the Bill and Melinda Gates Foundation that 
it was awarding grants of $168 million for vaccine and drug research 
and malaria prevention programs in Africa is welcome news. But the 
United States must do more. Instead of $8 million a year, Congress 
should appropriate $200 million for a partnership between the Army's 
labs, other government labs and the pharmaceutical industry. This is 
reasonable and commensurate with what the administration is spending 
on preparedness for other biological threats, like smallpox and the 
ebola virus.

There is also a humanitarian bonus. Not only would these new 
medicines improve America's military preparedness, but they would 
also probably help the one million or more people worldwide who are 
killed by malaria every year.

The choice is to spend a few million out of a Pentagon budget 
measured in the hundreds of billions, or to cede a huge swath of the 
tropics to terrorists proliferating under the protection of 
mosquitoes and microbes mightier than American troops.

Amir Attaran, an immunologist, is a fellow at the Royal Institute of 
International Affairs and the Africa Fighting Malaria Foundation.

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