The Unnoticed War Where Millions of Children's Lives are at Stake

On the border between Thailand and Cambodia, a mighty battle is taking place - and the outcome will determine whether millions of people live or die. If the right side falters and fails, the long list of the dead will consist overwhelmingly of children and pregnant women. But this fight is passing virtually unnoticed in the outside world. Why? Because the lives at stake are - initially, at least - "only" those of Asians and black Africans.

The war is against a tiny parasite that is suddenly - and rapidly - stripping away our ability to treat one of the deadliest diseases known to man. If the war fails, we will be left defenceless before it.

Malaria is already the biggest killer in the world after AIDS and tuberculosis. It infects 250 million people a year - the vast majority in Africa - and kills 1.5 million of them. In the Central African Republic last year, I met a woman the same age as me, thirty, who was stalking her village, howling and ripping at her hair. She stopped long enough to tell me she had given birth to four children, and three had died spasming and shrieking of malaria. Now her youngest baby had all the symptoms, and she couldn't bear it. "Why is this happening? Why?" she kept yelling, to herself, to the sky, to no-one.

It is caused by a parasite carried in the salvia of female mosquitoes. Once they inject it into your blood with a bite, the parasite heads for your liver and slows your blood flow. Within a few days, your organs fail. This happens to an equivalent of seven jumbo jets full of children every day.

The great Polish war correspondent Ryszard Kapuscinski described what it feels like. "The first signal of an imminent malaria attack is a feeling of anxiety, which comes on suddenly and for no clear reason. Something has happened to you, something bad," he wrote. Then comes "the dullness, the weakness, the heaviness... Everything is irritating. First and foremost the light; you hate the light. But you don't have a lot of time for these loathings. For the attack arrives quickly. It is a sudden, violent onset of cold. Someone has taken you naked and thrown you into the icy highlands of Greenland."

At this point, "You begin to tremble, quake, thrash about. You immediately recognize, however, this is not a trembling you are familiar with; these tremors and convulsions tossing you around are of a kind that at any moment now will tear you to shreds." He said it is like being imprisoned "inside a mountain of ice" and slowly crushed.

Up until this year, the world was making remarkable progress in whittling down this disease. Since the year 2000, seven of the worst-afflicted countries in sub-Saharan Africa have slashed malaria-deaths by 50 percent. It has a great knock0on effect too: for every £1 spent on malaria prevention, Africa gains £12 in economic growth, because people can work instead of lying sick and dying. It was a sign that aid, matched by good African government, can produce inspirational results.

But then something began to change - at first imperceptibly - in the forgotten forests of Western Cambodia, where the Khmer Rouge held their last stand-off. The drug that is most effective at treating malaria is called artemisinin: it shocks the parasite out of your system and saves your life. But in South-East Asia, horrified doctors have discovered that the malaria parasite is becoming resistant to it. In a Darwinian arms race, it has begun to evolve a way to beat the treatment. It is taking twice as long to work - and soon it will have defeated the medicine altogether.

We have been here before. In exactly the same place in the 1960s, the malaria parasite outraced the best available treatment of its day, choloroquine, and rendered it useless. The new super-parasite then spread rapidly to Africa. Across the map of the world, the ability to treat malaria was blacked out, region by region. Nick Day, Professor of Tropical Medicine at the Mahidol Oxford Clinical Research Unit working on the ground, says: "It caused millions of deaths. If we let it happen again, we will face a major public health catastrophe."

It took twenty years for another medicine as effective as choloroquine to be developed. Millions of Africans died waiting. If we lose artemisinin, we will face another deadly interlude - and given that pharmaceutical companies are doing virtually no work on diseases that afflict poor countries because there is no profit in it, it could last indefinitely. Professor Day says: "There are no new malaria drugs coming down the pipeline. There is nothing to replace them for the foreseeable future." The broken mother I saw in Central Africa would then be one of many, many more.

Nobody knows why Cambodia's malaria parasites are such buffed-up hyper-Darwinian winners - the Mr Universe of the parasite world. They have in the past rendered other treatments like SP and DDT far less effective by evolving resistance to them too. Some scientists think it is because the treatments have been used there longer than anywhere else, giving their parasites a head-start.

But it is not inevitable that this super-malaria will spread to Africa and cull millions. The scientists on the ground say we can contain them in Cambodia and prevent a disaster - if we act fast.

The scientists' plan is simple. It is to first of all massively suppress the spread of malaria in this area by a vast distribution of insecticide-treated mosquito nets, which have been shown to cut transmission by 80 percent. Then it is to ease the "drug pressure" on the parasite. At the moment, heavy doses of artemisinin are pushing the malaria parasite to evolve fast. So the scientists are drastically slashing the doses of artemisinin in the area, and complementing it with a cocktail of weaker malaria drugs that in combination can have some compensatory effect. They calculate that this will reduce the evolutionary pressure on the parasite and make it revert back to type.

But Cambodia is a desperately poor country recovering from a genocide. It is impossible for them to do it alone. The World Health Organization has stepped in with funding - but scientists are warning this project will require large and sustained funds.

The cost of not acting will be catastrophic for Africa - and, in time, we would all live to regret it. One of the most frequently anticipated effects of global warming is a spreading of the parts of the world vulnerable to malaria. The World Health Organisation has advised European governments and the Southern states of the US to take "urgent action" to prepare for "the spread of malaria" to its territory as warming accelerates. If we are going to make the planet tropical, we had better start paying attention to tropical diseases.

But this is a moment for excitement as much as despair. This is a chance to save the most precious medicine humanity has from destruction. This is a chance to save millions of people from dying "in a mountain of ice." This is a chance to do something heroic - for Africa, and for our own future. If we make this happen, we can be energized to keep on eradicating malaria, step-by-step, from the human condition: Dr. Robert Koch has shown that for just $10bn over five years, we could reduce deaths from the disease to a few thousand a year.

So will we seize the opportunity - or will we stand by, limp and passive, and wait for the advance of a super-charged killer?

POSTSCRIPT: There is a hard-right myth that environmentalists "banned DDT in Africa" and "killed Africans". It is possible some people will try to revive it in response to this article.

It is not true. There is no ban. African governments can still use DDT as much as they like. Many use it in moderation for indoor spraying. But they do not see it as a magic bullet, because it is less effective than other options, like insecticide-treated bednets, because mosquitoes have developed a significant degree of resistance to it, and because it can have dangerous side-effects, like contributing to premature births and killing off local fish populations.

Johann Hari is a writer for the Independent. To read more of his articles, click here . You can email him at johann -at- johannhari.com

 

Follow Johann Hari on Twitter: www.twitter.com/johannhari101

Comments

[AngryOhioan]

You set up a straw man 'ddt is completely banned and a panacea' to preempt any debate about where it may be useful and whether restrictions and threats by the EU are reasonable and productive.

[AngryOhioan]

ddt doesn't work for every situation and has to be used appropriately to be effective. But it should be up to local health officials who know the local situation; they shouldn't have to ask for permission from environmental zealots or the EU.

[AngryOhioan]

Did you even read the links before you posted them. They didn't ban imports they just said they would have to set up an expensive monitoring system they can't afford. Which might as well be a ban. You then post links claiming ddt doesn't work. If it does work why has South Africa been able to use ddt to control malaria?

"If Uganda is to use DDT for malaria control, it is advisable to do so under strictly controlled circumstances, and in consultation with other countries in the region which may be affected," the Brussels-based union said in a statement.

A parallel system to monitor foodstuffs for the presence of DDT also had to be set up. "This would ensure that any contamination of foodstuffs is detected and corrective measures taken," the EU noted.

[DamaskinosWasRight]

+
This is the type of Johnathan Hari commentary that I look forward to.
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[Rudabekia]

Show me one war - only one - where the lives of millions of children are not at stake!

[WilliePilgrim]

This is a serious crisis in the making and many are looking at the threat in very serious ways. One group in particular are the genetic engineers who are approaching a degree of facility with biotechnology that diseases such as HIV/Tuberculosis/ Malaria and virtually al lthe plagues of mankind throughout history will be a think of the past.
The media doesn't cover it much because it is so darn complex, but remarkable things are just around the corner. It's not the end of the problem, of course, What about famine? What about insecurity­/instabili­ty due to inequality and competition for resources? What about sectarian conflict where reproduction rates are being employed for one group to take over a neighboring country.
There will always be death and a desire to conquer it. Were it not for disease I suspect we'd come up with more motives for murder. We have a ways to go yet, before we're qualified as being truly civilized.

[fredwenn]

8 billion people in 2050 -... and no fish. 8 billion people in 2050 and no lions, elephants, tigers or gorillas.

No clean water or arable land.

Life without malaria will be a living hell sooner rather than later. .

sorry... it's the new reality.

We had better toughen up on the subject...­. or we all die. I want a planet filled with plants animals and people.

that includes mosquitoes - they serve an important function.

[Pyrum]

You're buying into a myth. The planet is capable of supporting 8 billion people quite well without the genocide of fish.

[fredwenn]

The fish are already GONE.... What ever are you saying?

Lobster fisherman are killing each other over diminishing catches..

Animals are losing habitat.

SORRY -- anybody who says the world can sustain 8 billion people needs to report to a high rise in Singapore for reeducation training..­.

[fredwenn]

Talk to Nova Scotia fisherman.­... NO MORE COD

[lastpost]

There seem to be countless scientists with funding to find out things that have no discernable bearing on human need. Suppose a few of these were tasked with trawling the internet for possible solutions. Surely there are more ways than medicine to manage mosquitoes. Methods which exploit the physiological and mental weaknesses of that creature. Natural techniques that communities have identified and resorted to in the past. Means that have been used against similar pests, and that might now be borrowed/converted/ improved to address this onslaught. We have a way to access some of the vast potential of human ingenuity. Why limit our response to only those approaches a few are familiar with?

[daffey]

Malaria kills, and in some places, kills far more than AIDS. Yet AIDS gets the lion’s share of the publicity. In fact, until the last year or so, I would bet most Americans hadn’t heard of a malaria pandemic. The popular focus was ever and always on AIDS. I saw an African spokeswoman just a month or so ago berate coverage of African medical needs by pointing out that malaria was wiping her people out, while AIDS - terrible as it was - got almost all the attention. It did little, she argued, to save people from HIV only to let them die from malaria. So at least a fair amount of the problem isn’t that those who are dying are of a particular ethnic makeup - after all, AIDS in Africa and other parts of the world gets far more press and attention than any one of ten other diseases in our own backyards (save perhaps breast cancer), and those people were Africans everyone was caring about. It’s that AIDS was focused on exclusively for the last decade or more, and until recently, the fact that there was any other threat in the world seemed to be all but ignored. So it’s a good thing that people are finally opening the door and letting a little light in on problems that are just as devastating, and just as real.

[ZenJu]

Great article, as always. It makes me sick when I think of all the storm and fury of such UN bodies as the so-called "Human Rights Council," which obsesses on the peccadillos of one tiny democracy while overlooking the most horrific (and genuine) abuses of human life on this planet. Prompt and thoughtful UN action could help put a stop to the misery caused by war, famine, poverty, and diseases such as this. Shameful.

[Frogfoot]

The banning of DDT has cost millions of lives, for nothing.

[jalex26000]

No, western intervention did that.

[scooter-tws]

1. DDT was never banned in Africa.

2. DDT worked wonders in the US (reducing yellow fever and eliminating malaria), but

3. It's a toxic compound.

So, sure, Western countries should encourage spraying a toxin across Africa. That'd work just swell.

Insecticide-treated netting works better anyways, but isn't nearly as easily understood by the average human as poison.

[jalex26000]

western intervention in Africa, has killed Africa, thats not hard right or left. thats reality. all the medicine and money in the world willnot "save Africa. Allow Africans to pull themselves up by their bootstraps without western weapons and "medicines", stop testing on them, stop supporting their dictators, stop looting that continent, and the Africans will be just fine.

western countries enslaved Africans, tested on them with their incurable diseases, destroyed their lands and now, yet again, they are meddling and destroying lives on that continent. Thanks for the article though.

[zola77]

You always write fantastic articles that provoke me to go do my own research on these issues. Great journalism, thankyou.

[mouselion]

Cost effectiveness of drugs that are needed for those who need them would be realized if research was conducted for that purpose instead of for the frivolous, vain purposes drugs for affluent western consumers are now developed.

Even the lower middle class US Americans are affluent compared to much of the population of the world. If US Americans would learn to see past the consumeristic approach forced-fed them by commercial interests, then resources could be concentrated where they are actually needed.

See the correlation with this and why we can not achieve single-payer healthcare in this nation?

The immediate question is, however, what can we as westerners do to help with this hellish situation for Cambodians stricken with or at risk to this supper-malaria?