The One to Watch in 2008: Malaria Kills Thousands Each Day, Mainly in the World's Poorest Countries. but with Little Money to Be Made from Developing a Vaccine, a Cure Has Proved Elusive. at a Research Centre in Mozambique, the Work of One Man Offers Hope

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Westerners travelling to work in malarial regions used to be told that there was only one way to avoid catching the mosquito-borne disease: don't get bitten. It was by no means a foolproof method, but at least wealthy expats could afford preventative medicine and proper treatment if infected by the parasite. These, however, are not easily available options for many of the 500 million people in developing countries who catch malaria every year. Estimates vary, but somewhere between one and two and a half million of those die.

The statistics make a ghastly roll-call: more than 90 percent of fatal cases are children under five. Most of these are in Africa, where roughly 2,000 children die from the disease every day. No wonder that ten years ago the World Health Organisation declared the mosquito "public health enemy number one".

If there is one man who provides hope in the long fight against malaria, which is spreading out of the tropics through a combination of increased travel and trade and, possibly, global warming, it is Pedro Alonso. The director of the Barcelona Centre for International Health Research is a modest man. He insists that he has "just been one of many". Nevertheless, he is the public face of a project in Mozambique that has made the prospect of eliminating malaria appear tantalisingly within our grasp.

Trial results from Alonso's Manhica Health Research Centre have just been published in the Lancet. After testing of an advanced vaccine on infants, new infections were reduced by 65 percent over a three-month period, and 35 per cent over six months." It is hard to overstate what a major step forward this is," said Ripley Ballou of GlaxoSmithKline (GSK), partner in the vaccine's development. The next phase of testing begins late this year, and will involve 16,000 children at ten different sites in Africa, Crucially, it has the backing of Bill Gates, who is stepping down from his day-to-day role at Microsoft in July to concentrate on his charitable foundation, which has already committed $258.3m to malaria research and development.

"More than a decade ago, Pedro Alonso set up Manhica in one of the most malaria-infested parts of Mozambique," Gates told a forum in Seattle in October. "It has the health research facilities of a university in a poor, rural setting--and the value to public health is priceless." He concluded: "We're not done, and we will not stop working, until malaria is eradicated." It's a bold target, but the results from Alonso's centre allow researchers to believe that it could, just, be achieved. It is hoped that a vaccine suitable for mass distribution could be available within the next four or five years.


Alonso, 48, was educated in Madrid and at the London School of Hygiene and Tropical Medicine. After internships in Madrid and Boston, Massachusetts, he spent six years with the UK Medical Research Council in Gambia. "When you arrive as a young doctor in Africa," he told Time magazine, "and you walk into a hospital, you're basically confronted with this massive disease that causes so much suffering and death. It is impossible not to become passionate about fighting it." At the time, in the 1980s, he thought a vaccine was imminent, as had many scientists in the previous 50 years, during which numerous attempts to discover one had been made.


The parasite that causes malaria is a complex organism, however, and drug companies had too little incentive to undertake extensive trials in the field for a product most needed by those least able to pay for medicine. It was the combination of the Bill and Melinda Gates Foundation, which started the Malaria Vaccine Initiative in 1999, GSK and Alonso's Manhica centre that made this breakthrough possible.

"Our group has been researching epidemiology and malaria control for more than 20 years," says Alonso, referring to the University of Barcelona, of which the Centre for International Health is a part and which he joined in 1992 before setting up Manhica in 1996 with aid from the Spanish government. …