Fly over coastal areas around the Indian Ocean, and you'll see the destruction wrought by the tsunamis that swept the region in December. Houses have been reduced to heaps of rubble, cars and boats sit atop seawalls and jetties, and everything is soaked, with murky, brackish water pooling in gardens, fields, and forests.
For survivors, that stagnant water poses a threat that will surely compound the suffering. Soon it will become a breeding ground for mosquitoes that carry malaria. "All you need is for water to sit in a hot environment for a few days, and you'll see an increase in malaria," says Laurie Garrett, senior fellow for global health at the Council on Foreign Relations in New York. Yusuf Hamied, managing director at Indian drugmaker Cipla Ltd., even sees the possibility of a widespread outbreak.
Malaria is already one of the world's most virulent killers. The disease causes as many as 500 million acute illnesses and kills 1.5 million people each year. Worse, the parasites that cause malaria have built up resistance to the drugs commonly used to treat it, chloroquinine and mefloquine. Often the only alternatives are low-tech, such as mosquito nets treated with insecticide. "They're easy to make," says Han Heijnen, a World Health Organization adviser in New Delhi. "You just have to leave the net in the solution for half an hour."
Where are the new medicines on the market to fight this scourge -- especially at this critical moment? Unfortunately, malaria research has for decades been hobbled by the fact that the disease no longer affects the affluent parts of the world. So few companies have paid much attention. Aid donors won't be rushing huge quantities of new malaria medicines to help tsunami victims.
But there is hope of a breakthrough, with new drugs now in the offing. For a decade now scientists have been working to perfect anti-malaria treatments based on a traditional Chinese medicine created from the artemisia, or wormwood, plant. Once ingested, the plant's extract, artemisinin, is converted into a free radical that can destroy the vital processes of the parasite. Used with other drugs, artemisinin has proved effective against resistant malaria strains. The natural drug, however, is in short supply, can lack potency, and sometimes creates neurological side effects, so researchers have been working to perfect synthetic versions.
Much of the progress in malaria research can be credited to the Bill & Melinda Gates Foundation, which is also funding research on AIDS and other ailments. Since 2000 the foundation has given almost $250 million for malaria research. "Before, people had ideas but no money to do them," says J. Carl Craft, chief scientific officer at Geneva-based and Gates-funded Medicines for Malaria Venture (MMV).
There's also a newfound willingness in Big Pharma to act on a pro bono basis to combat the disease. Since 2003, Indian drugmaker Ranbaxy Laboratories Ltd. has been working on an anti-malarial that was once a project of Roche Group (RHHVF). The Swiss company concluded it could not make the drug profitably and handed it to MMV, which then partnered with Ranbaxy. "This reinforces the commitment we have toward developing intellectual property," says Malvinder Mohan Singh, Ranbaxy's executive director. Swiss giant Novartis (NVS), which developed Coartem, the leading artemisinin-based drug available, sells the compound at cost -- though it is still expensive and in short supply.
Many of the new medicines are in early stages of development. But with tsunami-hit countries receiving billions in aid -- and malaria posing a threat to the recovery -- there may finally be both the will and the means to tackle one of the world's most dangerous diseases.
By Bruce Einhorn in Hong Kong, with Manjeet Kripalani in Bombay