Online Extra: Q&A With Nick White

The malaria expert on the medical challenge of fighting the disease and how to get the developed world interested

Nick White is one of the world's top experts on malaria. The English-born doctor has worked for years to convince the international health-care bureaucracy that a drug based on artemisinin, made from a Chinese herbal remedy, is the most effective way to fight the deadly parasite. White recently spoke to BusinessWeek's Bruce Einhorn about the recent decision by international agencies to approve artemisinin and the impact that the decision will have on the fight against malaria. Edited excerpts from their conversation follow:

Q: What first brought you to Asia?


I had always wanted to work in tropical countries. I started as soon as I passed my medical finals. I went to Nepal for about nine months, in a very remote area of eastern Nepal. There were a lot of interesting medical problems.

Q: How serious a health-care issue is malaria?


It's difficult to deny that malaria is a massive medical problem. It kills between 1 million and 2 million people a year. Five percent of the world's population has malaria. It's just massive.

Q: I've heard that, for scientists, the malaria parasite is also interesting because it's so hard to fight. Is that right?


It's relatively accessible for the researcher. You can actually see it under the microscope. You can count it. You can treat it. And yet it has proved a very, very tough opponent. That's intriguing.

[Experts] have tried to eradicate malaria. After the Second World War, one of the main focuses of attention was malaria. There was a global campaign to eradicate malaria. It failed.

Q: But now artemisinin represents a real breakthrough?


Beware of the word "breakthrough." Everyone in medicine is claiming that something is a breakthrough, because it's journalistically appealing. But medical science doesn't work like that. There tend to be small steps rather than eureka moments. What has been a breakthrough is the final realization by international agencies that we have here very effective antimalarial drugs.

Q: You first started working to convince people about artemisinin about 20 years ago. What's taken so long?


It has taken a very long time. There are a number of reasons: There's no lobby [for] malaria. Malaria is a poor person's disease. There aren't people banging on the doors of Congress or Parliament. It's a rural disease. [For diseases affecting more affluent people in cities,] we would never tolerate using the sort of drugs that are so ineffective as in malaria.

Second, the [first report on artemisinin] came from China, and it didn't go through the usual hoops and hurdles, so it was regarded with considerable suspicion. People said we can't use [those tests] because their quality isn't good enough.

Q: What comes next, now that artemisinin has finally received approval?


Our rough projections are that we need to raise $1 billion a year. If we could do that, we would have a massive impact on malaria. Half of that would go to mosquito control -- bednets and insecticide. The other half would go to drugs.

Q: What's the best way to convince people that they should spend the money?


It's the economic impact [of malaria] that these countries fear. Cynically, that carries the most weight. The humanitarian arguments don't actually do anything. If you can make a persuasive economic case, that's the most persuasive aspect that will make rich countries put their hands in their pockets.

At this time of global uncertainty, [we can have] a massive impact on the poor of the world for a relatively small expenditure. If we can get the world to do that, I will feel that I have contributed something.

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