Luis Angel Fernandez Hermana
For millions of people in the Third World, the dream of an effective vaccine against malaria might be coming true. The story behind this dream, however, can be described as a veritable nightmare. The vaccine was developed by Manuel Patarroyo, a Colombian scientist, in the 1980s and has since met every thread of economic and political resistance from the mighty drug industry and medical community — not to mention some development agencies — of the so-called First World. As the final trials are now under way in Africa, we asked Luis Angel Fernandez, a Barcelona-based journalist who has been following the story for years, to put Patarroyo's nightmare on paper. The hard line played by the scientific and industrial circles of the North against the work of this determined Colombian researcher is an illuminating — and terrifying — example of “profits before people's health”.
The first vaccine against malaria is entering into the final stages of clinical trials in Tanzania. The researchers carrying out the trials will report on the final results this coming September. For the moment, immunological and safety tests have proven positive in adults and children. Not one side effect has been reported and in all cases tested a specific and new immune response towards the crippling disease has been provoked, even among people who have been exposed to malaria several times.
To have come this far, the development of a vaccine against one of humanity's most scourging diseases had to overcome innumerous hurdles and was nearly shot down at several stages. Only the steadfastness of the man who developed it, the Colombian scientist Manual Patarroyo, and the scientific, economic and political support of Spanish institutes enabled the project to overcome all the obstacles facing it and reach the trial stage in Tanzania. Now that clear, positive results are coming to light, everyone wants to jump on the bandwagon of victory.
Patarroyo's vaccine suffered from a number of “defects” from the start. First of all, it was the first vaccine against malaria, which represented a slap in the face against the most prestigious pharmaceutical laboratories of the world which had been trying to develop a similar vaccine since decades. Second, it was the first vaccine against a complex parasite, which made its discovery even more difficult. As well, it was the first vaccine developed through chemical synthesis, which is something the mainstream scientific literature rejected on numerous occasions as virtually impossible. On top of all of this, the long sought-after vaccine with all of these characteristics was coming from an obscure laboratory of Bogotá, Colombia — which the world of dominant Western science neither knew of nor was ready to recognise. Seen from the side of the outspoken industrialised world, who was this damn Patarroyo who all of a sudden was threatening to change the modern medical system with the most geopolitically significant vaccine imaginable?
A disease of the poor
Malaria is the biggest killer of all diseases on earth right now. According to the UN World Health Organisation (WHO), the malaria parasite, known as Plasmodium falciparum , kills between three and five million people per year, 30% of them being children. Infectious bites from carrier mosquitos produce more than 200 million reported clinical cases per year, mainly in the tropical South where malaria is endemic. If these figures corresponded to the industrialised world as well, the spendings allocated to malaria control would skyrocket above the resources currently devoted to AIDS. But the fact is that malaria is not a disease of the rich world. It's a poor people's plague. For that reason, not only does malaria attract a pittance of current resources going to drug development, but most malaria research going on is directed toward stopping the post-bite effect of the illness. This kind of treatment is relevant mainly to tourists and foreigners visiting endemic areas and is the only strategy that's profitable to drug companies in the North. Hardly any research is devoted to the types of infection that local people suffer. Yet people living in malaria zones all their lives carry antibodies to the parasite since infancy and face the permanent risk of succumbing to this debilitating and often deadly disease.
In the early 1980s, when Patarroyo decided to devote his research to chemically synthesised vaccines and to focus on malaria, scientists ' eyebrows went up. Everyone told him to drop it, because his efforts would fail. Nobody had thus far developed a vaccine through chemical synthesis and, meanwhile, the malaria parasite was showing an incredible capacity to adapt to earlier drug treatments, making the prospects of an effective vaccine seem even more remote. Regardless, Patarroyo gathered together an excellent team of Colombian scientists and they got to work. A number of elements played in his favour: there is malaria in Colombia and in the Amazonian jungle lives the Autos monkey, a nocturnal species which seemed like an ideal test subject before trying the vaccine on humans.
The making of an enemy
In the mid-1980s, the first trials were carried out on the monkeys and then with people. The results were published and since they showed that the vaccine worked, hopes were raised. But then, the self-interest of Western science quickly ruled that this Colombian was an unwelcome individual. Patarroyo refused to cede any license on his discovery to the transnational pharmaceutical companies of the North, which was the least they expected from someone working in a “backwards” Latin American country and had to be desperate to make a fast buck. More startling to his Western pharmaceutical counterparts, Patarroyo announced his professional motivations in public: to make the vaccine available to all people either for free or at a very cheap price. If the vaccine worked 100% well, he would hand it over to the World Health Organisation so that WHO could distribute it at the cost of production — US$0.30 per dose — to those countries which could afford it, and for free to those which could not.
In one stroke of the pen, Patarroyo put the Western labs with their backs to the walls. For many people, the case brought to light the fact that the world's big drug companies are only interested in rich people's problems because that's where the money is to be made. This was very bad publicity for the industry. Furthermore, Patarroyo made his offer during the outbreak of the AIDS epidemic in the North, when all drugs being researched were those destined for wealthy patients while the poorer afflicted groups were clamouring to have any breakthrough be automatically made available for free. If Patarroyo went ahead with his strategy towards malaria, how could they avoid having to do the same with an AIDS treatment? For society would immediately demand that industry make its otherwise lucrative AIDS cure available to all sectors, rich and poor, in the name of “the common good”.
With this panorama, the doors started to close around Patarroyo and his team. First, the scientific quality of their work was criticised. Researchers claimed that the Colombian trials lacked a control group, which made it impossible to show how the disease had been prevented by the vaccine among those to whom it was administered. Then, some of the most powerful labs in the North issued injurious condemnations of Patarroyo's whole enterprise, questioning his ability to speak English, his capacity to actually produce the vaccine, and his reputation as a scientist in general. Finally, silence reigned. The really crucial test of the vaccine was to try it in a region of high endemism: Africa. Gambia was one possible site, as it offered an experimental station of the British Medical Research Council, one of the world's leading biomedical research institute. But the Colombians ' request for collaboration in the trial was denied twice. On the first occasion, the reasons to turn it down were later shown false. On the second occasion, no reasons were given at all.
By the beginning of the 1990s, Patarroyo found himself with the results of several experimental trials in Latin America, all of which showed positive results, and the doors firmly shut in the North. Only a marginal group of Spanish scientists working for the Superior Council of Scientific Research (CSIC) paid any attention to him. Through them, Patarroyo registered his vaccine in Spain, which put him in a better position to carry out trails with the support of a European country.
With the backing of Pedro Alonso, a Spanish epidemiologist, the Colombian team carried out a test in Colombia in 1992, following all the standards of the World Health Organisation. But even that Northern backing did not pay off immediately. In September 1992, Patarroyo offered the results of his work for publishing in the European bible of medical research The Lancet. Only after strong pressure from those who knew Patarroyo's work, The Lancet decided to publish it half a year later: on 20 March 1993. This was the turning point. It was the first time that a specialised Western scientific journal accepted that Patarroyo's vaccine effectively reduced the risk of clinical malaria among people living in areas where the disease was endemic.
In the meanwhile, Manuel Patarroyo had asked the CSIC if they would promote the development of a trial in Africa in which his team would specifically not participate. The Spanish institute, together with the Foundation for Biomedical Research of the Clinical Hospital of Barcelona, the Swiss Tropical Institute and the Faculty of Hygiene and Tropical Medicine of London, developed a protocol to carry out the trial, which is currently reaching its final phase in Tanzania. The Ifakara Centre, the Amani Centre and the National Medical Research Institute — all of Tanzania — are also collaborating in the trial.
While the African trial got into motion, Patarroyo stuck with his promises. Last year, he went to the WHO headquarters to surrender to them his vaccine and sign an agreement that this would be distributed at cost or for free. As this is a chemically synthesised vaccine which is relatively simple to produce, Patarroyo is also leaving the doors open to Third World countries which wish to produce it themselves.
While the scientists wait for the final results of the vaccination trial on 600 children in the Tanzanian village of Idete, Patarroyo and his team are improving the vaccine to increase the efficiency of its protection against malaria. In September 1994, four months before the International Conference on Populationa and Development, which will take place in Cairo, the real verdict on this vaccine — whose discovery has been described by some scientists as the most far-reaching medical feat of this century — will be known.