[HN Gopher] The most effective malaria vaccine yet discovered
___________________________________________________________________
The most effective malaria vaccine yet discovered
Author : hprotagonist
Score : 723 points
Date : 2021-04-23 16:13 UTC (1 days ago)
(HTM) web link (blogs.sciencemag.org)
(TXT) w3m dump (blogs.sciencemag.org)
| hanniabu wrote:
| Would this be a one and done vaccine or is it something that
| needs a booster every few years like tetanus?
| ncmncm wrote:
| It strikes me as extremely odd to call this a "discovery". The
| vaccine was very specifically designed to work in exactly its
| unique mode to be effective against one species of pathogen. We
| might equally well talk about SpaceX Starship being "discovered".
|
| To me, it is _invented_ , _constructed_ , _engineered_ , or
| _created_. What has been discovered?
| namenotrequired wrote:
| This is an interesting question. I'm honestly curious if anyone
| knows - why do we talk about, say, machines being invented but
| drugs and vaccines being discovered?
|
| (I get that you invent the drug, and then you discover whether
| it works. But the same is true for machines.)
| ncmncm wrote:
| It makes sense to talk about discovering a bioactive
| compound, such as from an herbal remedy, or by testing a
| family of related compounds. An engineered vaccine is a
| wholly different animal.
|
| The only other time we say "discover" about something
| manufactured is when somebody else did it. We can discover a
| meth lab, a Ponzi scheme, or (in principle) an alien
| civilization.
| anonymous4759 wrote:
| It's interesting how everyone in this thread (rightly) views this
| as a promising development, yet whenever articles are posted
| discussing longevity research, you see ghastly comments like
| this:
|
| https://news.ycombinator.com/item?id=26211722
|
| Isn't that hypocritical?
| dang wrote:
| No, because HN is not a person - it can't have human qualities
| like being hypocritical about something. That would be like
| calling a room hypocritical because people in it disagree. The
| community is a statistical cloud of people whose views are all
| over the place.
|
| While I have you: could you please stop creating accounts for
| every few comments you post? We ban accounts that do that. This
| is in the site guidelines:
| https://news.ycombinator.com/newsguidelines.html. You needn't
| use your real name, of course, but for HN to be a community,
| users need some identity for other users to relate to.
| Otherwise we may as well have no usernames and no community,
| and that would be a different kind of forum.
| https://hn.algolia.com/?sort=byDate&dateRange=all&type=comme...
| anonymous4759 wrote:
| I've used throwaway accounts here for a decade, since I post
| infrequently and don't care about karma, and it's never been
| a problem. Further, my comment wasn't flamebait (or anything
| otherwise objectionable) and shouldn't have been flagged.
|
| While I have you, dang: the flagging on this site is out of
| control. Why do you allow users to so easily hide from others
| comments they dislike? The downvoting, I don't care about.
| But flagging should be reserved for things like spam, racial
| slurs, and other stuff that obviously doesn't need to be
| seen.
| dang wrote:
| Although I turned off the flags on your comment, I don't
| agree that it wasn't flamebait. It was off-topic, generic,
| and provocative. It was even name-calling too ("ghastly").
| That's a flamebait cocktail.
|
| Creating accounts for every few comments you post is a
| problem for the reason I just explained. Doing it for a
| decade doesn't make it ok. It makes it worse!
|
| In a way, this is a freeloader problem. The richness of the
| community here comes from people interacting and relating
| with each other over time. On HN people are welcome to do
| that anonymously (pseudonymously, for those who speak
| pedantic), but still need some identity for others to
| relate to. If you don't contribute that, you're freeloading
| in the sense that you're benefiting from what other people
| are giving, without giving anything comparable of yourself.
| That undermines the community. If everyone did it, we would
| have no community.
|
| Throwaway accounts are ok on occasion when there's some
| sensitive relevant information that shouldn't be linked to
| the main identity--but note that I said _on occasion_.
| Using them as a matter of course is abusive. That 's also
| in the site guidelines:
| https://news.ycombinator.com/newsguidelines.html.
| anonymous4759 wrote:
| >ghastly
|
| That's a perfectly apt description of someone who desires
| the death of others, especially the death (by extension)
| of their own parents and grandparents in the name of some
| vague notion of "progress." And many of these same people
| then laud a vaccine that will increase the life
| expectancy and reduce the suffering of millions of
| people, oblivious to the contradiction.
|
| >In a way, this is a freeloader problem. The richness of
| the community here comes from people interacting and
| relating with each other over time. On HN people are
| welcome to do that anonymously (pseudonymously, for those
| who speak pedantic), but still need some identity for
| others to relate to. If you don't contribute that, you're
| freeloading in the sense that you're benefiting from what
| other people are giving, without giving anything
| comparable of yourself.
|
| Dang, as far as I'm concerned, _I 'm_ the one who's
| contributed and asked for nothing in return. I never
| asked for points (karma), or the ability to censor (flag)
| others' posts I dislike, or the ability to de-emphasize
| those posts (downvote). Meanwhile, I routinely see
| "uberusers" here get leeway, not just from you, but from
| the flag- and downvote-happy users, that anonymous users
| like me do not get.
| dang wrote:
| Most people who break the guideline against calling names
| feel that they are "apt descriptions". It's still against
| HN's rules, so please don't. You can make your
| substantive points without that.
| galgalesh wrote:
| I'm one of the people who agrees with both sentiments. I think
| decreasing child mortality is great and that humanity needs
| people to eventually die.
|
| Dying in itself is not an issue. Early mortality is an issue.
| Give everyone the chance to live a full life.
| anonymous4759 wrote:
| > and that humanity needs people to eventually die.
|
| People will eventually die with or without aging. Consider
| accidents, suicides, homicides, or other non-age related
| illnesses.
|
| Do you think humanity needs billions of people to eventually
| develop Alzheimer's or other terminal late-life dementias?
| aledalgrande wrote:
| From wiki:
|
| > Malaria strains found on the Cambodia-Thailand border are
| resistant to combination therapies that include artemisinins, and
| may, therefore, be untreatable.
|
| Having a vaccine as effective as this new one would save many
| lives.
| sabujp wrote:
| why aren't we releasing hordes of mosquitoes into these areas
| that will render the next generation incapable of breeding?
| https://www.cdc.gov/mosquitoes/mosquito-control/community/si...
| robbmorganf wrote:
| In this trial, shots were given in May-August to children a
| minimum of 5 months old. Assuming children that have not reached
| 5 months by August (or say October) can't be vaccinated in time
| for the seasonal peak of Malaria, should we recommend the safest
| time to have a child is roughly Dec-May? Therefore, couples
| should be trying for a child Mar-Aug if they want to reduce
| mortality risk to malaria.
| chmod600 wrote:
| Are any of the mosquito extinction approaches being seriously
| tried? Genetic engineering, etc.?
| ska wrote:
| Seriously tried, yes. Seriously effective, no (at least so
| far). At least that was the state of things last I looked a few
| years ago.
| bolangi wrote:
| Widespread supply of mosquito nets treated with an insecticide
| is one of the more successful measures.
| User23 wrote:
| The most successful measure was carpet bombing the USA with
| DDT for years[1]. Most people don't know this now, but
| malaria used to be endemic in the USA as far north as the
| border with Canada. DDT's environmental persistence is
| obviously a double-edged sword, but it made the eradication
| possible.
|
| [1] https://www.cdc.gov/malaria/about/history/elimination_us.
| htm...
| lesuorac wrote:
| Also worth point out that DDT is not blankety banned in the
| US. It's just not allowed as a pesticide. You can still use
| it to kill mosquitos.
|
| > Although Carson never directly called for an outright ban
| on the use of DDT, its publication was a seminal event for
| the environmental movement and resulted in a large public
| outcry that eventually led, in 1972, to a ban on DDT's
| agricultural use in the United States.
| https://en.wikipedia.org/wiki/DDT
| stuff4ben wrote:
| I don't mean to be crass, but why wouldn't that have worked
| in Africa? Yes DDT is scary bad, but we seem to be doing ok
| in the US.
| elric wrote:
| The US is pretty small compared to the parts of Africa
| that have to deal with malaria. The sheer size of the
| continent might make it difficult.
| Vrondi wrote:
| Weird as this seems, at the time, you had to be in a
| country that could _afford_ DDT. It wasn't free.
| FredPret wrote:
| DDT has worked perfectly well in some areas of Africa,
| but you have to do it right. You have to carpet-bomb the
| place with the stuff properly for years without any let-
| up. The tradeoff is higher cancer et al rates for those
| years, in exchange for no more malaria.
| jfk13 wrote:
| The environmental impact of widespread DDT use is pretty
| devastating.
|
| http://www.rachelcarson.org/SilentSpring.aspx
| User23 wrote:
| Silent Spring isn't a scientific work[1] and has some
| serious factual problems. If you want to support banning
| DDT in an evidence based way you need to look elsewhere.
| It is on the other hand observably a rhetorical
| masterwork.
|
| [1] https://www.nytimes.com/2007/06/05/health/05iht-
| sntier.1.600...
| jfk13 wrote:
| It wasn't written to be simply and solely a scientific
| work; and it's hardly surprising that over the
| intervening 60 years, things haven't followed exactly all
| the scenarios it suggested.
|
| That doesn't alter the fact that it was a seminal work
| that helped open many people's eyes to some very real
| issues; and the devastation of many ecosystems over the
| past half-century or more surely confirms the importance
| of its message.
| lazide wrote:
| If you ignore the reality of a situation in favor of
| rhetorical tricks to land a heavier impact - it still
| doesn't make it actually true. Even if the heavier impact
| has some positives.
| Fomite wrote:
| We tried it in Africa. _A lot_. DDT is great - it 's
| cheap, it's persistent, and there was a heady note of
| optimism that we might be able to drive malaria to
| extinction via vector control.
|
| Then DDT-resistance developed in the mosquitos.
|
| Combined with the health and ecological concerns around
| it, its use was largely halted. It's been reinvigorated
| recently as malaria incidence has rose, but it's a trade-
| off that it would be nice to minimize with other
| approaches.
| User23 wrote:
| Isn't DDT resistance a result of so-called "responsible"
| usage like DDT coated netting instead of overwhelming
| application such as in the USA? It's the same principle
| as antibiotic resistance: under-dosing selects for
| resistance.
| Fomite wrote:
| DDT resistance arose during a time when it was extremely
| intensively used to try to wipe out malaria-carrying
| mosquito populations. It's certainly sustained by the
| more moderate uses of it, but at this point, that ship
| has sort of sailed.
|
| It's been reintroduced in some countries as well - it's
| effective, and it's an important tool, but it's not
| nearly enough. And indoor residual spraying with DDT for
| malaria control remains fairly controversial - I fall in
| the camp of "It's probably worth it, but anything we can
| do to minimize it is a thing worth pursuing."
| alimw wrote:
| The WHO campaign of the late 50s and early 60s very
| nearly did eradicate malaria globally. Unfortunately, for
| people living today in those parts of the world where it
| has resurged, a miss is as good as a mile.
| icandoit wrote:
| This group Oxitec released some in Florida:
|
| https://www.oxitec.com/en/news/florida-keys-mosquito-control...
|
| They previously released some in Brazil:
|
| https://journals.plos.org/plosntds/article?id=10.1371/journa...
|
| those results?:
|
| ...in the Brazilian city of Indaiatuba found that Oxitec's
| mosquito suppressed disease-carrying Aedes aegypti by up to
| 95%* in urban, dengue-prone environments following just 13
| weeks of treatment, as compared to untreated control sites in
| the same city.
|
| *95% was the high 2-week rolling average and the individual
| weekly high was 98%; the highest 4-week rolling average was
| 92%.
| UncleOxidant wrote:
| Would mosquito extinction even be a good idea? There would be
| substantial impacts to ecosystems if mosquitos were completely
| eliminated.
| chmod600 wrote:
| My understanding is that only a couple species go after
| humans, and they don't have any important ecological niche.
| jfk13 wrote:
| So some people claim. Our understanding of ecosystems is so
| superficial that this looks like a pretty big gamble to
| take.
| chmod600 wrote:
| Or a big gamble not to take, if you are vulnerable in a
| malaria zone.
| abfan1127 wrote:
| yes. mosquitos do quite a bit of pollination.
| Fomite wrote:
| Vector control is the primary way that epidemiology and disease
| ecology have been exploring reducing the burden of malaria (and
| Dengue, and a number of other diseases).
|
| Genetically engineered, effectively sterile mosquito breeds are
| part of that effort. But that is _hard_ to do - ecological
| systems are hard to push off stable equilibria.
| Darmody wrote:
| https://www.bbc.com/news/world-us-canada-53856776
| FredPret wrote:
| I, for one, have been going at them one at a time for years now
| hintymad wrote:
| Isn't Malaria caused by parasites? So vaccine is not just for
| virus?
| rossdavidh wrote:
| The parasites are single-celled microorganisms. Generally
| speaking, anything your immune system can fight, you might
| theoretically be able to make a vaccine for. Emphasis on
| "might", of course.
| andi999 wrote:
| What is the difference to bacteria? (or is it a bacterium?)
| JonathonW wrote:
| They're not bacteria.
|
| The malaria parasite is considered a protist, which is a
| broad category comprised of organisms whose cells contain a
| cell nucleus but aren't otherwise classified as plants,
| animals, or fungi. This group includes some multi-celled
| and single-celled organisms (that aren't necessarily
| related beyond the fact that they have a nucleus); the
| single-celled species in the group distingush themselves
| from bacteria because bacteria do not have a nucleus, and
| are generally simpler overall.
| baybal2 wrote:
| There used to be a weird theory that malaria parasite has
| descended from algae.
| stephenhuey wrote:
| Malaria is caused by protists which are spread by Anopheles
| mosquitoes. So it's not a virus.
| smaddox wrote:
| I somehow had never seen/heard the word protist before
| (biology is obviously not my specialization). Thank you for
| that.
| frankus wrote:
| Not an epidemiologist but a bit of googling suggests that humans
| are the sole reservoir for the varieties of parasites that can
| cause malaria in humans. I wonder if how much closer a 77%
| effective vaccine could bring is to eradicating the parasite
| worldwide.
| alexedward wrote:
| I think that was a good initiative taken to save people from
| death as already lot of people died due to Covid-19
| walidwalid wrote:
| Curious to know how much money they spent on this vaccine while
| there is already a treatment for malaria - it's called Artemisia
| Annua. Ans big pharma is doing everything it can to dismiss that
| almost free solution to the problem.
| mabbo wrote:
| Why bother with a treatment when you can prevent even catching
| the illness in the first place?
| robbrown451 wrote:
| There is a problem with the parasite resistance to Artemisinin
| (https://en.wikipedia.org/wiki/Artemisinin#Resistance)
|
| Regardless, malaria still kills millions... and you are
| complaining about them spending money on it?
| Fomite wrote:
| "Big Pharma" has been providing antimalarials pretty much at
| cost through negotiations with the WHO and other international
| funders for quite some time now. But cheap drugs - especially
| since Artemisinin needs to be used as part of a combination
| therapy - aren't an easy solution to the malaria belt's woes.
| abeppu wrote:
| I vaguely recall people talking about human/malaria co-evolution.
| And I was of the impression that the malaria parasite was
| supposed to be good at evading our immune system, and that was
| part of why vaccines had limited efficacy.
|
| If anyone here is educated in this area ... would it be
| reasonable to expect that the 77% efficacy would decline if such
| a vaccine were put into widespread use? Like, I know we observe a
| pattern where antibiotics become less effective if they are
| deployed widely. Or are protists slower / less able to evolve in
| response to this kind of intervention?
| bullfightonmars wrote:
| There is a key sentence of this article that speaks to this:
|
| > This new vaccine (R21) uses a circumsporozoite protein (CSP)
| antigen - that's a highly conserved protein of the parasite,
| involved in several functions as the parasite makes the move
| from mosquito to human and into different human tissues such as
| the salivary glands.
|
| Circumsporozoite protein is a highly conserved protein meaning
| that it is a genetic sequence that is very unlikely to change
| regardless of adaptive/evolutionary pressure.
| abeppu wrote:
| I see. So the 23% does not suggest that, e.g. there's some
| minority of parasites that are "immune" already.
| jjk166 wrote:
| Not necessarily - vaccine effectiveness also relies on the
| person's immune system actually developing the needed
| antibodies. Some fraction of people simply won't. This is
| also why vaccine effectiveness goes up with multiple doses
| - sometimes the first one doesn't take but the second one
| does.
| asdfasgasdgasdg wrote:
| It depends on a lot of things. First is how easy it is to
| evolve a way around a particular defense. For example, it will
| be easier to achieve an vaccine escape when only one gene is
| required to mutate compared to ten thousand. If you have a
| vaccine that disrupts something fundamental about a pathogen's
| lifecycle, it's better than one that targets something
| superficial.
|
| Another question is what fraction of the population is exposed
| to the selective pressure, and to what extent the selective
| pressure confers a benefit or cost to all other members of the
| population. If responding to the pressure makes the population
| more fit in other hosts, then we should expect it to become
| widespread eventually. On the other hand, if it causes the
| disease to become less efficient in other hosts, you would not
| expect the mutation to become widespread.
|
| For example, imagine if there were a monster that lived in a
| small part of Alaska that tended to eat humans with small
| fingers, we would probably just not go to that part of Alaska.
| On the other hand, if such monsters were present throughout the
| world, you'd probably see humans with longer fingers over the
| generations. Does that make any sense? It's a strained metaphor
| but I hope it gets the point across.
|
| Another thing that can happen is speciation, but we'll leave
| that for another day.
| sleepydog wrote:
| I know mosquitos are a major carrier of malaria, but does modern
| malaria come from other humans? If a population got 100%
| vaccinated, would the next generation need the vaccine as well or
| would malaria be eradicated within that population?
| Gatsky wrote:
| The long and arduous task of dealing with malaria does give one
| pause when considering that there have been two new globally
| significant infectious diseases in the last 50 years. We aren't
| getting rid of HIV or SARS-CoV-2 any time soon. To me there is
| little doubt we should deploy massive resources to detect new
| infectious agents early and prevent their spread. We have the
| technology. There is no better gift we can leave to our future
| civilisation.
| stjohnswarts wrote:
| Well one good way might be to try to quit eating everything
| that walks, crawls or hops and switch over to veganism.
| pezo1919 wrote:
| Fun fact: potent anti-malarial drugs like HCQ and IVM do work
| well against covid19.
|
| They are being censored, but you can see some data on
| www.c19early.com
|
| Me being censored now here, 3, 2, 1...
| eloff wrote:
| What blows me away is in a study group of 734 infants, which
| benefited from maternal antibodies against malaria, 717 were
| infected by malaria in the first year of their life. That's
| nearly 100%, in the first year since birth. That's devastating.
|
| The vaccine is showing 77% efficacy in trials in Burkina Faso.
|
| That's an ongoing pandemic that makes covid-19 look like a case
| of the sniffles. Malaria deaths peaked around 930,000 a year in
| 2004, and is around 600,000 a year now. I believe covid-19 death
| toll stands around 3 million deaths, most above the age of 70.
| Malaria is over 100 million, most under the age of 5.
|
| Source: https://ourworldindata.org/malaria
| Exmoor wrote:
| > Malaria deaths peaked around 930,000 a year in 2004, and is
| around 600,000 a year now
|
| Your link does a good job showing this, but for those who don't
| click and scroll down it's probably worth mentioning that the
| vast majority of those deaths are in central Africa. So it's
| not just a _lot_ of deaths, but it 's a really significant
| portion of the population and, as you said, mostly children.
| ChrisMarshallNY wrote:
| I grew up in Africa. We weren't as scared of Ebola, as we
| were, of good old Malaria.
|
| It's also the gift that keeps on giving. Once you get it, it
| does a reunion tour, every now and then, for the rest of your
| life.
|
| At the dinner table, we (expats) used to have a bowl of
| quinine tablets, set out like a condiment.
|
| I really hope this works out, because, thanks to climate
| change, the lower 48 may get a chance to find something in
| common with our neighbors to the south.
| ff-- wrote:
| Malaria used to be common in the US until the 1950s or so.
| It was eradicated through extensive mosquito control and
| engineering efforts. Rich countries can cope; it's the
| developing world that's thoroughly boned, at least until
| industrial capabilities catch up.
| Zenst wrote:
| > Malaria used to be common in the US until the 1950s or
| so.
|
| I had no idea of that, as I suspect many given the time
| past if you wasn't around then. Did a little digging and
| nicely covered here:
| https://www.cdc.gov/malaria/about/history/index.html
|
| Which makes me wonder - what the cost of malaria drugs
| are and how much would it cost to eradicate it. Equally
| have the true environmental and ecological aspects of
| eradication methods been analysed. I wasn't aware that
| mosquito's were pollinators until a while back, not that
| anything usurps Bee's, but many insects are pollinators
| and in some area's they may even be crucial as a species.
|
| After all the 1950's approach was basic killing of the
| mosquito's and whilst that may of been a solution for one
| area like the US, I'm not sure that approach would be
| taken as much today and for Africa, certainly as I
| mentioned, the whole pollinator aspect of mosquito's may
| make for a more fragile ecosystem that removal of a
| species would be more impaction than the gains.
|
| I always found it fascinating that malaria has been
| around so long that a genetic mutation evolved in some
| that makes them immune to it.
| garyfirestorm wrote:
| Afaik mosquitoes don't really contribute ecologically.
| They are just nuisance.
| WalterBright wrote:
| I recall a town in Texas decided to wipe out the local
| bat population due to fear of rabies. The next year they
| had a major scourge of mosquitoes. Turns out bats mostly
| eat mosquitoes. They let the bats resettle the area.
|
| Bats eat tons of mosquitoes. Some outfits encourage and
| help people set up bat friendly enclosures to deal with
| local mosquito problems.
| [deleted]
| anonuser123456 wrote:
| Well bats certainly haven't caused us any major global
| health problems recently...
| himinlomax wrote:
| While the bat origin of Covid 19 is plausible, it hasn't
| been conclusively demonstrated. The gain of function lab
| leak is just as plausible, and equally unproven -- due to
| the Chinese dictatorship's suspicious lack of
| transparency and cooperation.
| eloff wrote:
| Lab escape is still bat origin, just potentially with a
| human assist (or human mistake with an unaltered virus.)
| girvo wrote:
| Sure, and they're a large viral reservoir, but I'd hope
| we don't think that's a good reason to eradicate them.
| They don't typically come into _our_ homes the way
| mosquitos do; we go to theirs.
| yyyk wrote:
| There's IIRC a single-digit number of mosquito species
| carrying malaria and a slightly higher number of mosquito
| species targeting humans - as compared to hundreds of
| species of mosquito. Kill the carriers off and they just
| get replaced by some other specie of mosquito.
|
| Lets face it, if the same Malaria mortality rate happened
| in the West, we wouldn't (and historically didn't) wait
| for vaccines - we'd pave over an entire ecosystem if we
| had to. We'd do the same even if we had the same death
| rate as the group that got vaccinated.
| galangalalgol wrote:
| Malaria has killed so many people I don't really care if
| wiping them out starts a trophic cascade, it would
| probably still kill fewer people than malaria. If we had
| to give up condors and bees, I'd still think it a fair
| trade.
| georgeam wrote:
| With the bees will go lots of foods that depend on them
| for pollination. Bees are very essential for agriculture.
| bijant wrote:
| Bees are just another legacy producer ripe for
| disruption. With recent Progress in AI and Drone
| technology the question isn't if Bees get replaced by
| autonomous Nanobots but when.
| galangalalgol wrote:
| I remember when I was a kid the EMP trucks went around to
| keep the nano swarms down, but most of us got bot-lung
| anyway.
|
| Even rogue nanoswarms are less worrisome than mosquitos
| as a vector.
| galangalalgol wrote:
| Actually very few of our foods, and none of our staple
| crops rely significantly on insects for pollination.
| Grapes for instance, can use insects but don't have
| significant problems in their absence.
| xvilka wrote:
| They are the food for birds. Not sure how big that chunk
| is. Also mosquito's larvae is a water predator, might be
| an important ecological niche in water reservoirs.
| BurningFrog wrote:
| I can't help being annoyed by how the West first
| exterminated malaria at home, and _then_ , once they were
| safe, started worrying about the ecological consequences
| of doing the same in Africa.
| goseeastarwar wrote:
| During cabin decompression, you put your oxygen mask on
| first, then help others.
| gammarator wrote:
| I think the right analogy for the GP post is putting your
| oxygen mask on and then telling your seatmate they
| shouldn't be flying due to climate change.
| IdiocyInAction wrote:
| I think it's a bit more complicated than that looking at
| the wiki article. It seems to have been very successful
| to begin with, but then the mosquitos became resistant to
| DDT and western countries have a climate advantage.
| Notably, they did try it in poorer countries too.
| DennisP wrote:
| DDT was also used incorrectly. It was supposed to be
| sprayed on walls, so it was made to be persistent.
| Naturally farmers crop-dusted it on their fields, and
| that made it an environmental problem.
| loonster wrote:
| And a ton of kerosene. Spray it on all bodies of water
| and the larva can't breathe.
|
| Malaria is why the first attempt at the Panama canal
| failed. Kerosene is partly why it became successful.
| NicoJuicy wrote:
| If all kids in your neighborhood get sick, including
| yours.
|
| Do you first try to heal your kid or everyone at the same
| time?
| Quarrel wrote:
| It used to be common in southern Europe as well and was
| an absolute scourge in SEA until the 20th century.
| Biologist123 wrote:
| Not just Southern Europe. Oliver Cromwell (English ruler
| in 1600s) died of malaria.
| havernator wrote:
| Malaria in North America and England is covered pretty
| well in Mann's _1493_. There are a couple kinds of
| malaria, one more resistant to cold than the other.
|
| No doubt the indigenous Americans had it bad, to put it
| mildly, but reading the accounts of early colonization
| efforts in that book, I mean, _damn_. Wave after wave of
| colonists, each losing 50+% in the first year (and it's
| not like the survivors stopped dying then). For years on
| end, across multiple colonies. Mostly to disease.
| Quarrel wrote:
| That's awesome trivia!
| nanijoe wrote:
| I dont know what part of Africa you grew up in, but growing
| up in Nigeria, no one was scared of Malaria.
|
| It is treated pretty much the same way Americans treat
| getting the Flu
| ChrisMarshallNY wrote:
| I was born in Nigeria. I barely remember it, but what I
| can remember, is being constantly told how bad it was.
| It's entirely possible that my parents had an unreasoning
| fear of it. When we are kids, they are our source of
| Truth.
|
| I also remember my sister getting caught in one of those
| 'squito swarms, near the Delta. That was freaking awful.
|
| Uganda was a bit worse; but we also had other things to
| be scared of.
|
| I should also mention that Ebola wasn't actually around
| (that we knew of), when I was a kid, but we hasd some
| _fun_ diseases. The parasitic ones (like Elephantitis and
| Belhartzia) were pretty difficult to look at.
| nanijoe wrote:
| Well then, nice to meet a fellow Nigerian :) Ebola is a
| recent thing AFAIK, so it would make sense that no one
| was freaking out about it when you were a kid.
|
| To be fair, it does sound like you were in rural Nigeria,
| so my Malaria experience is likely different from yours
| ChrisMarshallNY wrote:
| Someone pointed out that us Europeans were probably a lot
| more sensitive to this than others, who had been around
| it, all their lives. Also, my mother was the prime vector
| for my information, and she might have been a bit freaked
| out by all the fun ways Africa has to kill people.
|
| But I'm still here. I seem to have survived.
|
| My African friends would run around barefoot over the
| most God-awful crap, and were some of the healthiest
| people I've ever known.
| cm2012 wrote:
| 200000 kids under 5 don't die of the flu every year.
| ny2ko wrote:
| Agreed with the other responses. The main reason there are
| lots of malaria deaths is often due to the lack of access
| to medication but for folks that do, it is similar to the
| flu stateside.
|
| I was born and raised in Uganda and I'm shocked by this.
| Ebola was 100x more scary than malaria growing. At least
| way back before this recent vaccine. Get Ebola you are
| basically screwed, get malaria have a pill
|
| To be fair on your part, as an 'expat' (I have a lot of
| qualms with this word, see
| https://www.theguardian.com/global-development-
| professionals... as a starter), its harder as your immune
| system didn't grow up with it and so when you get it, its
| much worse. Quinine in my head is a hard core malaria drug
| for the tough cases (well atleast in was 10-20 years back).
| But for folks born and raised it really was like the flu.
| When I go back these days though, I'm in the same boat and
| actually start a dosage of anti malarials a week before I
| arrive
| Perceval wrote:
| Quinine is better as a prophylaxis rather than a
| treatment - i.e. for preventative or early-stage use, not
| once it's developed into a bad case. Low doses early
| (like in the tonic water of the late 1800s) could help
| prevent one from catching malaria while avoiding the
| nasty side effects of larger quinine doses needed for
| treating an advanced case.
| ny2ko wrote:
| Ah I see. I was only familiar with the latter advanced
| case usage
| janto wrote:
| Expat typically means emigrant, not immigrant.
| Tostino wrote:
| That's interesting and I hadn't thought about the
| difference in terms and how they were used before, thanks
| for the article to chew on.
| jquery wrote:
| Japanese working abroad are expats wherever they are.
| dmt0 wrote:
| And Russians are immigrants. It doesn't go by race, it's
| Haves vs Have Nots - the only two classes that really
| exist.
| spacemanmatt wrote:
| > it's Haves vs Have Nots - the only two classes
|
| Then what do you call it when the Haves trend light in
| skin tone and the Have Nots trend dark in skin tone?
| lxxxvi wrote:
| 3/4 of Europe are have-nots in the expat:immigrant
| debate...
| spacemanmatt wrote:
| I might be confused. Is your argument that 3/4 of Europe
| being Have Nots negates racial inequity?
| dmt0 wrote:
| I call it "fighting over bread crumbs when 0.01% take
| away the whole cake".
| ny2ko wrote:
| It's definitely more nuanced for sure. Factors that can
| play into it can include but aren't limited to race,
| social standing and class, country that you are living
| into etc. I agree there's a have vs have nots at play at
| times but I don't think you can discount race at play
| either.
|
| As an example, I always found it interesting that when I
| moved to the US, I found the words use suddenly
| disappears despite there being lots of people that could
| fit that mold. Has anyone experienced otherwise? I'd be
| curious to know
| jogjayr wrote:
| > Once you get it, it does a reunion tour, every now and
| then, for the rest of your life.
|
| Maybe only certain strains of malaria do that? I had
| malaria many years ago. It was a very unpleasant
| experience, but I recovered in a couple of weeks with no
| lingering effects.
|
| Growing up in India, malaria was common. But I don't recall
| anyone living in terror of it. Mosquito nets, mosquito
| repellent incense, repellent cream, turning the ceiling fan
| on to full speed were common countermeasures we employed at
| bedtime.
| ChrisMarshallNY wrote:
| I never got it, so I don't know.
|
| The way it was explained to me, is that it's a parasitic
| disease, and the parasites would embed eggs in tissues,
| with the possibility of the eggs (or whatever they are
| -spores?) being re-released in the future.
| elihu wrote:
| That's my understanding as well; there are multiple
| malaria (plasmodium) species, and their effects vary.
| Some are a one-time infection, and some come back
| periodically.
| macksd wrote:
| That's my experience as well - I had it 17 years ago, was
| very ill for weeks, but recovered and haven't had any
| problems since (but am no longer exposed to risk of new
| infections). However, it used to be that in the US you
| could donate blood if you had seen a doctor and been
| symptom-free for 3 years. It's now a lifetime ban. So
| perhaps there's new evidence it's not so simple?
|
| Edit: Or there just aren't many donors who have had
| malaria, so they err on the side of safety.
| jimkleiber wrote:
| From my understanding, the vivax variety can bury into
| the liver and come back out in the future, whereas the
| falciparum type, which seems to have faster and deadlier
| results if untreated, once it is treated, is no longer in
| the body.
|
| Or at least I hope so. I lived in Tanzania for a few
| years and I got malaria (I think falciparum) a few times.
| The first time it was the worst headache I've ever
| experienced. By the third or fourth time, I barely
| noticed that I had it and yet it was at maybe 5x or more
| the concentration it was when I first contracted it.
| qart wrote:
| I have had both falciparum and vivax (different years),
| confirmed by lab tests. The treatment was exactly the
| same in both cases. While one of them was quite
| debilitating, the other felt like an ordinary flu. I
| forgot which is which. In both cases, I was prescribed a
| month's worth of medication to get rid of the plasmodium
| from the liver.
|
| I don't live in a malaria-prone locality anymore, but
| when I did, the people did not consider it a deadly
| disease. I think access to medical facilities and good
| nutrition are the key factors why some populations
| consider it a deadly disease, and other populations
| don't.
| adonese wrote:
| I grow up in Africa too, Sudan to be specific. During my
| early childhood years, I contracted malaria more than 5
| times. It was really a very regular disease -- that an
| typhoid. It was only during college have I learned how
| devastating and seriously dangerous those diseases are:
| just to put things in perspective, a doctor once told my
| friend, after he checked his lab results (and be mused of
| it), they either have malaria or typhoid.
|
| I'm interested to read more about the possibilities that in
| africa we contracted so many diseases that explains the
| rather shocking covid mortality rate. It could be because
| of mean age too.
| Fomite wrote:
| Malaria is a massive drain on the lives, well being and
| economies of central Africa. An effective malaria vaccine
| would be _huge_.
| eloff wrote:
| I think it's common knowledge that malaria primarily affects
| Africa, but you're right that it's particularly devastating
| to a couple dozen mostly very poor countries.
| DoreenMichele wrote:
| The fact that malaria is so common in those areas is almost
| certainly a significant contributing factor to the
| intractable poverty in those areas.
|
| It's hard to be productive when you are sick all the time
| and/or caring for someone sick.
| black_puppydog wrote:
| I think the point was mostly that comparing the
| case/fatality numbers of covid19 - a truly global pandemic
| - with those of malaria has to factor in the size of the
| population being exposed.
|
| Sure, Malaria is unlikely to spread like covid or it would
| have done so a long time ago, but the absolute numbers
| don't tell the whole story about how bad each disease is.
| eloff wrote:
| Actually malaria used to be in much larger areas of the
| world, including the United States. But the population
| was much smaller at that time.
|
| It's a good point about absolute numbers versus
| population relative numbers.
| baybal2 wrote:
| Siberia used to be a giant malaria hotspot, and then it was
| suddenly gone at the onset of 20th century, and first
| semblances of effective treatment.
|
| Some say climate change killed it, some say the extinction
| of a mosquito species carrying it, some better nutrition,
| some say quinine.
| coliveira wrote:
| The wealthy nations don't care about malaria because it happens
| only in poor countries. Maybe global warming will make them
| finally take notice.
| PeterisP wrote:
| Malaria used to happen in USA and Europe, it was eradicated
| there less than hundred years ago.
| Fomite wrote:
| As an infectious disease epidemiologist, after HIV, malaria
| is probably the next most closely studied and well-funded
| infectious disease we look into. It's also been a WHO
| priority for basically the entire existence of the WHO.
| lastofthemojito wrote:
| I get what you mean: Malaria vaccines never got a sudden rush
| of Manhattan-Project-esque funding like COVID-19 vaccines.
| But according to the study, funding for this research was
| provided by "The European & Developing Countries Clinical
| Trials Partnership (EDCTP), The Wellcome Trust and the NIHR
| Oxford Biomedical Research Centre".
|
| The EDCTP is funded by the European Union as well as the
| individual member countries. The Wellcome Trust and Oxford
| are both British.
|
| Perhaps wealthy nations could/should be doing more, but it
| seems like wealthy countries are responsible for this
| breakthrough.
| Fomite wrote:
| Malaria eradication did get a massive Manhattan Project-esq
| push. It just failed.
| 0-_-0 wrote:
| "... somewhere in the region of 150 million to 300 million
| people have died from the effects of malaria during the past
| 100 years. If it is taken that around 6,000 million people have
| died during this period, malaria may be reckoned to have been a
| factor in between 2 and 5% of all deaths across the planet in
| the 20th century." [0]
|
| [0]: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC126857/
| Iv wrote:
| Covid-19 is a baby bike with training wheels. And we fail
| disastrously at that. It is far from the worse scenario
| epidemiologists train for, but it could easily become one: a
| variant with high lethality can always appear suddenly.
|
| And yes, malaria is not discussed enough. I remember Bill Gates
| releasing mosquitos in a room before a speech to get the public
| attention "these could carry a deadly disease we have no cure
| for"
| koheripbal wrote:
| You know, that's complicated...
|
| A more deadly virus, as we saw with SARS, was that it was
| actually _easier_ to control because the high death rate made
| it very easy to contact trace and identify infected.
|
| In many ways covid19 is a challenge exactly because it doesnt
| kill too many people.
| jhayward wrote:
| It wasn't the death rate of SARS that made it easy to
| control, it was the lack of an infectious period pre-
| symptoms.
| gizmo686 wrote:
| Unfourtuantly, this correlation is not always the case.
|
| HIV is extremely deadly without treatment, but has an
| asymptomatic stage that can last over a decade despite
| still being infectious during that time.
|
| The silver lining with HIV is that its modality of
| transmission is primarily sex and blood, which greatly
| limits the number of contacts an infected individual will
| have.
|
| An airborne disease with the lethality, incubation length
| of infectivity, and vaccine resistance of HIV would be a
| slow moving disaster of an unimaginable magnitude.
|
| I am not aware of any theoretical reason such a disease
| cannot exist.
| [deleted]
| renewiltord wrote:
| Ah, that's why GiveWell rates mosquito netting so high. To
| think I could save a child with a thousand dollars.
| georgeam wrote:
| Not to be too nit-picky, but a thousand dollars would help or
| save many children, not just one. $20 will get you a mosquito
| net on Amazon.
| renewiltord wrote:
| Ah but not each child will die. GiveWell estimates that one
| grand roughly to spend enough netting to transform one dead
| child into a live child.
| xbar wrote:
| In addition to the real and massive reduction in human
| suffering a 77% efficacy vaccine could bring, the opportunity
| for renewed investment and growth for the economic development
| of Central Africa cannot be overstated.
| IG_Semmelweiss wrote:
| malaria vector is mosquitoes, which are particularly
| devastating in tropical areas with rainy seasons that end up
| with numerous stillwater deposits.
|
| Stillwater deposits (i.e. no fish) are the perfect breeding
| grounds for mosquitoes. If you have a very wide area with poor
| transportation infrastructure, or if you don't have funds to
| fumigate for mosquitoes...you are toast.
|
| The incidence rate should not be surprising for anyone that has
| lived in a tropical country with a rainy season.
|
| You can't run and you can't hide. Mosquitos come out when you
| sleep, and use body heat and breathing to find their victims.
| You will be bit by mosquitoes. Many times. Sometimes multiple
| times a day. The question is whether you get enough bites that
| chance will deliver a malaria bite.
| aledalgrande wrote:
| Mosquitos use CO2 to find victims*
| soperj wrote:
| >That's an ongoing pandemic that makes covid-19 look like a
| case of the sniffles
|
| How? There are literally 3 times more deaths in the last year
| than peak Malaria, and that's only deaths that were actually
| counted.
| eloff wrote:
| Yes, but over the course of history, there's no comparison.
| Which was my point.
|
| Covid-19 is hopefully going to be short-lived thanks to the
| vaccines, but even if it weren't for that it would likely
| become more virulent but less deadly over time like the other
| Coronaviruses that are endemic in humans.
|
| There is a also a big difference in lives lost at the end of
| life versus at the beginning.
| soperj wrote:
| >Covid-19 is hopefully going to be short-lived thanks to
| the vaccines, but even if it weren't for that it would
| likely become more virulent but less deadly over time like
| the other Coronaviruses that are endemic in humans.
|
| Over the last year it's be come more virulent and more
| deadly.
|
| We have no idea how well the vaccines are going to work. We
| have a situation right now where a country(india) with 100
| million people vaccinated is getting 350,000 cases a day,
| and it's doubling every 10 days. That's a scenario where
| the evolution around the protection a vaccine offers
| becomes a very real and distinct possibility.
| eloff wrote:
| > Over the last year it's be come more virulent and more
| deadly.
|
| Evolution is a somewhat random process at its heart, but
| I stand by what I said as the likely outcome, because
| that's the path new diseases normally take. It's early
| days yet.
|
| > We have no idea how well the vaccines are going to work
|
| I think we have a petty good idea by now actually. A
| bigger question is how much will it be hampered by people
| afraid or unwilling to be vaccinated? I have never in my
| life seen such widespread and illogical fear of vaccines.
|
| We may have to just accept that there will be an ongoing
| toll in the unvaccinated population that keeps the virus
| circulating in quantity and keeps the hospitals busy.
| Until sufficiently many develop natural antibodies
| through infection.
|
| > We have a situation right now where a country(india)
| with 100 million people vaccinated is getting 350,000
| cases a day, and it's doubling every 10 days. That's a
| scenario where the evolution around the protection a
| vaccine offers becomes a very real and distinct
| possibility.
|
| Yes, that's a tail risk that's real and terrifying. I
| think the risk is small given such a mutation would
| possibly render the virus much less virulent. The
| vaccines tend to target the spike protein, without which
| it can't even infect humans. But nature finds a way. We
| can and will also adapt the vaccines in that case though.
| The money, motivation, and technical expertise are all
| there. But nobody knows how likely a risk that is.
| iso1631 wrote:
| > I have never in my life seen such widespread and
| illogical fear of vaccines.
|
| It's interesting, in the UK we had ridiculous reaction to
| the MMR jab after a fraudulent claim, fired up by the
| media - from the ever populist Daily Mail to Private Eye
| [0], which led to a collapse in MMR takeup and a
| resurgence in measles.
|
| But we haven't seen that with covid, perhaps because the
| printed press is (mostly) on the side of the current
| government (flag waving populists), and the vaccine
| rollout has been branded aprt of the generational
| "battle" between the UK, standing alone against Europe
| (many in the UK don't realise WW2 ended 76 years ago).
|
| I wonder if we'd had a Corbyn or Starmer led coalition in
| charge if things would be different.
|
| Or imagine if the lib dems had held on to 20-30 seats
| that the tories gained in 2015 -- likely another
| coalition, with a 5 year fixed term, no brexit
| referendum, and then the GE having to be delayed (it
| would have been set for May 2020)
|
| [0] https://behavioralscientist.org/how-fraud-and-a-
| broken-publi...
| soperj wrote:
| >Evolution is a somewhat random process at its heart, but
| I stand by what I said as the likely outcome, because
| that's the path new diseases normally take. It's early
| days yet.
|
| So that's why malaria is less deadly now? I've seen this
| said many times with zero backing, and it just really
| doesn't correlate with the history of disease. The reason
| we don't deal with the majority of deadly diseases is
| vaccines, not because they've evolved to become less
| deadly.
|
| >I think we have a petty good idea by now actually
|
| We have an idea of how well they work on the original
| covid-19 strain that we saw last year. We don't know how
| well they will work on actually eradicating the virus.
|
| >I think the risk is small given such a mutation would
| possibly render the virus much less virulent
|
| Based on what? It's already evolved to evade antibodies
| produced by infections from the first wave (P1 strain in
| Manaus specifically is a good example). Those have been
| mutations in the spike protein, and have made the virus
| more virulent and deadlier.
| WalterBright wrote:
| > not because they've evolved to become less deadly.
|
| Apparently our DNA is literally encoded with lots of
| viruses, as they've evolved to become utterly harmless to
| people. Our bodies are loaded with various bacteria and
| viruses that have evolved a symbiotic relationship to the
| point where we'd die without them, and they can't live
| without us.
|
| I seriously doubt they started out that way.
| lazide wrote:
| Smallpox (around since about 500 BC or earlier near as we
| can tel), still had a 35% lethality rate until it was
| eradicated in the 70's though an extensive vaccination
| campaign.
|
| Diseases can be severely lethal far longer than you or
| human memory can survive.
| hammock wrote:
| >Over the last year it's be come more virulent and more
| deadly
|
| Source?
| soperj wrote:
| https://www.bmj.com/content/372/bmj.n579
| jjk166 wrote:
| That's peak malaria deaths _in a single country_
|
| Globally, malaria kills 1-3 million people annually despite
| many people having some natural resistance to it and there
| being many effective treatments for it and it already having
| been eradicated in many areas. Covid killed the same amount
| in a much larger population that had no pre-existing defenses
| or treatments.
| reddog wrote:
| Because malaria has been killing people consistently for
| thousands of years? You can easily add Tuberculosis to the
| makes-covid-look-like-sniffles list as well. Over the last
| 200 years 1 billion people have died of TB.
|
| https://www.nature.com/articles/502S2a
| eloff wrote:
| Yes. Add HIV to that list as well. Polio, which is almost
| gone now. It's a long list.
| throwaway5752 wrote:
| It's incorrect to say it looks like sniffles in comparison.
| This is basically severity / priority in software. If we
| left sars-covid-19 without mitigation for a century, it
| would catch up rapidly. You compare things over relevant
| intervals.
|
| There are far more influenza deaths over the last 3 decades
| than ebola, but ebola is far more severe and greater
| concern.
| jefftk wrote:
| _> If we left sars-covid-19 without mitigation for a
| century, it would catch up rapidly._
|
| I think that's probably wrong? The most likely outcome
| would be that after the initial pandemic subsided (with
| lots of deaths), most people would catch it when they
| were reasonably young and then be mostly protected.
|
| This is different from malaria, which is much more
| deadly.
| amalcon wrote:
| It is as yet unclear how long effective immunity lasts
| after catching the disease, but pessimistic estimates put
| it at less than six months. While the pessimistic
| estimates are likely wrong (hence the term
| "pessimistic"), there certainly isn't confidence in the
| sort of lifelong immunity that one gets to some other
| contagions.
|
| Part of what's so exciting about the vaccines is that the
| antibodies seem to decay at a slower rate, meaning that
| it could result in longer immunity (though we obviously
| don't know for sure yet).
| jefftk wrote:
| _> pessimistic estimates put it at less than six months_
|
| If that were the case we would see large amounts of re-
| infection, since the pandemic started over a year ago
| throwaway5752 wrote:
| That's a pretty fair amount of speculation about the
| future evolution of sars-covid-19, but you might be
| right. I hope you are. To be direct with you - I disliked
| the framing altogether, neither of them are sniffles, and
| it's unhelpful and barely meaningful to compare an acute
| respiratory transmitted virus with a mosquito borne
| parasite over such wildly different timeframes. This is
| wonderful news about the vaccine for the terrible disease
| malaria. Covid is also a terrible disease.
| soperj wrote:
| >I think that's probably wrong? The most likely outcome
| would be that after the initial pandemic subsided (with
| lots of deaths), most people would catch it when they
| were reasonably young and then be mostly protected.
|
| Then why hasn't that happened with malaria?
| jefftk wrote:
| Malaria is a very different sort of disease? Among other
| things, covid is something that (a) doesn't seem to badly
| affect children and (b) seems to give some kind of
| immunity. Malaria does not have (a).
| eloff wrote:
| Yes. Also evolution tends to favor making diseases better
| adapted to their hosts and note virulent, but less
| deadly.
|
| We have a number of Coronaviruses endemic to humans that
| cause the common cold (among other viruses.) That's
| probably how covid19 would turn out, left to its own
| devices.
| estaseuropano wrote:
| That's not correct. The virus doesn't care whether you
| die or heal. It cares how long you are contagious, so
| generally the time until death after infection tends to
| stretch, not general deadliness.
| Someone wrote:
| I think the most likely outcome is that it will become
| like the flu: not that deadly in Western society, but
| mutating too rapidly for protection to last long, and
| still killing many elderly and people with chronic health
| conditions each year (according to
| https://en.wikipedia.org/wiki/Influenza, Influenza kills
| over half a million people each year)
|
| (Both are RNA viruses.
| https://en.wikipedia.org/wiki/Orthornavirae)
| soperj wrote:
| So somehow it being around longer makes the more lethal
| disease the sniffles? That doesn't make sense.
| missedthecue wrote:
| Covid's victims are mostly in their 70s and above.
|
| Malaria's victims are mostly under 5 years of age. In terms
| of life-years lost, Malaria is far far worse.
| owenversteeg wrote:
| The average age of death from the coronavirus appears to be
| in the 80s for many countries. In Norway it's 84, in the UK
| it's 82.4.
|
| You also have to take into account the health of those
| involved. Saving a life only for that person to live a few
| low quality years in poor health is worth less than saving
| the life of a healthy young child.
|
| The resulting measure is the QALY, the quality adjusted
| life year.
|
| Unfortunately there has not been nearly enough research or
| discussion about QALYs and their applicability to the
| coronavirus. There are a few studies out there, though,
| here's one:
| https://onlinelibrary.wiley.com/doi/full/10.1002/hec.4208
|
| TLDR: the mean discounted QALYs lost by someone dying of
| the coronavirus in the US is 4.3.
| cutemonster wrote:
| Yes, and, imagine you're 40 years old, and your 75 years
| old parents die, or your two 5 years old kids
| Tepix wrote:
| You're comparing the worldwide Covid-19 numbers with the
| malaria numbers of a small region.
| soperj wrote:
| You're wrong.
| MongooseMan wrote:
| Comparing the deaths side by side misses an important aspect:
| most malaria deaths are children, whereas Covid mostly
| affects older age groups.
| soperj wrote:
| Because old people are worth less than children?
| mkingston wrote:
| My anecdotal observation is that is a position that a
| majority of old people themselves take, at least
| nominally.
| fastball wrote:
| Yes but not in the way you're implying.
|
| A child dying robs them and the world of 60+ years of
| human life. An 80 year old dying of COVID-19 was not
| going to live much longer anyway, so the loss is less
| severe. Old people have already had the opportunity to
| live a "full" life.
|
| Imagine two societies - one where a disease kills 50% of
| < 10s every year, and another that kills 50% of > 70s
| every year. Which society would do better? Which society
| would you rather live in?
| soperj wrote:
| In the US, more people in the 55-74 age range have died
| than the 85+. Those are people who are taking care of
| grand children, or are still working. These are people
| that society has spent decades making fully functioning
| parts of society. A child has had none of that
| investment.
|
| A society of just children wouldn't work, just as a
| society without wouldn't work.
| fastball wrote:
| Is your goal to just be as misleading as possible in this
| conversation?
|
| Yes, of course more 55-74s have died - there are far, far
| more of them than there are >85s. Normalized, COVID is
| far more lethal (8x more lethal) for >85s than for your
| range. Here's the mortality rates:
|
| 55-74: 0.28%
|
| 85+: 2.5%
|
| https://www.statista.com/statistics/241488/population-of-
| the...
|
| https://www.cdc.gov/nchs/nvss/vsrr/covid_weekly/index.htm
| soperj wrote:
| How in any way is that misleading?
|
| The actual numbers are more representative than lethality
| percentages when we're talking about contribution to
| society.
| StavrosK wrote:
| What's more representative is "life years lost", and
| malaria wins there (we've lost many more years to it).
| soperj wrote:
| How do you calculate that in an area of the world with
| the highest rate of child mortality?
| StavrosK wrote:
| Same as in any other area, assume malaria isn't killing
| babies and do the math. Your question sounds rhetorical
| but is too simple to answer, so I'm confused.
| throwawayboise wrote:
| Frankly, yes. It sounds cold hearted but many of the
| COVID deaths were people who were going to die in the
| next 24 months anyway.
| jhayward wrote:
| > The average years of life lost per death is 16 years.
|
| https://www.nature.com/articles/s41598-021-83040-3
|
| And, dismissing the death of someone by saying "they were
| going to die soon anyway, so what" is disgusting.
| renewiltord wrote:
| In a QALY sense, yeah. The most valuable to society are
| the workforce but children are almost as valuable.
|
| My parents are 60+ yr old surgeons. They work during the
| pandemic not because they have to. It's because you run
| the QALYs and the morality is clear. You participate or
| make way.
| BiteCode_dev wrote:
| And the worst thing is: malaria is easily curable, as malaron
| is not only preventive, but fully kill the plasmodium in the
| liver cells. Despite that, we don't provide the drug to them.
|
| It would cost a fraction of what we spend on research for a
| vaccine, but no cigar.
|
| Of course, there is the argument that we risk developing
| resistant bugs. But the truth is, if suddenly all mosquitoes
| were moved magically to the US, you would see the drug
| massively used for everybody without a second though.
| stephenhuey wrote:
| Not sure why you were downvoted down much but here's my 2
| cents.
|
| I first started taking anti-malarial medicine as a child. My
| entire life I've been hearing of resistance to one drug and
| then another drug, and then another. Also, whenever we took
| chloroquine or any other drugs on a regular basis, we were
| well aware that having the medicine in our body would not
| prevent malaria---we took it just to help reduce the severity
| of malaria when we'd become infected. Looks like there are
| already strains resistant to your drug of choice:
|
| https://malariajournal.biomedcentral.com/articles/10.1186/14.
| ..
|
| So preventing and even treating malaria has never been a sure
| thing with ANY drug that I've ever known.
| estaseuropano wrote:
| Thats a weird argument. "Lets not give the medicine that
| might help as that might also encourage mutations." -->
| basically you are saying let's deny it to the many dying
| today in order to ensure the few (that can afford it) can
| still use it in the future. A deeply immoral and selfish
| perspective if spelled out this way.
|
| The only solution then is rapid and large-scale
| intervention. Massive use of the most effective/least side-
| effect variety of drug for all at risk populations for 3(?)
| months, then bring in the alternatives and quickly and
| widely ensure their use in those areas where resistant
| strains still spread.
| stephenhuey wrote:
| I am not saying don't treat people. The anti-malarial
| medicines we used growing up were very affordable, so
| access was not the problem. I'm saying the vaccine is
| more encouraging because the medicines have not been able
| to put much of a dent into the problem of malaria.
| jfk13 wrote:
| May be worth mentioning that the article documenting
| malarone-resistant malaria is virtually 20 years old
| already. As far as I'm aware, the problem of drug-resistant
| malaria hasn't been getting better...
| elihu wrote:
| Technically, they recorded 717 incidents of malaria in 734
| infants, which may have affected less than 717 infants if some
| of them were infected multiple times. Regardless, it's an awful
| situation.
| iso1631 wrote:
| Covid 19 affects rich powerful people (rich old people in the
| west who can't buy their way out of it)
|
| Malaria affects poor people with no power (young children in
| poor countries with limited access to medicine)
| jjeaff wrote:
| Except for the age difference of the victims, those numbers
| actually make covid seem pretty bad. Covid has hardly been
| around for a year and is killing 7x as many people a year.
| mchusma wrote:
| Also, while covid is not done yet, it's probably going to
| kill in total much less than 100M.
|
| COVID is bad, but in some ways we got lucky because there
| could have been way worse pandemics that acted more like
| smallpox or measles.
| jjk166 wrote:
| Those are the numbers for a single country. Malaria kills 1-3
| million people per year globally.
| lswainemoore wrote:
| Unless I'm misreading the link, those numbers (~600k/yr)
| are global. Still, staggeringly high, and concentrated in a
| region.
| vtail wrote:
| Malaria affects far smaller population size.
| himinlomax wrote:
| Covid is an acute infection, you get infected, you beat the
| infection or you die. Some may have life-long side effects
| from the disease, but they are free from the disease itself.
|
| Malaria, like HIV or Herpes, is a chronic disease. Once
| you're infected, you're affected by it until you die. The
| debilitating effects of malaria also have disastrous economic
| impacts.
| argvargc wrote:
| > Except for the age difference of the victims
|
| Right. Let's all just ignore that the majority of those
| killed by covid are around the average age of life
| expectancy, so that we can try and make the unprecedentedly
| panicked, massively-damaging and downright stupid multi-
| trillion dollar response to covid appear slightly less
| irrational and racist.
|
| Starving kills 9 million/year. They're mainly children of
| colour too, but don't worry - systemic racism is just fine
| with pretty much everyone when it comes to allocating funds
| and resources to save those most at risk from preventable
| death.
| oblio wrote:
| Why is it racism, though?
| [deleted]
| wizzwizz4 wrote:
| It isn't inherently racism (though there is racism
| involved). It's more a NIMBY type effect, but in reverse,
| I think - "it doesn't affect me, so I don't have to think
| about it" type thing.
| oblio wrote:
| > a NIMBY type effect, but in reverse
|
| We call that selfishness :-)
|
| And we can't force people to help others, no matter how
| much we dislike the attitude.
| iso1631 wrote:
| > And we can't force people to help others, no matter how
| much we dislike the attitude.
|
| We can, and we do all the time, via taxation. You're
| forced to pay taxes to fund the people who empty the bins
| in the park you never even go to.
|
| It's a good thing.
| oblio wrote:
| Yeah, but taxation stops at the national border level.
| [deleted]
| estaseuropano wrote:
| Ignoring smaller numbers in eastern Europe and central
| Asia, the people dying from poverty and preventable
| diseases tend to be African, south east Asian or south
| American.
| scrollaway wrote:
| It's called egocentrism.
| oblio wrote:
| Yeah, but nobody's killing them on purpose (I hope!).
|
| It's just that those regions are warm and humid, and this
| creates great living conditions for mosquitoes.
|
| To make things worse, many countries in these regions are
| poor, so they can't afford treatment or prevention
| (pesticides to kill mosquitoes, draining swamps, etc.).
|
| Rich countries in the same regions most likely don't have
| big problems with malaria (or if malaria is still a
| problem, it's probably a minor problem).
|
| It's just "bad" geography (from this point of view) and
| poverty.
| iso1631 wrote:
| Florida is warm and humid
|
| If you see someone drowning and refuse to throw them the
| life ring because you might damage your newly painted
| nails, you're not technically killing them on purpose,
| but you're still killing them through your inaction
| oblio wrote:
| I applaud your globalist approach, but nobody's really
| applying it. When push comes to shove, we're barely able
| to stand in solidarity at a national level.
| estaseuropano wrote:
| The thing is that the death rates would be manifold higher
| if not for those measures. In the global study on the
| effects of covid we are all in the _treatment_ condition.
|
| That said, I agree that many of those resources would be
| better spent on eradicating hunger and slavery, as well as
| the poverty diseases.
| argvargc wrote:
| Haven't seen convincing evidence the death rates would be
| higher without the measures employed, much the opposite
| (35 studies so far):
| https://www.aier.org/article/lockdowns-do-not-control-
| the-co...
|
| It is heartening to see many here agreeing we could do
| better.
| Footkerchief wrote:
| Infants can also be infected before their first year of life,
| via vertical transmission:
| https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4259075/
| treeman79 wrote:
| There is an extremely effective treatment.
|
| Millions have perished from being denied it.
|
| https://www.wsj.com/articles/SB113236412756302115
| yorwba wrote:
| The Stockholm Convention on Organic Pollutants contains an
| explicit exemption for DDT used for disease vector control. (
| http://chm.pops.int/Portals/0/Repository/convention_text/UNE.
| .. page 28.) Your "millions have perished from being denied
| it" is incorrect. I don't know whether that's the Wall Street
| Journal's fault, because I won't pay them to find out whether
| they're wrong.
| treeman79 wrote:
| https://www.latimes.com/archives/la-xpm-2006-may-29-fg-
| ddt29...
|
| Been awhile since I researched the topic, but it was clear
| Africa counties got a lot heat each time they tried to use
| DDT.
|
| So I will stick by millions dead.
| shoto_io wrote:
| Absolutely. Malaria is the reason why mosquitos are considered
| the species most dangerous for humans.
|
| Btw, I don't think it's a pandemic since it doesn't affect the
| entire globe. It's an epidemic, isn't it?
| Fomite wrote:
| These are somewhat fuzzy terms, because pandemic or epidemic
| both imply unexpected numbers of cases, not just "lots" of
| cases.
|
| For the most part, malaria is considered an endemic disease
| with a high incidence rate.
| yarcob wrote:
| Malaria is an endemic disease in parts of Africa (constant
| occurrence in a population). An epidemic is a disease rapidly
| spreading in a population (sudden outbreak). Pandemic is a
| worldwide outbreak.
| vanderZwan wrote:
| Although I am Dutch, I was born in Ghana. My parents worked in
| a local hospital as doctors. If you can expect anyone to be
| extremely cautious and in the position to be able to act on it,
| it would be them. Still got malaria before I turned one.
| stephenhuey wrote:
| I lived in Nigeria from the ages of 9-18 and while we did not
| use mosquito nets, I'd generally assume that even people who
| use mosquito nets would be likely to get bitten by a carrier
| mosquito at some other time of day. Hearing of people getting
| malaria felt like a very commonplace occurrence, and I had it
| several times.
| todd8 wrote:
| Although some posts suggest that the USA may experience malaria
| at some point in the future because of global warming; in
| actuality, the USA has already experienced malaria.
|
| In 1882, the range of malaria in the USA extended from the
| Canadian border on the north to southern border with Mexico on
| the south. The only states of the current 48 contiguous states
| unaffected were Nevada, Utah, Arizona, Idaho, Main, Vermont,
| and New Hampshire. Something like 41 states had malaria cases
| (the maps are a bit hard to read).
|
| Approximately 375 cases acquired in the USA per 100,0000
| population were reported in 1920.
|
| Eradication efforts continued until the 1950s when the USA
| essentially became free of malaria. See [1].
|
| [1]
| https://www.cdc.gov/malaria/about/history/elimination_us.htm...
| hackerbabz wrote:
| This is something that has confused me for a long time.
| America definitely has mosquitoes (I'm from Washington, DC).
| How are there mosquitoes but no malaria?
| pjscott wrote:
| It's bizarrely hard to find good explanations of this! The
| National Malaria Eradication Program, between 1947 and
| 1951, cut down on malaria transmission enough that the
| parasite was driven locally extinct. They drained wetlands
| where mosquitoes bred, sprayed house interiors and
| mosquito-heavy areas with DDT on a very large scale, and
| generally engineered a very specific ecological disaster,
| depriving the parasite of the human hosts needed for part
| of their reproductive lifecycle. Without enough infected
| humans, the parasites died out.
|
| Crucially, they didn't need to get rid of all the
| mosquitoes to do this: they just needed to drive mosquito-
| to-human transmission low enough for long enough.
|
| https://en.wikipedia.org/wiki/National_Malaria_Eradication_
| P...
| londons_explore wrote:
| If this were the complete story then just a single person
| coming back to the USA infected would lead to mass
| infection...
|
| Clearly that hasn't happened.
| juskrey wrote:
| The answer is malaria eradication efforts never stopped
| neither in US nor in Europe. It's just as routine as
| renewing asphalt roads or maintaining sewers
| im3w1l wrote:
| Only explanation I can think of is that the malaria from
| elsewhere is different somehow, worse adapted to US
| conditions.
| Brybry wrote:
| We do still have mosquito abatement programs too.
|
| I know here in Louisiana the local abatement program has
| trucks that spray synthetic pyrethroid chemicals
| (resmethrin, sumithrin and prallethrin) at night and uses
| an organophosphate (naled) from planes.
|
| And residents are routinely urged to be aware of and
| eliminate standing water on their property.
|
| We just don't use DDT anymore -- we almost wiped out our
| state bird with it.
|
| Edit: I have to wonder how much housing changes also
| mattered. With modern air conditioning and well sealed
| homes it's fairly rare to have mosquitoes in the home at
| night.
| Clewza313 wrote:
| Malaria does not spread from human to human, you need
| infected mosquitos in the mix. So you would need to get a
| breeding population of infected mosquitos biting humans
| for it to start spreading.
| nicoburns wrote:
| It's only a few (4?) species of mosquito that carry
| malaria, out of hundreds of species in total.
| cbkeller wrote:
| The _Anopheles_ mosquitos [1] which spread human malaria
| are present at some level across about half of the US, but
| are just not especially abundant here compared to other
| mosquitos that do not spread malaria.
|
| In fact, of the ~200 mosquito species which occur in the
| United States, only 12 are known spread any sort of human
| disease [2].
|
| [1] https://en.wikipedia.org/wiki/Anopheles
|
| [2] https://www.cdc.gov/mosquitoes/about/mosquitoes-in-the-
| us.ht...
| wincy wrote:
| The eradication efforts in the US included lots and lots of
| DDT.
|
| The Little House on the Prairie family caught malaria, and
| was so sick they almost died of dehydration because they
| couldn't get down to the river to drink.
|
| https://littlehouseontheprairie.com/dr-george-a-tann-
| pioneer...
| Fomite wrote:
| There's a reason the CDC is in Atlanta.
| wil421 wrote:
| Yea but I'm an Atlanta native and never hear of malaria.
| Plenty of mosquitos around here.
| Fomite wrote:
| That's because they did their job well.
|
| https://upload.wikimedia.org/wikipedia/commons/b/b3/Malar
| iaM...
| cmckn wrote:
| I grew up in Alabama, and remember a few times a summer
| seeing the "mosquito truck" drive by, spraying pesticide as I
| played in the yard. I guess it works!
| Tostino wrote:
| In FL, we still have the mosquito truck end up coming by at
| least every other week.
| tasty_freeze wrote:
| We had those growing up in suburban Chicago too -- in my
| case in the 70s. The trucks would only appear at dusk. We
| dumb kids thought the fog was a hoot so we would jump on
| our bikes and chase behind the truck hooting at the
| novelty, breathing in who knows what chemicals. I can still
| remember the smell.
| nerdponx wrote:
| My dad told me similar stories from midcentury New York.
| whyenot wrote:
| It was probably malathion, which is an organophosphate
| pesticide that is considered low toxicity, although it
| may be a carcinogen.
| mNovak wrote:
| I seem to recall this in the Midwest as recently as the
| 90s
| nicoburns wrote:
| > breathing in who knows what chemicals
|
| Probably DDT. Not thwebest of ideas!
| whyenot wrote:
| In the 1970s? No, almost all use of DDT in the US ended
| in 1972.
| brianwawok wrote:
| I don't think we do it for malaria these days, just to
| reduce mosquito stings? Thinking about like mosquito sprays
| in Chicago...
| notacoward wrote:
| AFAIK it's more about West Nile and EEE, maybe Zika and
| even others.
| Abishek_Muthian wrote:
| Also worldwide incidence of dengue has risen 30-fold in the
| past 30 years, and more countries are reporting their first
| outbreaks of the disease due to re-emergence of mosquito vector
| viruses.
|
| Yet there seems to be no better alternative for simple mosquito
| nets when it comes to safe, efficient way of protecting
| ourselves from mosquitoes.
|
| P.S. I've been tracking mosquito control strategies, it's the
| very first problem I posted on my problem validation platform -
| https://needgap.com/problems/6-safe-affordable-and-efficient...
| mr_overalls wrote:
| That's just an astounding incidence rate. That kind of
| selective pressure makes the reason for the sickle cell
| mutation in hemoglobin more obvious.
|
| https://www.cdc.gov/malaria/about/biology/index.html
|
| > Inheritance of this mutated gene from both parents leads to
| sickle cell disease and people with this disease have shorter
| life expectancy. On the contrary, individuals who are carriers
| for the sickle cell disease (with one sickle gene and one
| normal hemoglobin gene, also known as sickle cell trait) have
| some protective advantage against malaria. As a result, the
| frequencies of sickle cell carriers are high in malaria-endemic
| areas.
|
| > . . .It was found that that the sickle cell trait provides
| 60% protection against overall mortality.
| Quarrel wrote:
| Very strong selective pressure.
|
| Sickle cell has separately arisen in at least four
| populations in Africa and some in South East Asia.
| grecy wrote:
| Having personally had Malaria twice, I am elated at this news.
|
| It was fascinating to experience it from "the inside" in Africa,
| and attempt to understand how essentially everyone gets it, every
| single year. It's simply a part of life there.
| Fomite wrote:
| One of my Kenyan colleagues casually talked about every time
| she visited her grandmother, they came down with malaria.
| tgb wrote:
| Is it possible to get herd immunity to malaria? Does the parasite
| have non-human reservoirs (for the non-mosquito part of its
| lifecycle)?
| Fomite wrote:
| The parasite has non-human reservoirs, which is one of many
| reasons that eradicating malaria is extremely difficult. That
| being said, a protective vaccine even absent herd immunity
| would be a huge thing.
| lisper wrote:
| Yes and yes:
|
| https://malariajournal.biomedcentral.com/articles/10.1186/s1...
|
| https://pubmed.ncbi.nlm.nih.gov/22215999/
| tgb wrote:
| Thanks. I can't actually see where the second paper says that
| there are reservoirs, at least not of P. falciparum, which is
| the most relevant. It doesn't directly state it but seems to
| suggest that there's little in the way of human infections
| that arise from another species.
| yyyk wrote:
| The first link just says people would accept the vaccine. It
| doesn't get at all to the heart of OP's concern (that the
| parasite will hide in non-human reservoirs).
| pinipedman wrote:
| This is _not_ the most effective malaria vaccine. Three doses of
| intravenous PfSPZ-CVac is more effective.
|
| https://www.nature.com/articles/nature21060
| ArgyleSound wrote:
| 9 people? I don't think you can really say it's more effective
| based on this data.
| Vecr wrote:
| Intravenous is pretty nasty as well, people _will_ find a way
| of spreading viral /viroid hepatitis and HIV if it was ever
| deployed outside of well-staffed hospitals.
| _Microft wrote:
| For comparison, the mentioned "RTS,S" vaccine has an efficacy
| "from 26 to 50% in infants and young children", see
| https://en.wikipedia.org/wiki/RTS,S
| yyyk wrote:
| This is great news which will save many lives.
|
| We will need to do more though. There are species of Plasmodium
| which survive on non-human hosts which means the disease will
| always be waiting - and this vaccination regimen is very
| demanding, so interruption or underinvestment will make Malaria
| come back.
|
| IMHO to finish off malaria we'll need some other approaches to
| complement it, and my suggestion is to get rid of the specific
| mosquito species that carries the disease. That's what happened
| in all developed countries long before a vaccine ever existed,
| and that's a good solution for poor countries (this time, we can
| use more discriminate methods).
| 0-_-0 wrote:
| Gene drives might be able to get rid of entire species:
|
| https://en.wikipedia.org/wiki/Gene_drive
| Fomite wrote:
| There's a lot of debate in the field as to whether or not it's
| actually possible to eradicate malaria. Partially because
| mosquito eradication programs failed in the core "malaria belt"
| even with substantial international investment.
|
| There is work on this though, primarily around introducing
| genetically modified mosquitos.
| rossdavidh wrote:
| Well, the attempt in Brazil did not go as planned:
| https://www.dw.com/en/genetically-modified-mosquitoes-
| breed-...
|
| "The hope of the Ministry of Health was to reduce mosquito
| populations by 90 percent. And this worked well during the
| field trial. About 18 months after the end of the experiment,
| the mosquito population returned to what it had been before."
| yyyk wrote:
| It's was not unexpected that levels bounced back eventually
| - we'd expect them to, after a small trial lasting only 27
| weeks. Arguably if this approach (or the gene drive one)
| was sustained and combined with the standard treatments
| we'll get rid of these things or at least malaria.
| Fomite wrote:
| Indeed. Ecological systems are complicated and remarkably
| resilient.
| stjohnswarts wrote:
| that's a good thing since humans seem to be full steam
| ahead on destroying them (at least currently)
| perardi wrote:
| The crux of the vaccine technology:
|
| _This new vaccine (R21) uses a circumsporozoite protein (CSP)
| antigen - that's a highly conserved protein of the parasite,
| involved in several functions as the parasite makes the move from
| mosquito to human and into different human tissues such as the
| salivary glands. This has been a vaccine ingredient before, such
| as in the RTS,S vaccine (the first one ever licensed), but R21
| has a much higher proportion of CSP assembled into a virus-like
| particle. It also uses the exact same adjuvant from Novavax
| (Matrix-M) that they are using in their coronavirus vaccine - you
| can't keep a good adjuvant down, and this Chilean-soapbark-based
| one seems to really kick the immune system up under all
| circumstances._
|
| Great to see we are managing to develop new vaccine platforms.
| pradn wrote:
| "Chilean-soapbark"! Happy to see an ingredient such as this.
| One more reason to conserve biodiversity is for useful
| ingredients like this one.
| interestica wrote:
| I had the same reaction:
|
| https://www.theatlantic.com/science/archive/2020/10/single-t.
| ..
| DoreenMichele wrote:
| I'm guessing this is likely a large part of why the efficacy is
| so high.
|
| From what I gather, parasitic infections are hard to vaccinate
| against at least in part because at least some of them
| routinely change their protein markers, so it's hard to
| identify them. It sounds to me like this counters that.
| interestica wrote:
| > adjuvant > Chilean-soapbark
|
| More on this:
|
| https://www.theatlantic.com/science/archive/2020/10/single-t...
| omegaworks wrote:
| A fantastic article. Thanks for sharing this.
| yboris wrote:
| I'd like to urge everyone to consider contributing to cost-
| effective charities that work on alleviating the scourge of
| malaria.
|
| GiveWell, a charity evaluator recommends _Malaria Consortium_ and
| _Against Malaria Foundation_ as cost-effective ways to directly
| reduce instances of malaria.
|
| https://www.givewell.org/charities/top-charities
| [deleted]
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