War and Disease: Biomedical Research on Malaria in the Twentieth Century

Chapter 8: Lessons Learned

177 In November 1945, Paul F. Russell, a Rockefeller malariologist who had spent much of the war in the U.S. Army Medical Corps, addressed the annual meeting of the American Society of Tropical Medicine. He began with a lament for the horror and loss of war and a tribute to what had been done to advance science, technology, and medicine, especially with regard to malaria: “Man’s net losses from World War II are so enormous that it would be illogical indeed to refer to war-produced scientific advances as dividends or to point to them with thoughtless pride. Rather, such progress constitutes salvage which, to be sure, sometimes has considerable value because conditions of war while they rarely permit classical research do present an urgency which demands, and often obtains, quick answers to difficult problems. New lessons are learned and others re-learned, painfully and at great expense.” New lessons learned, and old lessons relearned: a common refrain for those who have worked on malaria. Russell concluded his address to the society with optimistic words: “One may reasonably hope that, with suitable organization, malaria will be eradicated from the United States within the next decade, and that in many tropical areas, even though economically depressed, this disease, now of the greatest importance, may become in the next half century one of the least of public health problems.”1 Read some sixty years later these words prompt two responses. For the United States, malaria was nearly eradicated even as Russell spoke.2 For the developing world, in harsh contrast, malaria remains one of the greatest public health problems. If the destruction of malaria throughout the world remains before us, what is the deeper legacy of the wartime work? Chapter 8 Lessons Learned 178 War and Disease The U.S. antimalarial program left legacies in three areas: malaria chemotherapy , general biomedical research, and the ongoing need to seek new and creative ways to attack malaria. First and most obviously, the treatment and control of malaria changed with the introduction of chloroquine and several other drugs immediately following the war. And subsequent years saw a number of additional drugs developed, some emerging from leads that wartime researchers had pursued, others emerging from natural products chemistry. Beyond the specific locus of malaria research, the program shaped researchers and altered expectations about what biomedical research could do and how it might be organized and funded.3 The public and private debates discussed in the previous chapters point up these changed expectations among those who lived through the war and participated in OSRD projects.4 Malaria has once more emerged into the public consciousness in the developed world during the last decade of the twentieth century. Global advocates for public health and funders of public health investigations and interventions, such as the World Health Organization (WHO) and the Bill and Melinda Gates Foundation, have raised the call for new research into this age-old scourge. Antimalarials after 1945 Antimalarial research, rooted in the wartime project, continued in the postwar period. The Committee on Medical Research clearly saw two drugs—both developed under CMR contracts—as significant contributions: pentaquine (SN-13276) and chloroquine (SN-7618).5 Wartime antimalarial drugs and research methods continued and evolved. For example, G. Robert Coatney’s group at NIH’s National Microbiological Institute continued to screen thousands of compounds against P. gallinaceum (chicken malaria).6 By the 1950s, such avian malarias began a rapid decline as laboratory materials.7 In the second half of the twentieth century, rodent malarias—especially Plasmodium berghei, discovered in 1948—became the dominant research models. Capable of infecting mice and rats, rodent malaria could in principle be extrapolated to simian models and thence to human disease.8 Of course, other new technologies in biomedicine impacted malariology as well. New microscopic techniques, advances in immunology, and the rise of molecular biology all yielded new tools for infectious disease research. Chemists continued to innovate even as the importance of malaria research in the United States diminished and attention turned to chronic disease research in areas such as heart disease and cancer. New malaria drugs Lessons Learned 179 attacked the previously hidden form of vivax malaria. Wartime pentaquine, as we will see, led to primaquine, which killed the newly discovered liver stage of Plasmodium vivax and helped to prevent relapse in vivax malaria. Even by the early 1950s, with the experience of...