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About the Author

Bart Knols
Medical Entomologist (Dodewaard, Netherlands)

Bart G.J. Knols (1965) is the Managing Director of MalariaWorld, the world's first scientific and social network for malaria professionals. He is a malariologist with a Masters degree in Biology and a PhD in Medical Entomology from Wageningen University, the Netherlands. He also obtained an MBA degree from the Open University (UK) in 2006, for which he won the prestigious international ‘MBA Student of the Year 2007 Award’ as well as the Alumnus of the Year Award from the Open University. With 11 years of working experience in Africa he has managed large-scale research and vector control programmes on malaria for ministries, international or national research institutions. He has worked for the UN (IAEA) as a programme manager for three years, has served as a consultant for the World Health Organization, and is currently a Board Member of the UBS Optimus Foundation, the second largest charity in Switzerland. He has published over 130 peer-reviewed research articles, has written 16 book chapters, and has served as senior editor on a WHO/IAEA sponsored book on implementation research. In 2007 he co-edited a best-selling book titled 'Emerging Pests and Vector-Borne Diseases in Europe'. He received an Ig Nobel Prize (2006), an IAEA Special Service Award (2006), and in 2007 he became a laureate of the Eijkman medal (the highest award in the field of tropical medicine in the Netherlands). He has been a member of the Royal Dutch Academy of Arts and Sciences since 2004. Bart held an Assistant Professorship at Wageningen University until April '09 with projects across Africa. He currently directs K&S Consulting, a firm he founded in the beginning of 2007.

Post

Malaria: When sudden beats chronic

Published 25th March 2010 - 11 comments - 8363 views -

This February the world marvelled when a group of scientists led by the Egyptian archeologist Dr. Zahi Awass shed new light on the cause of death of legendary ‘boy King’ Tutankhamun.  Although it was long considered that the King that ruled Egypt between 1333-1324 BC was murdered or poisoned, it now surfaced that he died of malaria and an infected leg fracture. Advanced DNA analysis of Tuts mummified remains revealed that the 19-year old suffered from the deadliest form of malaria, caused by the Plasmodium falciparum parasite. Received through the bite of an infected female Anopheles mosquito.

This February the world marvelled when a group of scientists led by the Egyptian archeologist Dr. Zahi Awass shed new light on the cause of death of legendary ‘boy King’ Tutankhamun.  Although it was long considered that the King that ruled Egypt between 1333-1324 BC was murdered or poisoned, it now surfaced that he died of malaria and an infected leg fracture. Advanced DNA analysis of Tuts mummified remains revealed that the 19-year old suffered from the deadliest form of malaria, caused by the Plasmodium falciparum parasite. Received through the bite of an infected Anopheles mosquito.
I know what he went through. In the eleven years that I worked and lived in East and Southern Africa malaria grounded me nine times. My wife nearly died of it in 1995 and was only saved through swift action by a local doctor on the island of Zanzibar that put her on a life-saving quinine drip. The parasites that got her had become resistant to the prophylactics she took. Although we were luckier than Tutankhamun it was the exact same parasite that infected us more than three millennia later. According to the World Health Organization’s World Malaria Report 2009, some 250 million people face the same fate each year. So why does King Tut make the headlines around the world and not the three thousand African children that die of malaria today, tomorrow, and also every other day of the year?
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When the tsunami killed nearly a quarter of a million people on Boxing Day 2004 it became world news. So did the earthquakes that hit Haiti and Chile recently. Although the devastation and loss of lives are by far outweighed by the annual global burden of malaria, the cost alone of which in Africa is estimated at 12 billion dollars per annum, the disease hardly receives global media attention. It is bad luck that malaria kills an African child every 30 seconds. It would have been much better if it would kill 250,000 of them on the last day of every quarter of the year. Four African malaria tsunamis each year. That would open the world’s eyes and generate the public attention malaria deserves. Where in Holland a single night of TV fundraising for the Haiti aftermath yielded more than € 100 million, a full week of 24/7 media attention for malaria during the Serious Request campaign organised by the Dutch 3FM radio station and the Red Cross last December raised a mere 7.1 million. So how to wake up a world that has become numb to the devastation caused by chronic killer disease like malaria?
Rephrasing the facts may help to raise awareness. I have limited each of these to fit in a tweet, so feel free to use them:
- Imagine seven Boeing 747 aircraft packed with African kids crashing every single day of the year. That is malaria.
- For every 10 drugs on the market, 8 were developed for diseases affecting the wealthiest 20% of the global population. For severe malaria there’s only a handful.
- In June, the Access to Medicine Foundation will present it’s new global analysis: ‘4.8 billion people have access to medicines, 2 billion go without’. 
- More products have been developed to rid your dog of fleas than were ever developed against malaria, which infects every 13th person on the planet each year.
- 3,300,000,000 people are at risk of being infected with malaria when they go to sleep tonight. On 40% of the planet’s surface.
- Coca cola is for sale in the remotest corners of the African continent. Bednets aren’t. Something has gone horribly wrong somewhere.
These are not pleasant facts, but remain the harsh reality in a world now in its tenth year after committing to the millennium development goals. When was the last time you heard about malaria? Two recent stories became world news: The US company Intellectual Ventures presented a laser canon for shooting down mosquitoes as they approach sleepers. ‘Star Wars against malaria’ was twittered to millions. Last week it was the genetic engineering of malaria mosquitoes that would not make you sick but instead ‘vaccinate’ you against the disease. ‘Flying syringes against a deadly foe’. These stories bring malaria to the forefront but deliver false hope to millions suffering from it. When I challenged Intellectual Ventures to test their technology in Africa they remained silent. Vaccinating people without them giving informed consent counters a basic human right. It will be hard to tell mosquitoes that you don’t want their bite. And imagine three laser beams, lenses and computer equipment around an African hut zapping bugs at night. The fate of this invention will follow that of the real US star wars programme that former president Reagan launched in the 1980s. It will end in a drawer.
Bringing malaria to the forefront in the international news arena is a challenge. It’s a disease of massive importance, yet only becomes interesting if eye-opening inventions are published. But hope may be on the horizon.
Last week the UN Special Envoy for Malaria, Ray Chambers, enlisted social media in the fight against malaria. High-profile internet users have pledged support and will start using twitter and other media outlets to raise awareness about malaria. It is now up to the likes of CNN host Larry King, co-founder of Twitter Biz Stone, and Facebook’s Randi Zuckerberg to open the world’s eyes. Chronic news to fight a chronic disease. If they will succeed in thrusting their celebrity status to the level where their tweets on malaria will reach us all with the same impact as the Haiti earthquake remains to be seen.  

I know what he went through. In the eleven years that I worked and lived in East and Southern Africa malaria grounded me nine times. My wife nearly died of it in 1995 and was only saved through swift action by a local doctor on the island of Zanzibar that put her on a life-saving quinine drip. The parasites that got her had become resistant to the prophylactics she took. Although we were luckier than Tutankhamun it was the exact same parasite that infected us more than three millennia later. According to the World Health Organization’s World Malaria Report 2009, some 250 million people face the same fate each year. So why does King Tut make the headlines around the world and not the three thousand African children that die of malaria today, tomorrow, and also every other day of the year?

When the tsunami killed nearly a quarter of a million people on Boxing Day 2004 it became world news. So did the earthquakes that hit Haiti and Chile recently. Although the devastation and loss of lives are by far outweighed by the annual global burden of malaria, the cost alone of which in Africa is estimated at 12 billion dollars per annum, the disease hardly receives global media attention. It is bad luck that malaria kills an African child every 30 seconds. It would have been much better if it would kill 250,000 of them on the last day of every quarter of the year. Four African malaria tsunamis each year. That would open the world’s eyes and generate the public attention malaria deserves. Where in Holland a single night of TV fundraising for the Haiti aftermath yielded more than € 100 million, a full week of 24/7 media attention for malaria during the Serious Request campaign organised by the Dutch 3FM radio station and the Red Cross last December raised a mere 7.1 million. So how to wake up a world that has become numb to the devastation caused by chronic killer disease like malaria?

Rephrasing the facts may help to raise awareness. I have limited each of these to fit in a tweet, so feel free to use them:

- Imagine seven Boeing 747 aircraft packed with African kids crashing every single day of the year. That is malaria.

- For every 10 drugs on the market, 8 were developed for diseases affecting the wealthiest 20% of the global population. For severe malaria there’s only a handful.

- In June, the Access to Medicine Foundation will present it’s new global analysis: ‘4.8 billion people have access to medicines, 2 billion go without’. 

- More products have been developed to rid your dog of fleas than were ever developed against malaria, which infects every 13th person on the planet each year.

- 3,300,000,000 people are at risk of being infected with malaria when they go to sleep tonight. On 40% of the planet’s surface.

- Coca cola is for sale in the remotest corners of the African continent. Bednets aren’t. Something has gone horribly wrong somewhere.

These are not pleasant facts, but remain the harsh reality in a world now in its tenth year after committing to the millennium development goals. When was the last time you heard about malaria? Two recent stories became world news: The US company Intellectual Ventures presented a laser canon for shooting down mosquitoes as they approach sleepers. ‘Star Wars against malaria’ was twittered to tens of thousands. Last week it was the genetic engineering of malaria mosquitoes that would not make you sick but instead ‘vaccinate’ you against the disease. ‘Flying syringes against a deadly foe’. These stories bring malaria to the forefront but deliver false hope to millions suffering from it. When I challenged Intellectual Ventures to test their technology in Africa they remained silent. Vaccinating people without them giving informed consent counters a basic human right. It will be hard to tell mosquitoes that you don’t want their bite. And imagine three laser beams, lenses and computer equipment around an African hut zapping bugs at night. The fate of this invention will follow that of the real US star wars programme that former president Reagan launched in the 1980s. It will end in a drawer.

Bringing malaria to the forefront in the international news arena is a challenge. It’s a disease of massive importance, yet only becomes interesting if eye-opening inventions are published. But hope may be on the horizon.

Last week the UN Special Envoy for Malaria, Ray Chambers, enlisted social media in the fight against malaria. High-profile internet users have pledged support and will start using twitter and other media outlets to raise awareness about malaria. It is now up to the likes of CNN host Larry King, co-founder of Twitter Biz Stone, and Facebook’s Randi Zuckerberg to open the world’s eyes. Chronic news to fight a chronic disease. If they will succeed in thrusting their celebrity status to the level where their tweets on malaria will reach us all with the same impact as the Haiti earthquake remains to be seen.  

Watch these great animations to learn about the malaria life cycle:


Category: Health | Tags: africa, malaria, disaster, think3,


Comments

  • Hemant Jain on 25th March 2010:

    “Vaccinating people without them giving informed consent counters a basic human right.”
    This is a brilliant article Bart.
    Thanks for this.


  • Jodi Bush on 26th March 2010:

    Excellent article. As you say “It would have been much better if it would kill 250,000 of them on the last day of every quarter of the year.” I suppose people find it hard to digest death on an a ongoing basis. That’s why a single event that wipes our one or many people is a tragedy, but millions of deaths over a long period of time is a statistic.


  • Bart Knols on 28th March 2010:

    Thanks Jodi and Hermaint, for your comments.

    This evening I watched the film ‘When the night comes’. This is a film about malaria to raise awareness about malaria. In it shocking details of a Ugandan child, Ivan, dying of the disease. See: http://www.whenthenightcomes.com

    They also gave some very interesting comparative data between the media coverage of swine flu and malaria. Between April and June 2009 there were more than 250,000 news reports on swine flu globally, compared to only 6,000 for malaria. When taking the number of deaths during that period, for swine flu there were 8,176 reports for every death versus 0.1 for every malaria death.

    That says it all…


  • Taif Adams on 28th March 2010:

    Great work, Bart. Indeed, a devastating disease highly underestimated. Thank you.


  • Bart Knols on 29th March 2010:

    Thanks Taif.

    Who will ever know about the death of a child in the heart of Congo? Or in the Darfur region? In remote Chad? In the hinterland of the Central African Republic?

    Guess we don’t even know the true impact of the disease…


  • Ingeborg on 31st March 2010:

    Excellent blog! and so absolutely true. Malaria is not ‘disaster-news’ like a tsunami and on the other hand it is not a serious disease of the north, like HIV. The challenge would be how to raise continuous awareness among different age- and social groups. A one time event, like serous request, is so quickly and easily forgotten. Awareness should make the general public more critical about current developments like the flying syringes and Star Wars solutions. These stories make people believe that we are close to a high-tech solution for malaria applicable in malaria endemic countries… Who is fooling who?


  • Bart Knols on 31st March 2010:

    Thanks Inga. To answer your question: Scientists are fooling the press, the press is fooling the public, and the public is fooling itself. That’s quite a statement, but true. Scientists need to ‘go public’ more and more, some donors even demand it. They also need to be seen in the press, as this will increase their likelihood of getting more funding. Funding means a lab, students, equipment, and…survival and career building. So, whereas in the past we would only see press releases at times when a spectacular breakthrough was achieved, we now see a press release for almost any article published. And of course scientists will portray their latest contribution as a big story with far-reaching impact. This is a sad development. One which the press benefits from and the public suffers from. I will certainly come back to this issue in a future TH!NK3 blog.


  • Tom Olijhoek on 01st April 2010:

    Very nice blog! You make a good point concerning a lack of awareness for what malaria really is.
    Equally important and also mentioned in your blog is the development of resistance to drugs in malaria parasites. I can’t help asking myself to what extent the use of prophylactics by tourists and aid workers in malaria-endemic countries could have an impact on the development of resistance.
    When I lived in Kenya my son got malaria which already couln’t be cured by artemisinin alone. The doctors then used a(at the time) experimental combination therapy of artemisinin and doxycyclin which did the trick.


  • Bart Knols on 01st April 2010:

    Hello Tom, thanks for your comments - highly valid and important. Drug resistance is critical in certain parts of the world and, sadly, spreading. The widespread use of prophylactics that are also used for curing (African) patients can indeed be a problem. At present, sole use of artemisinin is not recommended, and combination therapy (more than one active ingredient) is promoted to avoid the build-up of resistance. I was in contact today with Dr. Dondorp (Thailand) and the situation in Cambodia with artemisinin resistance is alarming indeed. Drug resistance will be an issue I will cover more in-depth in a future blog. Thanks and keep on posting comments, much appreciated!


  • Daniel Bridges on 02nd June 2010:

    Sorry to revive an old post, but Bart could you expand on the comment you posted on the 31st March relating to how only the ‘ultra-big’ or conceptually interesting breakthroughs e.g. lasers shooting down mosquitoes, make it into the news?

    As a youngster in malaria research, I wonder how we could use the media more effectively to focus attention on malaria.

    Thanks for the twitter sound bites - putting the statistics into numbers that we can identify with (e.g. 7 jumbo jets per day) spurs one on, but is also very useful in conversations!


  • Bart Knols on 03rd June 2010:

    @Daniel. Old post still remain valid and interesting (I hope), so thanks for picking this up once more.

    I guess the laser canon story has been milked to death by now. But, it did appeal to so many (journalists!) because: a) it is flashy, hot science, b) appeals to the imagination of readers (imagine unmanned planes shooting down mosquitoes), and c) it has the ‘Star Wars’ element in it, which Mhyrvold exploited very well…

    However, in spite of me offering to help them test their canon in semi-field settings in Africa, it has remained very quite on their end.

    See what I mean?


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