companies.
Trained at the London School of Hygiene and Tropical Medicine, Lanar had been at the National Institute of Health, working on other parasites—Leishmania and Shistosomiasis—but left to join the army because of its labs and capacity. Like many tropical medicine docs, he is cast against type for the U.S. military, but there’s not much of a market for private practice in this field. Those who want to work in it and want to have the tools necessary for success learn to salute and join one of the largest bureaucracies in the world.
When we got to his office, which was crowded with books and files, I asked why the interest in global disease and malaria had been increasing recently. He and his office mate, Ann Stewart, seemed aware of the revived interest in malaria but only vaguely, as if developments in the world beyond their microscopes were merely distant, rumored events. Stewart, who had a stuffed toy monkey draped over her microscope, attributed some of the increased attention in global health and neglected diseases to the Gates Foundation and the Harvard School of Public Health. She described a compelling dramatization of the continuing imbalance in investment that was presented by Amir Atarran, a lawyer and immunologist who writes and lectures on global health.
Attaran would take the stage with a large jar and a supply of small, round BB’s. He would drop in the few that he said represented the world’s investment in neglected diseases
like malaria, and then he would pour the amount that he said represented the world’s investment in HIV. Apparently he would stand there pouring for quite some time, with the racket getting louder and louder, until the point could not have been missed.
Lanar’s focus, like Steve Hoffman’s, is the development of a malaria vaccine, and for the same reason: Malaria has become resistant to almost all of the drugs that have been developed to fight it, “but we’ve never had a malaria vaccine so we don’t know how it will react.” The research process with new vaccines usually goes from table top to animal to human. But “there is no way to conduct animal experiments” with malaria vaccines, Lanar said, “because falciparum malaria is unique to humans. Obviously the FDA has tremendous confidence in our approach, otherwise they would never let us challenge human beings.”
Lanar and Stewart described what is known as “the hotel phase” of clinical trials. Volunteers that have been vaccinated are “challenged” with malaria by being subjected to mosquitoes until they are bitten a sufficient number of times. These aren’t just any mosquitoes, though; they are carefully chosen ones that are in a small box that is placed over a volunteer’s arm—five to a box, each carrying the parasite. The volunteers then check into a hotel with physicians who examine them twice a day for about two weeks. If a significant percentage of those who have been vaccinated resist the disease, the experiment is deemed a success. Those who show symptoms are treated immediately and effectively.
Lanar was cautiously optimistic about the vaccine he had been developing. Known as LSA-1, the liver stage antigen, it attacks the parasite at a mature stage of its development. But he was quick to suppress expectations. Lanar told me of the five years he had spent building the vaccine and said, “I was convinced it was going to make the cover of Science magazine. But the vaccine failed, and I have to tell you I got really depressed. I was clinically depressed for quite a while.”
It’s not surprising. Parasitologists tend to be obsessively committed to their task. Lanar had a stained-glass piece depicting the Trypanosoma parasite, which is transmitted by a tsetse fly and causes Chagas’ disease, hanging in his office window. It showed the parasite defecating and invading the heart muscle, all in glorious sun-streaked colors. Lanar had made it himself, and the brightly colored bits of glass
Trained at the London School of Hygiene and Tropical Medicine, Lanar had been at the National Institute of Health, working on other parasites—Leishmania and Shistosomiasis—but left to join the army because of its labs and capacity. Like many tropical medicine docs, he is cast against type for the U.S. military, but there’s not much of a market for private practice in this field. Those who want to work in it and want to have the tools necessary for success learn to salute and join one of the largest bureaucracies in the world.
When we got to his office, which was crowded with books and files, I asked why the interest in global disease and malaria had been increasing recently. He and his office mate, Ann Stewart, seemed aware of the revived interest in malaria but only vaguely, as if developments in the world beyond their microscopes were merely distant, rumored events. Stewart, who had a stuffed toy monkey draped over her microscope, attributed some of the increased attention in global health and neglected diseases to the Gates Foundation and the Harvard School of Public Health. She described a compelling dramatization of the continuing imbalance in investment that was presented by Amir Atarran, a lawyer and immunologist who writes and lectures on global health.
Attaran would take the stage with a large jar and a supply of small, round BB’s. He would drop in the few that he said represented the world’s investment in neglected diseases
like malaria, and then he would pour the amount that he said represented the world’s investment in HIV. Apparently he would stand there pouring for quite some time, with the racket getting louder and louder, until the point could not have been missed.
Lanar’s focus, like Steve Hoffman’s, is the development of a malaria vaccine, and for the same reason: Malaria has become resistant to almost all of the drugs that have been developed to fight it, “but we’ve never had a malaria vaccine so we don’t know how it will react.” The research process with new vaccines usually goes from table top to animal to human. But “there is no way to conduct animal experiments” with malaria vaccines, Lanar said, “because falciparum malaria is unique to humans. Obviously the FDA has tremendous confidence in our approach, otherwise they would never let us challenge human beings.”
Lanar and Stewart described what is known as “the hotel phase” of clinical trials. Volunteers that have been vaccinated are “challenged” with malaria by being subjected to mosquitoes until they are bitten a sufficient number of times. These aren’t just any mosquitoes, though; they are carefully chosen ones that are in a small box that is placed over a volunteer’s arm—five to a box, each carrying the parasite. The volunteers then check into a hotel with physicians who examine them twice a day for about two weeks. If a significant percentage of those who have been vaccinated resist the disease, the experiment is deemed a success. Those who show symptoms are treated immediately and effectively.
Lanar was cautiously optimistic about the vaccine he had been developing. Known as LSA-1, the liver stage antigen, it attacks the parasite at a mature stage of its development. But he was quick to suppress expectations. Lanar told me of the five years he had spent building the vaccine and said, “I was convinced it was going to make the cover of Science magazine. But the vaccine failed, and I have to tell you I got really depressed. I was clinically depressed for quite a while.”
It’s not surprising. Parasitologists tend to be obsessively committed to their task. Lanar had a stained-glass piece depicting the Trypanosoma parasite, which is transmitted by a tsetse fly and causes Chagas’ disease, hanging in his office window. It showed the parasite defecating and invading the heart muscle, all in glorious sun-streaked colors. Lanar had made it himself, and the brightly colored bits of glass
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