Following New York’s 1999 summer scare, West Nile went viral across the United States, southern Canada, and South and Central America, while increasing its intensity in Europe, Africa, Asia, and the Pacific. Within a decade of its debut in the Big Apple, West Nile surfaced as a global disease. Like St. Louis encephalitis, the complicated transmission sequence of West Nile travels from birds to mosquitoes to humans. Roughly 80–90% of those infected (tens of millions of people) will never know and will show no symptoms. The remainder will usually show mild flu-like symptoms for a few days. The unlucky 0.5% will develop full-blown symptoms that can lead to swelling of the brain, paralysis, coma, and death.
With the emerging threat of West Nile, specifically in America, the mosquito was everywhere and became a media darling, although there was certainly no sympathy for this devil. A catchy Microsoft Cloud commercial promoting both Bill Gates’s software product and his hunger to rid the world of mosquito-borne disease dominated television screens to help turn our deadliest “enemy into an ally.” Discovery Channel launched the film Mosquito in 2017 to highlight what it called “the single greatest agent of death in modern human history.” While the United States and the rest of the infected world was coming to terms with West Nile, another mosquito-borne disease with an even trendier name centered the mosquito in the global spotlight.
In the buildup and hype to the 2016 Rio de Janeiro Summer Olympics, Zika stunned the world. The virus, resembling West Nile and dengue, was first isolated from a monkey in Uganda in 1947, with the first known human infection occurring five years later. From 1964 to 2007, when Zika showed up on the isolated island of Yap in the Pacific, there were only fourteen other confirmed cases, all in Africa and Southeast Asia. But by 2013, it had slowly spread east from Yap across various Pacific Islands before gaining worldwide attention in Brazil in 2015. This epidemic of 2015–2016 spread to countries across the Western Hemisphere.
In the epicenter of Brazil, roughly 1.5 million people were infected, with more than 3,500 cases of reported microcephaly (babies born with small heads and other fetal brain malformations and impairments) caused by “vertical transmission” from mother to fetus. Even more distressing was the announcement concerning pathways of contagion. The Aedes mosquito acts as the common vector. Unlike all other mosquito-borne diseases, however, Zika can be sexually transmitted between partners of both genders (documented in nine countries) and from mother to fetus as evidenced by the heart-wrenching cases of microcephaly causing a host of neurological and physical complications. The symptomatic characteristics are almost identical to West Nile, with 80% to 90% of those infected presenting no indicators. Those who do get sick show mild symptoms similar to West Nile, dengue, or chikungunya. Akin to West Nile, less than 1% of those infected become seriously ill. Zika is also a cause of the neurological Guillain-Barré syndrome, which can result in paralysis and death.
Zika, like West Nile, has also gone globally viral, while the infection rates of their cousins, dengue and chikungunya, have increased thirtyfold since 1960, at a global economic cost of more than $10 billion per year. In 2002, the city of Rio de Janeiro reported nearly 300,000 cases in a dengue epidemic that lingered on before spiking again in 2008 with another 100,000 cases. Currently, global estimates place annual dengue infection at 400 million people. Sonia Shah contends that “dengue is expected to become endemic in Florida, has emerged in Texas, and will likely spread farther north too, touching millions.” In addition to cultivating locally sourced dengue and West Nile, in 2016, Texas hosted the first domestic case of chikungunya in the United States.
From her near-death experience following the Second World War, the mosquito, like a phoenix, has risen from her DDT-laced ashes to become a global force once again. The torch of eradication and extermination that had been extinguished during the silent springs of the 1960s was recently picked up and set alight by a multinational coalition of the willing, led by Bill and Melinda Gates.
A series of international meetings during the 1990s led to the launch of the Roll Back Malaria Partnership in 1998, which unveiled a multiorganization collective, Global Malaria Action Plan, a decade later. Buttressing the international eradication drive was an economic information campaign led by economist and Columbia University professor Jeffrey Sachs, highlighting the financial inequities and burdens posed by mosquito-borne disease. Sachs estimated in 2001 that malaria alone cost Africa $12 billion per year in lost output. In 2000, Bill and Melinda Gates formally opened their foundation and put malaria on the global radar for eradication, as articulated in the “Millennium Development Goals” of both the UN and WHO.
The Global Fund to Fight AIDS, Tuberculosis and Malaria, financed in large part by the Gates Foundation, was established in 2002 to make available large-scale funding to help achieve these mosquito-related millennium goals. In 1998, total spending from all sources on global malaria control was around $100 million. Between 2002 and 2014, the Global Fund approved nearly $10 billion in malaria grants. The Gates Foundation estimates, however, that another $90–120 billion is needed between now and the malaria eradication target year of 2040, peaking at $6 billion for the year 2025. During this same time period, direct economic productivity gains from eradication are expected to be in the ballpark of $2 trillion.
While $10 billion seems like an exorbitant amount of money, it comprises 21% of total funds. Of the total allotments, HIV/AIDS receives 59% and tuberculosis 19%. Over the last decade, annual AIDS-related deaths are less than half those of malaria. These “big three” diseases, however, are contractually partnered and somewhat synergistic. Tuberculosis remains the leading cause of death for AIDS patients, accounting for 35% of fatalities. Unfortunately, Africa bears the brunt of this disease overlap, accounting for 85% of new malarial infections and 50% of new HIV infections. Malaria increases the viral replication of HIV, while HIV, by weakening the immune system, makes carriers more susceptible to malaria. It is a double whammy. Since 1980, researchers estimate that HIV is responsible for more than 1 million malarial infections in Africa, and malaria has donated more than 10,000 HIV infections through its direct role in heightening reproduction. Keep in mind that Duffy negativity, as mentioned earlier, although bestowing immunity to vivax malaria, also increases the risk of HIV infection by 40%. Unfortunately for those most tormented and afflicted, malaria (and its genetic safeguard), HIV, and tuberculosis are reciprocal, tag-team miscreants.
Over the last few decades, the Gates Foundation and other philanthropic enterprises and organizations have led the global war on mosquitoes. “The most striking example of the power and influence of philanthro-capitalism is The Bill and Melinda Gates Foundation (GF),” writes Nancy Leys Stepan. “Founded by Bill Gates in 1999 with stocks from his company Microsoft, today the foundation has at its disposal $31 billion of Gates’s own money, as well as an additional $37 billion in stocks in Berkshire Hathaway Inc., the hedge fund run by Warren Buffett (given in 2006). Its annual expenditures on health rose from $1.5 billion in 2001 to $7.7 billion in 2009. The GF is, if you like, the Rockefeller Foundation of the global era.” The influence of Gates and Buffett extended even further. According to Alex Perry in his book Lifeblood, detailing recent eradication efforts, “A fresh high came on 4 August 2010, when Gates and Buffett persuaded forty of the world’s richest—among them Oracle founder Larry Ellison, Citigroup creator Sandy Weill, Star Wars director George Lucas, media mogul Barry Diller, and eBay founder Peter [sic] Omidyar—to announce they would all be giving away at least half their fortunes.” Mr. and Mrs. Gates, and their supporters, deserve a hearty round of applause.
The Gates Foundation is the third-largest underwriter of global health research, trailing only the governments of the United States and the United Kingdom. It is also the world’s single largest private donor to the WHO and to the Global Fund to Fight AIDS, Tuberculosis and Malaria. Unlike some governments and corporations, the Gates Foundation has no corrupt or underhanded interests other than t
he eradication of malaria and other mosquito-borne diseases among a circuit board of other health-related programs. It manages its transparent affairs and conducts its philanthropic administration with no strings attached, save its own good intentions.
On the heels of First Lady Laura Bush’s 2007 “Malaria Awareness Day” summit at the White House, even reality television got into the malaria melee. The two-hour American Idol malaria-focused “Idol Gives Back” star-studded extravaganza aired in April 2007, complete with guest appearances from dozens of bankable A-list actors and musicians. The show was capped by Canadian songbird Celine Dion performing a duet alongside a hologram of a young, and perhaps bewildered, Elvis Presley. The television gala, watched by 26.4 million Americans, created a viral response on social media and raised $75 million for malaria research. In April 2008, a second Hollywood-encrusted “Idol Gives Back” raised an additional $64 million. The war on malaria and mosquitoes is truly international.
A New Hope: Two schoolgirls waiting to be tested for filariasis and malaria in Nord-Est Department, Haiti, 2015. (Dr. Alaine Kathryn Knipes/Public Health Image Library-CDC)
While the altruistic efforts of Gates, Sachs, and Idol producer Simon Fuller (whose father contracted malaria in Burma during the Second World War) are certainly laudable, the larger global war on mosquitoes still operates under the umbrella of capitalism and the interests of big business. While aid for malaria and mosquito eradication, and corresponding media exposure, has dramatically increased in the last decade, programs are often fraught with administrative complications, corruption, and other impediments. Drug companies spend billions of dollars on research and development on antimalarial drugs and vaccines, and understandably need to recoup their costs, which makes treatments unaffordable to those most in need. “Malaria and poverty,” notes Randall Packard, “are mutually reinforcing.” Today, for example, 85% of malaria cases occur in sub-Saharan Africa, where 55% of the population lives on less than $1 per day. Southeast Asia houses 8% of the malaria caseload, with 5% in the Eastern Mediterranean region, 1% in the Western Pacific, and roughly 0.5% in the Americas. The masses afflicted by mosquito-borne disease live primarily in impoverished countries.
Underprivileged people in the most heavily affected countries in Africa and Asia cannot afford drugs and, until recently, did not stimulate commercial medical research and development for “their” diseases. Unlike AIDS, which receives the largest share of global drug funding, malaria and other “neglected diseases” are rarities in the affluent world, so they stealthily fly under the R&D radar. Roughly 10% of private R&D resources targets diseases, including malaria, that account for 90% of the global burden. Between 1975 and 1999, of all the thousands of drugs developed and tested worldwide, only four were antimalarials. There is hope, however, as these pharmaceutical titans have recently been recruited and enlisted in our war on mosquitoes through a sustained multimedia eradication campaign and financial contributions from the Gates Foundation and additional benefactors.
The Gates Foundation and other charitable organizations have funded numerous research ventures for the world’s first malaria vaccine. To date, the Gates Foundation has committed $2 billion in grants to combat malaria alone, excluding another total investment of almost $2 billion to the Global Fund to Fight AIDS, Tuberculosis and Malaria, which between 2002 and 2013 spent $8 billion solely on its skirmish with malaria. The Gates Foundation apportions resources to numerous malaria vaccine projects, including the PATH Malaria Vaccine Initiative and the Malaria Research Institute at Johns Hopkins University. By 2004, a diverse collection of independent teams at various universities and research institutes in several countries, all receiving financial support from the Gates Foundation, were serious contenders in the race to complete the magic malaria serum.
The first to the malaria vaccine finish line was the London-based drug giant GlaxoSmithKline. After twenty-eight years of development and $565 million from the Gates Foundation and other backers, its malaria vaccine RTS,S or Mosquirix was finally rolled out for the third and final round of clinical human pilot trials in Ghana, Kenya, and Malawi in the summer of 2018. Based on initial results, however, RTS,S is not a sure thing. Four years after initial vaccination and a series of boosters, the success rate of RTS,S was 39%, harshly sinking to 4.4% after seven years. “The problem with most vaccines is that their effectiveness is often short-lived,” explains Dr. Klaus Früh of RTS,S. “With further research and development, it could offer a lifetime of protection against malaria.” Other experimental vaccines are also nearing the threshold for the first stage of clinical human trials, including Pregnancy-Associated Malaria Vaccine (PAMVAC) developed by ExpreS2ion Biotechnologies in conjunction with the University of Copenhagen and the live-attenuated plasmodium falciparum sporozite vaccine (PfSPZ) engineered by the biotech firm Sanaria. In the summer of 2018, GlaxoSmithKline also unveiled the new radical single-dose treatment of the drug tafenoquine, or Krintafel, which suppresses relapse of vivax malaria by attacking the hibernating form of the parasite that nests in the liver. While this ongoing exploration is encouraging, our battle with the shape-shifting malaria plasmodium appears to be far from over or, in the case of vaccines, just beginning.
With these probing advancements in mosquito research and medicine, and the promise of potential malaria vaccines, it is easy to get the impression that humanity has entered a new era. It now seems that all the world’s troubles and glitches can be solved with cutting-edge science or a reboot from state-of-the-art technology. Everyday miraculous breakthroughs are achieved by brilliant minds across the vast oceans of academia. Everything is at our fingertips and anything seems possible. Within our many enterprises of discovery, we are exploring strange new worlds, seeking out new life-forms on our sphere and beyond, and boldly navigating the unknown frontiers of space. We talk about populating other planets as though it is just a matter of time.
The stirring visions and rousing horizons of the heroes and legendary figures of history and the curious conquistadors of colonization, including Alexander the Great, Leif Erikson, Genghis Khan, Columbus, Magellan, Raleigh, and Drake, were no different. They also encountered the foreign fringes of Alexander’s limitless “ends of the world.” During their inquisitive ages of antiquity, as in our own, the trajectory of progress appeared nearly infinite. Even the great, narcissistic genius Sir Isaac Newton gravitated toward the notion that if we “have seen further it is by standing on the shoulders of Giants.” To this, Friedrich Nietzsche attached his own illumination, declaring that progress is made possible only by “each giant calling to his brother through the desolate intervals of time.” We have advanced to border on, and push the boundaries of, what now appears to be the infinite. It is no longer considered irrational or a lamp-rubbed “I dream of genie” wish to talk about earthly immortality. In our modern reasoning and worldview, “when” has supplanted “if.”
Yet, within the whirling, dizzying technologically twittering world around us, the humble mosquito reminds us that in many ways, we are not all that different from Lucy and our hominid ancestors or our African Homo sapiens progenitors. They, too, were embroiled in a war for survival with the mosquito and set us on our collision course with our deadliest historical predator. Indeed, the more the modern world speeds up, the more it replicates those early, accidental encounters between humans, such as our Bantu yam farmers, and deadly mosquitoes. As humans migrated or were forced out of Africa, deadly pathogens, including mosquito-borne disease, tagged along. Over time, our modes of transportation and disease transference broadened from solely our feet to include beasts of burden, ships, wagons, and planes, trains, and automobiles. With these technological advancements we have merely quickened the pace of our first stumbling steps and of the broader dissemination of disease. While the mediums of microorganism conveyance may have changed, the spread of contagion remains relatively the same, except now the travel time has been drastically reduced and diseases are delivered from door
to door in hours instead of months and years, or even thousands of years in the case of early human-disease migration and settlement patterns.
As paleopathologist Ethne Barnes observes, “Deadly viruses are being teased out of their slumbering isolation as wars, famine, and greed bring people into contact with them in greater numbers. Migrations and air travel bring people into contact with microbes that they have never encountered before.” In 2005, for instance, 2.1 billion passengers flew the friendly skies. Five years later, the number of air travelers increased to 2.7 billion and ballooned to 3.6 billion by 2015. Global airports processed 4.3 billion passengers in 2018, a number expected to rise to 4.6 billion in 2019. A complimentary choice of diseases, including SARS, swine and bird flus, Ebola, and our mosquito-borne maladies as demonstrated by West Nile and Zika, passes through airport security to globe-trot across the planet with an increasing number of passengers to an increasing number of destinations on a cyclical, never-ending, all-expenses-paid world tour. Whether hitchhiking or freight hopping on (or in) the earliest human migrants leaving Africa, on a slave ship bound for the Americas courtesy of the Columbian Exchange, or on a 747 flight or Airbus A380, not much has really changed. Disease is enduring and embedded human luggage.
Ever since 1798 when Thomas Malthus postulated the existence of ecologically imposed limits to human demographics (or perhaps as early as 81–96 CE when John of Patmos penned his apocalyptic Revelation and its pale horse of Armageddon), paranoid doomsday promoters and self-proclaimed oracles have been predicting Malthusian plagues and famines, only to see the supposedly intractable limits to population growth pushed back by technology. And yet, something seems different this time. There were roughly a billion people on the planet when Malthus was writing (more than twofold what it had been consistently for the previous 2,000 years). Today, the proliferating and breeding global population has more than doubled since 1970, to 7.7 billion Homo sapiens. If you are still living by 2055, your global superbug-infested neighbors will be in the range of 10 to 11 million. As our numbers increase, our resources diminish in relation.
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