By Yaqoob
Millions of people contract malaria every year. More than half a million die from it.[1] Most of those people live in the majority world. And most of them are poor, since when the rich get the fevers and chills from malaria, they tend to seek out, and be able to afford the medical care to get well again.
It’s also highly likely that almost every one of those victims had a couple of other things in common. Firstly, they didn’t want to get malaria, and secondly, it came to them uninvited through the bite of an Anopheles mosquito.
A week ago, my son Solomon also got malaria. But unlike the other 249 million people who contracted it in 2022, Solomon wanted it, and it didn’t arrive through a mosquito, but through the syringe of a scientific researcher.
Solomon signed up for what’s known in medical research as a ‘challenge trial’. In such a trial, a healthy person is intentionally infected with a pathogen, in order for the researchers to study the effects of that pathogen (and often the effects of a potential vaccine). The ethics of challenge trials are understandably hotly debated, partly because they are in tension with the Hippocratic oath, to which all western doctors swear, to ‘do no harm’. Challenge trials clearly do intend to do harm. The counter point, argued by advocates of the trials, is that the minimal suffering of subjects like Solomon and his fellows is worth it, if it brings a vaccine or treatment quicker than conventional research methods (think injecting and studying mice and rats, or observing millions of people for years, of whom only hundreds might actually contract the pathogen of interest). In this way, challenge trials could potentially save millions of lives.
Solomon is part of a group calling themselves Effective Altruism. ‘EAs’, as they are known, recognise that everyone wanting to do good in the world has limited time, energy and money with which to do that good. Therefore, they suggest, we should do our altruism as effectively as possible. One such highly effective way to do good is through challenge trails.
So how does it work? After a rigorous medical check up, Solomon (now living in Oxford UK) and 20 others were selected for the trial. They were thoroughly briefed as to the process (which would spread over months) and given full information as to the potential dangers to participants and benefits to science and the world. They will, it should also be noted, be paid handsomely for their participation.
In early October, Solomon and his colleagues were injected with the malaria parasite. Malaria is caused by a parasite, unlike other diseases which come from bacteria (like TB), or viruses (like Covid). The researchers predicted that Solomon and the others were unlikely to have any symptoms for about a week, until the number of malaria parasites grew and hit a certain threshold. The researchers would do a blood test every day to check the number of the parasites and, once the threshold was hit, would start to treat the disease with anti-parasitic drugs. Sure enough, Solomon had no symptoms for 8 days, but then started to feel weak, and experience alternating fevers and chills – classic malaria symptoms. And, as expected, the researchers phoned Solomon that same day to inform him that his parasite levels had hit the threshold.
That night was uncomfortable, with poor Solomon shivering under coats and quilts for periods, and then, at other times, feeling very hot, and throwing off his blankets and clothes.
The next morning the researchers began the treatment – 4 tablets morning and evening for 3 days. They felt confident that the symptoms would abate from Day 2 of the treatment, and Solomon and the others would be reasonably back to normal soon after the final treatment on Day 3. Sure enough, that’s what happened, with Solomon’s symptoms now considerably better.
Assuming all goes well they will do it all again in a few months – re-injecting Solomon and his colleagues with malaria a second time, this time to see how a human body, which has already had malaria once, deals with it second time around. Hopefully, the researchers will then have some excellent data to work with as they attempt to understand malaria better, and potentially contribute to better vaccines or treatment.
So while I’m very proud of Solomon’s willingness to sacrifice himself for the greater good, as his father I also feel slightly anxious for him as his body deals with malaria, willingly accepted through the researcher’s syringe!
If you’re interested in knowing a little more about Challenge Trials, you might like to look at the 1 Day Sooner website or this UK parliament site.
Mosquito free clip art image at: https://www.dailyclipart.net/clipart/mosquito-clip-art/
[1] The World Malaria Report 2023 states that 249 million people contracted malaria in 2022 (in 85 different countries) and 608,000 died from it.
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