Can Malaria be Eradicated in Our Lifetime?

By Brian Lowther

My dad has always been especially bothered by mosquitoes. It’s the multitude of mosquito bites that bothers him, and the itchiness. He’s maniacal about keeping the doors closed on warm summer nights. Mosquitoes also have a particular attraction to my wife. In this way, mosquitoes and I are the same. Mosquitoes have never really bothered me, however. Maybe my blood doesn’t taste good to them.  My brother once told me that if a mosquito landed on a muscle, and you clench that muscle, when the mosquito starts to suck your blood, it will explode. I must have tried this a hundred times. Never got to see one explode.

On the front line against malaria: Army medical researchers in Kenya mark World Malaria Day 2010

Mosquitoes undoubtedly annoy everyone. But what if one mosquito bite led to the end of your life?

Today is World Malaria Day. If you do a little nosing around, you’ll find tons of information about the day and its purpose.

Malaria at a glance

• According to International Medical Corps, thirty-five countries (30 in sub-Saharan Africa and 5 in Asia) account for 98% of global malaria deaths.
• 86% of malaria deaths belong to children under 5 years-old.
• Malaria is 100% preventable and curable

Prevention

The main way to prevent malaria is through distributing insecticide-treated mosquito nets and spraying indoor areas with insecticides.

Treatment

The best available treatment to date is artemisinin-based combination therapy. However, the infection has demonstrated increasing resistance to this drug. Access to the drug, made from the wormwood plant, is in woefully short supply. Getting the treatment into the hands of the sickest children around the world is the real challenge.

Outlook

According to a recent report by the Roll Back Malaria group, more than a million African children have been saved from the disease since 2000 and annual funding to fight malaria rose from $100 million in 2003 to $1.5 billion in 2010.

But, as Ralph Winter often pointed out, if an ounce of prevention is worth a pound of cure, a tenth of an ounce of eradication is even more crucial. All of the above information relates to treating or preventing malaria. What is the status of malaria eradication?

Eradication

Among malaria experts the word eradication is somewhat taboo. The reason is, the World Health Organization already tried to eradicate malaria, and while it was eliminated in many wealthy countries, the goal was not achieved and the plan was abandoned. When Bill and Melinda Gates started talking eradication again in 2007, the response in public health circles was skeptical. However, late last year GlaxoSmithKline announced a promising new experimental malaria vaccine. Suddenly, a new sense of optimism is emerging. Gates has said, "I'd be disappointed if within 20 years we're not very close to eradicating this globally."

"I'd be disappointed if within 20 years we're not very close to eradicating [malaria] globally."
~Bill Gates

Two questions that interest those of us in the Roberta Winter Institute are, what does God want believers to do about malaria? And, what does the existence of malaria say about God?

Beyond Unreached Peoples?

By Brian Lowther

Here is one of Ralph Winter’s essays that I think you’ll enjoy. It is one of his shorter essays, only a thousand words. It was written on a Sunday, likely in the afternoon directly after attending the church service at Lake Avenue Church in Pasadena. I have a hunch that he wrote this essay during his four-hour shift in the prayer room at the U.S. Center for World Mission.

The essay is written specifically to the staff members of the U.S. Center. In it, he wonders aloud about some of the statements in use at the time to describe the vision and purpose of the U.S. Center.  

He titles the essay “Beyond Unreached Peoples” as he reflects upon whether the problems that unreached peoples face are merely a result of the absence of “good news.” He compares this to telling willing recruits that all they need to do is walk into Flouja (or any war torn area) and inform them that democracy is the answer to their problems. 

He then describes a “rousing charge” of a sermon he heard earlier in the day, but compares it to a rally cry to the troops to stop quarreling, rather than a rally cry to defeat the enemy and win the war. 

He concludes by proposing that mission work could be marvelously more fruitful if specific common denominators could be recognized between missionaries and the people they come to serve. The specific common denominators he has in mind both involve looking into a microscope. In Winter’s mind, there was sufficient evidence in any microscope to rouse and unify all of mankind to participate in a “great campaign of sabotage” against our common enemy. 

After Malaria, What is the World's Deadliest Parasitic Disease?

By Brian Lowther

There is a parasitic disease that kills about 500,000 people worldwide every year called black fever. That makes it the second most deadly parasitic disease in the world after malaria. Actually the medical name for this disease is visceral leishmaniasis (VL). But in India, where it is rampant among the poorest of the poor, it is called kala-azar, or black fever. If you get black fever you die a slow agonizing death as the parasite destroys your liver, spleen and bone marrow.

But here is the crazy thing: black fever is curable. All you need is an antibiotic called Amphotericin B.

So what’s the problem?

Amphotericin B is expensive. The people who need it most would have to work for an entire lifetime to afford it. If you put this in equivalent terms, this medication would cost the average American (making a  $40,000 per year salary) $1.7 million.

Enter Victoria Hale. She had an interesting mix of expertise that allowed her to see a solution to this problem. First she was a pharmaceutical scientist. Second she was a veteran of both the biotechnology industry and the FDA.

Her solution: create an effective and safe drug and distribute it for free.

To do this, there were three steps.

1. Create the drug. The pharmaceutical industry could easily do this, but research and development is very costly.
2. Make sure the drug is effective and safe. Again the pharmaceutical industry could do this but their clinical trials are a very expensive and lengthy process.
3. Distribute the drug to the people that need it.This is where the pharmaceutical industry couldn’t offer much help. For a pharmaceutical to get involved they’d have to believe that they could sell the drug at a high enough price to cover their overhead and produce a profit for their shareholders. This certainly wasn’t the case with black fever. But there was another option available: the Public Health model. This model is built to distribute drugs to the people who need it, but it doesn’t create the drug, or make sure the drug is safe and effective.

Hale’s genius was to launch a not-for-profit pharmaceutical company that would use the strengths of pharmaceuticals and the public health model and eliminate the weaknesses. Thus she launched the Institute for OneWorld Health in 2000 at the age of forty.

Instead of creating a new drug, Hale knew from her experience at the FDA that many promising drugs became abandoned because they were unprofitable. So she and her colleagues at IOWH searched for an abandoned medication that might work. Before long they found an antibiotic called Paromomycin, which originally came on the market in 1961 but was discontinued fifteen years later because it wasn’t profitable.

Next she got the drug tested and approved with funding from philanthropic foundations. Then she turned to governments to facilitate the distribution.

“Because the cost is a mere $10 per patient for a full course of treatment, the government of India was able to cover the entire cost for its citizens. IOWH is lobbying the other countries with large numbers of black fever sufferers to follow suit.”
The Opposable Mind: Winning Through Integrative Thinking By Roger L. Martin

I’m convinced that there is a group of believers out there who will be inspired by Victoria Hale and will pool their resources and resolve to eradicate black fever. Maybe they’ll follow her example to develop a vaccine. Because while Hale’s astounding work is absolutely crucial in alleviating the suffering caused by black fever, it won’t place black fever in the archives of human disease. For that to occur the immune systems of every susceptible person on earth must be able to destroy the parasite. For that to occur a vaccine is necessary. Currently there is no vaccine for black fever.

Will the Pharmaceutical Industry Eradicate Disease?

By Brian Lowther

I think the body of Christ is uniquely positioned to play a crucial new role in the fight against eradicable disease. To explain why, it’s important to identify the major players, the people and organizations that are already at work. First up is the pharmaceutical industry.

Now, I know it’s the in-thing to bash pharmaceuticals. While I’m not here to defend Big Pharma, I wonder where we would be without them? If it weren’t for pharmaceuticals there would be a lot more suffering, cold symptoms, headaches, missed work, high blood pressure, bad cholesterol, depression and sexual dysfunction. If we did not have a pharmaceutical industry, I’d want someone to invent one. Plus, Big Pharma employs a lot of people. According to Forbes, as many as 300,000 people work in just the three largest companies alone. Also, I’d never want to imply that people who work for pharmaceuticals are any less ethical than those who work in other industries. I know two friends employed by pharmaceuticals, and both have substantial integrity.

That being said, like a lot of people, Ralph Winter had strong feelings about pharmaceuticals. I’ve been studying his writings on the subject recently. Here are a few choice gems:

"Where there is no income there is no business. The medical/pharmaceutical complex gravitates to artificial substances that can be patented and sold at a very high price, and to medicines for chronic diseases which ensure that their customers will be long term. That's just 'good business.'"

And this one:

"Neither in the practice of medicine (doctors and hospitals) nor in the pharmaceutical world is there—nor can there be—significant concern or focus upon the origins of disease. Why? People pay to be cured. They don’t readily offer their life savings to attack the roots of diseases they do not yet have…"

I know a scientist or two who might take issue with Winter’s statements above. One researcher friend told me, “Every researcher believes they are working to eradicate disease.” But when I’m with non-researchers and the conversation turns to pharmaceuticals, I hear this same sentiment: “Pharmaceuticals won’t eradicate disease because they don’t want to dry up their income stream.”

Admittedly, there is some truth to it. Dr. Marcia Angell—Member of Harvard School of Social Medicine and former editor of The New England Journal of Medicine—makes that case very clearly in her book The Truth About the Drug Companies: How They Deceive Us and What to Do About It.

And honestly, it makes sense, doesn’t it? It’s logical from a business standpoint. But it just seems too devious to me. Am I naïve?

I followed my naivety and found that there are at least two pharmaceutical companies that donate medication to eradication efforts. In 1987 Merck started donating Mectizan which prevents river blindness. In 1998 GlaxoSmithKline started donating albendazole which treats lymphatic filariasis.

But here again, these are donations, not revenue streams. Pharmaceuticals can’t expect to satisfy their shareholders by donating all of their products. After all, a successful eradication effort by definition puts itself out of business.

Thus it doesn’t look like we can rely on the pharmaceutical industry to be extensively involved in eradication. Perhaps they can be convinced to donate more medications. But expecting them to change their goal to eradication is like asking the oil industry to change its goal to solar powered cars. That’s where government organizations like the World Health Organization, philanthropists like Bill and Melinda Gates and other non-profits come into play. But even with the present and potential contributions of these entities, there is room for much more.

This is why I think the body of Christ is uniquely positioned to play a crucial new role in the fight against eradicable disease. Perhaps we could follow the marvelous example of Victoria Hale. But you’ll have to wait until my next entry to find out about her.

The Whole Point of the Bible

By Brian Lowther

I had this remarkable conversation yesterday with a good friend of mine. For a little background, I’ll just mention that my friend was raised in a Christian home, went to a Christian school, got baptized as a young person and could count on one hand the number of times he missed church over the years. He’s also a fine person with a kind soul and a good heart.

We discussed the point of the Bible, which he described as, “God’s life manual.”

I said, “Basic Instructions Before Leaving Earth?”

He agreed. I asked him to sum up the whole Bible with one verse. He chose John 3:16.

Which prompted me to ask if he thought the whole point of the Bible is to get people a ticket into heaven.

He felt that a ”ticket into heaven” lacked sacredness, but essentially affirmed that it was indeed the whole point.

So I asked, “If the whole point is for people to believe in Jesus so they can get their ticket to heaven, why don’t we all go directly to heaven the moment we get saved?”

He responded, “If there were no Christians around, how would anyone else get saved?”

If the whole point is for people to believe in Jesus so they can get their ticket to heaven, why don’t we all go directly to heaven the moment we get saved?

“Ah. So would you say that the whole point of the Bible is both getting a ticket into heaven, and passing out tickets to others?”

We agreed that the Great Commission (Mat 28:19) was an additional good verse to sum up the Bible.

Then I asked, “Have you ever wondered if God is concerned with something more than just the salvation of human beings?”

He hadn’t ever wondered that.

So I expanded, “What I mean is, why did God create such an enormous and intricate universe? We’ve got stars as far away as the eye can see, and then we’ve got bacteria, which the eye can’t possibly see. Why did God create it so big, and so small at the same time? Doesn’t it seem sort of unnecessary if the whole point is about humans and getting them to heaven? What’s with all the complexity? Is it all just for our curiosity, or for his amusement?”

He didn’t have an answer.

Our discussion veered off in an odd direction. We talked about when the Pharisees told Jesus to rebuke his disciples for glorifying him, to which Jesus replied, “If they keep quiet, the stones will cry out.” (Luk 19:40) We talked about Abel’s blood crying out to God from the ground. (Gen 4:10) We discussed how the whole creation has been groaning and waiting in eager expectation for the children of God to be revealed. (Rom 8:22;19) We pondered whether God designed the universe with so much complexity because his eventual plan will include plants and animals, atoms, constellations, whales and dust mites glorifying him. And more than just through the intricate beauty of their design, actually crying out to glorify God.

I wanted to tie that all together with the concept that the universe is engulfed in a cosmic war between God and Satan, but it got a little fantastical, like a Tolkien novel, with trees and boulders fighting Satan.

So we stopped the conversation at that point. I can’t remember what we talked about next. It wasn’t nearly as interesting.

A Major Correction in the Mainstream of Christian Theology

By Brian Lowther

I am currently studying the transcript of a speech Ralph Winter gave in 1999 at a gathering of the Presbyterians for Renewal.The Presbyterians for Renewal gave the Winters the 1999 Bell-Mackay Prize recognizing life-long devotion to the mission of Jesus Christ in the world. This prize was named after Nelson Bell a medical missionary and father-in-law to Billy Graham, and John Mackay who was both a former professor to Winter at Princeton and a president of the World Council of Churches. The prize came along with a $5,000 gift.

The main thrust of Winter’s address was to explain why he and Roberta had decided to use the $5,000 gift as seed money for a new endeavor he called the Institute for the Study of the Origins of Disease (ISOD). This was his initial conception of what would later become the Roberta Winter Institute. He described this new project as a “major correction in the mainstream of Christian theology.”

He then described how John Mackay was familiar with both the values and the limitations of all particular streams of Christian belief. This fact served as a segue for him to say that he was not going to be speaking about a major correction in just one stream—such as the Evangelical stream from which he came—but rather, “an urgent Biblical insight lacking in all of them.”

One reason this correction is needed, he explained, is that our whole way of understanding God and the Bible was hammered out by people like Calvin and Luther centuries before we had any knowledge of microscopic forms of life such as disease germs, and that—amazingly—our theological sensitivities have not yet been updated to account for this new knowledge.

I wonder just now if Winter was correct. I’m sure he ran into people who disagreed with him on this topic, though I never heard him say so. But in my experience, when I’ve stood before an audience and said, “Our theology has not been updated to include germ theory,” I get a lot of blank stares.

I’ll venture a guess and say that a lot of the people are thinking, “Wait a second. Can it be true that our theology has just stayed the same since Luther and Calvin, with no regard for the scientific discoveries since then?” Certainly there has been a lot of theological reflection about other scientific discoveries such as Galileo’s heliocentrism, not to mention the raging theological debate about scientific theories such as evolution. Is it possible that microbiology has been untouched by theological reflection?

This notion made me curious so I did just a tiny bit of research and came across a 2004 paper entitled The Bible and Microbiology by Adventist and Biochemist George J. Tavor. In it he lists thirty terms in the Bible with direct links to microbial activity.

So it appears that there is some theological reflection occurring. There must also be plenty of serious pondering happening in groups like the American Scientific Affiliation, but I have yet to spend significant time combing through their archives.

I suppose the issue at hand here is not whether there has been any theological reflection about microbiology, but that we, as Winter put it, “do not commonly accuse Satan for destructive germs,” and that we “have no mission theology for destroying such germs.” When clarified in this way, this sentiment does seem to represent an empty space in the middle of our theology that no one has significantly ventured into yet.