Showing posts with label Malaria. Show all posts
Showing posts with label Malaria. Show all posts

Friday, 5 January 2024

A Pox On Them

 


Timing, they say, is everything. Tamba M'bayo, a professor in the Department of History at the University of West Virginia, Morgan Town, WV, United States arrived in Freetown in the fall of 2019 to research, of all things, the history of epidemics in Sierra Leone. The visit incidentally provided him with the opportunity for a bird’s-eye observation on how the Covid-19 pandemic would unfold in the country, as well as how the government would respond to the looming challenge. It was also an opportunity to compare and contrast Covid-19’s progression with that of previous epidemics which were, in the first place, the object of the professor’s intended year as a Fulbright Scholar.

The slow advance of Covid, and its apparent reduced lethality in Sierra Leone has been a surprise to many, as it was in the case for most of the Continent in general. Potential explanations include innate and/or acquired immunity, and/or minimal exposure of the community to the virus. The latter explanation is probably not sustainable because, where antibody studies have been done elsewhere in Africa, for example in Kenya and Malawi, there was evidence of Covid-19 infection in those communities, communities that are not dissimilar in the dynamics of life that obtain in Sierra Leone’s impoverished places.

So, how to explain the protective circumstances of being African and living in Africa? I do make the point of being African and living in Africa because we can contrast the lethality of Covid on individuals of African ancestry living in America, New York, say, with that of Africans living on their own continent. The high death rates among African Americans was one of the starker images, as the pandemic cut its way across the world, and which evoked tropes that, to some, confirmed that, in America, Black lives did not matter. But that is another story.

Anyway, America’s Covid experience leads us to the colonial designation of Sierra Leone as the ‘White Man’s Grave’. We have come a long way since White men, and women too, embarked, in their hundreds, and even thousands, on their civilizing enterprise in the 19th and early 20th centuries. (Before that, of course, Africa was just the source of unpaid human sweat and sinew, as well as the victim of theft of its intellectual property of rice- and cotton-growing skills). Today, looking through the long glass of decades of clinical insights and research, we now have some idea of how these European adventurers met their untimely deaths: They were just not biologically prepared for living in those places. In the case of malaria, for example, we now know that there are numerous ways in which, being African, born and bred in those climes, means that one may be partially protected against the lethality of the parasitic infection through a network of inherited biological devices. Among these, the best known is the sickle gene which, when inherited from one parent only, provides protection against one of the more deadly malaria species. There are, as well, several other genes that shore up protection against this infection, but these as are not as well-known among the general public. In any event, once the individual has survived infancy, parasite infestation results in a low-grade illness that does not usually result in death.

In the case of yellow fever on the other hand, this infection, also mosquito-borne, comes in epidemic waves that either kills within a few days or a week, or if the victim survives, confers lifelong immunity against future waves of the virus.

But, for the missionary, or colonial official, walking off the boat, totally biologically naive, never mind culturally unprepared, and armed with defences no more robust than biblical text or that in his orders from the Colonial Office, it was almost a certainty that things would not end well. They and the colleagues that replaced them did not stand a chance, as the old burial grounds around Freetown attest. Many died within weeks of landing, whilst others struggled on for a few months and then gave up, dying on the voyage back home, with a sea burial to mark their passing.

Smallpox’s is another story, that of a virus with an altogether different level of virulence but which, in the end, turned out to be central to an understanding of the phenomenon of vaccination that became a model of how to prevent many infectious diseases. The term, ‘vaccination’ itself, has its roots in the observation that individuals who milked cows infected with cowpox enjoyed protection when an epidemic erupted.

Back to Covid-19. Age, genetics, prior exposure, all play a part in an individual’s response to any infective agent. According to the online Worldometer statistics site, Covid cases in Sierra Leone during the entire course of the pandemic, so far, number just 7766. Seven thousand, seven hundred! And just 126 deaths!! Some speculate that resistance to Covid and its lethality may be dependent on the country’s population age structure, in which case, Sierra Leone, a country with one of the youngest populations (median age of 19.1 years), is likely to be a beneficiary of this age-dependent protection. The jury is still out on that.

The other side of this equation is that this young, robust, and vibrant Sierra Leone population should be up to any challenge. Pity is that the governing class has not seen it fit to mobilize this raw energy that is just waiting to burst forth and flourish all over the place. Instead, they use/manipulate it to achieve their notoriously venal purposes. And, alas, they succeed. Cycle after cycle. A pox on them, I say, not to coin a phrase.

Anyway, pandemics, and epidemics, have their own logic. They come and they go, starting somewhere, from something, from someone. Tamba M’bayo referenced the 1918-22 influenza epidemic that was brought to Sierra Leone on board a British Navy vessel, the HMS Mantua, and Covid-19 has become a textbook case of how pandemics spread, in its case, using modern transportation systems.

Although, in the end, Covid has been tamed by modern science, it is still a wild beast out there, full of tricks and devices, and ever ready to up its game. Scientists are happy to engage.

‘Nuff said.

Tell Fren Tru

Thursday, 3 December 2015

An Ally of Barbarism




During the 18 months that Ebola was grabbing headlines, malaria was quietly killing by the million. This is the estimate the Malaria Atlas Project (MAP) made of the number dying in Africa from that infection during our year of Ebola (http://www.nature.com/nature/journal/v526/n7572/full/nature15535.html)
 At the same time, MAP reports also that the overall incidence of malaria fell by 40% in the period 2000 to 2015. This was really good news, as 40% translated to a whopping 663 million clinical infections avoided. Bed nets treated with insecticide (ITN) was the most significant contributor to this decline in cases and deaths, MAP state. I should say though, that my experience with the ITN has not been that spectacular. I can testify to nightly engagements, armed with a weaponized electronic racquet, battling mosquitoes that refuse to die after gaining entry into my ITN. Obviously my second-line defence (chemo-prophylaxis) against the pests is effective enough because I have not, in recent years, suffered a single bout of the infection. But one and a half million deaths due to the infection among others in just one year is no joking matter.Any help in reducing this number, therefore, is more than welcome, and Britain’s recently announced gift of £1 billion (http://www.bbc.co.uk/news/uk-34892921) to help further the fight is hugely important.  Kudos to the Brits.
Malaria has been mankind’s implacable enemy probably ever since man gave up his hunting and gathering ways. The infection has been intractable not only because of its intrinsic biological sorcery but also because of environmental and economic factors as well. So any injection of new money is to be celebrated. The UK donation is to be added to funds provided by the Bill & Melinda Gates Foundation, creating a powerful synergy that should, once and for all, eliminate the pestilence.
          Still, in 2015, one cannot help but look back over the last century or so with something like awe, during which, one would have expected that the billions hitherto invested, should have yielded more ample dividends: Infection rates should be near zero by now, surely? Perhaps billions are not enough: A recent study has concluded that total spend remains much lower than the need. We should be looking at trillions, then? Besides, funding, when available, may not be always targeted at where it would do most good. Judging by the more than 2500 notifications of papers in peer-reviewed journals that land in my inbox every year, there must be among them, many that could be hardly fit for purpose. Obviously, a few, over the years have yielded worthwhile results. This year, the 2015 Nobel Prize in Physiology or Medicine was awarded jointly to three researchers. Half of the prize money went to the Chinese pharmaceutical chemist, Youyou Tu for her work in demonstrating the effectiveness of a herbal-derived remedy, artemisinin, as highly effective therapy for malaria. This award was more than 108 years after the prize was given to Frenchman Alphonse Laveran for demonstrating that malaria was caused by a blood parasite, and 113 years after the prize went to Ronald Ross, a Brit, for showing that the parasite was transmitted to humans by the bite of mosquitoes. Incidentally, in 1899, Ross was commissioned to find out why British soldiers in Sierra Leone were dying of malaria in such numbers. His discovery that the mosquitoes responsible for transmission bred in stagnant pools of water on the lowland plains around Freetown, led to the segregation of white British workers up on a range of hills at what became known as Hill Station. This was how, in 1904, physical racial segregation was born in Sierra Leone. Earlier, during his Nobel Lecture in 1902, Ross had declared of malaria: “There it strikes down, not only the indigenous barbaric population, but, with still greater certainty, the pioneers of civilization, the planter, the trader, the missionary, the soldier. It is therefore the principal and gigantic ally of barbarism. No wild deserts, no savage races, no geographical difficulties have proved so inimical to civilization as this disease.” My emphases.
But that was then and Ross has long been forgiven and is now rightly celebrated for his scientific work..
          The issue now in 2015 is to find ways of eradicating malaria entirely.

Tell Fren Tru