Malaria in 1998: advances in diagnosis, drugs and vaccine development

Malaria threatens almost half the world's population. Although a concerted worldwide effort might control this disease, the reality is that inadequate and ineffective laboratory diagnosis and treatment conspire in the yearly deaths of 2,000,000 children from malaria. The failure to institute and implement safeguards to maintain the efficacy of new antimalarial drugs is likely to accelerate the emergence of untreatable malaria, creating an ominous parallel to tuberculosis. There is hope. Field expedient, simple and affordable malaria diagnostics are at hand. Artemisinin derivatives remain surprisingly effective against the multiply drug-resistant falciparum malaria of southeast Asia, despite the widespread and unregulated use of these agents. Human trials have begun of WR238605, a promising primaquine replacement that has prophylactic, treatment and transmission-blocking potential. After demonstrating unprecedented protection against homologous challenge, RTS,S, a new sporozite-based malaria vaccine candidate, is now in field trials.