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Malaria: The view from Mozambique

In impoverished Mozambique, a drug trial provides glimmer of hope.

MAPUTO, Mozambique — Mozambique is not an obvious place to expect the end of a plague.

The southeast African nation has an average life expectancy of just 42, and is still recovering from a civil war between government forces and South African-backed rebels that swallowed a generation during the 1980s and 1990s. On the United Nation’s Human Development Index, Mozambique is ranked 168th out of 177 countries.

Like so many success stories, Mozambique's started with coincidence. A Spanish doctor, Pedro Alonso, had been working on a malaria vaccine in neighboring Tanzania — a former English colony. But the Spanish government’s foreign aid service offered more funding if the project moved to a nation with a strong relationship to Iberia. Mozambique had been a Portuguese colony, and was suffering terribly from malaria deaths. Its subtropical climate — a marshy environment crossed by the large Zambezi and Inkomati rivers — and doctor shortage — even today barely 800 doctors for a population of 20 million — made Mozambique both in need of attention and the ideal laboratory. The project settled in a back room of Manhica district hospital, in the south of the 620 mile-long nation, in 1994.

“The country was basically just coming out of the civil war,” Alonso said. But the university was open and the national medical school had never stopped teaching during the 16-year conflict. Just outside Maputo, Manhica had good links to Johannesburg, South Africa, where the project could fly in modern equipment.

Today, the drug trial that began in Mozambique 15 years ago has led to hopes for the first vaccine against malaria. In a trial of 2,000 Mozambican children up to 5 years old, one in two who took an experimental vaccine — called RTS,S — did not develop the disease. Similar results in Tanzania have led Mozambique’s Ministry of Health to announce that the vaccine could be included in international vaccination programs as early as 2011.

The mosquito-born parasite is the largest killer of children in Africa. Between 300 and 500 million people contract malaria annually, Alonso said. Despite the good news of a potential vaccine, Mozambique continues to suffer terribly from malaria: According to the World Health Organization, there were more than 6.3 million reported malaria cases in Mozambique in 2007, up from about 4.6 million in 2002. The WHO estimates that there were more than 7.4 million malaria cases in the country in 2006.

Before the Mozambique project, no one had seriously sought a malaria vaccine since the 1950s. Treatments for those infected are also lacking.