Jessie MacAlpine, a second year student at University of Toronto, has done outstanding research in the field of malaria. She has developed a drug that has the potential to be the most effective, inexpensive and accessible antimalarial treatment on the market. In order to understand how important this discovery really is as a solution to combat the global issue of malaria, let’s first take a look at what this infectious disease really is and what its effects are on the micro, and macro, levels of the populations most affected.
Malaria, buzzing its way from one person to the next
Malaria is an infectious disease caused by a single-celled parasite called Plasmodium. This parasite can be transmitted through Anopheles mosquitoes, where it can multiply in its intestines. When an infected mosquito bites a human, the parasite enters the bloodstream in the human body, multiplies in the liver and infects the red blood cells. This causes symptoms that usually arise between 10-15 days after the bite of the infected mosquito. These first few symptoms include fever, headache, chills and vomiting. If the infection is not treated properly, some types of malaria can have life-threatening effects by disrupting the blood supply to vital organs, allowing the infection to progress to severe illness, and often, death.
Over 300 million people continue to contract malaria each year and it results in 1-3 million deaths annually. In 2013, there were a total of 104 countries and territories in which malaria was considered endemic. Most cases (80%) and deaths (90%) occur in Africa, however Asia, Latin America, and parts of the Middle East and Europe also have an ongoing malaria transmission.
In Africa, most deaths due to malaria (77%) are in children under the age of 5, with a death rate of nearly 3000 every day. Thus, young children are one of the groups that are most at risk of being infected. The reason for this is that these children live in stable transmission areas and have not yet developed a strong enough immunity against the severe forms of this disease. Other groups of people who are at high risk of getting infected are semi- and non-immune pregnant women (in which case malaria can result in miscarriage and maternal death), people with HIV/AIDS, and international travellers who lack immunity.
Does Malaria lead to poverty or does poverty lead to Malaria?
A question of causation vs. correlation
Malaria and poverty are closely interconnected. This can be seen in the various places where the prevalence of malaria is high. As mentioned above, 80% of the malarial cases and 90% of the deaths caused by malaria occur in Africa, the poorest continent of the world. The northern and southern extremes are the only parts of Africa that are malaria-free, and not surprisingly, this is where the richest countries of the continent are found. The link between malaria and poverty is also noticeable in India, the country with the largest concentration of poor people in the world. Haiti is yet another example; it’s the poorest country in the Western Hemisphere and also the country with the worst malaria problem in this hemisphere.
A comparison of the average gross domestic product (GDP) per capita in 1995 (done by the World Bank) found that countries with a severe malaria problem had an average income that was 5 times lower than that of countries without malaria ($1,526 versus $8,268) that year.
Does this data imply that malaria causes poverty or the other way around? Not necessarily. Malaria is mainly determined by climate and ecology: it is geographically-specific. The climate and ecological conditions mostly needed for an efficient distribution of malaria are found in the tropical and subtropical zone. Poverty is also geographically-specific and is mostly found in these regions as well. So, to say that one is the direct cause of the other is not a completely accurate statement.
However, malaria and poverty have an extremely strong bi-directional correlation, since both of them thrive within each other. On one hand, malaria surely has its negative effects on poverty; this disease has a major impact on the productivity and income of individuals. Malaria also hinders children’s educational and social development, as a cause of both the absence from school and social environments, as well as the permanent neurological and other damage associated with severe cases of the disease.
On the other hand, poverty can also increase the risk of malaria, since those in poverty often live in areas with a high population density, making it easier for the disease to spread, thus causing higher and faster rates of transmission. To make matters even worse, people living in poverty also don’t have the financial capabilities to cover the direct costs of malaria. These include the personal and public expenditures on the prevention, medical treatment, research and education on malaria. In countries with high malaria prevalence, as much as 40% of the public health expenditure goes out to malaria. The African government has had approximately $12 billion loss in direct costs of malaria and the GDP growth has been decreasing 1.3% each year.
As you can see, malaria perpetuates a vicious cycle of poverty, which only serves to worsen the effects of the disease.
Disappointing elimination efforts
Intensive efforts to eliminate malaria in the most severely affected tropical countries have been largely ineffective. In many parts of the world, the parasites have developed resistance to a number of malaria medicines and also to the insecticides used. Climate change also plays an important factor, as this will expand the range of malaria to previously safe high-altitude territories, putting millions of people living here at risk. As resistance to drugs and insecticides as well as climate change continue to devastate the world, malaria cases are bound to increase in the coming years.
However, a lack of financial resources is one of the biggest barriers to eliminating malaria. An estimated $5 billion is currently needed to intervene with existing prevention and treatment methods. All of these reasons point to the fact that it is crucial to find an alternative solution for the prevention and elimination of malaria – especially one that is financially advantageous. This is where Jessie MacAlpine’s research comes into play.
Mustard Oil: a Potential Alternative Solution
MacAlpine has discovered that one dose of 10 mg mustard oil, a cooking oil that is used in developing countries, can be used as an antimalarial drug to inhibit over 90% of malaria infection. This dose of mustard oil can be given orally and its only “side effect” seems to be inhibiting bladder cancer.
Ahead of the Game
Current methods on the market to prevent malaria include medications and mosquito control. Of the different mosquito control treatments that are currently available, the insecticide-treated mosquito nets (ITNs) can be highly effective. Unfortunately, only half of the Sub-Saharan African population owns one of these nets, meaning that the other half is not protected against the infected Anopheles mosquitoes. The main problem is a lack of availability of these nets and the fact that there is a gap between what these nets cost and what a local family can and will pay for them.
When it comes to antimalarial drugs, the most common treatments are currently: Chloroquine, which is the most effective antimalarial drug known in history, and the Artemisinin-based Combination Therapy (ACT), which is highly recommended by the WHO. Unfortunately, these bring with them negative side effects and high costs.
Chloroquine is the most inexpensive drug currently on the market, but it has side effects that include nausea, diarrhea, blurred vision, sleep disturbances, and a chronic skin condition called psoriasis. ACT is a therapy used by combining drugs from different categories, in order to reduce the risk of developing resistance against the parasite. Unfortunately, ACTs can cost up to $11 when buying over the counter and a full course of an adult treatment of ACT can be up to 65 times the minimum daily wage. Depending on which drugs are combined, the side effects can range from vomiting, and nausea to diarrhea. ACT is also not recommended for pregnant women as there is still a lot of uncertainty around whether the drug causes developmental abnormalities. Not only are the prices and the side effects unattractive for people infected by malaria, but there is the added lack of availability which makes these drugs difficult for the locals to attain.
Aside from mustard oil being advantageous when comparing its side effects with those of the current treatments on the market and its availability to those most affected by malaria, it is also extremely economically viable and competitive with the efficacy of current antimalarial drugs. Based on the results attained from testing mustard oil, it was discovered that a single 10-mg dose is needed to inhibit 90% of the infection in human blood. This would cost 1 million times less than Chloroquine, the cheapest drug currently on the market. Based on the current economic value of mustard oil, this means that $30 could purchase 10 million doses, making mustard oil a breakthrough in the antimalarial drug market.
Jessie MacAlpine has been involved in Science Fair Projects since she was 7 years old, with one research idea leading her to the next. In high school, she developed an extremely effective non-selective bio-herbicide composed of garlic mustard roots, using coffee grounds, and water, which is currently being reviewed for an international patent. What she didn’t know at the moment was that this discovery would lead her into game-changing malarial research. One day, after discussing with the People Reaching Out Club at her school and researching which medication they could fundraise for developing countries, she came across an article in “Nature” on the potential for herbicides to treat malaria. Looking more into it, she discovered that the malaria parasite contains a vital organelle similar to a certain chloroplast of plants, and she realized she could modify the active ingredient in her herbicide to make it a treatment for malaria. Soon after, she contacted the laboratory in Toronto at MaRS Discovery District where she started running experiments to screen the potential antimalarial drug. What she then discovered was that the active ingredient in her herbicide was actually found as pure mustard oil, a cooking oil which is produced and used frequently in countries with high malaria prevalence. After various experiments and even a clinical study, they discovered that the active ingredient in mustard oil could inhibit 90% of the malaria infection and that even in high doses of the drug, the only side effect was an inhibition of bladder cancer, making it an extremely promising treatment for malaria.
Her research won her the honour of Top Youth Medical Researcher in the entire world (Best in Medicine at the Intel International Science and Engineering Fair). She was also declared the top researcher in the world that offers the best sustainable solution to a global issue. She received the International Cooperation Prize at the European Union Contest for Young Scientists (the top international research presented at the contest) and very recently, she won the 2014 Canada’s Top 20 under 20.
Making a Difference
MacAlpine’s future ambitions consist of finishing a doctorate degree in biochemistry and starting a biotechnology company to market both this antimalarial drug and her garlic mustard bio-herbicide. Both products are currently being patented and mouse trials for the malaria drug are being done at Mars Laboratory. Soon she will also be starting a new project, which could act as a potential therapy for AIDS.
Since an estimated $5 billion is currently needed to make the existing prevention and treatments for malaria possible, mustard oil offers a very advantageous alternative as it is economically viable and can be readily available. With half of the population currently vulnerable to malaria and climate change, expanding the range of infectious diseases, mustard oil is extremely promising as an effective, inexpensive and accessible alternative to antimalarial treatments currently being used. At the moment, MacAlpine is running mouse trials with the hopes that positive results will lead her to advance to clinical trials. Subsequently, she hopes that she can focus on creating awareness and distribution channels to get the drug to those who need it most. With mustard oil being so readily available in these places, her dream is that in the future, individuals could just take a spoonful of mustard oil from their cupboard as soon as symptoms arise. In order for this dream to become a reality, however, much remains to be achieved.
Fiorella Wever is a third year student studying Life Sciences at the University of Toronto.