Last week I read that Oxford University’s Jenner Institute had completed Phase II trials for a malaria vaccine that demonstrated a 77% efficacy. Malaria affects 500 million people on the globe; annual deaths due to malaria are as high as 1 million per year. Most are among young children. Previous attempts to develop a vaccine have been hindered by the complexity of the malaria parasite—any of several species in the genus Plasmodium—which invades host cells and whose genome contains thousands of genes.

Before leaving for Kenya, I had received a prescription for the antimalarial drug Lariam (mefloquine hydrochloride). It has an interesting history. Due to our nation’s experience in Vietnam and Southeast Asia, the US Army began a research program to find a vaccine for the disease; lariam was the fruit of the research. Its discovery was timely as the disease had developed a resistance to the standard treatment of the period.

The primary commercial potential of Lariam lay in its ability to prevent malaria in tourists and business travellers to the tropics. Prior to their obtaining FDA approval, however, no randomized Phase III tolerability study was carried out on the drug in a normal study population of healthy civilian volunteers. Likewise, there was no serious attempt prior to licensing to explore the potential drug-drug interactions of Lariam. Within months of their being licensed, reports of safety concerns around Lariam began to emerge. While it had the normal range of side effects, one of the effects was neuropsychiatric disturbance. If it manifested itself, it was in the form of vivid and disturbing dreams. I was unaffected, but my partner in mission had some truly psychotic dreams.

In Kenya it was used as a treatment if you got malaria. We were prescribed it as a prophylactic treatment. The pharmacist in the town of Kisii had received his PharmD at the University of Oklahoma. When I wandered into his establishment, realizing I was from the United States, invited me in the back office for chai and chat. As part of the conversation he noted the newly issued WHO and CDC warnings about Lariam as a prophylactic treatment for residents in malaria areas. He recommended that I stop taking the drug, wear long sleeve shirts at sunrise and sunset, and take the normal precautions.

Chandalua

I spend my nights under a chandalua
Imagine pronouncing the word with the most glorious of French accents
Such an exotic word
Bringing to mind images of grand ballrooms, the dining rooms of the world’s elite, where decisions are made, fortunes traded and one is safe from the world of the commoner
Chandalua
In the language of East Africa it means mosquito net
I spend my nights under a chandalua
Fortunes are not made under this particular net, but I am safe
Safe from the most deadly animal on the planet – the mosquito
For now, that is exotic enough.

A mosquito net is the most basic of precautions. Did I get malaria? I did and took Lariam as a treatment and things were fine. What was it like? For me, it was like the flu; a couple of days off and then back to normal. I had easy access to doctors, pharmacists and medicine. Others were not so fortunate. Most survived, but some did not.

There were local plants that were used to create a solution in which to soak your chandalua. I remember the first night under the treated net. You could hear the mosquitoes starting to gather sensing a warm-blooded target (me) in the room. They drew closer, landed on the net, and then heard their buzz rapidly wane – meanwhile, I am imagining the old Raid commercial, “This stuff just kills me.” In the morning a quick shake of the net outside recycled the night’s harvest.

All part of life overseas with the people of Kenya.