Malaria, the Terrorist's Friend

Amir Attaran | 25 Sep 2003
New York Times
CAMBRIDGE, Mass. — When the United States Marine Corps went ashore in Liberia in August, it discovered an enemy that had no ties to the various factions in the civil war there. More than 50 of the 225 service members, roughly a quarter, who landed in Liberia last month were hospitalized because of a longtime scourge of mankind: malaria.

This figure reveals a troubling gap in the military's preparations for dealing with unrest and terrorism overseas. Existing medicines for malaria are so ineffective or have such unpleasant side effects that they offer little real protection, yet many of the places terrorists could hide are rife with the disease.

The Department of Defense knows that malaria — which causes fever, and if untreated, anemia and death — is a threat. In Liberia, the marines were armed with the best malaria medicines, mosquito repellents and antimosquito suits that the Pentagon's money could buy. Since the Vietnam War, when malaria was the most common cause of hospitalization after combat wounds, commanders have known that soldiers in the tropics are vulnerable. A malaria epidemic during the Somalia deployment in the early 1990's reinforced this lesson. Yet little has been done despite scientists' warnings and abundant evidence that existing medicines are near the end of their useful life because drug-resistant strains of malaria have emerged.

Although the Army has the world's most successful malaria drug laboratory — the Walter Reed Army Institute of Research has discovered three of the five most effective drugs since World War II — the Department of Defense allocates it only $8 million a year. Other contributions raise the institute's budget to $13 million.

These sums are woefully inadequate. If a terrorist group had a weapon that would hospitalize 25 percent of American soldiers within weeks, wouldn't the Pentagon spend more than $8 million a year to defend against it?

The malaria cases in Liberia provide a lesson to any budding terrorist: base yourself in a tropical country with lots of deadly Plasmodium falciparum malaria. If you recruit locals to your cause, their acquired immunity will keep them relatively safe. And if America sends troops, they'll soon be too incapacitated to do much.

In a world where terrorists are as mobile as the soldiers pursuing them, America can hardly afford to declare some places off limits. Yet our troops' vulnerability to malaria is so great, as the Liberia deployment proves, that we may have to do just that, even when they are protected by the latest technology.

What is needed is a crash program of malaria drug development. The announcement this week by the Bill and Melinda Gates Foundation that it was awarding grants of $168 million for vaccine and drug research and malaria prevention programs in Africa is welcome news. But the United States must do more. Instead of $8 million a year, Congress should appropriate $200 million for a partnership between the Army's labs, other government labs and the pharmaceutical industry. This is reasonable and commensurate with what the administration is spending on preparedness for other biological threats, like smallpox and the ebola virus.

There is also a humanitarian bonus. Not only would these new medicines improve America's military preparedness, but they would also probably help the one million or more people worldwide who are killed by malaria every year.

The choice is to spend a few million out of a Pentagon budget measured in the hundreds of billions, or to cede a huge swath of the tropics to terrorists proliferating under the protection of mosquitoes and microbes mightier than American troops.

Amir Attaran, an immunologist, is a fellow at the Royal Institute of International Affairs and the Africa Fighting Malaria Foundation.