The chiefs in the Kenyan coastal district of Kilifi called people to meetings recently and asked them to co-operate with the researchers who would be arriving along the pocked road to launch a malaria-vaccine trial. The mothers told their chiefs that they would participate, if asked. But, among themselves, they worried.
For one thing, there was that snake in the logo painted on the sides of the sleek, white SUVs the researchers drove. A ubiquitous sign of healing in the West, to these women the snake was a demonic symbol. Then there was the problem of the blood samples.
“When they come, they take a lot of blood,” said Agnes Ndoro, a farmer and mother who is unsure of her age. “We fear where this blood is going. We have a belief that demons feed on blood.”
On the face of it, these farm women might seem like people that time has abandoned to the cyclic, all-consuming struggle of survival. Death comes so often and in so many forms that it seems better explained by superstition than reason.
In fact, the mothers of Kilifi find themselves at the forefront of the most technologically sophisticated and costly onslaught ever to be brought to bare on malaria, a scourge that kills a million children each year.
This year their children will become part of the largest and most advanced trial ever of a malaria vaccine. It's funded by the multinational pharmaceutical giant GlaxoSmithKline and the Bill and Melinda Gates Foundation.
The stories of the mothers of Kilifi open a window on the challenges faced by researchers as they build a trial that will include more than 16,000 babies from 11 sites spread across sub-Saharan Africa.
The first five babies were inoculated in Tanzania in late May. Scientists and doctors are readying millions of dollars worth of new laboratory equipment, training field workers and canvassing mothers in rural villages in Burkina Faso, Gabon and Ghana in the west, Mozambique and Malawi in the south and Kenya and Tanzania in the north to sign up the final volunteers.
Malaria is so deadly and the search for a vaccine has been drawn out over more than two decades, in part, because of the fluid adaptation of the parasite. It shuffles its surface proteins to adapt to new circumstances. If a vaccine is to be worth implementing, it must be capable of taking on malaria no matter where it is or what its guise.
“It's a historic milestone in the fight on malaria,” said Patrick Duffy, who directs the malaria program at the Seattle Biomedical Research Institute and is a grantee of the Gates Foundation. “It's such a huge undertaking. Like a trial anywhere, you need to get a diverse group of people all aligned on this single goal and to meet the same standards for an international trial.”
It is a task that pits hundreds of scientists, doctors and field workers against floods, famine and corruption that corrode the very core of health infrastructure and breeds deep public distrust. They believe it's worth it.
Pediatrician Patricia Njuguna, who will help oversee the trial, first came to Kilifi as a medical officer. During the rains of April, May and June, when malaria spreads fastest, small bodies – some comatose, others struggling through seizures – are packed two or more to a bed in the pediatric intensive care ward.
“You would do an on-call and find five very sick children needing intensive care,” said Dr. Njuguna, who is a principle investigator on the crucial phase-three trials. “So the idea of a vaccine to really reduce the cases was very enticing to me.”
