Malaria is endemic in Malawi, especially in the areas around Lake Malawi, the 350-mile-long lake that sits between Malawi, Mozambique and Tanzania. Malawi has a high infant mortality rate, declining life expectancy and an estimated 1 million orphans, mostly because of the HIV/AIDS epidemic. In Lilongwe, University of North Carolina at Chapel Hill researchers have been researching HIV prevention and treatment, sexually transmitted disease management and malaria vaccine development. [Image 2 of 6 related images. See Image 3.]
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Cameron Taylor, a University of North Carolina at Chapel Hill undergraduate student, went to Lilongwe in Malawi in the summer of 2008 to help lay the groundwork for a Phase III clinical trial of the most promising malaria vaccine to date. Like most other sub-Saharan countries, Malawi is hard-hit by malaria, and the vaccine trial is gaining popularity among Malawians.
But this isn’t your standard clinical trial. Run by the Malaria Vaccine Initiative and the pharmaceutical company GlaxoSmithKline, it’s a double-blind trial with 16,000 kids -- and a bunch of geographers.
Vaccine trials usually compare how many people get the disease in a vaccinated group to a group given a placebo. But medical geographer Michael Emch thinks researchers should consider more factors, such as where the participants live, whether they’re exposed to the disease, and how frequently they’re exposed. "Maybe there’s some sort of pattern to the communities where a vaccine doesn’t work well and where it works really well," says Emch. What if those patterns could be changed to make the vaccine work better?
Emch and his team have been developing new clinical-trial methods in a field called spatial epidemiology, which he hopes will lead to a better understanding of vaccine efficacy. After years of successful work on cholera vaccine trials in Bangladesh he was called to work on a huge malaria vaccine trial going on in Africa.
GlaxoSmithKline and other researchers reported encouraging Phase II clinical-trial results in 2007 for their malaria vaccine. It was given to two thousand infants and young children -- the people most vulnerable to the disease -- and it protected 53 and 65 percent of them, respectively, against malaria. This past summer, a Phase III clinical trial began at eleven African sites, one of which is the UNC site in Lilongwe.
Emch's research is supported in part by the National Science Foundation. (Date image taken: 2009; date originally posted to NSF Multimedia Gallery: Sept. 15, 2017)