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The Crunch # 58

The War on Malaria has just entered its third, and most critical phase. Plus, ayurverdic 3D printing, Icelandic cricket + the Interwebz, and so much good news we ran out of space. 

He was an impenetrable darkness. I looked at him as you peer down at a man who is lying at the bottom of a precipice where the sun never shines … I was startled to hear him say a little tremulously, ‘I am lying here in the dark waiting for death’ … He cried in a whisper at some image, at some vision, — he cried out twice, a cry that was no more than a breath — “The horror! The horror!”

Joseph Conrad
Heart of Darkness (1899)
With tears and toiling breath,
I find thy cunning seeds,
O million-murdering death.
Sir Ronald Ross
 Winner of the Nobel Prize for Medicine (1902)

Malaria is old. And it's mean. Humans have been suffering at the hands of the plasmodium parasite for a long time. Historical reports of malaria symptoms appear in texts as far back as the ancient Egyptians and the Greeks, and at various times the disease has affected nearly every region of the world. Joseph Conrad was terrified of it, and Shakespeare called it "the ague" and used its “poisoned air” and “reek of rotten fens” (the smell of mosquito breeding grounds) as his favourite metaphor for all things wicked. 

For good reason. Over the course of our species' history, malaria has killed more people than all of humanity's wars combined. It continues to be a far deadlier killer than human beings. Murders account for around 437,000 deaths annually, while malaria killed 445,000 people in 2016, nearly one life every minute. It killed twice as many people as Ebola during West Africa’s Ebola crisis, and is responsible for the majority of deaths in South Sudan and in those parts of Nigeria still battling Boko Haram. It is the disease most frequently dealt with by Medecins San Frontieres medical teams, who treated 2.5 million people for it in 2017.

There are five types of malaria that can infect humans. Plasmodium falciparum, the most commonly found type in sub-Saharan Africa, is the most malicious. It causes half of all malaria cases and about 90% of deaths. Most of those are babies and young children. It's an agonising way to go - shaking, sweats, fever, vomiting, splitting headaches, terrible pain, and eventually death, in as quick as 48 hours. Even if you survive, it can leave you permanently brain damaged. Here is one person's description:

I awoke to what felt like lightning going through my legs, and then spreading through my body and in my head. Probably the worst headache, body aches, and chills you could possibly imagine. It felt like I was being stung repeatedly by an electric shock gun and could barely control my movements. The pain was so intense; I believed I was dying.
a magnified drop of infected blood - the plasmodium parasite amongst red blood cells

Fighting this disease is a war that's truly worth waging.

The first phase of that war took place in the 1950s and 1960s. At the time, malaria was endemic in many places, including southern Europe and the southern states of the United States. By the 1970s, much of the rich world had wiped it out. However once the global focus moved on, malaria returned with a vengeance, gaining a stranglehold on Africa. It was a silent disaster, flying under the radar for the rich half of the world's population that no longer needed to worry about it.

That changed in 2000. The war on malaria entered its second phase, with the Abuja Heads of State Declaration and the launch of the Millennium Development Goals. Philanthropic and government spending increased 15 fold, and by 2015, one billion insecticide-treated mosquito nets had been given out in Africa alone. Cheaper drugs arrived on the market, and the introduction of rapid diagnostic tests made it possible to figure out whether someone was suffering from malarial or non-malarial fevers, making quicker treatment possible. 

Progress was remarkable. 17 countries managed to eliminate malaria, and 21 came close. Several countries in the Middle East and central Asia were certified as malaria-free, including Morocco, Armenia and Turkmenistan. In 2017, Kyrgyzstan and Sri Lanka joined their ranks, having gone three years without recording an indigenous case. China used to have 24 million annual malaria cases in the early 1970s; last year, they announced that nobody was infected via mosquito bites, and are aiming to declare the country malaria free by 2020. 

This second phase was the one that turned the tide. By ramping up funding, and concentrating it on one disease alone, the fatality count fell from 839,000 at the turn of the millenium to 446,000 in 2015. In the space of 15 years we managed to save 7 million people - mostly children - from truly awful deaths. It's one of the most remarkable and under-celebrated public health achievements in our species' history. 

That phase is now over. Progress has stalled.

The World Health Organisation's most recent annual malaria survey reported that in 2016, for the first time in a decade, there were 5 million more malaria cases than in the previous year. Progress has also stalled on on reducing mortality: 445,000 deaths in 2016, only a marginal decline from 2015.

Part of the problem is that funding seems to have plateaued. To beat malaria the world needs to be spending $5bn to $6bn per year, and yet in 2016, only $2.7 billion was made available. 216 million people in 91 countries are still being infected every year. The same tools aren't as effective and resources don't stretch as far. Mosquito nets soaked in insecticide are the primary form of protection, but despite incredible progress, more than half of households in sub-Saharan Africa don't have them yet. Mosquitoes have also been evolving the ability to resist the pyrethroid insecticides most commonly used on the bednets, and the trait is spreading, putting millions of lives at risk. 

Malaria is fighting back, and the world is now at a crossroads.

The war is now entering its third, and most crucial phase. A response is starting to form. The new plan of attack is multi-pronged, and a lot more reliant on science and technology. At stake are nearly half a million lives a year. 

A new generation of mosquito nets impregnated with a new kind of insecticide, chlorfenapyr, have just been given the go ahead by the WHO - its first recommendation for a product based on a new insecticide class in more than 30 years. Another kind of net, incorporating a chemical called piperonyl butoxide, was trialled in a two-year study for 15,000 children in Tanzania, and reduced the prevalence of malaria by 44% compared with a net treated only with pyrethroid. 

A malaria vaccine is also in the works, after decades of development, and is currently being rolled out in Kenya, Ghana and Malawi. New genetic sequencing techniques are allowing data to be gathered in the field and transmitted swiftly to sophisticated surveillance systems, allowing scientists to identify evolving strains of malaria parasites and track drug and pesticide resistance. 

In the tiny African kingdom of Swaziland, one of the most effective tools is a telephone number: 977. When someone tests positive at a clinic, a nurse immediately dials the number to report the case to the country’s national emergency response center. The call triggers a text message to the national malaria program team, which dispatches investigators, armed with computer tablets, satellite maps and GPS, to interview the patient and test all people living within a kilometer radius of their home. A separate team is called in to reapply insecticide to the walls of homes in the community to help protect other families from infection.
Genetic sequencing and genetic editing technologies are also creating new approaches to combating the disease. Chinese researchers, for example, have been able to sequence the genome of Artemisia annua, a Chinese shrub producing a potent antimalarial compound artemisinina, revealing new ways to extract more antimalarial medicine from the plant. And earlier this year, a collaboration between British and US researchers revealed the core genes that are essential for the deadliest malaria parasite to survive, revealing new targets for drugs or vaccines.

Gene editing techniques are giving scientists the ability to create gene drive technologies that change a mosquito's DNA. In the ones that transmit malaria, genetic changes can be used to cause infertility or permanently change the insects' ability to carry and pass on the parasite. These approaches are controversial; people are understandably concerned about 'tinkering' with nature. However, as Bill Gates recently pointed out when asked about the controversy, "Malaria itself is quite controversial - it kills about 400,000 kids a year."

Ultimately, the next phase of fight against malaria will take many years and a range of tools both new and old, from bednets and mosquito traps to a new vaccine and next generation gene tools. And none of it will happen without funding. Fortunately there's signs of hope there too. Less than a month ago, at the 2018 Malaria Summit in London, 14 heads of state and leaders from science, business, and the aid sector committed $4.1 billion toward research, malaria treatments, prevention methods, and transmission surveillance.

This story, of the war on malaria, is one of the most epic things humans are engaged in right now. There are thousands of people racing against time in labs all over the world, and hundreds of thousands of volunteers, doctors and nurses on the frontlines, working every day to fight back against our ancient killer. Their efforts have already achieved the greatest public health success story of this millennium, but the work is far from finished. Billions remain at risk. It's a fight worth having. Humanity may be on the brink of wiping out one of its oldest and deadliest foes - but only if we start paying a lot more attention. 

Good news you probably didn't hear about

We're slackers, and haven't sent a newsletter in four weeks. So many great things have happened around the world since then that we couldn't fit it all in here. If you want the full list of all 18 good news stories from the last month, it's up on the website. For now... here's our top eight. 
Costa Rica's newly elected president, Carlos Alvarado, has announced a nationwide ban on fossil fuels, aiming to become the world's first decarbonized society. TeleSur

China is now adding an electric bus fleet the size of London's every five weeks. If they continue at this rate, by 2025 half the world's buses will be battery powered. Bloomberg

70 years after independence, India has finally managed to bring electricity to every village in the country (three years ago, 18,452 villages had no electricity). Moneycontrol

Still worried about the kids? In the last generation, arrests of Californian teenagers have fallen by 80%, murder arrests by 85%, gun killings by 75%, imprisonments by 88%, teen births by 75%, school dropouts by half, and college enrollments are up by 45%. Sacbee

The proportion of people being sent to prison in the United States has fallen to its lowest level in 20 years, according to new data from the Department of Justice. Pew Research

Trinidad and Tobago is set to decriminalize homosexuality, and Pakistan has passed a law guaranteeing basic rights and outlawing discrimination against transgender citizens.

Eight months after enacting the world's toughest plastic bag ban, Kenya's waterways are clearer, the food chain is less contaminated – and there are fewer 'flying toilets.' Guardian

Colombia has announced it will protect 80,000 km2 of new land for conservation and will also give indigenous communities autonomy to govern their own territories. Yale360

Indistinguishable from magic

NASA's new exoplanet hunting satellite has just been launched, and over the next two years will observe 85% of the sky, searching for thousands of new worlds.

Delhi Police got their hands on facial recognition glasses a month ago. First thing they did? Track down nearly 3,000 missing children from the city's orphanages in four days. NDTV

The World Food Program is using the Ethereum blockchain to run its entire food distribution program for 100,000 refugees living at the Zaatari camp in Jordan. MIT TR

Inspired by the work of Alan Turing, Chinese researchers have developed a nano-technology saltwater filter that's three times better than conventional filters. Nature

Our ayurvedic readers (not many of those) will be pleased to hear that coating 3D printing scaffolds in turmeric reportedly improves bone regeneration by 45%.

Harvard biologists have adapted a technique from astronomy to invent an incredible new microscope that captures live, 3D movies of cells inside living organisms. HMS

Genome 'writers' have started the practical work of improving on nature, announcing that their first target is to recode human cells so that they cannot be infected by viruses. STAT

The information superhighway is still awesome

Janelle Monae is the most talented musician in the US, and Childish Gambino is the smartest. Their new videos say more about America in 2018 than 1,000 op-eds ever could.

Interested in ethical discussions about the development of robot consciousness? Check out Kayla Ancrum's very funny, and very clever synopsis of the next 35 years of debate. 

There’s no scientific basis for race. New genetics now show that everyone alive today is descended from a few thousand humans who left Africa 60,000 years ago. NatGeo

Regular readers know how we feel about ketamine as a new treatment for depression. This in-depth investigation from Wired is the best thing we've read on the subject yet. 

Forget Myers-Briggs - the five different flavors of magic from the colour wheel in Magic: The Gathering is a far better method to identify different personality types. Medium

Wait But Why is back (after what feels like years in the wilderness) with some career advice. Make yourself a nice cup of tea, and give yourself an evening to get through it all. 

Best internet story ever. Iceland's cricket team needed funding, but couldn't get any, until word reached cricket fans on r/Cricket. The subreddit is now their official sponsor. Beebom

All your moneyz should belong to us

Time to announce the latest recipient of the funds our readers have raised on Patreon

We're sending US$2,400 to the wonderful people at E-NABLE Canada, who are teaming up with E-NABLE Nepal to set up a 3D printing lab in Kathmandu to print prosthetic hands and arms for recipients all over the country. The donations from you, our Future Crunch subscribers, will be used to buy two 3D printing machines. The whole thing is volunteer run, so all funds are used for equipment and materials only. 

We love this project because it's a great example of technology making goods and services available to people that didn't have access to them before. Prosthetics have traditionally been too expensive for most people on the planet - but thanks to additive manufacturing and open source code, that's no longer the case. If you'd like to find out more about the E-NABLE community, check out the video below.

We are done here. Apologies for being slackers. Will try harder next time. 

If you'd like to support our work, then please consider joining our Patreon. For the price of a small morsel of avocado on toast, you can help us get funding to people using science and technology to do some amazing things in the world.

Or not. You may just wish to tell a friend to subscribe right here

Much love,

Gus and Tane
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