In my book ‘Malaria is spread by mosquitos?’  I made the point that even within the vast quantity of peer reviewed research focusing on supporting the conventional mosquito-plasmodium narrative there are hints to what might really be causing the illness. And one reference this week in Malaria World is an example – ‘Close Proximity to Mining Is Associated with Increased Prevalence of the Drug Resistance-Associated Mutation dhps540E in Eastern Democratic Republic of the Congo’ by Mitchell et al. Images of children mining for cobalt for electric car batteries in the Congo came to mind. Unfortunately, the article is behind a paywall. Clearly its hypothesis, supporting the consensus cause, is that mining somehow lessens the effectiveness of the old standby drug, sulfadoxine-pyrimethamine, for treating malaria. But could the real cause be exposure to toxins from mining – heavy metals, chemicals and particulates? Mining has always been known to cause illnesses.

So, I searched the terms malaria and mining and a long list of peer reviewed literature emerged. As with the first article that piqued my attention many were behind paywalls. However, one ‘Nature’ open access article ‘Risk factors of malaria transmission in mining workers in Muara Enim, South Sumatra, Indonesia’ by Hasyim et al had interesting background references that indicate a link between increased prevalence of malaria and mining activities in Africa and South America as well as Asia. The major finding of this research revealed that smallholder mining areas were risky areas for malaria transmission. The study foci themselves are of less interest – the usual statistical effort to justify nets, internal insecticide spraying and mosquito repellent.  Somehow the ‘elephant in the room’, the exposure to toxins and particulates that are part of the mining process escapes considered attention.

The Johns Hopkins Malaria Minute asks if genetic approaches could be a sharper tool in the ‘malaria toolkit’ to go with old standbys like bed nets and indoor residual spraying. Its quotes Dr Damaris Matoka-Muhia of the Kenya Medical Research Institute who considers gene drives a potentially sustainable, long-term, and cost-effective solution for malaria – especially as resistance dulls other tools. And in Kenya, there are regulations in place to support gene drive implementation.

But as I stated in ‘Malaria is Spread by Mosquitos?’, these advanced bio-weapon methods are interesting topics to fund dubious scientific research. However, the likelihood that they could be of benefit even if mosquitos spread malaria is highly dubious. And because it seems unlikely that the conventionally accepted malaria transmission narrative is real, these research topics are doubly useless.

And to strengthen this point there was an article in Malaria World this week ‘Talking About Gene Drive in Uganda: The Need for Science Communication to Underpin Engagement’ by Hartley et al funded by the Wellcome Trust. The researchers found a paucity of information available and political sensitivities to genetic technologies. Gene drive organisms are designed to spread in wild populations, which means they could cross regional and national boundaries. The idea of gene drive is that the modified organisms are biased to ‘drive’ selected genetic characteristics higher than the typical 50% chance of inheriting a particular trait. One approach is biasing toward male offspring to reduce number of breeding females in future generations.

The study itself is a popular type in malaria academia, a communication analysis with focus groups and other methods, to try and understand why the general public do not understand this great plan. The details can be found in the linked paper.

But in reality, one does not need a very sensitive BS detector to work out that gene drive is not a sharp tool and no amount of explaining will change that. In the 19^th century Charles Darwin developed a theory that confounds this idea. Mosquito numbers are limited by food availability especially at the larval stage. If there are fewer larvae, each that is will have a greater chance of survival. The offspring of the fewer females in the first generation will be more likely to survive. As time goes by the effect of the modified organisms will disappear and unadulterated mosquitos will predominate. Elementary statistical analysis of genetic evolution over time clearly demonstrates that in most cases 50% male female ratio is stable. I recommend works by Richard Dawkins and others on this topic (The Selfish Gene is good on this).

In Malaria World this week there is a press release from GAVI about Mozambique introducing malaria vaccines into routine immunisation. GAVI describes the vaccine as lifesaving and  a critical step forward to revitalize the fight against malaria and improve children’s survival.

The vaccine introduced in the childhood vaccination schedule in Mosambique is the same R21 vaccine that I examined earlier and is only safe and effective when compared with an Indian Rabies vaccine. There was no trial with a true harmless placebo. It beggars belief that Mozambique thinks it is improving the life of its infants by facilitating this programme.

In its own words Gavi, the Vaccine Alliance is a public-private partnership that helps vaccinate more than half the world’s children against some of the world’s deadliest diseases. The Vaccine Alliance brings together developing country and donor governments, the World Health Organization, UNICEF, the World Bank, the vaccine industry, technical agencies, civil society, the Bill & Melinda Gates Foundation and other private sector partners. The full list of donor governments and other leading organisations that fund Gavi’s work is available on its website,  www.gavi.org.

Since its inception in 2000, Gavi claims to have helped to immunise a whole generation – over 1 billion children – and prevented more than 17.3 million future deaths, helping to halve child mortality in 78 lower-income countries. Gavi also claims to play a key role in improving global health security by supporting health systems as well as funding global stockpiles for Ebola, cholera, meningococcal and yellow fever vaccines. After two decades of progress, Gavi is now focused on protecting the next generation, above all the zero-dose children who have not received even a single vaccine shot! The Vaccine Alliance employs innovative finance and the latest technology – from drones to biometrics – to save lives, prevent outbreaks before they can spread and help countries on the road to self-sufficiency.

I like many others was awakened to the dangers of vaccines by the overreach during the COVID pandemic. My greatest regret now is that I allowed my children to have all the prescribed childhood vaccines without questions. They have not been subject to proper placebo-controlled trials and target diseases whose prevalence was already decreasing as a result of improvements in water and food supply and sanitation.

And now it seems that because of the increasing scepticism in the west, GAVI and other poison pushers are redoubling their efforts in the Global South.

This week malaria world featured an interesting article about the ‘collateral damage’ caused by insecticides used against mosquitos and how the effect on nuisance insects is a major reason people continued to use insecticide treated nets. The authors are concerned that the development of resistance by bedbugs and cockroaches to the insecticides usually used on insecticide treated nets was discouraging continued use of these products.

‘Review on the impacts of indoor vector control on domiciliary pests: good intentions challenged by harsh realities’ by Hayes and Schal of North Carolina State University was published by the Royal Society. This review identified 1,248 potential articles and narrowed examination to a final total of 28 peer reviewed articles of most relevance.

They found that recipients of insecticide treated nets and other indoor and outdoor insecticide treatment programmes are more likely to continue their use if they are effective against nuisance insects such as bedbugs, cockroaches and house flies. But as insecticide resistant strains of these pests become more common, they are more likely to discontinue their use.

This suggests that many people in the target countries (including Tanzania, Gambia, Papua New Guinea, Botswana, India, Ethiopia) may value the effect of these insecticides more on reduction of nuisance insects than they do as a prevention of bites by the supposed disease vector mosquitos. They do not seem as concerned with preventing mosquito bites.

If the instinct of the potential victims is ambivalent, again, the question has to asked – why are malaria researchers so convinced that the disease diagnosed as malaria is actually spread by mosquitos? The underlying basis for this belief, the research carried out 120 years ago by Ross, Grassi and others is far from convincing. I refer to my books ‘Malaria is spread by mosquitos?’ and translation of Grassi’s ‘Studies Of A Zoologist About Malaria’ for more information.

Last week in Malaria World there were two articles about the resistance of malaria to artemisin derived treatments. Artemisinin-resistant malaria in Africa demands urgent action by Dhorda et al and Immediate policy changes urgently needed as drug-resistant malaria spreads in East Africa from the Centre of Tropical Medicine and Global Health.

The core of the research, sponsored by the Wellcome Trust, is that the efficacy of artemisinin derivatives, the cornerstone of current treatments for malaria, is being compromised in Africa. Mutations indicating artemisinin-resistance have been found in more than 10% of malaria infected individuals in Ethiopia, Eritrea, Rwanda, Uganda, and Tanzania. Dr Mehul Dhorda recommends that “Combining an artemisinin derivative drug with two partner drugs in triple artemisinin combination therapies (TACTs) is the simplest, most affordable, readily implementable, and sustainable approach to counter artemisinin resistance.”

Typically, triple artemisinin combination therapies (TACTs) are extra combinations such as artemether-lumefantrine with amodiaquine, and dihydroartemisinin-piperaquine with mefloquine. More details are  in Kokori et al Malaria Journal article (2024) Triple artemisinin-based combination therapy (TACT): advancing malaria control and eradication efforts.

The Kokori article goes to great length to extol the benefits of three treatments together instead of one but the evidence does not seem very convincing. They note that adding mefloquine or amodiaquine to existing artemisinin-based combinations was associated with a slight increase in the incidence of vomiting. And adding amodiaquine slightly prolonged the QTc interval (a measure of the heart’s electrical activity), although it did not reach levels associated with cardiac arrhythmias. And as for efficacy, TACT was not inferior to ACT for treating uncomplicated Plasmodium Falciparum malaria!

Also, coincidentally this week I saw for the first time a tweet associating artemisinin with detoxification of COVID-19 vaccines (and also as a treatment for COVID). This information from China is interesting. I have no reason to suspect that it is any more effective at treating these than it is at treating malaria, but if were suffering seriously from the side-effects of you know what I might be inclined to try it.

An article in Malaria World by Alemayehu et al., Asymptomatic malaria in pregnancy and associated risk factors in Majang Zone, Gambella Region, Southwest Ethiopia: a hard-to-reach malaria hotspot, examines the association of various factors with the occurrence of asymptomatic malaria in pregnant women.

I am suspicious of the description of illnesses as asymptomatic especially since such reports were used to raise fears during the COVID19 pandemic. In this paper three methods were used to identify asymptomatic cases. The overall prevalence of Asymptomatic malaria in pregnancy (AMiP) was 15.3%. It was 11.3% measured by rapid diagnostic tests (RTD), 11.8% by microscopy and 17.6% by PCR. (With PCR the prevalence of ‘asymptomatic illness’ is significantly greater than the other two methods of detection. It is unclear how it can be considered a valid diagnostic test).

Those who tested positive were associated with not utilizing insecticide-treated net (ITN) within the previous week, having a history of malaria within the previous year and lack of indoor residual spraying (IRS) within the previous year. The second observation is obvious. The other two observations imply that if they had used the treated nets or sprayed their homes, they would have been less likely to contract their asymptomatic ‘illness’. But it does not say what other factors might be associated with these two factors and be the more likely reason. Poverty and malnutrition are probably associated with those who had less access to the interventions.

What was also interesting was the underlying justification for the research, that preventing asymptomatic malaria in pregnancy is a worthy enough goal to justify insecticidal and pharmaceutical interventions. Two articles were cited in the background for this. The first by Saito et al (2020) contains no evidence to support this. The second by Fried and Duffy (2017), a review article has a supporting reference, McGready et al (2012) with data that may support the goal.

This study of 17,613 chosen from 48,424 pregnant women in Thailand used microscopy to screen for malaria and determine if it was Plasmodium falciparum or Plasmodium vivax. Of the 17,613 pregnant women 80% delivered babies and 20% miscarried. 95% did not have malaria in the first trimester. The data state that 32% of those with asymptomatic malaria miscarried and 47% of those with symptomatic malaria miscarried. This does suggest that there is an association of asymptomatic malaria to increased risk of miscarriage, although notes in the article state than many data are missing.

But what does this mean? The microscopy analysis finds plasmodia in the blood. These organisms clean up dead cells and so indicate possible recent illness. Clearly those without symptoms are not as unwell as those with obvious symptoms but may have just recovered. As such it is not surprising that they were slightly more likely to have adverse pregnancy outcomes, but better than those with symptoms. It is also worth noting that most of those with symptomatic malaria in the study were treated with chloroquine, quinine or artesunate and were still very likely to miscarry.

And none of this research in any way supports the underlying mosquito-malaria hypothesis or proves that treatment will improve outcomes.

In Malaria World last week there was an article researching the uptake of intermittent preventive treatment in pregnancy (IPTp) in six sub-Saharan countries (Xu et al, 2024). This is just one example of many research papers that examine uptake of malaria preventative treatment and try to propose how to increase it. This would seem to suggest that the target populations are not enthusiastically participating in these programmes.

My Blog post from last week reported a correlation between incidence of malaria in 0-5 year olds and their mother’s participation in IPTp programmes during pregnancy. Clearly there is no mechanism by which this could be the cause so it is one case in which correlation is not linked to causation. The purpose of IPTp is to prevent malaria during pregnancy. So what evidence is there that IPTp is effective?

The introduction of the Xu paper references the WHO World Malaria Report, 2023, and states malaria is mostly found in tropical countries and poses the greatest risk to vulnerable populations, such as pregnant women, young children, international tourists, and people living with HIV. The report claims that in 2022, 35% of pregnant women in susceptible African nations were ‘exposed to malaria infection’. However, 22% of the population as a whole in these countries were exposed. There is greater risk, but could it be explained by other factors?

The increased incidence of malaria during pregnancy was shown in 1983 by Brabin in An analysis of malaria in pregnancy in Africa.  But women in all countries suffer from additional health issues while pregnant. Is it surprising that potentially malnourished pregnant women in poorer countries where ‘malaria’ is a commonly diagnosed illness might be more susceptible?

Based on this increased susceptibility, the WHO in 2012 updated recommendations that IPTp treatment with sulfadoxine-pyrimethamine (SP) should be administered as part of ante-natal care in susceptible countries at every ante-natal visit starting as early as possible in the second trimester, provided that doses are at least one month apart. The WHO claims sulfadoxine-pyrimethamine (SP) is safe and effective for pregnant women, a claim somewhat doubted by US FDA who grade it Pregnancy category C. Risk not ruled out: Animal reproduction studies have shown an adverse effect on the fetus and there are no adequate and well-controlled studies in humans, but potential benefits may warrant use of the drug in pregnant women despite potential risks.

So why are there no well-controlled studies in humans showing a benefit? No evidence is provided in the Xu et al paper, or any other research article I have reviewed, that there are benefits to pregnant women from administration of this toxic medication. I wonder why these research results are not available?

Malaria World this week has an interesting research article published in BMC by Mbishi et al that finds that poverty is a significant factor in the prevalence of malaria. The findings of the pooled data research article found that maternal education, household wealth and rural/urban place of residence had significant effects on the occurrence of malaria. This result concurs with observations from other studies and seems to point to the importance of factors other than mosquito bites.

But the article also found a positive benefit linked to Fansidar uptake during pregnancy. Fansidar is a Hoffmann-La Roche trademark for the malaria drug sulfadoxine/pyrimethamine frequently used in Intermittent Preventive Treatment of Malaria (IPT) programmes in target countries. This drug has the usual long list of potential side effects including stomach pain, feeling full, hair loss, headache, muscle weakness, depression, nervousness, ringing in your ears, sleep problems (insomnia), diarrhoea, dizziness, nausea, vomiting, and loss of appetite. An FDA warning states FATALITIES ASSOCIATED WITH THE ADMINISTRATION OF FANSIDAR (sulfadoxine and pyrimethamine) HAVE OCCURRED DUE TO SEVERE REACTIONS, INCLUDING STEVENS-JOHNSON SYNDROME AND TOXIC EPIDERMAL NECROLYSIS.

The benefit was associated with use during pregnancy. The data sheet also states There are no adequate and well-controlled studies in pregnant women. However, due to the teratogenic effect shown in animals and because pyrimethamine plus sulfadoxine may interfere with folic acid metabolism, Fansidar (sulfadoxine and pyrimethamine) therapy should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus. Women of childbearing potential who are traveling to areas where malaria is endemic should be warned against becoming pregnant, and should be advised to practice contraception during prophylaxis with Fansidar (sulfadoxine and pyrimethamine) and for three months after the last dose.

It is difficult to understand how their mothers taking Fansidar during pregnancy could cause a 26.9% reduction in the prevalence of malaria in children under five. It is not that the children are taking it. Given the side-effects it is probably wise for them not to. I won’t speculate. It could simply be a confounding of factors, perhaps a greater proportion of wealthier, urban women were enrolled in the IPTp programmes.

This week there was an article in Malaria World Newsletter of interest to those of us who do not live in countries in which malaria is supposedly endemic. The subject is blood donations. I am an active donor. I give blood because it supposedly reduces blood pressure. It is easy to see how this would be a short-term effect but would the effect last? But whether this is true or not, the blood may be of use to an accident victim, and my blood is uncontaminated with experimental medications.

But for 12 months after returning from Africa the Irish Blood Transfusion Service did not want my donations. I visited Gaborone in Botswana which is not on the malaria map. But because I changed planes in Addis Ababa in Ethiopia my blood was not wanted. I didn’t see a single mosquito at the airport, but the fact that I was transported to and from my planes by bus disallowed me as a donor for 12 months.

I doubt the mosquito-plasmodium link to malaria and do not see the benefit of this blood donation ban imposed by western countries. But the recent paper published in BMC based on data from Spain by Corbacho‑Loarte et al comes to the conclusion that blood donations are being restricted by the current rules and tests, even if one believes in the role of mosquitos and plasmodia.

In this study the blood of 121 potential donors, both immigrants and Spanish travellers from malaria endemic countries, who had positive results in immunological tests were retested using sensitive PCR assays. The PCR tests detect genes coding for ssrRNA, AMA1 or Plasmepsin of P. falciparum, P. malariae, P. ovale, P. vivax and P. knowlesi. All 121 tested negative for the Plasmodia.

Nevertheless, because of the positive immunological tests all 121 are still not eligible blood donors. One wonders what the objective of these restrictions are.

Response to Declaration for accelerated malaria mortality reduction in Africa by Ministers of Health of High Burden High Impact (HBHI) countries in Africa. Burkina Faso, Cameroon, Democratic Republic of the Congo, Ghana, Mali, Mozambique, Niger, Nigeria, Sudan, Uganda and Tanzania.

Dear Minister,

I am responding to your call to build collaborative partnerships for resource mobilization, research and innovation to further the goal that no one shall die of malaria.

First, I have a question for you – How do you know that malaria is spread by mosquitos?

The story of malaria transmission was first developed by medical officers in colonial armies – Charles Lavaran, a French army physician in Algeria and Ronald Ross, a British army Surgeon-major in India. Western health organisation and aid agencies continue the promotion of the transmission story and ‘cures’ based on it in a manner that has overtones of post-colonial interference. I expect that most of the aid workers have the best of intentions. They may not be aware that they are acting in a colonial manner using methods that are not in the best interests of your people and are more in the interest of western organisations.

I have a second question – how do you know that poisoning your children and your mosquitos will eliminate the scourge of malaria?

If malaria is not spread by mosquitos these ‘cures’ may cause only harm and do no good?

I have good news that may help you reduce the burden. I would like to collaborate, develop partnerships and innovate by looking at malaria in new ways.

Malaria is a disease that affects the malnourished and those without access to clean water and sanitation. It seems unlikely that it is a disease spread by mosquitos. Mosquitos are present in many countries that do not have malaria.

We can educate you about malaria, about its history, the difficulties with conventional treatment and an approach based on nutrition and WASH. The treatments promoted by some health organisations have not been proven effective such as the R21 vaccine discussed in my blog. https://usmalaria.com/blog/

The book is also available as a paperback, ebook and audiobook. Visit https://usmalaria.com/ for more information and links to the book.

We look forward to discussing malaria with you.