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FIGURE 3.8 Top 10 causes of deaths from infectious diseases, 1998.
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Source: WHO
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Areas of Significant Malaria Risk
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FIGURE 3.9 Areas of signi cant malaria risk (in gray).
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Source: WHO
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costs, including lost productivity and lost income associated with illness and death. Malaria is also a signi cant problem to the inhabitants of India, Southeast Asia, and the Philippines. In China, relatively low-tech approaches to controlling the bite of the infecting mosquito, including the use of netting and insecticides, has helped control the disease. For example, in 1970 Henan Province, with a population of 90 million, had an annual incidence of malaria of 17 percent, or over 10 million cases per year. In contrast, in 1999, China reported only about 29,000 cases of malaria in the same region, and less than 100 deaths. The change in the prevalence of malaria resulted in markedly improved economics for the region, since each case not only incurred a loss of the victims productivity from the workforce, but the cost of medicine, the health-care infrastructure, transportation and food for the patient, and the training of clinicians was a signi cant burden for the government to bear. According to the World Health Organization, the average cost for patients in Henan Province seeking treatment for malaria was equivalent to 10 days income for a rural resident. Obviously, there is a signi cant market opportunity for a vaccine that successfully treats potential malaria victims. Given the increasing drug resistance observed in many parts of the world, the most promising malarial vaccines rely on genomic methods, including DNA vaccines and genetically engineered viruses under development in many laboratories around the world.
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Despite problems of cost and ef cacy in early gene therapy experiments, which are designed to replace, manipulate, or supplement nonfunctional or misfunctioning genes with healthy or normal genes, gene therapy is viewed by the medical community as the best means available to treat de bilitating, fatal genetic diseases that are unresponsive to traditional thera pies. Consider that cystic brosis, which is one of the most common lethal inherited disorders among Caucasians, affects about one in every 3,000 live births in North America. In the United States alone, this translates to over 71,000 ultimately fatal cases of cystic brosis annually, based on 2000 census results. The cost of conventional palliative treatment for cystic brosis varies considerably from one person to the next, but is in the range of $400 to $92,000 annually, based on studies in Canada in the late 1990s, with about half of the cost attributable to drugs. Palliative treatment is treat ment that abates the disease but does not cure it. Single-application gene therapy would not only extend the life of each patient, but it could also signi cantly reduce the economic burden on the health-care and insurance industries, even if the gene therapy costs were in the $100,000 range. Even though about half of people with cystic brosis don t live past their twen ties, the cost of conventional therapy over their lifetimes can easily exceed $1 million per patient. Cystic brosis is only one of many potentially lethal diseases that seem amenable to treatment with gene therapy. Figure 3.10 shows a partial list of diseases that are targeted for gene therapy. Establishing the market for gene therapy depends on rst getting the technology right that is, over coming the technology hurdle in devising therapies for each condition. The rst person in the United States to undergo federally approved gene therapy suffered from severe combined immunode ciency (SCID). She was treated successfully in 1990 by researchers at the National Insti tutes of Health (NIH) and, with the help of occasional booster treatments, remained healthy for years. However, this initial success was followed by profound failure. By 1996 over 3,000 patients had been treated with gene therapy, and the majority died, either from reactions to the therapy or be cause the therapy failed to reverse the underlying disease. Most of these failures remained out of the public eye until 1999 with the death of an 18-year-old boy who received gene therapy as part of an experiment at the University of Pennsylvania. The highly publicized fatality resulted in a public outcry and hearings by the FDA and the suspension of gene therapy research at several universities. The death raised questions about the science involved in gene therapy, as well as the ethical decisions
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