MAN has vanquished only one disease, smallpox. In 2007 Bill Gates set out to eradicate another, malaria. The World Health Organisation (WHO) was soon rallying its troops to the cause and a flood of money followed. $612m went to research in 2009 alone. This week the Bill & Melinda Gates Foundation trumpeted another announcement: results from a phase III trial (the more extensive process of testing drugs in people) of a malaria vaccine called RTS,s. This is the world's most advanced vaccine for malaria and the results, published in the New England Journal of Medicine, were encouraging. It is an important step in combating a disease that still kills more than 70o,ooo people a year and debilitates millions more. But it is also a reminder of how much work remains to be done. 目前人们只解决了唯一一种疾病，天花。在2007年 比尔盖兹着手根除另一样疾病"疟疾" WHO接着招集了防疫人员而且投入了大笔的金钱，注入了约6.12亿的研究经费。这个礼拜， Bill & Melinda Gates Foundation 宣告了一项声明:RTS,S这个进入PHASE III的疟疾疫苗 。而这个目前最先进的疟疾疫苗也着实令人振奋、其结果同时发布於NEJM上。 这也是对抗这个每年夺去70万人生命并且造成数百万人罹患的疾病重要的一步。 但这也提醒了依旧还有不少需要工作必须要执行的 Mr Gates is only malaria's latest adversary. The parasite has plagued man for millennia. Chinese texts from 2700BC de-scribe plants to treat its fevers. More recently, in 1955, the WHO embarked on its first malaria-eradication effort. But transmission rates in Africa seemed intractable. After 14 years the WHO gave up. The last time the world tried to eliminate malaria, some scientists lament, the world eliminated malariologists. Mr Gates是唯一目前对抗疟疾的最後旗手。这个寄生虫千年以来不断的困 扰人类。中国的典籍早在西元2700年前就已经记载有植物可以治疗这个寄生虫引起的发烧 (应该是青蒿吧...没记错的话)。最近直到了1955年，WHO才着手进行疟疾的根除工作。 在非洲的传染率看来令人感到棘手的。14年後WHO放弃了，因此有些科学家对於这个上次， 也是最後一次的尝试消灭疟疾感到叹息。 The new wave of enthusiasm came with the founding of the Roll Back Malaria Partnership in 1998 (to co-ordinate planning), the PATH Malaria Vaccine Initiative in 1999 (with money from the Gates Foundation) and the United Nations' Global Fund to Fight AIDS, Tuberculosis and Malaria in 2002. This culminated in Mr Gates's call to arms four years ago and has helped to lower the number of malaria deaths by 20% over the past decade. 这个新的热浪来自於1998年的Roll Back 疟疾合作计画、1999年疟疾疫苗展新路径、以及 2002来自美国环球资金所对抗的AIDS、肺结核、疟疾其中的一个部分。满意的是四年前 也达到了Mr Gates目标，而且过去十年之间降低了20%的疟疾死亡人数。 More progress will be difficult. The existing tools of insecticide-treated bed nets and treatment drugs require careful co-ordination and good health systems. Eliminating malaria in a stable country is dramatically easier than doing so in a turbulent one. Worryingly, these tools may become less effective. Parasites in South-East Asia, for example, seem to be develop-ing resistance to artemisininbased treatments. To achieve eradication-or any-thing close to it-new weapons are needed. 越来越多的程序将会是困难的。现存的驱虫剂、蚊帐和治疗药物需要良好的协调和卫生 系统。根绝疟疾对於稳定的国家中是非常简单的，但是在动乱的国家则否。例如在东南亚 寄生虫对於青蒿素为主的疗法已经出现抗性了。为了跟除疟疾，新的武器将是必要的。 RTS,s, developed by GlaxoSmithKline (GSK), a British pharmaceutical company, will help. The vaccine tries to stop one type of malaria parasite, Plasmodium falciparum, before it has a chance to wreak havoc. A mosquito's bite delivers malaria to the body. Travelling swiftly to the liver, the parasites hide, mature and multiply before staging a grand second act in the blood-stream, where they invade red blood cells, multiply again, and invade more cells. RTS,s combines a circumsporozoite protein, which exists on the parasite's surface, with a protein from a hepatitis B vaccine. Together, these trigger an immune response which can fight off invading para-sites before the second act. RTS,S，这个由英国GSK药厂开发的疫苗将会帮得上忙。这种疫苗试图要阻止这种造成 以往造成疟疾大举肆虐的寄生虫Plasmodium falciparum。而这种寄生虫造成感染的路径是 快入进入肝脏之中，然後迅速的成长，第二阶段接着入侵干细胞当中，再快速的成长，进 而侵蚀更多细胞。RTS,S结合了存在寄生虫中的环包蛋白以及来自B肝疫苗中的蛋白，她可 以在第二阶段反应前快速触发对抗入侵寄生虫的免疫反应。 GSK tested the vaccine in 6,ooo infants across sub-Saharan Africa. It reduced the risk of clinical malaria by 56% and severe malaria by 47%. This efficacy was "on the positive side of what we were expecting," says Christian Loucq of the PATH Malaria Vaccine Initiative, GSK's partner on RTS,s. GSK测试了6000个非洲沙哈拉以南的新生儿。降低56%临床疟疾的风险以及47%的严重 疟疾。GSK在RTS,s上的研究夥伴，the PATH Malaria Vaccine Initiative，Christian Loucq，表示"这正是我们所期待的正面结果" However, more is to come. The trial examined children aged 5-17 months. Results for younger babies will follow. Still uncertain is how long the vaccine's protection lasts. The first year that the vaccine might be used would be 2015, and that is if every-thing goes as planned. Even then, it is unclear how RTS,s might be deployed. Its price is uncertain and its power limited. "We realise that RTS,S is not the ultimate malaria vaccine," says David Brandling-Bennett of the Gates Foundation. "But it will have some role. The challenge is figuring out what that role is." 然而，问题随之到来。有项结果检视了5-17个月大的幼儿。结果显示抗体将会持续。但是 仍不确定疫苗的保护效果会有多长。如果一切顺利的话，第一批的疫苗将会在2015年全面 开打。即使RTS,S有这些不清楚的地方，依旧可能被散布开来。而价格也尚未明朗，效力 也是有限的。Gates基金会的David Brandling-Bennett说"我们明白RTS,S将非最终的疟疾 疫苗，但是他仍会扮演一定的角色。现在这项挑战就是明白她的角色" GSK Researchers are already working on the next generation of vaccines. GSK hopes to induce a stronger immune response by combining RTS,s with a vaccine from Cru-cell, another drug firm. Scientists are also keen to develop vaccines that target different kinds of malaria parasites and in different ways-for example, in mosquitoes' guts. All of this work requires further investment at a time when global health programmes must compete fiercely for cash. Mr Gates has helped to spur progress. Sustaining it is the next challenge. GSK的研究团队已经开始研发下一代的疫苗，GSK希望藉由结合RTS,s以及来自Cru-cell的 疫苗能产生更强大的免疫反应。科学家也密切发展不同的方法路径，对付不同种类的寄生 虫，例如蚊子的内脏。 这些工作同时皆是需要更多的资金，同时其他卫生议题也在猛烈的 竞争资金。Mr Gate 已经获得了激励的进展，而持续下去则是另一项挑战。 from :[The.Economist].Volume.401.Number.8756.Oct.22nd Nejm : First Results of Phase 3 Trial of RTS,S/AS01 Malaria Vaccine in African Children http://www.nejm.org/doi/full/10.1056/NEJMoa1102287#t=article --

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