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How do you test a vaccine for malaria? Well, you vaccinate people and then give them malaria.
Ideally, this test happens under controlled conditions, so the infected person can recover safely, and in a part of the world without mosquitoes of the species that transmit malaria, so the guinea pig can’t give the disease to anyone else.
That’s how a friend of mine, John Beshir, a British software engineer in his late 20s, got malaria this week. John is involved with effective altruism, a movement to address the world’s most pressing problems in the most cost-effective ways possible. Malaria is one of the world’s biggest killers of pregnant women and children. In 2017, it caused 435,000 deaths.
John donates some of his salary to the Against Malaria Foundation, which distributes bednets in affected areas, and he joined this round of vaccine trials, through the Jenner Institute at Oxford, to help scientists learn which vaccines work best so that they can be put to use where they’re needed.
I called him up at Oxford, where he’d just taken his last dose of antimalarials and is waiting for notice that he’s clear and can go home. Here’s a transcript of our conversation, lightly edited for length and clarity.
Kelsey Piper
Hey! How are you doing? Are you recovering okay?
John Beshir
I‘m actually doing surprisingly well. I’m somewhat nauseous because of the antimalarial drugs, but that’s a known side effect. I broke out with a fever on the day I got it, but since then, it’s gone away — I’ve been relatively lucky in that regard. One of the things they were looking at, for what the vaccines would do, was whether it would decrease the severity of the illness, so maybe that’s promising.
Kelsey Piper
What motivated you to sign up for these trials?
John Beshir
A friend let me know about a different trial by the same people. I went to a screening for that, but I had antibodies that meant I couldn’t participate in it. But then they reached out about another opportunity and said we’ve sent you all the details, let us know if you’re interested in participating.
Malaria is something I’m very interested in combating. I’ve donated to the Against Malaria Foundation for almost three years. I’d heard about it being a big killer. That was the main reason.
Kelsey Piper
So how does all of this work?
John Beshir
They’re giving everyone three or two vaccination boosters, and then you go and get bitten by mosquitoes, and then you spend a few weeks being checked on twice a day to see if you get symptoms.
And they’re trying to check whether getting the vaccine repeatedly makes a difference —[whether it] boosts immunity over getting it once.
Six unlucky people are controls — they get infected with malaria without a vaccine.
Kelsey Piper
Do you know whether you’re one of the controls?
John Beshir
I do, and I’m not — it’s not blinded in that respect.
Kelsey Piper
I’m curious about the part where you get bitten by mosquitoes. Do you just walk into a room full of mosquitoes?
John Beshir
No, no, they actually have this very fancy-looking isolation setup. You go into a room and sit down, and other people in a different room prepare this plastic cup with exactly five mosquitos in a cup with gauze over it. They pass it through an airlock into your room.
A doctor gives it to you, you hold it against your skin, then they pass it back and check if the mosquitoes are full of blood, and check that they really had malaria. I took a picture if you want to see it.
Kelsey Piper
Yeah, absolutely.
John Beshir
I was a little bit of a shutterbug throughout the trial, honestly.
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Kelsey Piper
I would be pretty terrified, sitting around waiting to get malaria. Were you nervous?
John Beshir
A little. When I first knew I had it, I was gearing up for spending a few days being relatively miserable, not getting anything done but just playing days of games while I waited to get better. It hasn’t been that bad.
Kelsey Piper
Knowing that malaria kills people, I’d be worried about that. Is the idea that with prompt modern medical care, that risk is very low?
John Beshir
With modern medical care, you can pretty confidently be fine. There’ve been over 1,000 people deliberately infected with malaria, and all of them have been fine and none have died or had long-term consequences.
It comes on like a bad flu. As long as you treat it and you’re not immunocompromised, you should recover pretty quickly. And the malaria they’re using here, it responds well to antimalarials.
I had a lower fever but a worse experience with the second vaccine dose than I did with the actual malaria. The first vaccine dose, I didn’t have any side effects at all. The second one, I broke out in a fever and they had to keep me overnight, just for monitoring.
Kelsey Piper
And there’s no risk that another mosquito will bite you and transmit malaria to anyone else?
John Beshir
I don’t know that mosquitoes that can carry malaria are endemic here. Convenient to run it here [in the United Kingdom] for that reason, I imagine.
The thousands they have in central London don’t get loose. I cannot imagine the paperwork they have to file to be allowed to keep them.
Kelsey Piper
Overall, has this been better or worse than you expected?
John Beshir
I’d say better than expected, for the simple fact that I didn’t get very ill. Also, I didn’t expect food to be covered, but it turned out they covered breakfast and dinner at the hotel. I guess they want us to be well-fed.
Kelsey Piper
They pay you for this, right?
John Beshir
Yes, they do. They paid £2,445 [about $3,200].
Kelsey Piper
That includes travel expenses and the inconvenience of getting malaria?
John Beshir
That actually doesn’t include all travel expenses; they reimburse train fare separately if you’ve got it properly recorded. The payment is for the inconvenience around getting malaria and the time you spend in Oxford and in London. In London, there’s the hospital where I got vaccinated and then had to go to about 10 more times for checkups, and they have the store of mosquitoes.
In Oxford, they have the vaccine group where, once it’s been about a week since you’ve been bitten, you have to go visit twice daily to have them check you for symptoms, check your temperature, and take a blood sample just to see if you’re developing malaria.
Kelsey Piper
Do you have recommendations for people who are interested in doing this?
John Beshir
They should go look at the Jenner Institute’s website. They have recruitment starting for another trial for a malaria vaccine starting in March. They have a list of studies they’re recruiting for there. You can do a trial for a different kind of vaccine that may work even if this one doesn’t, and there’s a bunch of other diseases they’re working on.
Kelsey Piper
So the thing that appeals to me about this is — I’m so proud that humanity can fight, and sometimes eradicate, these diseases that used to affect us so much. But I’m not, you know, personally doing anything. It seems like it’d feel great to know you’re personally contributing to that fight.
John Beshir
It does! I’m not sure it’s the most efficient use of time in fighting malaria, but it’s very nice to be a part of it in a way. Here’s something trying to save all the people getting killed by malaria, and it doesn’t get in the way of donating to the Against Malaria Foundation, and bednets, and doing other things.
I think I would do a trial like this again if I had the opportunity. There’s a lead-up time between trials before you can do them again. In terms of long-term effects, I’m no longer allowed to donate blood, at least for years — which is a time-saver, frankly. It did pay well, but I think as long as I have the travel expenses and accommodations covered, I’d have done it without anything above that. It is a nice story to be able to have and to keep with me.
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