For decades, the U.S. Army and its partners have been trying to develop a vaccine for malaria, a disease that has thwarted man for centures and receives scant attention from the West. Michael Leahy , whose story appeared in this week's Washington Post Magazine , asks if this is a battle that can be won.

Today, Leahy was online fielding questions and comments.

Michael Leahy is a staff writer for The Washington Post Magazine.

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washingtonpost.com: Michael Leahy will be online momentarily. Please stand by. Thanks for your patience.

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Michael Leahy: Hi, everyone. Thanks for joining us. Let's take some questions.

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Potomac, Md: I was stunned to read of malaria's disproportionate effect in Africa, which strikes me as the last place that needs another killer disease. You did an incredible job of revealing the pain and the magnitude of the crisis, and that was an excruciating and wonderfully reported tale from Kenya. Was it discouraging at all for you? Did you see any hope that with all these ambiguous vaccine tests and unsuccessful drugs that there is hope on the horizon?

Michael Leahy: Thank you for your comment and question. As to whether what I saw was "discouraging": As I note in the story, there never has been a vaccine that has been successful in thwarting a parasitic disease affecting a human being. So this challenge could not be more formidable. But the results of the RTS,S vaccine trial -- which showed levels of unprecedented protection even in simply protecting about 50 percent of kids against severe disease - suggest that the serious chance that dramatic could come down the road, though there is an obvious question about how many bends might be in that road. Re drugs: Given the parasite's swift resistance to drugs, you continually need to develop new drugs, if drugs are to have any chance at all. That accounts for part of the reason why you have vaccine advocates regularly talking about a vaccine's potential cost-effectiveness.

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Falls Church, Va: Great story. What a strange and fierce disease, that parasite is a tough little bugger, good luck to everyone involved. It was good to read of the enthusiasm of the volunteers and that the doctors were so quick to treat them. Has Samantha Nolte or any of the other volunteers you followed had any weird side effects since they were treated and released?

Michael Leahy: Samantha Nolte and all the other volunteers are doing great. Samantha recently married her fiance.

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Carrboro, NC: I am taking this opportunity to ask a question I have always wondered about malaria. In colonial days, I have heard that malaria was endemic in places like the Chesapeake Bay or the low country of South Carolina. Even though there may have been swamp draining in those areas, there are still swamps and certainly still misquitos. How is it that malaria disappeared? Thank you for taking my question.

Michael Leahy: It's true; it was endemic, in such places. Two things helped to eradicate the disease in that area: One, projects like the Tennessee Valley Authority (TVA) helped to get rid of swamps and other areas of standing water; and, secondly, health systems improved and quickly treated infected human beings, in the process preventing the transmission of the disease to a previously uninfected mosquito which, in turn, would have the potential to pass it on to an uninfected human being. Malaria involves a continuous cycle of transmission in the worst-ravaged areas, and so part of the challenge is to break that cycle at both the human and the insect, if possible.

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Columbia, Md: Michael: It was a treat to read your latest story. Marvelously done. Painful to read about the Kenyan children but inspiring to read about men like Heppner and Ogutu and nice that some hearty souls over here were willing to be bitten by the mosquitoes in the interests of furthering the research into the vaccine. Glad that everyone is doing fine. I am just curious, did you allow yourself to be bitten? Would you ever do it? Thank you.

Michael Leahy: I actually thought about asking to be part of the trial. But then I thought I couldn't afford to be down even for 24-48 hours, which was about how long the flu-like symptoms lasted for the volunteers before they were feeling great again. I needed that time to observe the volunteers, though it was amazing how quickly they recovered.

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Washington, DC: I was a volunteer in the clinical trial mentioned, and I experienced no strange side effects. Chloroquine, the drug the doctors gave us to treat malaria, worked very quickly and I was symptom-free within two days.

Michael Leahy: I'm publishing this comment because I'd like readers to note that the drug chloroquine was used to treat the volunteers. Chloroquine was effective in their cases because the strain of malaria used during the WRAIR trial was a very old one (no less potentially lethal, just old). But its age meant that chloroquine could work. Over in Africa, the parasite long ago became resistant to chloroquine. In fact, it is stunning just how swiftly the parasite has become resistant to what were at one time a whole series of first-line drug treatments.

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Near Walter Reed, DC: Hi - Living near Walter Reed, I had one (selfish) question: If the subjects in the immunization trial were allowed to go about their daily lives during the trial, how did that not expose the community at large to malaria? They could have been bitten by a mosquito, and then she could have passed it along.

Michael Leahy: Thanks for your question, which is a good one. At that point -- say, around day 10 of the trial -- even an infected volunteer is not at a stage where the disease can be passed on to the mosquito. The volunteer would need to be out in the community for a couple of more weeks for that scenario to become a possibility. The infected are treated immediately, of course, and treatment does not end until the infected volunteer has three negative blood smears.

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Arlington, Va: Dear Michael,

Fascinating article. Was curious when you are telling the story about Okoth and Bibiana (p. 33) whether the fact that not only were antimalarials not on hand, but also that all the attendants could tell her was that "Bibiana appeared to have malaria" is significant. In writing/researching the article, did you get any sense that the availability/cost of reliable diagnostics for malaria is an issue? A little later on the same page you quote Heppner and Ogutu as saying that "the technical equipment used at the Kisumu hospital to look for microscopic parasites is substandard, meaning that some cases will be missed."

I work for an NGO that is interested in seeing what can be done to create a mass market for high-quality, lowcost malaria tests that could make a dent in this problem, but diagnostics doesn't get as much press 'play' as vaccine trials etc. We have been in touch with some people at WRAIR on this and while quality can be an issue, cost is not (since those who are going to be tested are US military and they are not so concerned about large numbers of poor Africans who may need such high quality tests at low costs).

Thank you, Gary G

Michael Leahy: Short answer, yes, diagnostics and general care are real issues.

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Charlotte, NC: I've spent some time in Africa and often have wondered why American and European papers don't give more ink to malaria. My hat is off to you for a comprehensive, moving and terrifically written account of the challenges facing everyone with this. I was also moved the efforts of people like Heppner and Lanar who keep at their passion despite the inevitable frustrations. It sounds like they are getting closer all the time. At any point have the two men considered giving up? How long do they give themselves to do this?

Michael Leahy: Heppner and Lanar are resolute men. My sense was that they have ideal personalities for the challenges and periodic disappointments that accompany such challenging work. Heppner has spent much of his adult life refusing to give up at one kind of task or another. (This is a man who refused to give up when medical schools turned him down the first time around.) Lanar has moved ahead with work on a new malaria vaccine. Indomitability would seem an essential characteristic in the vaccine field. It is not an area meant for the weak of heart.

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Washington DC: Your article documents well the noble dream of developing a malaria vaccine - yet leaves the reader discouraged that such a solution won't be ready in the near future. Aren't the effectiveness and scalability of other solutions - like long lasting insecticidal nets - proven by research and experience?

Michael Leahy: Thanks for the comment and question. If by the "near future," you mean the next couple of years, you're absolutely right: a vaccine won't be ready for pediatric use by then. GSK and WRAIR hope to have RTS,S ready by 2011. Let's just say, hypothetically, that the rates of protection at that point aren't a lot great than those suggested by the clinical trial that I referenced. Still, even if you, say, halved the number of deaths and the cost burden, the effect would be profound. This is likely an early-generation vaccine, meaning that improvements will be coming over time -- though how swiftly is a matter of debate.

Re insecticide-treated bed nets: Yes, studies demonstrate they can be highly effective if used properly. Any reasonable global strategy needs to include bed nets, drugs and vaccine research and development. But each approach faces its own stiff challenges. With bed nets, you always need to wonder whether they'll be utilized properly and, particularly in Africa, whether they'll be deployed in structures that can lend themselves to bed nets (where you don't have holes in modest habitats). There are other prosaic challenge. For instance, can you always count on children coming in during prime biting-time around dusk? Kids everywhere in the world like to play outdoors at that time. So there is no panacea here.

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Washington, DC: Hi-

Great article...

Did you get any sense as to how the United Nations or US gov't are providing any funding for research for this epidemic? Or is aid only given for current efficacious prevention/ treatment methods?

Rob

Michael Leahy: Just a quick comment here about a funding matter: As I note in the story, the President's much touted "Malaria Initiative" has no malaria vaccine research component, choosing instead to focus on drugs and bed nets.

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Oxford, Miss: Brilliant job creating an insider's perspective on a global concern. Why is the infected, experimental group not considered carriers of the disease? If they are in the mainstream of public and a randem mosquito bites them, are their bodies not hosts for spreading the parasite to other mosquitos? It seems the researchers might be spinning a parasitic roulette wheel.

Also is research funding for a vaccine dependant on the regional population affected?

Thanks for your terrific writing and work at the Post.

Michael Leahy: Thanks for the nice comment. I think I answered this question earlier. They would need to be infected and out in the community for at least a couple of weeks before they could pass it on to a biting mosquito.

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Philadelphia, Pa: Remarkable story. I wondered while reading your compelling and heartbreaking descriptions about suffering children in Africa, why it is taking so long for Western countries to step in and fund things as they should be funded so that Heppner and his vaccine making competitors can have a real chance here, and that in the meantime there is enough funding for the good drugs and bed nets. Why don't we hear more about malaria and who in Congress might champion this?

Michael Leahy: I'll simply tell you what anonymous source at NIH told me: that there is some frustration that no one in Congress has made this his or her crusade, in the way that congressmen and some senators champion the cause of fighting other scourges.

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Albany, NY: Kudos to you and the Post for this insighful story and for the poignant portraits of all involved in trying to stem malaria. After having looked at all the research efforts in the U.S. and all the agony overseas, do you have some thoughts on the basic challenges that stand in the way of defeating the disease? Are there some basic issues of logistics, financing or organization that the world refuses to confront here?

Michael Leahy: A few thought: I do think that it would be worth at least considering a Manhattan Project-styled model to research. Sometimes great researchers in different agencies and companies work at cross purposes and even duplicate each others' efforts. And, obviously, everyone involved in malaria research could benefit from more funding, which remains relatively scant despite the leadership of such groups as the Gates Foundation.

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Arlington, Va: Mr. Leahy: I was surprised to read that Col. Heppner does not take a pill to stave off malaria. Are there many tourists equally as brave? What did you do about that? Thanks for a rich look at all this. I hope you will go back in time and look at more health menaces in Africa, an undercovered region if you ask me. My appreciation goes out to men like David Lanar and Heppner for devoting themselves to a great mission. Pardon the pun but what a shot in the arm this would be for Africa and for American science if they can pull this off.

Michael Leahy: Thanks. An aside here: someone earlier asked me about how people like Lanar and Heppner persevere in the face of disappointment. Let me share some great news about Lanar: Last week, he received the Army's highest civilian award, the Decoration For Exceptional Civilian Service, for his scientific achievements and sustained leadership in malaria vaccine research.

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Alexandria, Va: I'd never read much about this subject and was pleased to see it tackled with such depth and humanity in your story. Walter Reed, GSK and their partners are to be commended for their dedication in an environment where funding seems sadly limited. If the RTS-s vaccine doesn't do a great job, what are Walter Reeds and GSK's and other groups' plans for a follow up vaccine? Thank you.

Michael Leahy: There are as many strategies out there as there are researchers. At any moment, GSK and WRAIR are working on a number of vaccine approaches. Then you have someone like Lou Miller trying to develop a so-called blood stage vaccine, which is an altogther different approach. There are a multitude of competing ideas, and so I think it is fair to say we are only the advent of progress in this field.

But what all these competing researchers would agree upon is that you need funding for research. The volunteers in the WRAIR trial repeatedly expressed amazement to me that more malaria vaccine trials weren't being done, given the stakes involved. Samantha Nolte, who had heard of malarial suffering from her classmates in nursing school, made this point to me and then added that participating in the trial had been an honor; that she hoped she had contributed to an effort to move everyone a small step closer to the solution. She was grateful for the first-care treatment that she and other WRAIR volunteers had received, but what she appreciated most was simply being part of an endeavor that has the potential of saving millions of children over time.

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Michael Leahy: I see that we've run out of time, but I want to thank everyone for the great questions and kind comments. I look forward to chatting again with you soon.

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