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Dr. Hoffman vs. the Mosquito
A Rockville scientist has spent 30 years struggling to eradicate malaria, the deadly insect-borne disease that has outwitted generations of medical researchers. Experts have long called his vaccine a fantasy. Now he has one last chance to prove himself. By Luke Mullins
Malaria-infected mosquitoes may be the greatest source of human suffering of all time. The lethal insects helped unravel the Roman Empire, and they kill hundreds of thousands a year. Photographs by Greg Powers.
Comments () | Published October 23, 2013

In the summer of 2012, Dr. Stephen Hoffman did everything he could to keep his mind off the experiment. He took a vacation to Malaysia with his wife and three children. He worked out for 45 minutes a day. And each morning, he walked into his Rockville office, sat down at his desk, and pretended it didn’t matter what the results of the study would look like. But as the calendar flipped to October, he found it impossible to think about anything else.

One year earlier, researchers had begun injecting Hoffman’s experimental malaria vaccine into healthy volunteers. Any day now, the National Institutes of Health might call with the results.

In years past, when the critics or the failure or the anxiety became too much, Hoffman found himself lying awake at 2 AM, his mind spinning with panic. He’d made a lot more money before he began chasing this vaccine a decade earlier, and nobody ever called him a crackpot. He had a wonderful family and all the honors a scientist could hope for. He never had to worry about a blackout at his laboratory or a grant that might not get approved or his life’s work being measured by one last experiment.

“I have said, ‘Why do I need this?’ ” Hoffman says. “And the answer is that this is a gift and a treasure to have the opportunity of making this kind of impact against the kind of odds that were presented to me. It’s an extraordinary opportunity in life. How many people get that chance?”

Now, as he waited to find out—once and for all—whether his vaccine worked, Hoffman felt the pressure of a basketball player in a playoff game. “It’s double overtime,” he says. “And you’ve got to make the last shot.”

It’s been more than 30 years since Hoffman set out to rid the world of malaria—the mosquito-borne, parasitic disease that has outwitted every scientist before him. He couldn’t have chosen a more ruthless adversary. Malarial fevers have ravaged humankind for half a million years. There’s evidence that the disease killed Alexander the Great, helped unravel the Roman Empire, and repulsed the army of Genghis Khan. Malaria parasites infected George Washington and led to a million Union casualties in the Civil War. The Centers for Disease Control and Prevention was established specifically to fight the epidemic. Even today, malaria afflicts nearly 220 million people a year—predominantly African children—and kills more than 650,000.

“It’s probably the greatest single source of human tragedy in the history of our species,” says Dr. Thomas Richie, research coordinator of the US Military Malaria Vaccine Program.

Hoffman’s quest to annihilate the parasite has come at his own peril. He has trudged through Indonesian swamps and watched children with malaria die in his arms. He has injected experimental vaccines into his body and survived a plane crash during a research trip to Kenya. He once let more than 3,000 malaria-infected mosquitoes feast on his arm.

But Hoffman’s biggest gamble came in 2002 when he quit his high-paying job to develop the malaria vaccine that everyone else considered impossible. Launching the effort from his kitchen table, Hoffman became the laughingstock of the malaria-science establishment.

“Even calling it a vaccine is a compliment,” Dr. Pierre Druilhe, a malaria expert, told the New York Times. “It has no chance of offering protection. It is like Captain Ahab in the movie trying to kill Moby Dick with his knife.”

The NIH trial in 2012 was Hoffman’s last chance to prove that he just might have found the way to eradicate the world’s most elusive killer once and for all.

• • •

Dr. Stephen Hoffman at the Rockville headquarters of Sanaria, the lab where he and his staff are producing what they hope will be the first FDA-licensed malaria vaccine.

The call came in around midnight. It was serious: A four-year-old girl with malaria was slipping away, fast. Hoffman jumped out of bed and raced through the tropical humidity to the single-story hospital. Inside, he found the girl alive but unresponsive; her body was cold and clammy.

It was 1984, four years after Hoffman arrived in Indonesia as a young US Navy doctor ready to save the world. Since that time, he had seen malaria snatch too many children from the lowland rainforests and beaches that surrounded him. He wasn’t about to let another one go.

As with all malaria victims, the girl’s crisis began with a tiny bug bite. When a malaria-infected mosquito pierces human skin, it shoots a handful of microscopic parasites into the bloodstream. The parasites squirm into the liver, where they quietly multiply. About a week later, a violent mob of 3 million parasites explodes back into the bloodstream, savaging red blood cells and overwhelming the immune system. The incursion triggers fevers, headaches, chills, and fatigue. In severe cases—like the young Indonesian girl’s—the disease chokes off blood flow to the brain, causing coma or death.

When Hoffman and a colleague examined the girl, they found that her blood sugar was dangerously low—a malaria-related complication that can send patients into shock. The doctors injected her with a large dose of sugar solution. Almost immediately, the girl’s condition improved; her blood pressure increased, her body warmed, and she returned to consciousness.

Walking out of the hospital, Hoffman felt like a hero. If we hadn’t been here, he thought, that girl would have died.

Hours later, he received another phone call. The girl was dead.

“We had the hubris to think that somehow we were doing something great and congratulating ourselves,” Hoffman says. “And now, three hours later, you get a wake-up call—which is truly a wake-up call—which is that you thought you were good, but this disease is tougher than you are.”

Hoffman had come to Indonesia to save patients like this young girl. During a yearlong break from Cornell University Medical College, he had traveled to Ecuador and contracted typhoid fever. For ten days he roasted in a South American hospital. The experience crystallized his commitment to fight the tropical diseases—such as dengue fever and malaria—that devastate poor communities in Latin America, Asia, and Africa.

The Navy had one of the world’s leading tropical-medicine programs. US soldiers have been battling malaria for as long as they’ve deployed to the rain-soaked regions where the parasite thrives. The parasite caused more lost person-days for Americans than bullets in 20th-century military campaigns in malaria-endemic regions. As a result, the Department of Defense has plowed hundreds of millions of dollars into the effort to protect US servicemembers from it.

In 1980, Hoffman had clipped his ponytail, pressed his new Navy whites, and arrived at his post in Indonesia. But after nearly five years of watching children die of malaria, he decided to return to the United States to search for a way to defeat it.

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Posted at 10:00 AM/ET, 10/23/2013 RSS | Print | Permalink | Comments () | Washingtonian.com Articles