Don't kill the parasite: control the disease.

It is clear from both laboratory and clinical studies that the blood-stage malaria parasite does not itself directly cause most of the serious complications of the disease, with the possible exception of anaemia. For example, T cell- deprived mice with lethal infections survive longer and mice can be protected against early death by vaccines that appear not to affect parasitaemia. In certain cases antibodies to TNF have the same effect. Clinically it has been known for over 50 years that children in endemic areas develop immunity to the serious toxic aspects of malaria several years before their parasitaemias start to fall. Recent work on the induction of cytokines such as tumour necrosis factor (TNF) by exoantigens of the blood-stage parasite and on the role of cytokines in this and other toxic diseases suggests that an appropriate vaccine might induce antibody that blocks the effect of the exoantigens, thus conferring on young children the anti-disease immunity that normally takes years to appear. Such vaccines might be less hampered by the antigenic variation that makes anti-parasite immunity slow to develop. Characterisation of the molecules involved is a high priority.