The Man Who Would
Conquer Malaria
The turn-of-the-century stone building is rotting inside, floorboards dusty
and dilapidated, pigeons roosting
in the eaves. There are no windows in the moldy sills, and weeds are thriving--even
this structure in the
middle of Bogotá, Colombia, suggests the jungle is not so very far
away. "This is how my buildings always
come," says Manuel Elkin Patarroyo, proud of the efforts that have transformed
other nearby structures into
a charming enclave, complete with gardens, that recall the Pasteur Institute
in Paris--a similarity that delights
Patarroyo, because he says that it irritates his rivals there.
Once restored, this addition to the Institute of Immunology at the San
Juan de Dios Hospital will permit
Patarroyo to expand his research empire and to begin mass-producing the
source of his fame and his
controversy: the malaria vaccine SPf66. But the immunologist does not want
to dally in the ruined building
and talk about whether the world is going to want such vast quantities
of the compound. The day is slipping
away, it's already 10 o'clock in the morning, and there are labs to dash
through and years of work to
review.
Patarroyo has a talent for transforming more than architecture. In the
decade since he appeared on the
international immunology scene, he has ridden innumerable highs and lows.
Currently, in the eyes of many
researchers, he is down again--this time for good. The most recent trial
of SPf66 (published in the Lancet
in September) failed: Thai children given several inoculations were no
more protected than those given
placebo. This finding follows a 1995 study of young children in the Gambia
that also found the vaccine
ineffective.
But Patarroyo has rebounded before. And anyway, to his mind no such thing
as a down period exists--no
matter what the studies find. His spirit is irrepressible, as is his belief
that he does not have to answer his
critics, that all will be made clear eventually. "I don't care. They cannot
touch me. It is their problem," he
states emphatically. "My enthusiasm will not leave me for a minute. The
opposite! They don't know what a
favor they do me."
Then he is off again, dashing through another lab and sliding down the
length of a hall to answer a
telephone. In rapid succession, he gives a tour of the molecular modeling
room, the place where work on
tuberculosis and on leishmaniasis is being conducted, and the "peptideria,"
where the synthesized peptides
that form the basis of the malaria vaccine are stored. He also points out
myriad other labs and the entrance
to the restricted area where SPf66 is made. "I usually arrive at eight
in the morning, and I leave at 10 P.M.,
Saturdays included. It is not unusual for me, because it is as I want it
to be," he says, pausing in front of a
mural, one of the many works given to the institute by famous Latin American
artists. "If you are doing what
you want and what you like, you do not feel a tension. My wife and my family
are used to that."
A group of his colleagues passes at that moment, and Patarroyo ruffles
their hair, slaps them on the back,
teases them. They laugh and joke with him. He explains--still for a moment
against the swirling, colorful
backdrop of "A Sense of Immunology," by Colombian painter Gustavo Zalamea--that
he sets up
competitions in order to get work done more quickly. He has promised trips
to Cartagena, a beautiful city
on the coast, or seats at one of the Nobel ceremony dinners if his researchers
finish projects ahead of
schedule. "But I tell them, 'You son of a gun, if you want to go the Nobel,
you have to buy a tuxedo,
because we are not going to be underdeveloped,' " he laughs.
Patarroyo refers often to his position as a Third World scientist in the
First World research community. Yet
he is in a very privileged situation. In Colombia, Patarroyo is a national
hero; according to a magazine poll,
his popularity exceeds that of his good friend, author Gabriel García
Márquez. His funding is guaranteed by
the government, as is his access to a large population of owl monkeys,
some of the only animals that can
serve as hosts for the malaria parasites that plague humans. Unlike many
researchers whose finances are
linked to their results and to being politic, Patarroyo really is free
to ignore his critics.
He is not free, however, to ignore the realities of life in Colombia--where
numerous guerrilla groups vie for
power, where the drug trade bleeds into every activity and where the magic
realism of García Márquez can
seem prosaic. This summer one of Patarroyo's shipments of white powder--that
would be SPf66--was
replaced with vials of a quite different white powder. And a few years
ago Patarroyo and his family
encountered guerrillas on a drive home to Bogotá from some pre-Columbian
ruins. "I was captured for five
hours because they wanted to talk to me," Patarroyo says, making light
of the experience, his voice perhaps
more quiet than he realizes.
But what makes him most happy about his notoriety, Patarroyo continues
quickly, is that young Colombians
are becoming interested in science. Another poll pronounced that 67 percent
of the nation's kids want to be
scientists. "What other success could I claim better than that one? To
have brought into this country a
consciousness," Patarroyo exclaims. "So for the children, rather than being
Maradonas [the Argentine
soccer great] or rock stars, no! They want to be scientists, and I think
that is very important in our country."
Patarroyo himself had a very particular vision as a youth, as he tells
it: "It was when I was 11, really, that I
liked chemistry so much. And my dream was always to make chemically synthesized
vaccines." His parents
were both business people and wanted their children to be the same; they
ended up with five physicians,
one nurse and one child psychologist among their progeny. Although Patarroyo
opposed his parents'
business values, he acknowledges that his father gave him a firm sense
that whatever he did, he must be
useful to humankind.
He left his hometown of Ataco, in the Tolima region, to attend medical
school in Bogotá. He says that he
was a mediocre medical student and that it was not until his internship
at San Juan de Dios that he
understood what science was about. "It was so beautiful to me to save lives,"
he muses. "I wanted to make
vaccines because I wanted to be useful."
In the late 1960s Patarroyo went abroad--something he encourages his researchers
to do. After a short
stint in virology at Yale University in 1968, Patarroyo worked in immunology
at the Rockefeller University
for several years. He then returned to Colombia, where he studied various
infectious diseases until a
colleague urged him to change his focus. "He said I was an idiot, that
I was working on a problem that was
not as important as malaria. Then he gave me the statistics," Patarroyo
recounts as he drives carefully but
quickly through the Bogotá traffic to a traditional Colombian restaurant.
Every year as many as 500 million
people contract malaria; between 1.5 and three million of them, mostly
children, die. Treatment of the
disease is tricky, because strains of the parasite in many regions have
become resistant to the principal drug,
chloroquine, and the alternative, Lariam, increasingly appears to be highly
toxic.
Patarroyo's approach to developing a malaria vaccine was unusual. Instead
of creating it from dead or
weakened strains of the malaria parasite, he synthesized peptides identical
to those used by the most
virulent strain, Plasmodium falciparum. At the time of Patarroyo's initial
experiments, few immunologists
thought manufactured peptides could produce a strong immune response. Patarroyo
nonetheless tested
various peptides for their ability to produce antibodies in monkeys and
settled on four: one used by the
parasite during its larval stage and three used by the mature parasite
to bind to and infect red blood cells. In
1987 he reported that vaccination protected 50 percent of the monkeys.
Controversy subsequently flared
up when investigators could not replicate the results; Patarroyo claims
they used a different compound.
Pausing in the middle of his lunch, Patarroyo starts to sketch a timeline
on a yellow pad, marking the dates
of his papers. Right after his first success, he fell into his first quagmire.
"I made a mistake because of my
ignorance in epidemiology," he explains. He decided to vaccinate Colombians
but did not set up a
double-blind study. He was roasted by the scientific community for his
methodology and for the ethics of
moving so quickly to human trials.
As other results were reported over the years--the vaccine was consistently
safe but proved inconsistently
protective--the community continued to divide. "He has always been a very
intense personality, provoking
strong emotions," notes Hans Wigzell, head of the Karolinska Institute
in Stockholm. "I have been very
impressed by his capacity to press on. His science is like brute force."
Wigzell cautions that even early on
Patarroyo "had the feeling that people didn't understand him. So this is
not something that has just popped
up. Personally, I like him."
Even though most studies found the vaccine benefited only about 30 to 40
percent of patients, many in
public health were delighted: 30 percent of 500 million is still a great
deal. SPf66 was held to a different
standard than other vaccines because of the peculiarities of malaria: even
people who have developed
natural immunity to the parasite often lose it. As major trials in Colombia
and then in Tanzania bolstered the
30 percent or so figure, it seemed as though Patarroyo was vindicated.
In 1995 he donated the rights to the
vaccine to the World Health Organization.
Then came the Gambia and Thailand. Although some immunologists maintain
they are not ready to give up
on SPf66, they are frustrated by the variability of the results. "There
has got to be some way of evaluating
why it is or it is not working," comments Louis Miller of the U.S. National
Institutes of Health.
Patarroyo notes that there may be reasons for the inconsistencies: very
young children's immune systems,
such as those of the six- to 11-month-olds inoculated in the Gambia, are
different from those of adults; the
vaccine used in Thailand may not have been identical to SPf66; genetic
variability determines immune
responses. But, he adds, he is uninterested in point-counterpoint. He just
wants to keep going, studying
ways of improving the vaccine and of developing others. That is the credo
of the institute, he insists: "It is
the search for the essence of things. It is not that we are going to develop
a malaria vaccine. It is that we
want to develop a methodology. Really to make vaccines." Then Patarroyo
hints that his new research will
illuminate why SPf66 seems so mercurial.
Whatever he may have in the wings, SPf66 remains the only malaria vaccine
in trials, and his work,
confounding and controversial, has enlivened the field. As for Patarroyo,
he seems thrilled as always to be a
scientist, thrilled to be directing his laboratory and thrilled to be free
to think and transform. "We are really
privileged, scientists," he says, skipping up the stairs to his office
a little more slowly than usual because of
lunch. "We get to have intellectual development! How many get to have that?
Most people have to do
things they don't like."
--Marguerite Holloway