MANUEL ELKIN PATARROYO

          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

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