...

Download the PDF: Chin_William_Oral_History_2005  (PDF 343 kB)

Dr. William Chin Interview

...

Dr. William Chin:        The work we were doing was two-fold.  One, we were screening parasites for their response to various antimalarial drugs.  When I first went there, most of the parasites were sensitive to chloroquine, so there was a minimum of drug research.  The other part was to try to infect volunteers with various monkey malarias.  This was a subject of Dr. Coatney’s keenest interest -- and not just academic interest.  He was the one -- probably more than anyone else -- who made monkey malaria a very prominent subject in terms of malariology.  He and his colleagues probably found and identified more new species of monkey malaria than any other group. 

³  The next question was would these monkey malarias infect man?  This was during the malaria eradication era.  Dr. Coatney was concerned we (the World Health Organization’s malaria eradication program) could not be successful in eradicating malaria, if monkey malaria could make the jump into man and take over?  If eradication of human malaria could be done, this would present an entirely different problem.  So that was his focus.  We had these two areas:  drug evaluation and monkey malaria. 

...

Dr. William Chin:        In 1967, the primary responsibility for U.S.  participation in the malaria eradication program was shifted officially from USAID to CDC.  Previous to that, USAID was the agency responsible for the collaboration with the WHO on malaria eradication. 

⁴  Bob Kaiser was the director of the Malaria Eradication program at the CDC.  He realized that the old method, USAID’s method, of operating was totally insufficient.  What USAID did was to recruit people from various disciplines -- particularly sanitarians and entomologists -- give them a several month course on malaria and then send them out as malaria advisors.  Bob Kaiser’s approach was to recruit young physicians, train them as epidemiologists, first of all; then give them additional training as malariologists; and then send these people out with more training and more technical capability than the previous group.  In those days, I believe, we had something like 18 foreign countries where the U.S.  was supporting the malaria eradication effort through donations of foreign aid.  Each one of these nations was assigned one of the newly trained epidemiologists.

...

Dr. William Chin:        It was 1976, and there was a simple reason “why.”  In 1976, Dr. William Trager of the Rockefeller Institute reported on his ability to cultivate falciparum parasite in vitro. 

  And ⁵  And that was an exciting finding because up until that point, people who tried it were totally unsuccessful.  Bob Kaiser recognized the potential of this new technology.  He thought that -- with my background in the laboratory -- I was a suitable candidate to return to CDC’s Chamblee facility and head up the new lab for in vitro cultivation.  He brought me back to CDC, just for that purpose.  And I set up the in vitro cultivation:  I spent two weeks with Dr. Trager learning his technique and went back to CDC and started the lab. 

...

Dr. William Chin:        Producing the large amounts of falciparum parasites was done using a semi-automated large-volume method that was reported in 1979 in the British This method was labor intensive, requiring the changing of Transactions of the Royal Society of Tropical Medicine and Hygiene. 

⁶  This method was labor intensive, requiring the changing of culture medium on an approximate 8 hour basis.  Since I was doing this by myself, much sacrifice had to be made by limiting time spent with family.  This hectic pace of daily activity, 7 days a week, continued for some 2-3 months.

...

The problem of relative ignorance with malaria in the U.S.  in recent years is understandable because of the dearth of opportunity by most of the medical personnel to encounter a malaria case.  To mitigate such a problem, the CDC, during my tenure at that Center, established a “hot line” for the medical profession to call and consult with one of its officers knowledgeable about clinical malaria.  During the last three or four years prior to my retirement, I became the senior officer to respond to such questions on a 24-hour basis.  One of the most memorable calls came one evening, I believe, in 1978.  The caller, a physician from the medical center at the University hospital in Madison, Wisconsin, was asking for advice on how to treat a semi-comatose and critically ill patient with falciparum malaria.  The patient was a young lady of Caucasian ethnicity who had been working in Ghana, West Africa on a summer project for the University of Wisconsin.  Shortly after her return home, she felt ill but did not seek medical care until at least a week after she became ill.  She also reported that while in Ghana, she had not taken any prophylactic against malaria.  When I asked the physician how high was her parasite density, his response was that he did not know.  I then advised him to ask a technician to examine one of her thin blood smears and examine just one high power field by counting the total number of RBCs and then count the number of infected RBCs to derive an approximate percentage infection of the RBCs.  I also told him to call back as soon as he has this information.  He called back shortly and said that some 70% of her red cells were infected.  I advised him that the patient most likely has only hours to live and the only possible way to save her life was by performing an exchange transfusion.  (During my earlier days as a malariologist trainee at the prison project, I recall Pete Contacos telling me that a member of the black clergy with a similar story of having returned recently from Africa died of falciparum malaria when his parasite density was just below 50% infection of RBCs even though he was being treated aggressively with intravenous quinine.  At the same time, I also have had experience in Thailand of advising Thai physicians on the treatment of patients with extremely high parasite density, the use of exchange transfusion.  I vividly recall two such cases in children of five or six years of age and was amazed that both survived after the transfusion operation.)  The next day, I called and as the saying goes “hoping for the best while preparing for the worse” and to my delight, I was told the patient’s parasite density had dropped to just under 10% infection of RBCs.  The patient was treated with intravenous quinine first followed by a standard course of chloroquine and made a full recovery after suffering additional complications including partial renal failure.  This dramatic case was reported in the American Journal of the Medical Sciences in 1979. 

  Another ⁷  Another method Bob Kaiser used to increase the awareness of the medical profession to the problem of malaria during the few years prior to my retirement was to send me to various medical teaching institutions to lecture on malaria, particularly clinical and treatment aspects.

...

This is another interesting sidelight.  When I was finishing up in Bangkok, a USAID sponsored team came out and concluded that our accomplishments were minimal, and we essentially had not done the job we were sent out to do.  The person who gave me that harsh verdict, I still remember his name.  He was USAID, Director of Strategic or Technical Studies, Dr. Joel Bernstein.  He came to Bangkok and set up a meeting to let me know that I was no longer needed in Bangkok.  My type of work was no longer needed because, he said, “A vaccine is around the corner.  We’re using the money for this project and we’re going to put it into vaccine development, and within a few years, we’re going to have it.”  I told him, “Dr. Bernstein, you’re lucky if you have the vaccine within 20 years.”  An interesting development in the vaccine story took place some three or four years after Dr. Bernstein’s meeting in Bangkok, when a few of the major USAID consultants were involved in a scandal for misappropriation of funds.  (You can ask Bill Collins for greater detail.) 

⁸  

Some twenty years later I’m in Pakistan, and I’m listening to a broadcast from the BBC, and this broadcaster was interviewing malariologists.  I’ve forgotten, maybe it was Wallace Peters, a respected malariologist, and he was talking about the vaccine.  He said, “I think we’ll have a vaccine in 20 years.”  So we’re talking about 40 years now into the future, and still we’re not closer to a vaccine than before.  This hope of a vaccine I think is just a simple bureaucratic diversion to justify the neglect of funding of all these malaria programs worldwide.  That’s basically my major complaint at this time.  Although, from my brother’s perspective, I may be all wet since he’s a USAID consultant on AIDS, at least he was.  He wrote a book on his retrospective assessment of the USAID and the WHO’s support of the AIDS control effort, and apparently it is so controversial that no one wants to be associated with it. 

⁹

Finally, a few last words:  Malaria is a disease dating from prehistory.  Its distribution was worldwide at least until the middle of the twentieth century.  In the U.S., malaria transmission in the southern states began to recede by the 1930s and totally ceased by the 1950s.  Malaria transmission ceased in the northern states far earlier.  Malaria disappeared in the U.S. and other developed countries not because of a well executed eradication program but because the socio-economic development in these countries reached a point where the environment was no longer conducive to support malaria transmission.  Housing was better and built with screened windows and doors.  Water was generally brought indoors via pipes thus eliminating outdoor pools and puddles needed for the breeding of anopheline mosquitoes and finally, modern medical care was becoming readily available to treat the last few residual cases.  Viewed from this perspective, it takes little imagination to realize that malaria transmission will remain a major health problem for people of developing or underdeveloped countries for many generations or even centuries to come.  Given this imperative, the decision to ignore the malaria problem of the underdeveloped world by the policy makers in those countries with the resources to assist in the effort to control malaria, particularly the U.S, is unconscionable. 

...

Presently, our national leaders, more often than not, are making public health decisions affecting us as well as people in foreign countries based on political expediency or on the behest of small fringe groups including religious zealots and not on practical realities.  Policy decisions are influenced by groups who are out to promote their own agenda by gaining access to those making the decisions.  The question of how best to continue the control of malaria in developing countries over the long haul of many generations to come or longer is being aggressively addressed by those urging a “high tech” approach, the development of a vaccine.  Even though such an initiative, when it was first launched, promised that a vaccine would be available in a matter of years, the reality is that more than 30 years have passed and millions and millions of dollars have been spent, and there is still no sign of a useful vaccine in the foreseeable future.  In the mean time, other “low tech” cost-effective methods have been discarded and abandoned for lack of funding resulting in death or morbidity by countless millions of victims due to malaria infections over the same span of more than 30 years.  Had even half of the funding already invested in vaccine development been used to seek more affordable methods to reduce malaria incidence in the less developed world, the outlook for controlling this disease would be far brighter today.  The resources needed to develop local competence in malaria control is at most, modest:  Train national experts in the epidemiology of malaria to supervise the control program; develop a core of trained microscopists with fully equipped laboratories to diagnose malaria by examination of blood smears; aggressively pursue the concept of minimizing contact with infected mosquitoes by the liberal use of clothing impregnated with a repellent and use of bed nets impregnated with an insecticide and finally make available effective drugs to treat resistant parasites.  Such a plan is affordable when compared to the annual expenditure for vaccine development.  It is time the policy makers reassess the resources already squandered over the past three decades in their pursuit of a vaccine by comparing the total expenditure already spent to the progress made in controlling malaria in order to decide, pragmatically, whether the investment hasbeen has been worthwhile.  If not, then money should be shifted to control malaria the old fashionwayfashion way, practice malaria prevention aggressively and then gradually reduce the infectivereservoir infective reservoir by the elimination of malaria a few cases at a time through treatment.

...

1. Southeast Asian Treaty Organization. ↩
2. From the University of Maryland, Baltimore, website (http://medschool.umaryland.edu/Epidemiology/ihdiv.html):  “The International Health Division in the Department of Epidemiology and Preventive Medicine was established in the 1950s at UMB as the International Health Program, with overseas research facilities (International Centers for Medical Research and Training; ICMRT) in Pakistan and Brazil and seminal investigations on malaria chemotherapy and vaccine development in Baltimore.  It became a division in the Department of Epidemiology and Preventive Medicine in 2000.” ↩
3. See, for example, G. Robert Coatney, William E. Collins, McWilson Warren, and Peter G. Contacos, The Primate Malarias (Washington, DC:  US Government Printing Office, 1971), also available online at http://www.dpd.cdc.gov/DPDx/HTML/Search_Choices.htm. ↩
4. USAID = United States Agency for International Development, CDC = Center for Disease Control, WHO = World Health Organization. ↩
5. William Trager and James B.  Jensen, “Human Malaria Parasites in Continuous Culture,” Science, 193, 1976, 673-675. ↩
6. William Chin, “A Method for Large-Volume Cultivation of Malaria Parasites Based on the Principle of the Trager-Jensen Culture Method,” Transactions of the Royal Society of Tropical Medicine and Hygiene, 73, 1979, 334-335. ↩
7. Richard L. Nielsen, Richard B. Kohler, William Chin, Leo J. McCarthy, Friedrich C. Luft, “The Use of Exchange Transfusions: A Potentially Useful Adjunct in the Treatment of Fulminant falciparum Malaria,” American Journal of the Medical Sciences, 277, 1979, 325-329. ↩
8. For more on the sad tale of USAID’s malaria vaccine program, see Robert S. Desowitz, The Malarial Capers: More Tales of Parasites and People, Research and Reality (W.W. Norton, New York; 1991), pp. 257-276. ↩
9.  James Chin, The Glorious Myth about a Generalized AIDS Pandemic: Collision of Epidemiology and Political Correctness, to be published by Radcliffe Publishing in the UK. ↩