New Vision Podcast
New Vision Podcast
The Malaria Podcast: Chloroquine
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Malaria is a big issue for countries like Uganda.
It kills over 600,000 people every year and the most affected are children who are under five years old.
There are efforts to combat the disease, and, in this series, we find out if it’s working and hear from Ugandan scientists who are fighting for us to win the war against mosquitoes in particular and malaria in general.
In this episode, science journalist Olivia Ndubuisi goes on a journey to understand why a drug that used to treat malaria stopped working.
610,000 people died from malaria in 2025, according to the latest World Malaria report. 95% of those people were in Africa, and Nigeria has the highest number of cases globally, followed by Girl Congo and Uganda. The most affected are children under 5. Not that long ago, chloroquine was the only option for treating malaria, despite its maddening side effects like the itching. How did it become the only drug for malaria? And then how did it cease to be that drug? My name is Olivia Ndubisi. This is the Malaria Podcast, Episode 1, Tloroquine.
SPEAKER_03Christian Happy is my name. I'm the founder and director of the Institute of Genomics and Global Health in Nigeria.
SPEAKER_00Christian Happy is a molecular biologist and TED speaker. He's one of Time's 100 most influential persons of 2025. He's also an adjunct professor at Harvard and founder of the Institute of Genomics and Global Health at Redeemer's University in Nigeria.
SPEAKER_03As a kid, I took chloroquine. I used to, I was very allergic. I'm one of those people that are so allergic to chloroquine. When I take chloroquine, I have itches all over the place. The itches are worse than the disease itself. The itching was terrible, but then itch was still better compared to other drugs.
SPEAKER_00For example, there was an option that caused cardiac arrest, and another You take a drug and suddenly you lose your mind.
SPEAKER_03So which one would you prefer, itching or losing your mind?
SPEAKER_00The answer to the question of how chloroquine came about in the first place involves explorers and soldiers and synthesizing an older natural substance called quinine.
SPEAKER_03Remember that you know most countries in Africa and probably Southeast Asia and South America were colonized.
SPEAKER_00And so early explorers were getting fevers and dying from malaria.
SPEAKER_03And that really spurred a scientific curiosity to say, okay, now we need to find a solution. We can send our soldiers out there to go and die just for nothing.
SPEAKER_00A solution was needed and fast.
SPEAKER_03So they needed to find a solution for that disease that was killing their soldiers, that was killing their explorers, that was killing the Christian leaders that they were sending at the time, the priests, the pastors, and things. That was the major catalytic thing for them. Finding the solution.
SPEAKER_00Before that solution came and the drug was made, in places like my country, Nigeria, local people found and used local solutions to cure the disease. They discovered what plants or the parts of what trees contained quinine, a naturally occurring substance. To actually make chloroquine in the 1930s, German chemists created in a lab the first synthetic version of what would eventually be called chloroquine. At the time, they thought it was too dangerous for humans. But after World War II in 1947, the drug was refined, named chloroquine, and became commercially available.
SPEAKER_03I think chloroquine, no matter what, remained one of the best molecules that was used to treat malaria in terms of the fact that it helped to save a lot of life.
SPEAKER_00Chloroquine represented a revolutionary shift in the life cycle of malaria treatment. When it became available, it meant that children, pregnant women, and everyone else had access to a first-line drug to treat malaria. This option was better than local remedies. It dissolved better, it was absorbed faster in the body, and it lasted longer in the bloodstream. Now, so far, we're coming from a place where people depended on local remedies, and then came this miracle drug, if you like, which, even though it felt like it turned your life upside down, it made it easy and was the safest way to treat malaria. Now, we're at the point where by some science that drug started to fail. Why was this happening? And what made the drug Professor Christian Happy called the best molecule to stop working?
SPEAKER_04Hi, how are you?
SPEAKER_00Kay is the other expert I found with a personal connection to the science. When he was a child, he was given chloroquine and he got the full experience. He grew up and he did his master's and PhD researching malaria and chloroquine. Now he's a researcher at the University of Notre Dame in the US and he's studying how climate change means that mosquitoes are now being found in places that used to be too cold for them. To understand why chloroquine stopped working, it might help to unpack how it did the work that it did.
SPEAKER_04So, part of the life cycle of the malaria parasite is that it spends some time in the red blood cell, right? And what it does is actually feeding on the hemoglobin in the red blood cell, right? So the red blood cell has something called hemoglobin that helps to transport oxygen, right? Does that make sense?
SPEAKER_00What Kay is explaining in plenty of scientist language is that part of the process with the malaria parasite is that it spends some time in the red blood cell feeding on hemoglobin. When it does this, it releases a harmful substance. Then, to survive in the presence of that harmful substance, it converts it into one that is harmless. What chloroquine did was in interfering with that process, chloroquine worked in preventing the parasite from turning that waste harmless.
SPEAKER_04So that is just how chloroquine works, and that is where resistance comes to be.
SPEAKER_00Resistance didn't mean that people stopped taking chloroquine, but it meant that the drug worked less well. The malaria parasite was adapting, which we will find out in episode 2, it loves to do. So if initially the drug could kill 100% of the parasite, it could now only kill 70 or 80%. The parasite had acquired a mutation that meant it could survive in the presence of chloroquine. Many factors make resistance happen. One is the ability of the parasite to mutate so that it can evade drugs like chloroquine, but also behavioral issues like becoming ill and getting symptoms that feel like malaria, not confirming that it is malaria before taking malaria drugs. Number two is similar to number one.
SPEAKER_04Generally, people, when they take the drug and they say, Oh, you're supposed to use this drug for three days, after day one, when they feel better, they stop using the drug because I'm already better. But that singular act is one of the major drivers of the measures of resistance.
SPEAKER_00From when chloroquine was mass-produced to the first records of resistance was roughly 12 to 15 years. I wasn't sure if that was long or short in the lifespan of a drug.
SPEAKER_04I think it is short, but some people would argue that it is not that short. And I would explain why. When you factor in how resistance happens, for chloroquine it was short because it was used as a monotherapy.
SPEAKER_00Monotherapy is when you use one drug instead of combining multiple ones.
SPEAKER_04One of the things that we've come to realize is when, and not just malaria but parasites generally, when you expose them to just a single drug, they tend to develop ways to resist that drug faster than when you combine multiple drugs. For instance, HIV drug is not just one drug, it's a combination of two or three drugs attacking different parts of the virus. So some would attack the ability of the virus to enter into certain cells, some would attack the ability of the virus to replicate. So you're looking at the drug that attacks more than three components of the life cycle of the virus. That way, it is difficult for the virus to kind of gain resistance, right? So multiple or combined therapies tend to reduce the emergence of drug resistance because you are attacking the pathogen with multiple drugs that attack different parts of the life cycle of the pathogen.
SPEAKER_00After it became obvious that chloroquine needed to move over for something else, the replacement, that is, the drug that came after, was no longer a monotherapy. It was now a combined therapy drug called the atomicinin-based combination therapy or ACTs. That's what's used today. That's what replaced chloroquine ACTs. So the COATEM, the AMATEM, and similar drugs like that that you can buy in Nigeria and Uganda and such places are all ACTs. And then in 2011, the WHO acknowledged a threat, confirming resistance to the artemisinine part of that combination therapy. This means that even though ACTs are now a combined therapy, no longer a monotherapy like the chloroquine that stopped working, now there was resistance to one part of that combined therapy. And again, it was present in Cambodia, Thailand, and now Vietnam and Myanmar. In 2020 and 2021, the WHO again confirmed that that partial resistance was now also present in Rwanda and Uganda. What does partial resistance mean for actual people, for regular people who don't understand the science that is going on? What does it explain for people that there is partial resistance?
SPEAKER_03You know, resistance is in stages, it's a process of adaptation. Maybe you have one mutation, then next time you have another one, then you have another one. So as that becomes the norm, then you realize that you are treating somebody with a new medicine, and you and then the person is not fully cured. So partial resistance will take who says that you have parasites that are responding only partially. As they acquire more mutation, they will become fully resistant. And we find ourselves in a situation where we were with chloroquine in the year 90s, that you take a drug and then it doesn't even the malaria parasite is just there smiling, not even getting knocked out by it.
SPEAKER_00As a Nigerian, and since beginning my reporting for this series, I've been told many stories. Some of them have been familiar because of course malaria is common. But lately, I've heard more and more worrying accounts of malaria, and you may have heard or had these experiences yourself where, like me, you're thinking something is off, or that it seems that malaria is getting worse, and that's scary. When adults get malaria, it is bad, but it is much, much worse for pregnant women and children. Children under 5 are the most high-risk group, and this is because they haven't built the immunity that adults develop over the years. Because of this, they are more prone to having their malaria progress to the severe kind, and sometimes this progression can go from fever to death in about 24 hours. It is also particularly dangerous for pregnant women. It can lead to heart failure during childbirth, a miscarriage, and low weight after a baby is born, which is the single greatest risk for death in newborns. So if adults can shrug off malaria and they find it's not that easy, children simply cannot. But when a Nigerian woman gets pregnant, malaria is one of the things that they start to adjust for. Yeah?
SPEAKER_02Yes.
SPEAKER_00So I want to know how much was malaria on your mind during your pregnancy?
SPEAKER_02It was very much on my mind, and I it wasn't unpounded because yeah, I ended up with a lot of malaria.
SPEAKER_00How did you go from being worried about malaria to actually having malaria?
SPEAKER_02So my first malaria came before I took the prescribed prophylaxis, and I didn't really have symptoms. I just went for my regular antenna visit, and then there was malaria. The second time I went to the hospital because I was having some serious headaches, and I usually don't have headaches, so I was worried. I thought it was my blood treasure. But it's all no, it wasn't my blood treasure. My blood treasure was fine. It was malaria. I can't forget that one. I wasn't in the future. The hospital I'm fine of. I had malaria. Same with the cheater. Injection and uh kills to follow. That was my 36th week, and I had them I had my baby in the 38th week. That was two weeks before. I had a baby. I had malaria. Yeah. I don't remember at what point, but I just use the prophylaxis twice.
SPEAKER_00Adugo told me she, her family, her doctors were worried throughout her pregnancy, and they were right to be concerned. People tell me they're changing how they respond to getting malaria. For example, my friend Jane. She says she treated malaria back to back last year.
SPEAKER_02I don't know if it's in the drugs or if it's in the um immune systems, or if it's that we're getting fake drugs. I don't know what's the problem, but there's there's definitely something wrong.
SPEAKER_05Um, you started with the general symptoms of malaria, you know, pains in your joints, weakness, especially around the evenings, uh, some fever. I thought it was just going to be a regular situation. However, while I was going to get medication, I started shivering. And this was maybe 6-7 in the evening. And I tried to start my car, and I was shaving so bad that the keyforb broke.
SPEAKER_00Tests at the hospital said he had malaria plus plus plus. He took the first set of injections and went home. Then that night he had the Rigors, a sudden intense rise in temperature that comes with cold and shivering and sweating.
SPEAKER_05If I thought the first night when I had the Rigors was bad, this was worse because now I was vomiting. One of my best friends actually just randomly just texted in all my account details of the passwords and everything, and like, yeah, in case anything should happen, because that's what it felt like. It genuinely in that moment felt like I wasn't going to make it till morning.
SPEAKER_00So, in the middle of these shifts happening, what is going on in research to respond to these developments so that we can get ahead of what is one of the world's oldest diseases?
SPEAKER_01We develop a new insecticide, the mosquitoes evolve and now they're not dying. We develop new nets, they evolve.
SPEAKER_05Until the news broke that there's going to be a malaria vaccine for kids aged X, Y, Z, I had no idea anybody was doing any work on that.
SPEAKER_00So, are you saying that the mutations that you're studying and learning about as a scientist are responsible for what my friends and I are now experiencing out in the real world?
SPEAKER_02100%. 100%, yeah.
SPEAKER_00How scared should we be? That's in episode two of the Malaria Podcast. The Malaria Podcast was reported, written and presented by me, Olivia Ndubisi. The editor was Alison McAdams. Mixing and sound design by Jamal Roberts. Artwork was made by Ibukun Shobola. Additional production in Lagos by Chica Ago. Theme music by Premium Beats. Thank you to Farida Braimo, Odinaka Kingsley Obeta, and Bralade Koroe Emananjo for their help with this episode. The Malaria podcast was made with funding from the John Connor Journalism of Ideas Fellowship.