D.C. General, an enormous brick complex near RFK Stadium, was shut down in June after serving impoverished southeastern Washington, in one form or another, for 195 years. Although a skeletal emergency room remains open, vast wings of the hospital are closed, its windows cracked and broken like superannuated Moscow dormitories. On Tuesday, police shooed hordes of reporters away from the doors while Red Cross volunteers passed out crackers and soft drinks.

Many of the postal workers, who got 10 days’ worth of Cipro, said their superiors had urged them not to talk to the press. Some worried about getting sick while others expressed confusion about why they were getting antibiotics without first being tested for anthrax.

“They told me three days ago I was going to be tested,” said a 51-year-old mail carrier whose route is in Georgetown. “Today’s what? Tuesday. We should have been tested long before.”

In fact, none of the postal workers were tested Tuesday. Fearful of more deaths and sickness, officials decided it was better to medicate than to wait for accurate test results that might take a few days to arrive.

“They said there was no reason to get tested because they were giving us medicine to prevent us from getting anything. If they prevent,” said postal worker Gordon Garrison, “they don’t have to diagnose.”

With the whoop of ambulance sirens as soundtrack, it was an icky day in our nation’s capital, despite the Indian summer. The White House got its first anthrax scare, though a minor one. Secret Service employees found anthrax on a mechanical mail-opener at a military base where White House mail is opened.

Anthrax panic even found its way into my son’s backpack in the form of an alarming informational leaflet from the D.C. Department of Health, distributed to all schoolchildren. Its most trenchant bit of advice was to “resist the human urge to rush to a person you believe has been exposed” to anthrax.

At a noon news conference, Mayor Anthony Williams confirmed that postmen Thomas L. Morris Jr., 55, and Joseph P. Curseen, 47, died of toxic shock from anthrax exposure after being misdiagnosed and sent home early from a Maryland hospital.

Two other postmen were hospitalized with anthrax in serious condition at a Northern Virginia hospital, and 16 other D.C.-area hospital patients are under observation for possible anthrax symptoms. Most had worked at the Brentwood mail distribution center, where postal workers who handled the anthraxed letter to Tom Daschle stayed at their jobs until this week.

The comparison to Congress, which recessed last Thursday for five days, was odious. “Basically,” said Charlie, a Gaithersburg, Md., postal worker who refused to give his last name, “I think they just wanted us to deliver the damn mail.”

Barely audible over the snarl of reporters, the Centers for Disease Control’s Rima Khabbazz tried to explain the missteps of the team of 40 epidemiologists investigating the Washington outbreak. Khabbazz’ comments pointed to the basic problem with handling this outbreak: the lack of precedent.

Based on the Florida and New York anthrax cases, Khabbazz explained, there was no reason to suspect that the anthrax-tainted envelope received in Sen. Tom Daschle’s office would have leaked in the Brentwood distribution center that handled it.

On Thursday, Postmaster General John Potter had even held a news conference at Brentwood to say there was only a “minute chance” that anthrax spores had escaped into the plant.

“We make recommendations based on the best science available at the time,” said Khabbazz. “The paradigm shifted at Brentwood.”

On Saturday, after Leroy Richmond became the first Brentwood employee confirmed ill with anthrax, CDC officials gave prophylactic antibiotics to his workplace neighbors. But Morris and Curseen apparently worked hundreds of feet away.

One theory is that high-pressure air nozzles used to clean mail-sorting gear may have whisked clots of anthrax spores across the sealed room. Or there may have been another letter. “We haven’t ruled anything out,” Khabbazz said.

It wasn’t until Monday that bacteria from 29 swabs gathered at Brentwood had been allowed to grow — and 14 came back positive for anthrax.

By then, the blood of Morris and Curseen was boiling with anthrax poisons.

Who are the next victims? Could the Daschle letter, a reporter asked, have rubbed onto other mail, including some that continues to arrive at our houses this week? Khabbazz, humbled by previous errors, let out a big sigh. “There is science,” she said. “There is science. We don’t fully understand the situation.”

Brentwood employees began going on antibiotics Saturday. Postal workers from 36 post offices that do business with the center got their drugs starting Monday night. They were given a 10-day supply of Cipro and told not to drink milk or alcohol with it. If the bug turns out to be susceptible to older antibiotics like doxycycline or amoxycillin, the postal workers may later be switched to those drugs, according to CDC officials, who are following the recommendations that an expert panel published in 1999 in the Journal of the American Medical Association.

Williams and the officials around him took a pass on making recriminations for the failure to protect the lost postmen, although Williams did get in a jab at Congress by saying that “anyone, no matter what they look like or where they work, deserves the best treatment.”

“The most important thing is to maintain confidence in the public health system,” added Ivan Walks, D.C.’s chief public health official.

“The enemy is not public health or the D.C. government or the CDC,” said Deborah Willhite, a vice president of the Postal Service. “The enemy is the murderers who sent the letters.”

In suburban Washington, D.C., police and local news teams rushed to an Episcopalian church, scene of the following emergency: A secretary had felt a “tingling of the mouth” after opening a dusty envelope.

Are we a nation on the verge of a nervous breakdown? In the brutal shadow of 9/11, in the peculiar wake of the still-mysterious Florida and New York anthrax cases, powders are giving people jitters coast to coast. Health departments, clinics and emergency rooms are swamped with calls from the worried well; scores of buildings have been evacuated, and some employees quarantined, by fear of unknown powders.

Historically, many mass psychosomatic disease outbreaks have occurred in closed social groups under pressure — among Tokyo subway riders, for example, or teenage girls in the hothouse of junior high.

“We’re all in the hothouse now,” says Dr. Timothy Jones, an epidemiologist at the Tennessee Department of Health.

Seven or eight Internet medicine-peddling sites have even added ciprofloxacin — the antibiotic of choice for inhalation anthrax — to their wares.

“Cipro and Viagra — that kind of blew me away,” said Dr. Michael Fleming, a family practitioner in Shreveport, La. Fleming has already talked down two patients — one with a cough, the other with a small rash — who were convinced they had anthrax.

Wars have a way of spreading psychosomatic illnesses among the hometown crowd. In 1944, during the Battle of the Bulge, 29 people in Mattoon, Ill., by ones and twos, began to fall faint, to vomit and grow dizzy. Some said they’d been sprayed with a sweet-smelling gas by a man hiding in the bushes. The Mad Gasser of Mattoon, the tabloids called him. During the Gulf War, 17 Rhode Island teenagers and teachers became ill after an imaginary toxic gas release.

While no one can know how much anthrax will surface in the United States in the coming months or years, for every real case there will probably be hundreds of patients whose illness is mainly in the head. “The perception of the disease could be worse than the reality,” says Dr. Peggy Neill, a Brown University professor who heads the Infectious Disease Society of America’s bioterrorism committee.

The prospect of mass hysteria is not to be taken lightly, some believe. In a month or two, flu season starts — and it has the potential to be rough on the mildest of hypochondriacs. Influenza, with its pounding headache, cough and high fever, is nearly identical to the early symptoms of inhalation anthrax. Public health officials have started urging American adults to get flu shots this year — not only to prevent flu, but because they also enable doctors sniffing for bioterror germs to rule flu out.

“Flu season is scaring us all, because people are hearing in the media how similar the symptoms are,” says Jones. “And medical folks are not good at predicting how severe a flu season is going to be.”

The overcharged atmosphere of today feeds the psychosomatic tendency, experts say.

In a study published in the New England Journal of Medicine last year, Jones dissected a 1998 mass hysteria outbreak at a McMinnville, Tenn., school. There, 170 students and teachers were hospitalized or treated in an emergency room. A teacher fell ill after reporting a “gasoline-like smell” in her classroom; several other students reported symptoms and ambulances began arriving. Subsequent waves, the study found, fed upon the earlier alarms.

“There were lots of sirens in front of the whole school and it spread like wildfire,” Jones says, adding that when a building is evacuated because of an anthrax scare, “it could lead to psychogenic symptoms even if the threat is later shown to have nothing real about it.”

The more obvious public health downside of the anthrax scare is the run on Cipro and gas masks, both worthless personal weapons against anthrax. Gas masks wouldn’t be put on until invisible anthrax spores had already spread around. As for Cipro, leading physician groups strongly oppose personal stockpiling.

“Why is this not a good idea?” Neill asks rhetorically. “In the first place, you are pulling something off the shelf that is not available to people who need it.” Cipro is prescribed for severe urinary tract infection, and bacterial diarrhea, among other uses. “Second, these stockpiles go into private medical cabinets without the benefit of informed medical opinion. If there were an anthrax attack, and you treated yourself instead of going into an emergency room, you could end up compromising your own care.”

Most important, Neill says, is the obvious point that stockpiling personal means of protection, however ignorant, is also mean-spirited.

“We’re all in this together,” she says. “There is a national pharmaceutical stockpile that represents a community-level response to this problem.”

Still, amid the reports of funny-smelling packages and mystery liquids, of anthrax vectors aimed at tabloid photographers and news anchor mail openers, the run on Cipro continues. One Washington family practitioner got requests for prescriptions from the local NBC affiliate Friday morning — and the ABC team an hour later. He told them both to get lost. “The place for treating anthrax is in the intensive care unit — and that’s only if you’re actually sick.”

“We’re getting inundated with calls from doctors and patients,” added Shelly Pumphrey, a nurse at an infectious disease practice in Washington. “And people are really up in arms because we’re refusing to prescribe Cipro to everyone who wants it.”

What concerns Neill is that runs on Cipro and vaccine supplies reveal that people are unaware of the steps government has already taken to prevent biowarfare outbreaks, or at least to detect and shorten them. Billions have been spent on the program in the past several years. “People haven’t been given adequate reassurances,” she says.

Although no system can guarantee that no one is going to die in a terrorist attack, the government response to the Florida anthrax case showed that the existing system is working pretty well. The infectious disease doctor who treated Bob Stevens noticed rod-shaped anthrax spores while testing for bacterial meningitis; anthrax would probably never have occurred to this physician had the CDC not begun alerting physicians to the risk recently. “Push-packets” of medicines and biomedical hardware were shipped to Boca Raton within a day of the confirmation of the first case.

In a massive anthrax attack, all this might be too late to save hundreds of lives. But the likelihood of a mass attack is not great. The Iraqis tried and failed to figure out how to disperse anthrax with bombs and missiles. Without U.S. or Russian help and/or a sophisticated lab, terrorists wouldn’t be able to use the germs for killings on a massive scale. Aum Shinrikyo, the Japanese terror cult, made eight tries at dispersing biowarfare agents in the city of Tokyo — failing each time.

Jonathan Ban, an analyst at the Washington, D.C.-based Chemical and Biological Arms Control Institute, conducted an assessment of biowarfare for the CDC in July that concluded that smaller-scale attacks, perhaps not dissimilar to the Florida episode, were the most likely form of bioterrorism. The key to blunting such attacks, Ban says, is neither the National Guard nor Hazmat suits, but good information and communication.

The quicker disease germs can be identified, the quicker accurate news of an outbreak spreads, the faster doctors can identify, treat and, when necessary, quarantine patients. Lots of defense research money has already gone into biosensors and molecular quick-identification techniques — some of which were used experimentally in Florida — and hundreds of millions more is in the pipeline.

The spinoff of better detection and reporting networks is that such technology works for all infectious germs, not just those spread around by evildoers. “It’s a great investment,” says Ban. “These are tools for public health for everyday natural diseases. And our public health system has deteriorated in the last 20 years.”

As for diagnosing psychosomatic illness, it’s often characterized by tingling around the mouth and fingertips, lightheadedness and dizziness — classic symptoms of breathing too fast, says Thomas Nagy, a Palo Alto, Calif., psychologist. “The antidote is to drop your shoulders and breathe from the tummy.”

Further advice for the anthrax-obsessed is to sit back, watch your tax dollars at work and hope for the best.

And get a flu shot.

The biggest surprise of the rough analysis of the first sequencing of the human genome was the number of genes it contains. For years scientists had been predicting that human DNA would contain somewhere between 100,000 and 140,000 genes. It turns out we may have as few as 26,000 — a genome about the size of a corn plant, with roughly a third more genes than the fruit fly.

When it comes to numbers of genes, size definitely does not matter. Not only that, but our genes look pretty similar, in structure, to most of the genes in fruit flies, roundworms and even brewer’s yeast.

For example, we seem to have only about 300 genes that mice lack. We also have about 200 genes that have come down to us from bacteria. Some of those genes have important functions in the brain — one, for example, is key to the processing of certain antidepressant drugs.

It turns out only 1 percent of our DNA is what we think of as genes — i.e., chemical components that help build proteins, the building blocks of our bodies; scientists had thought at least 3 percent of our DNA was coded for proteins. Half of the rest of our DNA is made up of “jumping genes,” semidecrepit strings of DNA that migrate like viruses in and out of our genomes with mysterious purpose.

People used to call jumping genes and other noncoding segments “junk DNA.” Nobody was calling it junk on Monday. “Probably these other regions of DNA are important,” said MIT’s Eric Lander, a leader of the decoding effort. But neither he nor anyone else was all that sure how.

If nothing else, Monday’s news will necessitate an overhaul of the bromides commonly used to describe our relationship with our DNA. We should no longer be identifying ourselves by “what’s in our genes.” It’s not that we aren’t biological beings. But our I.Q. and hair color and foot tapping and propensity for diabetes, and all the rest, are clearly caused by a mishmash of things — not just genes and environment, but also interactions among genes and proteins and all the noncoding DNA, whose functions are still shrouded in a good deal of mystery.

There was something breathtaking about this event. Maybe it was the fact that all these intensely intelligent people, with the most modern machines at their disposal, had been taken by surprise by what they diligently found. In a way, it was science at its best.

As an enormous 15-foot banner filled with tiny script was trotted out before the podium — a graphic representation of the DNA sequence and genes on a single chromosome — the scientists expressed amazement at what they’d accomplished.

“We felt like Lewis and Clark, crossing new mountain ranges and entering new valleys, seeing new rivers,” said Robert Waterston, who headed one of the large sequencing labs, at Washington University in St. Louis. “Even two years ago I didn’t know if I’d live to see this day.”

One of the groups presenting its findings Monday was a U.S.-led, international consortium of 20 major laboratories, some of which have been decoding DNA for 12 years or more. The other was Celera, the private biotech firm led by renegade scientist Craig Venter.

Surprisingly, it was Venter — who engendered the envy and hatred of geneticists around the world three years ago when he announced he would beat the consortium to the complete sequencing of the genome — who made the politically astute connection between the data and what they mean sociologically: a blow to genetic determinism.

“The smaller number of genes supports the notion that we’re not hard-wired,” said Venter. “We now know that the notion that one gene leads to one protein and perhaps one disease is false. One gene leads to many different protein products that can change dramatically after they’ve been produced. We now know that regions of the genome that are not genes may hold the keys to the complexity that we have in ourselves. We know now that the environment acting on biological steps may be as important in making us what we are as the genetic code.”

“It’s clear that genes can’t answer all, or even most, questions about human biology,” he concluded.

Wunderkind Lander, who heads the consortium’s largest sequencing laboratory, at MIT, concurred. “We have far fewer genes than we expected — less than two times more than the fruit fly,” he said. “What a comedown.” But as Lander explained it, “We are far more complex than the fruit fly, and we manage it because our genes can make more proteins, and more proteins with multiple roles. Regulatory parts of DNA add to the complexity.”

Even as the scientists presented their exciting findings, a parallel drama of human ambition was playing itself out — with two teams of scientists and dueling science magazines squaring off. Science, the leading American scientific publication, this week is running Venter’s version of the genome. Nature — Science’s British archrival, which published James Watson’s seminal 1953 paper on the double helix — is running data and analyses presented by the public international consortium.

In an arrangement reminiscent of the early Khrushchev-Kennedy meetings, the middle of the stage at Monday’s news conference was shared by Venter and Francis Collins, director of the National Human Genome Research Institute at the National Institutes of Health.

Collins and Venter have often been at odds in the past. Venter has suggested, in so many words, that Collins, a loping, pedantic Virginian, is a flunky bureaucrat afraid of competition. Collins, meanwhile, has claimed that Venter, a millionaire many times over, is doing sloppy science while trying to privatize the patrimony of mankind.

But they kept their catty remarks to a minimum Monday. In fact, they seemed genuinely happy there were two copies of the genome out there — especially since they seemed so similar. “This is a rare moment in science when you get virtually simultaneous confirmation of results,” Collins said. “This means we can all build on this data.”

For those who equate private biotech ventures with a fast-buck brushing off of the subtleties of science, it was instructive to hear that Venter’s interpretation of the data put much more stress on its complexity.

On the other hand, Collins, a Christian in the C.S. Lewis vein, described the genome as the “first draft of the book of life … written in the mysterious language of all the ages … some would say the language of God.”

Venter suggested that fewer genes would mean that diseases are likely to be harder to understand, because it was clear that so much other, nongenetic stuff was causing them. Collins voiced the more provincial view that fewer genes would make it easier for geneticists like him to find the ones responsible for diseases. “The haystack just got a lot smaller,” he said.

Venter also stressed that he thought the sequenced human genome would “not aid those who want to perpetuate racial prejudice.” Celera got the DNA for its sequencing effort from three women and two men, including African-American, Chinese and Hispanic donors. The donors’ DNA was 99.99 percent similar, said Venter. Differences among members of the same “race” are far larger than those between races.

One couldn’t help feeling that Monday was a vindication for Venter, who was a surfer dude until he went to Vietnam and witnessed the horrors of war and the frailty of the human body as a medical corpsman.

The international consortium and Venter’s group used different techniques to sequence human DNA. The consortium took small pieces of DNA and painstakingly sequenced them. Venter’s “shotgun” approach was to blast apart an entire complement of DNA, sequence the bits and then reconstruct them using computer programs.

But Venter ended up relying heavily on public databases, which his critics claimed undermined his claims of success. Also, in trying to map genes on the 46 chromosomes, both Venter and the consortium relied on DNA libraries established by publicly funded scientists.

Back in the early 1990s, when Venter quit the NIH and went private with the automated DNA sequencing programs he’d developed, Watson — who headed the NIH’s genome institute at the time — famously dissed him. “Any monkey can do what he’s doing,” Watson said.

Watson, who co-discovered the double-helix structure of DNA back in 1953, was there today, his mad cornflower-blue eyes flashing over the flowered tie he had tucked into his belt. He displayed no animosity toward Venter at Monday’s event. Instead, the men shook hands.

Chatting with a few reporters, Watson said competition had been good for the sequencing effort. “This is a historic day — we have the instruction book,” he said, adding: “I’d like to use this knowledge to cure senility before it gets me.”

Just as President George Bush banned federal funding for research using fetal tissue (a ban Clinton quickly overturned), so right-to-lifers expect Bush to quickly reverse Clinton’s endorsement of embryonic stem cell research. Bush has “consistently opposed federal funding for research that requires embryos to be discarded or destroyed,” says his spokesman, Scott McClellan.

But banning funding for work involving embryos could be politically thorny. Embryonic stem cell research is particularly promising for diseases that plague seniors, like Parkinson’s, and it has many Republican backers in the Senate and elsewhere. And at HHS, Thompson would be in charge of funding the research through the National Institutes of Health.

Thompson has a solid anti-abortion record, but in January 1999 he angered right-to-lifers in his home state when he invited University of Wisconsin biologist James Thomson to his state-of-the-state speech. Thompson introduced Thomson to the Legislature as a “bold pioneer” who is “leading Wisconsin into the next millennium.” A few months earlier, Thomson had turned science on its ear by growing embryonic stem cells — which have the potential to become any human tissue — in a petri dish. The stem cells came from embryos donated by women at a campus fertility clinic. To get the stem cells, Thomson had had to destroy the embryos.

Although embryo destruction isn’t the same as abortion — the embryos were never implanted in a woman — many right-to-lifers equate the two. At the time, Mary Matuska of Pro-Life Wisconsin blasted Gov. Thompson for endorsing research that “involves mutilating and destroying human embryos.”

Despite her group’s criticism, a Wisconsin university official says, Thompson has remained a steadfast supporter of Thomson’s work. As governor, he spearheaded funding for several new biology buildings on the Madison campus, and a few weeks ago quietly helped quash legislation to ban fetal and stem cell research in Wisconsin.

All this has somewhat clouded Thompson’s bona fides among cultural conservatives in his state. “The Wisconsin right-to-life folks are uneasy about Thompson,” says Richard Doerflinger of the Pro-Life Activities secretariat of the U.S. Catholic Bishops Conference. Doerflinger says he’s confident that regardless of his HHS choice, Bush will undo the federal guidelines, published in August, that enable funding for the research. “He has already said he disagreed with the [embryo research] guidelines, and we expect him to reverse them,” Doerflinger says. “I’m pretty confident that’s what he’s going to do.”

But the embryonic stem cells controversy is just one of a number of cutting-edge biomedical issues that don’t cleave along traditional party lines. The use of genetic tests and distribution of private medical data, the screening of fetuses for a variety of genetic variations and the cloning of animals to make organs for transplant are all issues on the horizon in which Green neo-Luddites and the fundamentalist right may be warmer bedfellows than are Christian and libertarian conservatives.

Many biologists believe that Thomson’s creation of an in vitro line of embryonic stem cells in 1998 opened breathtaking vistas in science and medicine. Hardcore abortion opponents, though, regard the microscopic embryos — using what might be called the “Horton Hears a Who” rule — as persons no matter how small, and just as worthy of protection as any fetus or born person, although they can legally be flushed down the toilet in most states.

Bush could scrap federally funded embryo research with a stroke of the pen, but McClellan wouldn’t say if he’s going to do that. Bush will “review executive orders, regulations and rules after he takes office,” McClellan said, echoing the caution heard in earlier Bush camp statements on the issue.

Although the guidelines were published in August, an NIH board set up to review grant applications for embryonic stem cell research won’t hold its first meeting until April. Robert Walker, a science policy advisor to the Bush campaign, says he doesn’t think Bush has focused on the issue yet.

“I don’t think it’s a foregone conclusion what position he’s going to take,” agreed Dan Perry of the Alliance for Aging Research, a leading lobby for stem cell research. “I don’t write off George Bush on this.”

Neither does Doug Melton, a Harvard University embryologist and one of the few American scientists who has had a chance to tinker with the cells. Melton, whose work is privately funded, would like to try to use embryonic stem cells to make a human pancreas. He has a personal stake in it: His 8-year-old son has Type 1 diabetes.

“If Bush decides to retreat from the federal guidelines it will be a great disappointment to the scientific community. A lot of people spent a lot of time creating them very carefully,” Melton says. “We hope that he spends at least as much time thinking about this as he does on death penalty cases, which from what I understand is maybe 10 or 12 minutes.”

Embryonic stem cells are one of the hottest phenomena in biology. Biotech companies, which Republicans are eager to court, are excited about potential therapies growing out of stem cell research. Patient groups representing millions of voters are pushing hard for federal funding.

Although biotech companies such as Geron Corp. in Menlo Park, Calif., are funding some research with the cells, it’s all secret. Many scientists feel that if done at all, such science should be publicly funded so the general populace can examine procedures and results. And it will take dozens (and perhaps hundreds) of labs working with the cells to get meaningful research in a short period. That can only happen with federal funding.

Christopher Reeve, who suffered a spinal cord injury in a 1995 riding accident, and Michael J. Fox, who has Parkinson’s disease, were among the famous people trotted before the budget subcommittee of Sen. Arlen Specter, R-Pa., last year to demand NIH sponsorship of the research.

Senate leader Trent Lott, R-Miss., an opponent, promised to allow floor discussion and a vote on Specter’s bill, but didn’t deliver. An aide said Specter hasn’t decided whether to reintroduce the bill this year.

The entities at the center of the controversy are the more than 150,000 embryos currently stored in liquid nitrogen at fertility clinics around the country, left there by parents who had their babies, or failed to get pregnant but moved on.

Each embryo contains several hundred cells of a primordial type that, when cultured, can be made to replicate eternally. The hope is that once scientists figure out how to manipulate them, the cells could be converted into any kind of human tissue, providing a virtual fountain of youth for cell cultures to replenish tissues damaged in anything from Lou Gehrig’s disease to juvenile diabetes to Alzheimer’s. In the nearer term, embryonic stem cells may provide valuable substrates for testing drugs and doing basic biology experiments.

“We need to make Bush understand this is potentially as big as space travel,” Melton says. “He should think of the economic advantages. Cell replacement therapy could end up coming from companies outside of the U.S. because of restrictions he puts on research here.”

Doerflinger and others have been quick to point out that there are potential alternatives to using embryonic stem cells to create transplant tissue. Other types of stem cells, generated from adult or fetal tissue, have shown some promise. Researchers, for example, have turned bone marrow stem cells into brain cells.

“There seems to be a great deal more plasticity in the human body than we imagined,” says Ron McKay, a leading NIH stem cells researcher. But McKay and others still believe embryonic stem cells offer the most promise because they can be cultured relatively easily and grown indefinitely. And these scientists don’t want any avenues of research shut off.

Rabinovich cycled through cascades of fever and shaking, burning and cold for a few days before returning home from the hospital. She had undergone her rite of passage as a malaria researcher with the Malaria Vaccine Initiative, created earlier this year by the Bill and Melinda Gates Foundation.

During the Vietnam War, in response to the more than 100,000 cases of malaria recorded among American troops, the United States invested significant funds for development of antimalarial drugs. In the decades since then, however, malaria research has been a disheartening, underfunded field — despite the fact that the parasite is the No. 1 killer of children in Africa, claiming more than 1 million victims a year, and causes illness in 400 million people annually worldwide.

Once the U.S. military managed to control the disease among its troops, the failure of a United Nations-backed global antimalarial campaign around the same time — stymied by stubborn mosquitoes and parasites and a lack of resources — caused a decline in Western interest in the disease. U.S. and European governments spent less than $50 million annually on malaria research while drug-resistant strains of malaria proliferated in Africa.

Poverty and disorganization have frustrated African efforts to control malaria’s spread with low-tech means — such as spreading oil on stagnant ponds where mosquitoes breed and distributing window screens and bed nets. And until recently, few pharmaceutical companies had shown much interest in what may be the most promising solution — a vaccine.

As it happens, though, Rabinovich may be a harbinger of a change in that picture. She was a prominent public health official at the National Institute of Allergy and Infectious Diseases before being named in December 1999 to head the private malaria initiative, part of a $1 billion philanthropic investment by the Gates Foundation for development of vaccines for the Third World. Her group plans to create partnerships with universities and private companies that commit to creating a malaria vaccine.

The Gates Foundation’s spending on malaria follows upon big investments over the past few years by the National Institutes of Health, the World Health Organization and Britain’s Wellcome Fund, with total spending from all sources totaling $100 million or more. What’s more, the World Bank has pledged up to $500 million in interest-free loans to African countries for malaria prevention and control. And the lame-duck Congress could add to its appropriations a $1 billion tax credit program — pushed by the Clinton administration and based on a proposal by Harvard professors Jeffrey Sachs and Michael Kremer — to encourage spending on malaria research by the pharmaceutical industry.

Money has begun flowing into this fight for two reasons. Public health officials are worried about drug-resistant strains of the parasite that are on the rise around the world, and they are encouraged by the emergence of several promising antimalarial vaccines, which need big cash infusions to move forward.

But when both houses of Congress approved a $50 million U.S. Agency for International Development program to combat malaria on Oct. 26, another factor was at play: the self-interested inclination to do something about malaria before global climate change brings a “third-world disease” to our doorstep.

“As we know from our experience with the West Nile virus,” said Rep. Barbara Lee, D-Calif., during floor debate on the bill, “if we do not act quickly to break the back of a disease abroad, the inevitable result is outbreaks of the disease here in the United States.”

Global climate change does seem to be bringing more mosquito-borne diseases to this country. Scientists speculate that an errant mosquito that somehow traveled to the United States in the belly of a plane may have caused New York’s 1999 outbreak of the occasionally deadly West Nile virus. By this fall the germ — which spreads from mammals and birds to mosquitoes and back again — had established itself all along the East Coast, prompting spraying campaigns in places as far south as the Washington suburbs. Scientists believe that the West Nile virus is here to stay, and will probably spread across the entire country within a few years.

Dengue fever, a dangerous mosquito-borne viral disease that causes joint pain and sometimes death, has dramatically increased along the U.S. side of the Mexican border in the past few years, according to research presented at a conference in Houston in November. As in the case of West Nile, dengue-carrying mosquitoes may be hitching rides across the border in tractor-trailers brought north by increased trade, with warmer temperatures allowing the virus to gain a foothold.

Malaria thrives in hot temperatures, which enable the plasmodium parasite that causes the disease to mature more quickly in the bodies of the mosquitoes that carry it. Paul Epstein, a Harvard Medical School tropical disease specialist, has presented computer models suggesting that malaria, endemic in areas of the world where 45 percent of the population lives, could affect 60 percent of the world’s population by 2100 if warming trends continue.

In the 19th century, wealthy Washingtonians sent their children to cooler climes in the summer and British diplomats living in the city got hardship pay for their posting in the federal district’s malarial sump. But many malaria experts are skeptical that the disease could become endemic in America again. Lifestyle changes and aggressive anti-mosquito campaigns were what rid Europe and North America of the disease, they point out, not the fact that the regions were cold.

“Yes, malaria could return to these regions,” says Jo Lines, a malaria researcher in Britain, “but only if we go back to living together in unglazed houses with our animals.”

Still, the return of endemic malaria in the United States is not out of the question. “If warming brought in populations of mosquitoes that are more efficient vectors than the ones we have now, it could happen,” says Ripley Ballou, who led malaria vaccine research at the Walter Reed Army Institute of Research for 17 years.

In the 1930s, Anopheles gambiae mosquitoes, deadly efficient malaria carriers, were brought from Africa to Brazil by accident and caused major outbreaks before aggressive spraying campaigns subdued the invaders. The Anopheles strains of mosquitoes in this country aren’t nearly as effective as Anopheles gambiae at transmitting the disease — which may be why the United States, despite frequent cases of imported malaria such as Rabinovich’s, hasn’t experienced large outbreaks.

“We don’t have gambiae in North America, but if they moved in because of global warming, even a small population of [these] infected mosquitoes could cause a lot more disease,” Ballou says.

Still, researchers like Ballou, who retired from the military last year and now consults part time for Rabinovich’s initiative, view the threat of malaria in the United States as a narrow basis for attracting funding for their work. “If we start seeing more cases of malaria in New York City and along the population centers around the country — which is certainly possible — there will certainly be more resources put on this,” says Ballou. “But I don’t see that as a very good way of moving the emphasis along.”

Rabinovich agrees. Seeking increased funding based on fear would be a short-lived effort, she says, because she doubts malaria will become a chronic U.S. problem. “I’m hoping for more of a perspective that we’re a global community and this is an infectious disease affecting the world, and the U.S. should have a role,” she says. “That’s more sustainable.”

Whatever motivates funding for malaria research, there are some encouraging signs in a field with vexing difficulties. It has been tough to develop a malaria vaccine because the parasite that causes the worst symptoms, Plasmodium falciparum, has evolved a remarkable capacity to thrive in our bodies. Falciparum, the dominant strain in Africa, lives out four life stages in humans, and it tends to colonize cells in a way that protects it from a person’s immune system.

Last year, for the first time, an experimental malaria vaccine successfully protected a large group of people. The trial of 306 adults was conducted in Gambia by researchers from Walter Reed; Smith Kline Beecham Biologicals (SB Bio), a Belgian subsidiary of the pharmaceutical giant; and the British Medical Research Council. The vaccinated group had 71 percent fewer episodes of malaria than the controls — although the protection lasted only two months.

Rabinovich, whose initiative is likely to help fund further trials of this and related vaccines, was accompanying SB Bio officials on a visit to the Gambian villages that took part in the trial when she got her nasty bite.

The Gambia vaccine, known as RTS,S, marshals an immune response against malarial sporozoites, the spindly forms of the parasite that the mosquito injects into the body and that quickly swim through the bloodstream to lodge in the liver. Scientists at Walter Reed are working to incorporate another component into the vaccine so it can attack the next stage in the parasite’s life cycle — the seedlike merozoites, which propagate from the mature sporozoite and burst out of the liver into the bloodstream by the tens of thousands, colonizing and destroying an infected person’s red blood cells.

One particularly awful aspect of malaria is that for reasons that aren’t entirely understood, humans don’t develop immunity to the disease after getting it once. “What really hits you,” says Rabinovich (who during an interview in her office is wearing a sweat suit against recurring malarial chills despite Washington’s October heat), “is that, OK, I’ve been through this. I’ve seen the millions of antigens multiplying in my blood, and yet the next time I go back to Africa I could get just as sick.”

No malaria vaccine is likely to be as effective as, say, the measles vaccine. But in the Third World, where the parasite’s resistance to common, inexpensive antimalarial drugs is growing and expensive drugs just aren’t an option, a vaccine may be the best hope, as in the case of AIDS.

It would be easy to blame the drug industry for failing to develop a malaria vaccine until now. But malaria researchers make it clear that some major technical hurdles had to be crossed before sinking big bucks into a vaccine made sense.

In the United States, the only sustained, well-funded malarial vaccine work in the past few decades has been done by the military, at Walter Reed or at the Naval Medical Research Center in nearby Silver Spring, Md.

Key breakthroughs began in 1979, when scientists discovered that the sporozoite proteins could be targeted with a vaccine. From about 1986 to 1995, Walter Reed and the Navy tested nearly two dozen vaccine formulations. They all flopped.

Usually, the drill went like this: Scientists developed a new vaccine; scientists tested the vaccine on animals for safety; then the lead scientist and lab partners rolled up their sleeves, got a shot and exposed themselves to malarial mosquitoes.

Next, everyone came down with malaria.

While recovering from the disease — whose symptoms can easily be controlled if treated quickly enough — the scientists often learned that the company working with them on the vaccine had decided to end the partnership.

“The term ‘rolling up your sleeves’ has a particular connotation when it comes to malaria research,” says Ballou. He got a malarial bite in 1987 while testing a failed, early-generation vaccine. Gray Heppner, now head of immunology at Walter Reed, got malaria in 1993 while testing an updated version. “That vaccine was safe, well-tolerated and completely without effect,” Heppner says with a laugh. “There were 17 of us — controls [who also exposed themselves to mosquito bites] and vaccinees — and we all got malaria.”

Companies typically worked with Walter Reed to the point of testing a vaccine on a few people. “If it didn’t show results, they bailed,” says Heppner. “Things were tough. An awful lot of people said it’s not possible to make a malaria vaccine.”

To this day, SB Bio is the only division of a major pharmaceutical company that has shown a long-term commitment to working on a malaria vaccine. A side benefit for SB Bio has been that its malaria research enabled it to test vaccine technologies with applications for other, more salable vaccines.

The military’s malaria vaccine research has trundled along for years as “a flea on the back of military R&D,” says Ballou. Funding for the labs was hurt some by downsizing of the military and, Ballou adds, “we didn’t have a deployment where we had a lot of people getting malaria, to the point where some general hollers, ‘Where’s my vaccine!’” Most of the malaria drugs on the market, Ballou points out, were developed as a result of a huge drug-screening program the military funded in response to the devastating effects of malaria on U.S. troops in Vietnam.

The hope now is that private initiatives like the Gates fund — with federal support — can sink enough money into partnerships with researchers to lower the financial risk for the pharmaceutical companies that ultimately will have to manufacture the vaccine.

Rabinovich and other experts say that an effective, widely available vaccine is probably still at least 10 years off. In the meantime, they continue to risk their health in the hopes of saving babies. Rabinovich sometimes wears a pin with three children on it — the number of African children who die each minute of malaria.

One night during her visit to Gambia, Rabinovich attended a celebration of the vaccine trial. Villagers performed humorous skits about the painful shots and the misery of malaria. “As dusk came down we were passing bug spray back and forth and surreptitiously rubbing it on ourselves, because you could tell what was around,” she says.

For the scientists lathering themselves with protective bug juice, it was sobering to watch the children, who had no protection at all. “The village kids,” Rabinovich recalls, “were all just running around.”