Arian Rustemi

The Fever: How Malaria has Ruled Humankind for 500,000 Years, by Sonia Shah

In The Fever: How Malaria has Ruled Humankind for 500,000 Years, investigative journalist Sonia Shah uses anthropological history, scientific explanations, and current stories from the sidelines to explain exactly what her title so aptly conveys: how malaria has ruled over humankind for much of history. Shah goes into great detail to shed light on how much influence malaria had during major historical events – Atlantic Slave Trade, the US Civil War, World War I, World War II, the Vietnam War, the fall of the Roman Empire, and the construction of the Panama Canal – as well as on the reasons why this disease has not only survived despite mankind’s many attempts to eradicate it (i.e. resistance to certain medicines and variation of strains among different regions), but how malaria may still be around because of certain human actions (i.e. building the city of Rome on the Tiber, construction of public squares atop the swampiest parts of the island of Manhattan, and current mining, logging, and farming projects).

The Fever is essentially a public health history of malaria. Each chapter tackles a major issue regarding the disease such as: its development, the ecologies that give rise to it, the history of pharmacological interventions, the various perspectives on both the illness and treatment, among others. In addition to delving deep into the world’s history to highlight the affect that malaria had on civilization (“In countless wars,” Shah writes, “malaria has killed more soldiers than combat. And the intensity of wartime malaria can extend well into peacetime, as soldiers returning home introduce their newly gained malaria parasites into virgin landscapes, triggering yet more malaria epidemics.”), Shah looks at the current state of malaria by, among other things, following Terrie Taylor in Blantyre (Malawi) and accompanying Jose Calzada to Chepo (Panama).

Being extremely passionate about the field of global health, I considered myself rather knowledgeable about malaria before reading The Fever. This knowledge came by virtue of recently working in a non-profit organization that dealt with this disease, along with HIV/AIDS and tuberculosis. Nevertheless, I was left astonished by the majority of the content in Shah’s book, especially the detailed chronicles of malaria throughout the world’s major historical events.Including the fact that there were times during war when one-third of the troops were unfit for combat due to their bouts with malaria and that malaria was most likely responsible for Caesar’s death helps Shah illustrate the point that this is a disease that takes full advantage of the environmental conditions around it (congested populations, stagnant water) but does not discriminate with regards to race, class, or region. As an investigative journalist, Shah has the incredible advantage of digging up facts and delivering them to the general public who would otherwise be unlearned in certain aspects of malaria. It is safe to say that Neil Hamilton Fairley’s persistent advocacy for quinacrine and the Chinese government’s top secret Project 523 during the 1960’s would have flown under the radar to those outside the field of public health had it not been for Shah’s book. The fact that she is not first and foremost a public health expert makes it simple for her to articulate the elaborate history and current status of malaria in a way that’s accessible to readers of all different backgrounds, not just those already involved in medicine and public health.
The use of solid facts and quantitative data supported Shah’s mission of emphasizing the impact of malaria on humankind. In this way, focusing more on the history of the disease rather than the current state of it was strength rather than a limitation in that it allowed Shah to present undisputable statistics and figures rather than simple observations and unproven inferences. Here we see again that her background as a journalist saves her from laying out these specifics in a purely scientific way that may not appeal to the general public. Presenting numerical data before going on to state the repercussions of malaria’s staying power captures the reader’s attention more than a scientific article, which presents the findings in the abstract, would. Once one learns of the historical impact of malaria and recognizes that the problem has not yet gone away, rather has gotten worse over the years, it is logical to follow that malaria’s current strong presence is due to both the various strains of Plasmodium (with certain strains being prominent in specific geographical areas) and humans themselves (whether it be in the form of environmental disruption, distribution of counterfeit drugs that undermine the effectiveness of legitimate treatments, or bringing Plasmodium strains from one region into another). Shah does a brilliant job of putting the pieces of the malaria puzzle together in such a way that allows the reader to not only follow along, but at some point even predict what Shah will state next. This logical presentation of evidence is a testament to Shah’s ability as a writer to engage the reader and guide him/her to grasp the main ideas of her work, even when it pertains to an issue that is far from mainstream.
The Fever demonstrates Sonia Shah’s excellent ability as an investigator to dig up relevant and hard-hitting facts as well as her strength as a writer to captivate her readers. Her use of historical evidence and profiling of current conditions help her get across the historical and, more importantly, current implications of malaria on the world.