Joseph Scarpelli
The Fever: How Malaria Has Ruled Humankind for 500,000 Years. Sonia Shah.
New York: Farrar, Straus and Giroux, 2010. 307pp.
Malaria has been affecting the population of this planet in different iterations for millennia. Sonia Shah’s book, The Fever: How Malaria has Ruled Humankind for 500,000 Years, provides a fresh perspective on this complex matter. Shah is an investigative journalist who focuses on health issues and she writes with a certain vigor and enthusiasm seldom seen in such literature. Although her work exhibits a significant amount of layered historical anecdote and she writes with a relatively objective viewpoint, Shah eventually makes her main argument evident. In sum, Shah believes that malaria must be dealt with more effectively on the local level so that it recedes from the impoverished areas of our globe. She views the best way of accomplishing this not with so-called “silver bullet” pharmacological approaches, but with structured “nation-building,” which focuses on improving government infrastructure so that this issue can be dealt with by communities on the ground where the disease resides. Unfortunately, Shah does not introduce this proposal until very late in the text, thus not allowing herself an opportunity to adequately or sufficiently defend her premise.
Sonia Shah’s work investigates malaria from historical, geopolitical, scientific, and cultural perspectives. She begins by examining the genus of the disease and how its spread has forever altered the face of global development. She furthers this idea by describing how malaria’s unique ecology contributed to the decline of various empires and affected the location of the great cities of the world. She bemoans the failures of the pharmaceutical industry throughout history in dealing with malaria when she states how “despite the range of effective parasite-killing drugs in our arsenal, despite the world being awash in anti-malarial medications, malaria flourishes” (Shah, 87). Evidence in support of her claim shows that despite the discoveries of quinine from the cinchona tree as early as the 17th Century, relatively effective chloroquine treatment since the early 20th Century, and eventually the more recent adaptation of artemether-lumefantrine applications to fight off malaria, we still are not anywhere close to eradicating malaria. Shah partially blames the incongruities of the pharmaceutical industry and its profit-driven motives for these lapses in care.
Sonia Shah is a very keen observer of Western thought as it pertains to contrasting expectations in the developing world. She uses this perspective in The Fever to explain the disconnect between the Western scientific community’s approach to malaria and the experience of people living with the disease in endemic regions. Strikingly, readers can view this jarring contrast via her rich description of the pristine and shining hallways of the Harvard Malaria Initiative in comparison to the haphazard situation on the ground in rural Africa. Shah eloquently elaborates, “We want to think of Africans as battling an enemy, malaria, so that we can help them fight the enemy…but the fight outsiders would like to wage against malaria isn’t always the same one fought by those who live with the disease” (139). This issue of differing viewpoints has not adequately been explored in other literature and she should be credited for addressing an issue that is so often ignored. Her point that many living on the ground would rather use treated bed nets to catch fish with is a valid one; earlier in the text she supports this claim by citing a study in which inhabitants of a developing country reported that plastic buckets were one of the three things they most wanted. Clearly, if an individual living in an impoverished area wishes solely for something as simple as a bucket, their willingness to perform behavioral health interventions as they pertain to malaria control may not be so likely. Shah’s skepticism at the effectiveness of the scientific community’s response to malaria deepens as she describes the failed attempts at using DDT to wipe out mosquito vectors in the middle part of the 20th Century and the great lull this brought to malaria research. She explains, “So completely did malaria vanish from the public mind that many people in the West grew up thinking that there was, literally, no more malaria in this world” (219). Clearly, Sonia Shah believes deeply that we as a scientific, public health, and global community must do a better job in tackling the complex issues surrounding malaria, including infection and prevention.
Sonia Shah’s main argument and, indeed, her most impassioned plea is that anti-malaria work must take the form of a grassroots movement at the local level and must be propagated from within endemic communities; however, she doesn’t make this case until the final portion of her text. She also fails to support this idea with empirical evidence or anecdotes of past successes of this model. In speaking of anti-malarial work at a local level, she states, “it is the only way [it] will be controlled” (original emphasis, 239). She believes strongly in the great importance of improving technology, infrastructure, roads, and initiating better governance to get malaria under control. In her view, not all of this needs to be the task of the public health community working in these endemic countries, but rather mentions that housing styles and settlement patterns will have to change while simultaneously building up education and healthcare systems from within the endemic regions. These are all perfectly valid points, but they leave the reader yearning for hard evidence to support her argument. Shah’s overall emphasis on the importance of the local community’s role in malaria prevention is lacking in both empirical and anecdotal evidence and is therefore difficult to validate as a whole.
One of the great ironies in The Fever is that its format is perhaps its biggest strength and greatest flaw. On the one hand, her colloquial style of writing lends itself to easy comprehension for the lay reader of the basic issues underlying the disease. The text flows easily and lightly despite the ominous subject matter and the reader presumably gains a general understanding of the complexities and challenges surrounding the disease.
However, her main thesis on the matter comes as a surprise much later in the text. If she was planning on using her work as a staging ground for making a strong argument emphasizing the importance of local-level intervention, it would have been beneficial to state it earlier in the text and support it throughout with both anecdotal and numbers-based evidence. Nevertheless, Sonia Shah’s The Fever does indeed provide a comprehensible backdrop on the overlaying issues surrounding the history of malaria and the current debate; she provides some valid takeaways on what should be done on the path going forward, albeit in a slightly disjointed and unsupported manner.
