Lauren Kleimola
The Fever: How Malaria Has Ruled Humankind for 500,000 Years. Sonia Shah. New York: Farrar, Straus and Giroux,
July 6, 2010. 320 pages.
Sonia Shah, born in the United States to Indian immigrants, has made a career of confronting social inequalities brought about by politics, health, and human rights. Shah provides convincing evidence in The Fever: How Malaria Has Ruled Humankind for 500,000 Years that suggests humans cannot achieve malaria eradication. She cites history, biology, and human behavior as key factors in the malaria parasite, Plasmodium’s, influence over humanity. She creates an educational and entertaining read for anyone interested in health or history by weaving together science and storytelling. However, Shah fails to look critically at her own ideas for eradication, leading to the omission of a major ethical dilemma in the disappointingly weak conclusion of The Fever.
Shah describes how malaria shaped and destroyed societies throughout human history. She uses examples across time and place to illustrate the longstanding and ubiquitous influence of malaria. In doing so, Shah makes malaria relevant to all her readers. She skillfully turns it into a common factor among people instead of a division between developed and developing countries.
Intricate details of Plasmodium and its vector, the Anopheles mosquito, supplement the description of malaria’s reign. Plasmodium evolves at an alarming rate, developing new strains such as vivax and falciparum, allowing the parasite to multiply faster and infect a greater amount of its victims’ blood, respectively. Likewise, humans evolve to defend against malaria. The difference, Shah explains, is in the rate of evolution. Shorter lifespan and greater number of progeny allow Plasmodium and the Anopheles to evolve at rates far greater than humans. Though long descriptions of the biological foundations of malaria can be cumbersome, Shah rightfully includes them. She gives her readers a greater appreciation for the vulnerability of the human body and elucidates her point that humans are not fighting a single organism and consequently there is not a single cure.
Shah shows that frighteningly, even with greater scientific knowledge, human behavior spreads malaria and thwarts opportunities for control. Disruption of malarial ecologies, through deforestation, agricultural changes, and transporting species of Plasmodium and Anopheles to new environments, can lead to epidemics. A lack of cohesion among human populations in the fight against malaria, often in the form of private interests, leads astray potentials for malaria control. Unfortunately, even in circumstances of good intent, humans have done more harm than good. Widespread use of antimalarials in hopes of eradication left populations with no immunity. When malaria eventually returned to these communities, the prevalence of disease often surpassed previous rates. Shah chronicles both the effects of malaria on humanity and the effects of humans on malaria by using scientific and historical facts.
Shah compiles evidence through her systematic description of malaria that suggests that worldwide malaria eradication is unattainable. However, in her conclusion, she asserts that eradication is possible using a multidirectional approach. Concurrently building infrastructure, strengthening education and healthcare systems, reorganizing communities, and giving power to the people living in endemic regions becomes Shah’s preferred method of malaria eradication. Shah’s conclusion seems hasty and lacks logical progression from the rest of The Fever. She explains why past attempts at eradication failed but does not provide evidence for why her method will succeed. Further, Shah does not acknowledge any shortcomings that might come with her broad solution. While she readily criticizes past efforts to eradicate malaria, Shah does not apply the same level of scrutiny to her own plan.
Shah’s proposal looks similar to how malaria was eradicated from the United States. During the Industrial Revolution, roads paved over Anopheles habitats, better housing protected people from mosquito bites, and railways allowed people to move away from wetlands. However, malaria at first flourished near dams built by power companies. The wealthy and powerful escaped malaria-infested regions, but others were left vulnerable to the new outbreaks. Meanwhile, economic achievements brought on by the power companies fostered development that eventually led to eradication.
Shah fails to address in her own proposal the critical fact that development is not instantaneous. Like in the Industrial Revolution, her method can only be achieved over time. During the time it takes to develop a region, the opportunity for a malaria epidemic magnifies. As seen near the mills at the start of the Revolution, workers disrupt malaria ecologies and people not yet protected by improved housing or the ability to move away are sacrificed. The ethically challenging part and, perhaps conveniently, the part that Shah does not discuss is the temporary increase in disease inherent in her proposal. In stark contrast to her thorough investigation of malaria throughout The Fever, Shah’s conclusion lacks depth and consideration.
The Fever is a useful tool for better understanding the interaction between Plasmodium and humans. It is an important piece, and one that anyone involved in malaria eradication should read, because it helps readers learn from the past. Shah sets up the opportunity to move forward towards successful malaria eradication by explaining human and Plasmodium contributions to the current state of malaria. However, if activists choose Shah’s proposed method of eradication, further discussion is necessary, as it comes with considerable consequences. In The Fever, Sonia Shah carries her readers through history to the present state of malaria but falls short in her proposals
