Sara Gille

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

Investigative journalist Sonia Shah stays true to the title in her latest book, “The Fever: How Malaria Has Ruled Humankind for 500,000 Years.” Shah gives the reader an engaging, comprehensive history of the “how” behind malaria’s retreat and ultimate advancement over the past 500,000 years. She chronicles the positive and negative effects of land and economic development with the elusive and adaptive malaria parasite. Shah argues that economic and land development is, and has always been, the reason for malaria’s global reach and persistence. Paradoxically, according to Shah they are also the key items needed to eradicate malaria.  Unfortunately Shah doesn’t have an answer as to how to balance this paradox.

At times Shah seems to see land and economic development as the ultimate panacea for malaria. She posits that land and economic development in the United States, specifically paving, and the irrigation and mechanization of farmlands effectively “disrupted malarial ecologies” (Shah, 2010, p. 189). Yet conversely, Shah details the malarial aftermath of the deforestation of Rome in fifth century AD that created marshland habitat for mosquitoes, and the construction of milldams in the eighteenth century that created pools of stagnant water perfect to breed mosquitoes. Both of these activities were steps of land and economic development that caused an increase in the incidence of malaria. She also lists more recent examples of development projects that have done the same, such as the introduction of hybrid maize in Ethiopia, and construction in Mumbai. These examples create doubts that land and economic development are the best ways to eradicate malaria.

According to Shah, malaria crossed the ocean from Africa to the New World because of European colonization. Land development and exploration of the New World was spurred by European desire for commodities such as sugar, and a need to produce and export them as cheaply as possible. This brought slaves from Africa to the New World to work the plantations of the Southern Colonies. African slaves were prized because many of them carried the sickle cell trait, a genetic condition that protected them from Plasmodium (the malaria parasite).  Shah shows that humans, like mosquitoes, can serve as a vector for Plasmodium. Most of the African slaves had been infected with Plasmodium at some point, and as they were toiling in the fields, the local mosquitoes bit them, turning the mosquitoes into vectors of this new strain of disease. Shah makes the interesting point that in this case the African immunity spurred the growth of slavery, racism, and segregation in the southern United States; it also increased the global reach of malaria.

Although malaria has been eradicated from the United Sates, it is still a daily burden on many parts of Africa. Shah plainly states that building infrastructure in countries where malaria is endemic must be “the responsibility of local governments.” In fact she says that is, “the only way malaria will be controlled” (Shah, 2010, p. 238-239).  She goes on to say that, “one way or another, the schools, roads, clinics, secure housing, and good governance that enable regular prevention and treatment [of malaria] must be built” (Shah, 2010, p. 239). Of course local governmental support of anti-malaria programming is necessary, as is local buy-in of said programming. However, Shah mostly gives us evidence of how difficult this is to achieve. For example when the drug manufacturer Novartis offered artemisinin combination therapy drugs at a large discount, the African governments that could have afforded to purchase them only bought half of the available supply. She also states “only 21 percent of people [in Africa] with malaria actually visit health centers” (Shah, 2010, p. 135).  If these statements are true then it appears something additional is needed to the “good governance” and “clinics” that Shah says will “enable regular treatment and prevention.” Perhaps Shah is right, and it will just take even better governance and clinics to treat and prevent malaria. However, the level of economic development needed before governments could afford to build the roads, schools and secure housing that Shah proscribes would simply take too long to attain. Moreover, as evidenced in the previous examples, Shah shows that the process leading to this level of development can actually increase the incidence of malaria in a population.

Shah advocates local governments take responsibility for tackling malaria because she does not think outside agencies have done the best job. She makes ample observations about their shortcomings. She criticizes the World Health Organization’s (WHO) hesitancy, in the 1960’s, to announce that Plasmodium had developed resistance to the anti-malarial drug chloroquine, and their subsequent refusal to approve the more effective therapy, artemisinin, because it would have to be produced in China. She also castigates The Global Fund to Fight AIDS, Tuberculosis and Malaria, and the United Nations Children Fund for distributing chloroquine when artemisinin combination therapy drugs would have been more therapeutic. While Shah’s critiques are valid, and she does acknowledge the positive contributions of these organizations, the overall tone is that a lot of money is being spent on futile efforts.  Her intended readers are not members of WHO or The Global Fund, and she is not writing an appeal to effect policy change.  Her intended readers are more likely well educated citizens interested in global issues, and her writing does provide a comprehensive, well researched overview of malaria. However, regardless of her intent, it is possible Shah’s arguments may deter these readers from giving to an anti-malarial campaign. In “The Fever,” Shah tells us exactly what the title indicates- how malaria has ruled humankind for the past 500,000 years. The reader will have to go elsewhere if they are interested in the details of how humankind can effectively rule malaria.

Shah, S. (2010). The fever: how malaria has ruled humankind for 500,000 years. New York: Sarah Crichton Books. ISBN: 978-0374230012. $26.00. 320 Pages.