Therese Claxton

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

There is no cure for malaria, nor is there a vaccine. Many have their own opinions about how to end this global scourge, and over the past hundreds of years, many have tried. The Fever: How Malaria Has Ruled Humankind for 500,000 Years works to describe this puzzling situation, explain the science behind the disease, and finally, give malaria a historical foundation. Journalist Sonia Shah takes on this monumental task by attempting to discuss the most significant aspects of the malaria pandemic. This includes malaria’s history, biological background, impact on the development of nations, pharmaceutical interventions, and the development community’s response. The Fever is not written for scientists or those working inside the development field. Rather, it written for the casual reader who wants to learn more about malaria in a low-key approach. This is certainly not a scientific text. It is full of interesting anecdotes and colorful stories that help to build the reader’s background regarding the disease.

Shah’s thesis is simple and can be found in the book’s title. Malaria is a complex and deadly disease that people have been fighting for thousands of years and there is no end in sight to this struggle. She expertly gives the reader a lesson in the biology of malaria, as well as thoroughly covering its history in a conversational and engrossing manner. Shah stumbles when she takes on the last 60 years in the fight against the disease. Malaria is paradoxical in nature; many approaches have seemingly succeeded only to fail later on. There is no end in sight to this disease and Shah’s approach does not help her to deal well with this problem. Throughout the book she makes arguments that range from why malaria is endemic in certain regions to why a particular intervention has failed. The reader expects her to make clear pronouncements about the future of the fight against malaria. However, Shah does not make an attempt to provide solutions, instead summarizing the pros and cons of the fight. While it is certainly not possible to foretell what the future holds for malaria, Shah should have at least spelled out a simple action plan for what to improve in order to get moving towards the stated goal of finding a cure or slowing down the disease in some way.
The Fever is strongest when Shah tackles the science of malaria and the historical background of the disease. At the beginning of her book she focuses on scientific information to give the layperson a solid biological background before wading into malaria’s complicated social history. Shah’s conversational manner lends itself well to the difficult biology behind the disease. She expertly explains the protozoan Plasmodium, differentiates between different genuses of Anopheles mosquitoes, and describes in detail about how the protozoan survives in different climates around the world, yet perishes in others.

Shah succeeds again when discussing malaria’s particular historical significance as people have migrated around the world over thousands of years. For example, Britain decided against sending prisoners to the Gambia because malaria’s presence made imprisonment there a death sentence. Instead, prisoners were sent to Australia, thereby beginning its colonization. Malaria contributed to the slave trade’s explosion because the disease decimated white colonists while slaves from the African continent were prized for how little malaria affected them. She clearly displays the impact that malaria has had on world history. Readers become involved with the story, setting them up for the final chapter about the future of the fight against malaria.

Shah also powerfully details the pharmaceutical industry’s failure to develop a vaccine as well as a dependable medicine to treat malaria. She criticizes the pharmaceutical company Novartis for overpricing Artemisinin, which at the time was extremely effective in treating those suffering from malaria. She also condemns USAID for refusing to dispense it after the price was lowered (but not low enough), and in its place, choosing to dispense untreated bed nets because they were seemingly easier and much cheaper to distribute. She vilifies UNICEF for refusing to use Artemisinin in Ethiopia in 2003, instead administering the outdated medicine chloroquine, which by that time was almost useless. One of Shah’s strengths is her ability to convey her passion and anger about injustice. She easily transfers this to the reader.
Shah’s previous work, The Body Hunters: Testing New Drugs on the World’s Poorest Patients, was centrally focused on a good versus evil angle that she attempts to duplicate here. Unfortunately, it does not work for many aspects of malaria’s story. She does not write as well when there is no clear villain or hero. This becomes particularly evident when she describes the current status of the malaria fight. Shah finds herself backtracking from strong judgments she made previously. For instance, she spends a number of pages describing the Bill and Melinda Gates Foundation’s impact on the global malaria agenda. She is concerned that the foundation is not a public health authority and that is not accountable to any governing body. She seems to agree with the WHO’s Arata Kachi’s description of the foundation as a “cartel” (235) with a dangerous amount of power. However, almost immediately she backs down from her argument by saying that despite all of these potential issues, the foundation deserves recognition for the work it has done. This may be true, but in this context by not being willing to take a strong stand for or against the Bill and Melinda Gates Foundation’s malaria interventions, she confuses her readers and weakens her argument.

Throughout the book, Shah complains about the actions of pharmaceutical companies and mocks important research facilities, such as the Harvard Malaria Initiative, for being Harvard insiders and for their cluelessness because they have no sense of how much their research actually costs. However, at the end of the book she suddenly changes her tune. She quotes the grumblings of malariologists that “…[the Bill and Melinda Gates Foundation]…are making all the same mistakes again” (235) by focusing on research and technology to make an impact in the anti-malaria fight, but within the same chapter, she states that she hopes that anti-malaria campaigns will focus on technology to reach their goals. Shah holds disdain for the current quality of scientific research but yet pins her hopes of malaria eradication generically on that research and the same scientists she spends the book disparaging, which does not make logical sense.
After finishing The Fever a lay reader will have gained a good understanding of malaria’s biology, history, and global impact but will be left confused about the future of the anti-malaria struggle. Sonia Shah is an accomplished journalist who is effective when she brings her passion to the subject matter. In The Fever she displays her ability to make this topic enthralling. However, she stumbles when discussing matters that really have no right or wrong answers. She wants to have a hero or villain in every story. When that isn’t possible, she doesn’t know how to proceed.

Reference:
Shah, S. The Fever: How Malaria Has Ruled Humankind for 500,000 Years. 1st ed. New York, NY: Sarah Crichton Books; 2010.