Battling Malaria: Bring Your Questions for Sonia Shah, Author of The Fever

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Malaria has been infecting and killing humans for many millennia, yet it continues to elude man’s efforts to control it. Sonia Shah‘s fascinating new book, The Fever: How Malaria Has Ruled Humankind for 500,000 Years, describes our long relationship with the disease:

These days, mosquitoes infect between 250 million and 500 million people with malaria every year, and close to 1 million perish. Equally shocking is the sheer length of malaria’s tenure upon us. Humans have suffered the disease for more than 500,000 years. And not only does it still plague us, but it has also become even more lethal. That’s quite a feat for a disease we’ve known how to prevent and cure for more than a hundred years. During that same time, we’ve vanquished any number of similarly once-commanding pathogens, from smallpox to the plague, and have come to expect nearly complete control over newer pathogens, such as SARS or avian flu….Yet despite the fact that we’ve known about malaria since ancient times, and have the drugs, killing chemicals, and know-how to avoid it, something about this disease still short-circuits our weaponry.


Shah explores the history of the disease and explains why malaria hasn’t “mellowed” with age (like other diseases have) and why humans haven’t adapted to the disease. She explains why our many efforts to conquer the disease — the drugs and DDT “spray-gun wars” of the 1950’s – have failed so miserably, and she offers the following, rather depressing conclusion:

No one can accuse us of lack of diligence in our devotion to the magic-bullet cure, the miracle drug, the wonder pill. And yet, though antimalarial drugs are ‘one of humanity’s most precious and cost-effective public health resources,’ as the nonprofit Medicines for Malaria Venture puts it, it’s useful to remember this: even if we somehow got our act together to unleash the full power of our antimalarial drugs upon the malaria parasite, we still wouldn’t win.

Humans, who often fail to comply with simple measures like sleeping under treated bed nets, don’t get a free pass either, in a comparison that will resonate with readers of SuperFreakonomics:

So while it’s true that sleeping under a treated net is simple and effective, it is so only in the same way that, say, physicians washing their hands before attending to their patients is simple and effective.

Shah has agreed to answer your questions about her new book, so fire away in the comments section and, as always, we’ll post her answers in due time.

Addendum: Shah answers your questions here.


iamreddave

How much do westeners spend on malaria drugs for tourist trips to malarial regions? What would be the effect of this much spent on local schemes?

Mark Wolfinger

I understand looking for cure/prevention etc. All worthy humanitarian goals.

My question is this: When you save hundreds of thousands, if not millions, of lives, who is going to feed the gigantic population boom?

Equal time and effort must be spent on projects that feed the population - based on the assumption that your goals will be realized.

Otherwise, poverty and starvation await

Brett

How much did DDT's ban set back anti-malarial work?

David Leppik

Mark (comment #2): the rate of population growth in many parts of the world is high enough relative to malaria deaths that curing malaria wouldn't make a big difference to the population size. In fact, curing malaria could even reduce the population. For one thing, parents may be having more children in order to compensate for childhood death. For another, if fewer children die of malaria, fewer resources will need to be expended on treating them (or in caring for ultimately doomed children), helping the remainder to escape poverty. And if fewer adults die of malaria, they will be around to raise the next generation more effectively. Reducing poverty reduces the demand for more children, as well as increases the opportunities to get access to effective birth control.

Paulo

@iamreddave - On a recent trip to northern Laos, our group of ten spent over a $1,000 on anti-malarial prophylaxes. Some on the trip were doctors, other well-traveled yet lack of solid information lead all to err on the side of caution. Ultimately, very few of us were even bitten during the entire trip. We later learned from locals malaria only occurred in areas we had passed through only briefly and of course had slept with mosquito nets.

Jon L.

"mosquitoes infect between 250 million and 500 million people with malaria every year"

Is there an extra zero in there somewhere? That number is way too high, since even on the low end everyone in the entire world wold have malaria in 30 years. From the CDC:
"WHO estimates that in 2008 malaria caused 190 - 311 million clinical episodes"
which is within the lower bound of the range, but they use the word clinical episode whereas you use the word infect. There isn't a good link for defining what a clinical episode is, but it appears to be a period of time in a clinic - which means that if you have a disease that isn't cured, every time you visit a doctor is a clinical episode. From http://www.ncbi.nlm.nih.gov/pubmed/16148888 it looks like there are perhaps 500 million people with the disease, which is a very high number but does not indicate such a high infection rate, unless everyone is cured of the disease every year.

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Drill-Baby-Drill Drill Team

The Greatest Predator of Mankind is the Mosquito. It is the the top vector for infectious disease. Mosquitos are Mankind's Greatest Pest.

Can an enviormentalist morally defend the eradication of the mosquito? What would a world without mosquitos look like? Should we "Save the Mosquito"?

frankenduf

sorry i haven't read your book, but thank-you for writing about this intriguing disease- i have 2 questions- 1- "humans haven't adapted to the disease"- isn't this not entirely true? i have a friend from ghana who says he is immune (so can you acquire immunity if you live there and survive the infancy period?); and i thought that G6PD deficiency (particularly northern african males) are immune, and that prevalence is increased in malaria areas- 2- If you were omnipotent, would you kill all mosquitos? (spoiler alert- i think this is a trick question?!)

jimi

RE: Drill-Baby-Drill Drill Team

Why preface your question instead of just asking it?

Jean Logan

With the help of Divine guidance, I have developed a powerful energy glyph that can kill bacteria and viruses. I would like a way to test this out on malaria. These energy glyphs can also be used to inhibit the growth of various insects. I have one that has completely resolved scale on plants and another that has resolved problems with aphids. Another has stopped the peach borers on my peach tree. I have not tested one for mosquitoes yet as I do not have that problem in my area but I have no doubt it can be done. Please see my website at www.holygroundfarm.org and click on book where I have a manual with 30 of these glyphs. I have many more glyphs available that can be a great benefit to all people.

Jean Logan

I would like to add to my former post that I will gladly send these glyphs to anyone who is interested in helping to test them. If we work together we can do anything.

Quill

I contracted malaria three times over the course of a year despite scrupulous use of bed nets. The first bout resulted in 10-day hospital stay, while the second and third just required medication.

I realize that's just my personal anecdote, but I think the Western fixation on "just use bed nets" is quixotic. Using a bed net every night in hot, humid tropical areas is uncomfortable at best - and then there is the fact that most people are not willing to sit under a bed net for 12 hours a day while mosquitoes are active. It's also impossible for someone to tell if the bed net's insecticide treatment, which is what makes it effective, is still potent or if it must be treated again.

So what is the alternative to bed nets?

Jimbino

Mosquitoes don't bite me.

They hover without landing on my skin. I've seen a couple maybe bite me when I tried to let them land. In 66 years, I've maybe been bitten a dozen times, but I never get a welt.

Funny, but the exception was one night I spent in a free-swinging hammock without mosquito net in Rondônia, Brazil, smack dab in the Amazon Rainforest, among the most dangerous malaria regions in the world. I awoke with what I thought were 200 welts from bites, which rapidly went away.

Mosquitoes still bug the hell out of me with their buzzing and touching of the fine hairs on my skin.

It occurs to me that there's a lot we don't know about mosquitoes, their varieties and habits, and what conditions lead to malaria.

Mike

I've heard many stories about how the drugs to treat malaria can be just as bad or sometimes worse than malaria (This American Life had a segment on a man who suffered spontaneous amnesia from anti-malarials, and my SO has come in contact with anti-malarials while traveling). Why is this, and what can be done?

Metamorf

I'd like to second Brett's question (#3) -- to be more specific, are there stats on malaria prior to Rachel Carson's "Silent Spring", and after the subsequent efforts to ban DDT?

Mantonat

What is it about the mosquitos that carry malaria that prevents thier spread to temperate regions? What prevents temperate-region mosquitos from carrying or spreading malaria? Is there any danger of malaria eventually spreading to mosquito populations in climates like central Canada, where summers can be pretty miserable because of the mosquitos?

uthor

Why aren't we deploying more laser death rays to fight this?

http://www.ted.com/talks/lang/eng/nathan_myhrvold_could_this_laser_zap_malaria.html

J

"the drugs and DDT "spray-gun wars" of the 1950's - have failed so miserably"

I'll pile on with the DDT question. This is the first time I've heard anyone say DDT didn't work, even from the environmentalist camp. Unless, like most environmentalists, you consider failure to control the population of brown people who talk funny and breed too fast "not working".

Jz

Was malaria ever endemic in the US.? If so, how was it eradicated?

David Zaumeyer

I am curious about the role of animal reservoirs for the malaria parasite. Do infected birds or mammals supply fresh infections to mosquitoes? Is this a factor in the difficulty of eradicating the plasmodium from an area?