Disclosure: This follows on the heels of Mountains Beyond Mountains: The Quest of Dr. Paul Farmer, a Man Who Would Cure the World and The Emperor of All Maladies: A Biography of Cancer, and I am an avid consumer of epidemiological histories, like And the Band Played On: Politics, People, and the AIDS Epidemic (an all-time favorite book of mine) which indubidably biased my reading of The Fever
. The Fever
suffers from being too short. I trying to be too many things in 240 pages+footnotes: a cultural history, an environmental and ecological history, a popular science work of microbiology and entymology, and a post-colonial history. The fascinating thing about malaria is that any book on this disease must be all of these things. And no author, no matter how good, can do that well in a book this short, a choice I'm sure that was made by an editor trying to capitalize on malaria's recent resurgence as a cause celebre(covered in the last chapter) with out scaring off a book reading public scared of anything over 300 pages.
Shah gives it the old college try, though, and a reader of The Fever
will uncover a lot of facts with some trite but spot on analysis. One point I found fascinating:
Malaria was a global phenomenon until lthe early 20th century and its prevalence until then accounts for the lack of habitation or agriculture in many otherwise arable and habitable places that remain relative uninhabited today: rural Georgia and Alabama, for example. It was fascinating to me that a disease that is today associated so heavily with the tropics would be responsible for the poor settlement of places like the Upper Peninsula of Michigan, where my mother's family is from: a decidedly non-tropical locale. Malaria did not recede from the developed world through aggressive tactics like those practiced in poor, tropical countries today, however. It receded because development destroyed mosquito habitats and increased herds of farm animals were more attractive sources of food for those mosquitos that remained. Shah gives the lie to people like economist Jeffrey Sachs, who claim that malaria creates poverty and eradicating malaria will also eradicate it: Poverty, she points, out, can create malaria, too.
Shah is also very good when it comes to the malaria and drug development, and makes a really interesting point that Siddhartha Mukerjee also makes in The Emperor of All Maladies
. There is an almost militant and religious dedication to high-tech solutions to diseases from malaria to cancer. These high-tech solutions have their draw backs, however: they are incredibly expensive, result expensive therapies, and here's the kicker for malaria - rarely work as well as wormwood or quinine and, because of their high specificity, are theoretically more likely to generate resistant strains. In both cases, new chemotherapies are just as likely to be found through the classic stab in the dark methods as they are through high-tech engineering. Yet we chase high-tech methods because, as Shah notes, they are 'economy building.'
I really would have loved to hear more about the modern drug development efforts being made, and the efforts being made to deliver the drugs to malarious countries. I do believe, like a Nigerian health official quoted in the last chapter, that we have to find a way to manufacture these drugs in situ, as opposed to manufacturing them outside and then shipping them in, with all of the extra costs and difficulties that ensures.
This is highly recommended as an introduction to the history and current state of the epidemiology and treatment of malaria.