“The Fever” by Sonia Shah

Malaria is one of mankind’s most ancient scourges. A century after the discovery of its cause, various species of the parasite Plasmodium, humanity still remains in its deadly grip in many areas of the world. Malaria is estimated to have caused 225 million illnesses and almost 800,000 deaths in 2009, making it one of the top infectious disease killers. Many of these deaths occurred in children under the age of five.

Shah traces the history of malaria from the introduction of the parasite into the human population to modern-day controversies about malaria treatment, research, and funding. It’s a fast-paced read; informative but never dry. Indeed, Shah makes much use of metaphor; sometimes, to the detriment of the scientific narrative, in my opinion. However, that’s more of a minor issue to me.

Shah begins the book with an anecdote about her own childhood as an American visiting her relatives in India; sleeping under a bed net while her cousins sleep in the open, fearing mosquitoes, and India, and being ashamed of her fears. She notes later that, when her family hears she is writing a book about malaria, they ask her why–to them, it seems as silly as writing a book about the common cold. Shah notes this several times throughout the book–for example, explaining that many in malaria-endemic regions, people would rather use their bednets for fishing than to protect from mosquitoes, so while programs which deliver such nets can tout high numbers of bednets distributed it doesn’t necessarily mean that everyone who receives one is using them correctly.

Indeed, much of the book is spent discussing the limitations and missteps of anti-malarial programs, past and present, from issues of mosquito resistance to pesticides, to parasite resistance to chemotherapy. Another repeated thread is political will, or lack thereof, in anti-malarial programs, and the ping-pong that is played by many funding agencies. When programs demonstrate success and malaria is reduced, there is little will to continue such programs–which may be hampered in any case by the emergence of resistant mosquitoes or parasites. It’s a messy business, and today’s programs don’t seem to be much better off than those carried out in the previous century.

Shah’s book is a thoughtful read for anyone interested in global health–not only for the history of Plasmodium‘s detection and eventual proof as the cause of malaria (after many false starts), but also for the thoughtful descriptions of global health programs carried out by outsiders throughout the decades, and possible ways to change these and avoid repeating the mistakes already made by predecessors.