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Malaria: the persistence of disease

'Tabloid' medicine chest used by Teddy Roosevelt in 1909, London, England, 1900-1909

'Tabloid' medicine chest used by Teddy Roosevelt in 1909, London, England, 1900-1909

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Infectious diseases through the ages

The power of infectious diseases can rise and fall. While new plagues surface, former killers can become minor inconveniences. They might be tamed by medicine and one - smallpox - has been eradicated by human action. But others stubbornly endure, killing for century after century.

Malaria: from Antiquity to the present day

Malaria is such a disease. Of great antiquity, it has shadowed human history, and has been endemic at one time or other throughout much of the world. It persisted as Fen Ague in 19th-century England, but from a modern British perspective malaria has become, at most, a potential pitfall of exotic holidays, a feature of this country’s colonial past. For many former colonies it remains a constant, deadly threat.

A South American ‘tonic’ against malaria

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Malaria has always plagued travellers - be they merchants, missionaries, soldiers or colonialists. But as well as encountering malaria, early Spanish colonisers of South America found a local treatment - cinchona. And when in 1820 its active components - quinine and cinchonine - were isolated, the resultant drugs became essential elements of any traveller’s medicine chest. Its use is still evoked today by tonic water, a solution of quinine once used as a ‘tonic’ against malaria.

The use of quinine around the world in the 1800s

As new European empires expanded, control of tropical diseases such as malaria was seen as crucial. Those sent out to seize and administer new colonies needed to stay healthy. In India alone, the British government was using nine tons of quinine annually by 1850. Fighting malaria was also symbolic - bringing a beacon of civilisation to what was considered savage and barbarous. Quinine became a tool of 19th-century colonialism. It allowed troops to cross malarial lands and without it the penetration of much of Africa would have been extremely difficult.

The Second World War, malaria and the mosquito

In 1898 British doctor Ronald Ross confirmed what had long been suspected. The mosquito was the malaria vector, the carrier of the disease. This prompted early attempts at mosquito control, but it was not until the Second World War (1939-45) that global action against malaria gained momentum. Japan had seized the main cinchona plantations and the Allies were fighting in lands infested with malaria. This encouraged both the development of new synthetic antimalarial drugs and the use of a new insecticide: DDT. In 1955, in an optimistic post-war world, the World Health Organization confidently announced a global malaria eradication programme.

Malaria in the former colonies

By 1970 the eradication programme had failed. Malaria had retreated, but it remained in key areas, including Africa. The link with colonialism continued. Malaria concentrated in many former colonies, now independent but subject to war, famine, political instability and rocketing populations. To succeed, control measures needed levels of discipline that were difficult in such circumstances. In parallel was growing evidence of drug and insecticide resistance in mosquitoes and environmental damage from DDT - it wasn’t just killing mosquitoes.

The WHO and malaria: a losing battle?

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Funding was cut as the number of cases began to rise. Between 1973 and 1977 global malaria cases rose by 250%. The battle was lost and thoughts moved from eradication to disease control. Vaccination offered an alternative path, but after years of research an effective vaccine remains elusive. And so in 1998 the World Health Organization announced a renewed effort, the Roll Back Malaria Campaign, a global partnership with numerous local groups, charities and NGOs. Using new drug therapies developed from artemisia, insecticide-impregnated nets and the judicious use of indoor spraying, it pledged to halve cases by 2010.

Malaria today

Today there continues to be around 500 million cases of malaria annually, with at least 1 million deaths. Around 40% of the world’s population remain at risk from malaria and every day close to 3000 children die of it.

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Bibliography

R S Desowitz, The Malaria Capers: More Tales of Parasites and People, Research and Reality (New York: W.W. Norton, 1991)

R M Packard, The Making of a Tropical Disease : A Short History of Malaria (Baltimore: Johns Hopkins University Press, 2007)

K H Rieckmann, 'The chequered history of malaria control: Are new and better tools the ultimate answer?' Annals of Tropical Medicine and Parasitology, 100/8 (2006), pp 647-662

F Rocco, The Miraculous Fever-tree: Malaria, Medicine and the Cure That Changed the World (London: HarperCollins Publishers, 2004)

R Ross, Memoirs: with a Full Account of the Great Malaria Problem and its Solution (London: J Murray, 1923)

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