Sonia Shah, The Fever

The cover of Sonia Shah’s The Fever declares “How MALARIA Has RULED MANKIND for 500,000 YEARS.” Emphatic enough, but not altogether true. Some of us have been ruled but others have mostly escaped. At any rate, malaria and mosquitoes and their human targets have evolved together. Forget the big number — 500,000 — and limit yourself to the most recent 25,000 and the story is still very impressive. As we have changed ecology by draining swamps, building dams, cutting trees and plowing the land we have also changed the mosquitoes’ habitats, encouraging and discouraging the various breeds. Some species transmit malaria to humans, while other do not. Some prefer other animals but will bite people if nothing else is available. Besides more than one species of mosquito and we also more than one variety of malaria. The situation is complex.

Shah spells this out in perhaps more detail than some readers want, but she makes her point. Her description of the various forms the malaria parasite takes during his life cycle convinced me I do not have the patience to pursue that kind of essential research.

The best chapter in the book is “The Karma of Malaria.” Step aside and look at the big picture: the perceptions of the people on the ground who cannot completely avoid mosquitoes and malaria.

 In their lived experience they know that the overwhelming majority of the parasite’s incusions are trivial. Most of the time, carrying the parasite means next to nothing: no fever, no chills, no readily discernible symptons, especially against a gray backdrop of other, more pressing ailments.

This attitude has consequences for the results of campaigns to eradicate malaria.

Most of the ways we’ve devised to destroy malaria rely upon the committed participation of malaria’s victims. It is they who must drain the standing water, swat the mosquitoes, wear the repellant, sleep under the bed nets, go to the clinics, and take the drugs.

Anti-malaria campaigns which fail or are abruptly discontinued because of budget problems may make the victims’ experience worse, by causing them to lose the temporary immunity given by previous mild infections. Shah also writes knowledgeably of past and present drugs, as well as the politics of malaria. Welcome to the fight. My money is on the mosquito.

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