The Long Struggle against Malaria in Tropical Africa by James L. A. Webb Jr. (review)

James L. A. Webb’s The Long Struggle against Malaria in Tropical Africa is an interdisciplinary historical study of the successes and failures of twentieth-century efforts to control malaria in tropical Africa. The book is a critical contribution to the study of world history and the growing literature on histories of disease, ecology, and global health, as well as the emergent subfield of historical epidemiology, of which Webb is a pioneer. Historical epidemiology brings a historical perspective to the study of contemporary disease challenges, which can be used to evaluate the strengths and limitations of current practices (p. xi). This book serves as a sequel to and elaboration of arguments that Webb presented in Humanity’s Burden: A Global History of Malaria, which detailed the complex ecological history of humans and malarial parasites.⁹

The Long Struggle against Malaria in Tropical Africa begins with an introduction to the history of malaria, which lays the groundwork for understanding the author’s critical arguments about acquired immunity and the severe consequences of lapses in malaria control policy, a core theme that Webb reiterates throughout the text. Gaps in malaria control efforts enabled the resurgence of malaria and caused impacts that were more devastating to adult African populations than prior outbreaks, since they were not exposed to malaria as children and did not acquire immunity.

The first two chapters, “European Vulnerability” and “African Immunity,” outline European and African experiences with malaria in the early twentieth century. Chapter 1 discusses the history of European efforts to avoid malaria, which included the use of quinine, residential segregation, and mosquito control. Chapter 2 focuses on African responses to malaria and outlines indigenous strategies for treating malarial symptoms and repelling mosquitoes, including burning smoky fires, applying plant ointments, and using mosquito traps. These chapters also demonstrate how European settlement, agricultural development, and urban growth resulted in new patterns of malaria transmission in rural highlands and lowlands in tropical East Africa.

Chapter 3 focuses on the postwar global malaria eradication campaign (1950–1965) led by the World Health Organization (WHO) and elucidates the consequences of the closure of WHO pilot projects. The WHO campaign operated by spraying synthetic insecticides and administering synthetic antimalarial drugs. The success of eradication campaigns in the United States, Mexico, Italy, Greece, Corsica, Venezuela, Ceylon, and elsewhere led to optimism among global public health policymakers. Webb argues that these campaigns ultimately failed in tropical Africa due to the development of resistance to insecticides among mosquitoes and the lack of cooperation with African populations in malarial zones. Further, the loss of acquired immunities among local populations eventually enabled the resurgence of malaria, with higher mortality and morbidity rates among African adults than ever before.

The book’s discussion of African responses to public health programs raises questions about the necessity and motivations of early eradication campaigns. During the colonial period, European states were primarily concerned with protecting nonimmune Europeans from malaria; however by the World War II era, they became increasingly interested in eradicating the disease in African environments. Cultural perceptions of the seriousness of malaria shaped African and European ideas about the necessity of antimalarial campaigns, as most African adults saw malaria as “an annoyance, an unpleasant reality of life like the seasonal flu, rather than a problem to be tacked with scarce resources” (p. 94).

Chapter 4, entitled “Positive Turbulence,” focuses on responses to malaria among new independent African governments between 1965 and 1980. Webb argues that resistance to WHO campaigns was political as well as ecological; new African governments expressed ideological resistance to colonial models of public health administration, and parasites and mosquitoes developed genetic resistance to antimalarials and insecticides. However, African states did facilitate the distribution of chloroquine, which was generally accepted among Africans and led to a general decline of malaria in sub-Saharan Africa. Despite the promise of chloroquine, “serious trouble lay ahead,” as chloroquine resistance...