The Making of a Tropical Disease: A Short History of Malaria (review)

To provide a panoramic perspective on what was called for many decades “the king of diseases” is a challenging task. It is important to remember that throughout history malaria has been considered, and is today, one of the main infectious diseases of the world, affecting especially the rural poor in developing nations, namely the poorest of the poor. Randall Packard has accomplished this task successfully in this one-volume history. His book clearly indicates a command of the theme, which many historians of medicine know is a result of his many years of study.

The book begins with Packard’s memories from his time as a Peace Corps volunteer in Uganda, where he contracted malaria. His reason for mentioning this personal anecdote is that the young historian-to-be came up with a revolutionary idea on how to improve the living conditions of people suffering from malaria. However, his ideas did not catch the attention of his American boss, who was more interested in specific interventions to control epidemic outbreaks. The anecdote is relevant because it becomes one of the organizing principles of the book. There have been two approaches to malaria: first, there are those who consider it a sociomedical problem that will not be solved unless the misuse of water and poverty, among other factors, is solved. Second, there are those who see it as a biomedical reality that needs only a magic bullet that will control or eradicate the disease in a short period of time. Packard demonstrates that the second approach has usually failed and that the first one might be slower but has a holistic scope, relies on community efforts, and produces more lasting positive results.

However, not all in this book is about a natural reality and its corollary medical and political responses. In the first chapter, Packard provides an excellent explanation of the biology and ecology of the disease. He clearly explains why malaria could be found in subtropical areas of Europe and North America until the mid-nineteenth century but later became “tropicalized,” or confined to the tropical areas of the globe. This process is by itself a demonstration that poverty has played a major role in the historical evolution and distribution of the disease around the world. One of this book’s additional virtues is that it combines a clear explanation of the changing scientific ideas on the disease and context in which they appear.

The chapters that deal with the twentieth century concentrate on the scientific findings on malaria and on the political responses to the disease. There is a very interesting discussion of the global program of malaria eradication launched by the World Health Organization (WHO) in 1955 in a Cold War context that became after a number of years a big failure. The initial hopes came with the residual powers of the insecticide DDT and new antimalaria drugs that eventually proved to be insufficient to deal with the vast array of the species of mosquitoes Anopheles, the parasite plasmodium, and the persistent misery of rural dwellers.

Packard provides a clear summary of the goal, the evolution, and the decline of the eradication program, questioning the whole idea of malaria eradication. However, I think that he has failed to mention an important motivation for malaria eradication. He deals with only a broad economic motivation (incorporating the peasantry in a commercial economy). But there was also a specific economic motivation, namely that the funds provided by U.S. bilateral aid became an indirect subsidy to American industries because most of the financial aid for malaria went to buy insecticides and insecticide equipment that was mainly produced in the United States. In addition, the final section on the WHO program, “Roll Back Malaria,” launched in the late 1990s, has one mistake and one omission...