War and Disease: Biomedical Research on Malaria in the Twentieth Century (review)

The question addressed by Leo B. Slater is clearly summed up toward the end of his book: "What was the antimalarial program's role in connecting prewar biomedicine to postwar medicine?" (p. 174). Between those two chronological boundaries, Slater's essay expounds upon the details of this tremendous undertaking, its necessity, and its uses. Slater's finely organized historical study explains the roots of this program developed during the Second World War, from its logical outgrowth from German chemical industry to the discovery of the wonder drug chloroquine, put into use in 1944. Slater explains in copious detail the relevant elements and parameters of the antimalarial program's architecture and supports his arguments with impressive references, which serve as an almost exhaustive bibliography on the topic.

What is striking for the historian of biomedical sciences is Slater's tracing of the development of this program, which emerged from efforts to protect U.S. soldiers in malarial countries without jeopardizing war mobilization at home. He shows how these wartime origins led to the elaboration of a full-scale program, which led to a network linking government agencies, an ad hoc committee (National Research Council), the pharmaceutical industry, and biomedical research and development. Slater clearly assesses the evolution of the use of quinine, a natural compound, to the development of synthetic drugs for prevention and treatment of malaria. One therefore can trace the German Bayer scientists' contributions to what Slater calls "new drugs," moving from Ehrlich's early research on dyes and their presumed actions on the malaria parasite to Bayer's work on a synthetic antimalarial in the 1940s. First- and second-generation synthetics (plasmochin and then Atabrine) led to the third-generation wonder drug, chloroquine (reminding the reader of the other wonder drug, penicillin, to which Slater sometimes refers as a parallel story). Shifting from Germany to the United States, the author then details in three important chapters the strengths, weaknesses, and stakes of the U.S. government's antimalarial program. The importance of the National Research Council from 1939 onward—and its limits—are detailed. Slater emphasizes the Rockefeller Foundation's and Institutes' major roles, the restructuring of the research network, and of course, the wartime investigations into malaria control as an important stepping stone for biomedical research. The author carefully analyzes the growing bureaucracy and the methodological, ideological, and ethical conflicts and crises over information-sharing among committees, research, and industry. Slater illuminates the changes in scale and methods of drug development, as well as the complexity of wartime research and government funding. Historians, scientists, and social scientists will learn much from the questions and evidence provided in the two final chapters, in which Slater highlights the legacies of the antimalarial program: the malaria chemotherapy, the general biomedical research, and the "ongoing need to seek new and creative ways to attack malaria" (p. 178). Recalling that malaria still kills millions of people throughout the world, the author reviews the late-twentieth- and twenty-first-century programs and their financing.

Although the book's title might mislead readers into thinking that Slater is examining all wars and diseases in the twentieth century, the author provides readers with a major contribution to malaria historiography, an essential complement to recently published, important synthetic works, including Frank Snowden's The Conquest of Malaria, Italy, 1900-1962 (2005), Randall Packard's The Making of a Tropical Disease: A Short History of Malaria (2007), and James L. A. Webb's Humanity's Burden: A Global History Of Malaria (2008). This indispensable study on antimalarial drug history leaves us with the reminder that a magic bullet against malaria still does not exist, despite major efforts against the disease, and that multiple chemotherapies, in conjunction with mosquito control efforts, are needed. More than anything, Slater contends, the fight against malaria requires a struggle against poverty.