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The Making of a Tropical Disease: A Short History of Malaria (Johns Hopkins Biographies of Disease)
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Manufacturer: The Johns Hopkins University Press
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Binding: Hardcover
Dewey Decimal Number: 616.9362009
EAN: 9780801887123
ISBN: 0801887127
Label: The Johns Hopkins University Press
Manufacturer: The Johns Hopkins University Press
Number Of Items: 1
Number Of Pages: 320
Publication Date: 2007-12-18
Publisher: The Johns Hopkins University Press
Studio: The Johns Hopkins University Press
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Editorial Reviews:
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Malaria sickens hundreds of millions of people -- and kills one to three million -- each year. Despite massive efforts to eradicate the disease, it remains a major public health problem in poorer tropical regions. But malaria has not always been concentrated in tropical areas. How did other regions control malaria and why does the disease still flourish in some parts of the globe? From Russia to Bengal to Palm Beach, Randall Packard's far-ranging narrative traces the natural and social forces that help malaria spread and make it deadly. He finds that war, land development, crumbling health systems, and globalization -- coupled with climate change and changes in the distribution and flow of water -- create conditions in which malaria's carrier mosquitoes thrive. The combination of these forces, Packard contends, makes the tropical regions today a perfect home for the disease. Authoritative, fascinating, and eye-opening, this short history of malaria concludes with policy recommendations for improving control strategies and saving lives.
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Spotlight customer reviews:
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Customer Rating:
Summary: Fascinating history of the interaction of disease and development
Comment: I picked up this book out of a mild curiosity about malaria, something I know little about but I do have a fascination with the way biology intersects history. Not only did I find this book to be a readable exposition of how development patterns and efforts to control and fight malaria have changed and often increased exposure to it, I actually had a hard time putting down a book that would seem to be a fairly dry topic.
The author gives an overview of the types of malaria, the mosquitos that tend to carry them, the variety of symptoms and effects that they have on humans, and the conditions that best foster the entire disease process of germ/parasite/insect/human. Then it gets really interesting, as he explores in depth 4 sites in the world which historically had malarial conditions and how human settlement and environmental changes (natural and human wrought) increased, decreased and changed the experience of the disease. He then moves on to tackle the effects of concentrated attempts to wipe out malaria worldwide in the 20th century and the successes and failures of those attempts, before wrapping up with a look at more effective ways to combat the disease.
Overall I found the historical chapters the most fascinating. To see how malaria increased and decreased over time in places ranging from the southern US to eastern Europe was really interesting. There is good scientific material here but it is all written in a very readable narrative and as a layperson, I understood what was going on. The author concentrates on telling the story and there is a minimum of graphs, number crunching and statistics, which I appreciated as those tend to make my eyes glaze over.
This book is a must read for anyone engaged in policy making on malaria prevention and is instructive for anyone working on larger issues of combating disease and poverty, or even of economic development and the environment. I am none of those things, just a curious reader, and I found the book to be edifying and enjoyable.
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Summary: Proof that health care nowadays is only for those who can afford it while the poor die like dogs
Comment: read this book and realize what globalization does to our world.
to our soul
read this book and realize how wrong we have become
this book is proof positive
you don't like Michael Moore's Sicko (Special Edition)
read this book instead and learn what our economic structure does to poor populations
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Summary: in-depth discussion of all of the factors associated with the spread of malaria
Comment: When I was in high school, malaria was something that I'd heard of, but I'd mentally categorised it with polio and smallpox -- diseases that were still out there occasionally, but were mostly controlled. After all, malaria is spread by mosquitos, and it can't be that hard to control mosquitos. Then a friend spent some time in Brazil, and came home with malaria. She nearly died. Malaria suddenly became real to me.
Mosquitos are vector that spread malaria, but the story of malaria is more than just mosquitos. In this book, Randall Packard argues that the failure of world health policy to consider the holistic problem of poverty rather than just the mosquito problem means that we will always fail in attempts to eradicate malaria. He argues that we can't do it with just medication, mosquito nets, and insecticide. Those are required, but they're not the whole story. Providing low-cost mosquito nets is useless if people still can't afford the subsidised price. Medication is useless if it's not readily available, which means that the infrastructure of the afflicted area must be considered.
Packard considers the history of the spread of malaria to make his case. In each case study, the story is almost identical. At first, this feels repetitive, but as he goes on with case study after case study, it is simply depressing. The world community keeps on making the same mistakes over and over again: not ensuring that the affected area has enough education to recognise malaria in its early stages, not having access to mosquito nets to avoid the bites, not having access to sufficient medication to treat the disease, and not having sufficient infrastructure to do more than just an occasional spray of insecticide when the problem is the worst.
The text is dense, but as a layperson, I did find the book easy to follow. It's obviously not a summer beach read; it's something that you have to make a commitment to read. But it is well-written and well-researched. Packard does a good job of balancing between the larger story and anecdotes of how it impacts the afflicted areas. This is a worthwhile read, certainly for anyone who is interested in global health or global policy.
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Summary: "It's the ecology, stupid."
Comment: This book isn't nearly as arcane as one might think. The subject and general theme are far outside my standard reading zone, yet I never once lost interest nor felt lost in the subject matter.
Author Randall Packard's central message is abundantly clear: malaria is a social disease and only significant economic development and social change can eradicate it. He seeks to demonstrate his point with historical case studies. For instance, malaria once thrived in such places as southeastern England and across the United States as far west as Illinois. Yet, malaria is practically unthinkable in those places today despite the fact that no concerted anti-malaria campaigns were ever undertaken.
So how did malaria disappear from such places in the absence of even elementary knowledge of the disease and its transmission? Simple, Randall argues: the social ecology of those places changed in ways that are not conducive to the propagation of malaria. Namely, it was plantation cash-crop farming that relied on large numbers of indigent, migrant labor residing close to irrigation water sources that allowed malaria to thrive. It was the introduction of inland rice and cotton farming in South Carolina, for instance, as well as the introduction of African slaves who in all likelihood brought the parasite to the US, that brought the disease to this country, and it was the industrialization of the south and the end of sharecropping in the early twentieth century that eliminated it. Again and again, through numerous examples, Packard shows how human action, usually related to farming practices and then industrialization, led to the introduction and/or elimination of the disease.
The fundamental lesson that Packard draws from his work is that only human ecology and economic development can address malaria in any meaningful way. Any effort to destroy the disease either through killing off the vector (female anopheline mosquitoes) or attacking the parasite itself (Plasmodium falciparum, in particular), Packard argues, can at best keep the disease under control, but with no hope to eradicate it. Although he never comes out and says so explicitly, Packard makes it clear that the Gates Foundation's push for a malaria vaccine is "here we go again" and will ultimately end with disappointing results like previous attempts at malaria eradication by attacking the vector or parasite only.
Needless to say, I learned a lot in this book. One thing that surprised me was just how difficult the transmission of malaria actually is. In order for a person infected with the most serious form of malaria (Plasmodium filciparum) to pass the disease on via the mosquito to another host a string of statistically unlikely events need to occur. First, the malaria parasite needs to be at a phase in its life when it is producing a sufficient number of gametocytes, which are required for sexual reproduction in the gut of a female anopheline mosquito. According to one study cited by Packard, only about 1% of an infected population has a sufficient number of gametocytes in their bloodstream to serve as "infectors." Second, even if a mosquito bites an "infector" host there is only about a 35% chance that it will actually ingest a gametocyte. Finally, before the parasite can be passed from the mosquito to a new host, the gametocyte needs to reproduce and send sporozoites to the mosquito's salivary glands, a process that takes 14 days to complete - and the lifespan of a female anopheline mosquito is just 10 to 21 days. Another study cited by Packard suggests that for every 10 gametocytes ingested by a mosquito, only one successfully reproduces and is introduced to a new host to start the lifecycle anew. Thus, the numbers required to keep malaria alive in a population - both infected people and mosquito vectors - is enormous. I did some back-of-the-envelope analysis and determined that it would take over 3,000 people infected with malaria in a mosquito-rich environment to pass the disease on to just a single new host.
In 1957 epidemiologist George Macdonald sought the eradication of malaria by treating the problem as a mathematical challenge that sought to achieve the cross-over point the disease simply could not sustain itself and ultimately vanished from existence. Given the numbers above, I can see why this approach had appeal. The end result of this hypothesis to disease eradication, Packard notes, is that malaria became viewed a vector-borne disease (i.e. efficiently kill the mosquitoes and you will wipe out the disease) rather than what the author argues passionately it is, a social condition. Moreover, the wonder chemical that promised to end malaria once-and-for-all by destroying mosquitoes was DDT.
That anti-malaria effort of the 1960s was actually quite effective in rolling back malaria in many countries, although the disease quickly returned once the aggressive pesticide treatments abated, while no economic development had occurred.
In sum, this is a fascinating book and is highly recommended to anyone with an interest in economic development or simply intrigued by difficult puzzles to solve. Unfortunately, the book is somewhat depressing as Packard maintains that only serious economic development in sub-Saharan Africa and other depressed areas where malaria is endemic will end the disease. And, of course, that is a nut not easily cracked.
Customer Rating:
Summary: Interesting History of the Forces that have Shaped Malaria's Epidemiology.
Comment: "The Making of a Tropical Disease: A Short History of Malaria" is true to its title. Malaria used to be prevalent over much of the globe, but its decline in other parts of the world have made it a disease primarily of the tropics. Randall Packard draws on his personal experience with the disease and 20 years of research to explain how and why malaria came to be the tropical disease it is today. He discusses the interplay of climactic, biological, social, and economic factors that have shaped the history of malaria, with particular emphasis on the socio-economic factors that have sometimes been neglected in the past century in favor of medicinal and technological approaches. Packard insists that efforts to combat malaria must consider all historic reasons for the disease's expansion and decline if they are to be successful.
The author is the first to admit that the early history of malaria is contested, but he starts it in Africa anyway, for lack of better information. Malaria is caused by a protozoan that is transmitted through the bite of the female Anopheles mosquito. The first four chapters of the book explain the history of malaria, how biological and broad societal forces caused the disease to spread in Africa and then to Europe, Asia, and the Americas, through case studies of the incidence of malaria in different locations at different times. The last four chapters focus on efforts to eradicate the disease in the 20th and 21st centuries and the reasons for their failures or limited successes, including the World Health Organization's failed Malaria Eradication Programme and the current global Roll Back Malaria initiative.
"The Making of a Tropical Disease" impresses upon the reader the role of social change, especially agricultural development, in shaping epidemiology. Although he is a sharp critic when he believes a strategy is flawed, Packard is passionate about decreasing malaria in sub-Saharan Africa. Nonetheless, I am left unconvinced that the resources dedicated to combating malaria are worthwhile. Packard states that the "vast majority" of malaria deaths in tropical Africa are among young children. He doesn't say what percentage. And he doesn't say what the birth rate is in those areas. He also mentions a number of genetic blood conditions that confer immunity to malaria but doesn't say how many Africans benefit from this protection. He does say that malaria control does not affect economic development and that it has increased poverty in some cases. So I can't say how big a problem malaria really is or if programs that target malaria specifically are the best way to fight it.
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