If there is one immediate takeaway from Sonia Shah’s enjoyable but strangely shallow book about malaria, it is that malaria means different things to different people. To modern medicine, it is a scourge. To modern media, it is a cause. To historians, malaria is a kind of abstract background hum, a white noise that is ever present. To the mostly tropical poor who suffer from it, it is more immediate but still a part of the background, and hardly something that requires drastic action.
Against that disparate range of human reactions, plasmodium, the microscopic parasite that causes malaria, has gone happily about the business of reproducing itself. Early in “The Fever”, in one of the best sections of the book, Shah describes the dizzying lifecycle changes that plasmodium goes through in its perpetual cycle between human and mosquito. The damned thing transforms itself over and over, each new iteration specifically evolved to survive in a very narrow, and yet very common, set of circumstances. In popular writing about disease, a fearsome description of the little killer is de rigueur. Shah’s placement of plasmodium in that bestiary of the invisible is exceptional: descriptive, understandable, and frightening.
She fleshes out that description through the bulk of the book, which is largely a history of humanity’s efforts, especially those since the advent of evidence based medicine, to combat malaria. We have the important scientists, the lucky correct guesses, the missed opportunities, and the petty jealousies. There is false hope, selective treatment, and cyclical periods of official neglect and attention.
What emerges is a picture of a disease that is more or less perfectly adapted to survive amongst humans. It thrives on the disruption and chaos that come so naturally to us. Build a dam to power a mill; stagnate the water and suffer the consequences. Disrupt countless lives to eliminate one brand of mosquito, find that malaria travels by another. It takes advantages of our social weaknesses as well as our immune ones. It withstands our most potent blows, even those like DDT that are worse than the disease.
It is in that last area that the book’s main weakness rears its head. After an informative history of the DDT-centered attempts to rid the world of malaria post-World War II, Shah makes brief mention of the recent attempts at rehabilitating DDT. Unfortunately, she doesn’t take a truly clear position on it, settling for more of a catalog of complaints. The same is true of her rather timid criticisms of the current high profile anti-malaria efforts spearheaded by the famous likes of Bill Gates and Bono.
Shah isn’t shy about describing what she sees as unrealistic promises and publicity driven inefficiencies in today’s anti-malaria campaigns, but neither does she delve into them the way she does older efforts. We’re told that eliminating malaria – a promise with a lot of cachet for donors – is an impossibility, and based on the rest of the book there’s no reason to doubt that. But she offers no substantive alternatives, nor even any speculative ones.
It has the feel of skimming over a topic that is surely rich and interesting, and it isn’t the only time in the book. That quinine remains remarkably effective against malaria is a given, but we’re never given a good explanation of why plasmodium adapts so easily to other medicines and not this one. The story of the rediscovery of the anti-malarial effects of the wormwood tree in China is given slightly more detail, but still feels like a story that’s incomplete. The same is true of the whirlwind way Shah brushes through history and malaria’s effects on it. Roman times give way to the 19th Century in just a matter of paragraphs. For a book that goes into serious detail on other topics, the cursory nature of others is a little strange.
When the worst criticism of a book, other than the fact that its subtitle “How Malaria Has Ruled Humankind for 500,000 Years” overestimates the existence of humanity by about three hundred millennia, is that there should be more of it, it’s probably a pretty good book. And “The Fever” is indeed a pretty good book, if a tad too short for such an expansive topic.
