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I've been reading a lot about malaria since I got back from Africa. It's something of which I've been dimly aware, in a "must take preventative action to make sure I don't get this" kind of way, but I didn't know much about the disease.
I didn't know, for example, that it's caused not by a virus or bacterium but by a protozoan called plasmodium, which has a long and complex life cycle involving mosquito saliva, livers, red blood cells and even human brains. Ick. Actually, only one of the four species of plasmodium -- P. falciparum -- infects the brain, but that's the one that causes 90% of fatalities.
I had no idea of the vastness of the malaria problem. A conservative estimate is that someone dies of malaria every 30 seconds -- between one and three million people a year, in other words. Ninety percent of them are in Africa; seventy percent are under age 5. And that doesn't even include the millions of children every year who survive but with permanent damage. Robert Gwadz, head of the malaria department at the National Institute of Health, says, "It's possible that due to malaria, almost every child in Africa is in some way neurologically scarred." As a result, malaria is a significant contributor to economic stagnation and poverty: according to a Lancet article cited on Wikipedia, it costs Africa $12 billion a year in health care expenditures, reduced productivity, and reduced tourism. That number is particularly notable since Jeffrey Sachs suggests in The End of Poverty that $2-3 billion a year would be sufficient to control malaria in Africa -- not to eradicate it completely, but to reduce fatalities to near zero.
I also had no idea that there was precedent for malaria control. Malaria used to be prevalent in the U.S. and southern Europe, until the mosquitos that carry it were wiped out in the 1930s and 40s through means I would otherwise find quite dubious -- ample use of DDT and the drainage of millions of acres of wetlands. While I think of malaria as a tropical disease, a National Geographic article chronicles its history planetwide:
Shocking.
Reading all of this makes me feel very grateful that I can pop a doxycycline, spray on some DEET, and rest assured that even if I catch malaria despite these precautions, effective treatments are available. Malaria is no AIDS; despite all the problems finding a vaccine and dealing with disease-resistant strains, it is still an eminently treatable disease. This makes it all the more tragic that so many people die of it. The reinforcing cycle of disease and poverty depresses me: poverty leads millions of Africans to suffer and die from a disease that could be prevented or cured, while meanwhile the sequelae of malaria infection -- death, disability, brain damage -- cause even more poverty.
And now, a fun fact about malaria: before antibiotics were invented, doctors purposefully infected syphilis sufferers with malaria, because syphilis bacteria can't survive the alarmingly high fever that is a hallmark of malaria. The hapless patients could then be treated with quinine. Some of them didn't survive, but hey, they were going to die of syphilis anyway, so what the heck.
(Main sources for this entry: "Bedlam in the Blood," from this month's National Geographic; Wikipedia; Jeffrey Sach's The End of Poverty.)
I didn't know, for example, that it's caused not by a virus or bacterium but by a protozoan called plasmodium, which has a long and complex life cycle involving mosquito saliva, livers, red blood cells and even human brains. Ick. Actually, only one of the four species of plasmodium -- P. falciparum -- infects the brain, but that's the one that causes 90% of fatalities.
I had no idea of the vastness of the malaria problem. A conservative estimate is that someone dies of malaria every 30 seconds -- between one and three million people a year, in other words. Ninety percent of them are in Africa; seventy percent are under age 5. And that doesn't even include the millions of children every year who survive but with permanent damage. Robert Gwadz, head of the malaria department at the National Institute of Health, says, "It's possible that due to malaria, almost every child in Africa is in some way neurologically scarred." As a result, malaria is a significant contributor to economic stagnation and poverty: according to a Lancet article cited on Wikipedia, it costs Africa $12 billion a year in health care expenditures, reduced productivity, and reduced tourism. That number is particularly notable since Jeffrey Sachs suggests in The End of Poverty that $2-3 billion a year would be sufficient to control malaria in Africa -- not to eradicate it completely, but to reduce fatalities to near zero.
I also had no idea that there was precedent for malaria control. Malaria used to be prevalent in the U.S. and southern Europe, until the mosquitos that carry it were wiped out in the 1930s and 40s through means I would otherwise find quite dubious -- ample use of DDT and the drainage of millions of acres of wetlands. While I think of malaria as a tropical disease, a National Geographic article chronicles its history planetwide:
The disease has been with humans since before we were human. Our hominin ancestors almost certainly suffered from malaria. The parasite and the mosquito are both ancient creatures—the dinosaurs might have had malaria—and this longevity has allowed the disease ample time to exploit the vulnerabilities of an immune system. ...
Few civilizations, in all of history, have escaped the disease. Some Egyptian mummies have signs of malaria. Hippocrates documented the distinct stages of the illness; Alexander the Great likely died of it, leading to the unraveling of the Greek Empire. Malaria may have stopped the armies of both Attila the Hun and Genghis Khan.
... At least four popes died of it. It may have killed Dante, the Italian poet. George Washington suffered from malaria, as did Abraham Lincoln and Ulysses S. Grant. In the late 1800s, malaria was so bad in Washington, D.C., that one prominent physician lobbied--unsuccessfully--to erect a gigantic wire screen around the city. A million Union Army casualties in the U.S. Civil War are attributed to malaria, and in the Pacific theater of World War II casualties from the disease exceeded those from combat. Some scientists believe that one out of every two people who have ever lived have died of malaria.
Shocking.
Reading all of this makes me feel very grateful that I can pop a doxycycline, spray on some DEET, and rest assured that even if I catch malaria despite these precautions, effective treatments are available. Malaria is no AIDS; despite all the problems finding a vaccine and dealing with disease-resistant strains, it is still an eminently treatable disease. This makes it all the more tragic that so many people die of it. The reinforcing cycle of disease and poverty depresses me: poverty leads millions of Africans to suffer and die from a disease that could be prevented or cured, while meanwhile the sequelae of malaria infection -- death, disability, brain damage -- cause even more poverty.
And now, a fun fact about malaria: before antibiotics were invented, doctors purposefully infected syphilis sufferers with malaria, because syphilis bacteria can't survive the alarmingly high fever that is a hallmark of malaria. The hapless patients could then be treated with quinine. Some of them didn't survive, but hey, they were going to die of syphilis anyway, so what the heck.
(Main sources for this entry: "Bedlam in the Blood," from this month's National Geographic; Wikipedia; Jeffrey Sach's The End of Poverty.)
