Sonia Shah, journalist and author of the book The Fever, delivered a TED Talk about the questions that inspired her to research and write about malaria. Why, she asked, do so many people still suffer and die from a disease we’ve known how to cure since the 1600s (when Jesuit missionaries discovered quinine from tree bark) and prevent since 1897 (when scientists learned that mosquitoes, not “bad air,” were responsible for causing malaria).
Shah uncovered three challenges that are barriers to eliminating malaria once and for all.
- Scientific challenge: The malaria parasite is complex. Its physiology transforms with each of its seven life stages, and it is as tenacious as it is versatile. Mosquitoes and human beings are different yet equally hostile environments, and the parasite survives and thrives regardless. Moreover, it is nearly impossible to avoid a mosquito’s habitat: a soft footprint in the ground followed by a rainstorm is enough to create a puddle and breeding ground.
- Economic challenge: Environmental elements that go hand-in-hand with poverty exacerbate the burden of malaria: no window screens or electricity to encourage indoor evening activities, poor drainage, poor health, and poor transportation infrastructure for delivering prevention and treatment solutions, and so on. Poverty causes malaria, and malaria also causes poverty. The disease strikes during harvest season, when it is most important for farmers to be in good physical condition. Economist Jeff Sachs even quantified the economic impact: malaria depresses an economy by an estimated 1.3% each year.
- Cultural challenge: Because getting malaria is often considered a normal part of the fabric of life in poor areas, and because many people recover, it doesn’t necessarily instill the fear of a life-threatening illness. It is analogous to the way people in the United States view cold and flu season. Shah asks the audience to ponder, “Would you wear a face mask every day to protect yourself from the flu?” Probably not, and program implementers face the same challenge when asking people to sleep under bednets, seek immediate treatment for malaria symptoms, and so on.
Historically, outside political forces have neglected one or all of the scientific, economic, and cultural challenges in their battle against malaria. In the 1990s, for example, a bednet delivery campaign resulted in only about 15% of the nets being used, because it neglected to consider the cultural factors: people didn’t bother with the inconvenience because they were worried about other things. Today, more time is spent educating communities about the importance of bednet usage.
Shah concludes with a call to learn from our mistakes and focus on the unique local forces that contribute to malaria in each setting, including environmental factors. Though it takes time, money, and resources, it is the only true way forward.
For more information:
- The Roll Back Malaria Partnership and the United Nations Development Programme launched a Multisectoral Action Framework for Malaria.
- The vast majority of malaria is caused by two parasites. Plasmodium falciparum is more common and better understood by scientists. At a recent conference, scientists shared the latest data to help shed light on the more challenging Plasmodium vivax parasite.