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.

CUSTOMER REVIEWS (Average Customer Rating: 4.5 based on 39 reviews)

An Overview of a Disease by Alan Beggerow (Rock Falls, IL USA)

4 Stars
April 07, 2009
Malaria is a disease that is mostly thought to be tropical in nature. This book dispels those thoughts as the author traces the disease from its tropical origins and how it spread as far north as the town of Archangel. Archangel is a town in Northern Russia, about 125 miles from the Arctic circle.

Malaria was thought to be caused by the 'bad air'(the literal translation of malaria) around swamps and bogs. It wasn't until 1900 that the disease was linked to malarial parasites that lived in the bodies of anopheline mosquitoes. These mosquitoes introduced the malarial parasites into humans when they would bite them to draw out blood needed for propagation.

Historically, there is hardly a corner of the globe that has not been affected by malaria. At the present time malaria is mostly a concern of the tropical regions of the world. But the author relates how many factors can cause the disease to be introduced practically anywhere.

Hundreds of millions of people are affected by malaria today, with between 1 to 3 million deaths being attributed to it a year. This book tells the tale of this disease. How it is passed on, what affect it has on people and cultures, and how the present attempts to control the disease fall short.

Fascinating history of the interaction of disease and development by Colleen McMahon (Atlanta, GA)

5 Stars
November 28, 2008
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.

Proof that health care nowadays is only for those who can afford it while the poor die like dogs by C. Scanlon (among us humans)

5 Stars
September 03, 2008
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

in-depth discussion of all of the factors associated with the spread of malaria by Nadyne Mielke (Mountain View, CA USA)

5 Stars
August 30, 2008
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.

"It's the ecology, stupid." by Timothy J. Graczewski (Burlingame, CA United States)

4 Stars
July 04, 2008
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.

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