The Fever: How Malaria Has Ruled Humankind for 500,000 Years

Sonia Shah’s The Fever: How Malaria Has Ruled Humankind for 500,000 Years is deceptively packaged as a popular science book, the kind that distils complicated data, numbers, and facts and presents it to the “layperson”, as the term goes, in “plain English”. What it is, however, is a work that operates on many levels, not least science, and expands the knowledge contained within those sets of data, numbers, and facts to present a multifarious work that is as much about biology as it is about anthropology, sociology, culture, history, and significantly, how all these shape and determine economic and political concerns and decisions.

It may seem like an ambitious attempt for a book that purports to be about malaria, but there’s nothing that puts a pause in the breathless exclamations over human agency and the wonders of technology as much as disease. That Contagion-level anxiety of “everything is beyond human control” (until of course, everything comes seamlessly within human control, but only in a Hollywood all-star production) is an element that Shah wrestles with throughout the book, putting aside the conventional binary thinking of human agency vs. nature that informs much of techno-politics, to borrow a term from Timothy Mitchell’s Rule of Experts, in favour of detailed, impeccably-researched explorations of the confluence of factors that help a disease to thrive in a particular location or hinder its development.

Malaria is perhaps commonly known as a “third world disease”, one of those relics of the past that inspire comments like “I didn’t know it still existed”, as Shah notes of an American hedge-fund manager “turned antimalaria organizer” who said this as recently as 2005. But as Shah points out, while much of the “developed world” has blithely moved on to other concerns, thinking malaria a scourge of the past, the disease has been slowly wreaking havoc in parts of Asia, and crucially, in Africa.

Shah’s book begins in Panama City in 2006, where she goes to learn about the 2005 malaria epidemic at the village town of Chepo where almost half the settlement was infected with the fever. As Shah points out, Chepo was “less than two hours’ drive from a boisterous city of three million… The scene of malaria’s malevolent homecoming in this secluded settlement cast its shadow over the very doorstep of the global economy.”

And economics is what we keep returning to. In charting the path of the re-emergence of the mosquito-borne parasite, Shah tells us that the Americas were generally malaria-free for thousands of years before the European colonists arrived. In Africa, the demand for slave labour by the European colonizers meant that slave raiders went deep into the lands, and as Shah explains, “whole villages in Africa abandoned their lands and long-established trade routes, and the exquisite balance between man and parasite forged over millennia was abruptly ruptured.”

Imperial and colonial manoeuvres influenced the factors that played into control and access of medication used for the treatment of malaria, like quinine. Quinine, from the cinchona bark found in South America, was introduced into Europe by Jesuit missionaries. Later, in 1865, a British trader acquired cinchona seeds from a Bolivian harvester by means of death threats, with the pirated seeds eventually making their way to the Dutch, who, as Shah explains, “lovingly prepared a bed for them” in the colonized soil of Java. The price, supply, distribution, and dosage of quinine quickly grew to depend upon the whims of political and trade expediencies, as the Dutch, Spanish, and British all fought over gain and control over the prized medicine.

These factors mirror the imperial forces at play today, forces that determine when and how malaria gains attention and subsequently, research and funding. Shah outlines the discrepancy between the experiences of people living with malaria both as a disease or an imminent threat, people who are mostly in the global South and among the world’s poorest, and the policies and research that go into malaria eradication, where it typically takes places thousands of miles away, in cool, air-conditioned spaces like the Harvard Malaria Initiative amidst class and wealth privilege “where students and faculty lunch on green salads and beautifully ripened fruits”. (Or through imperialistic-philanthropic efforts like the Rockefeller Foundation, more imperial than philanthropic.)

Particularly revealing is the chapter on “The Spray-Gun War”, or the use of dichlorodiphenyltrichloroethane (DDT) which began during World War II. Here, Shah describes how actual warmaking shaped the attitudes towards malaria-prevention: “Americans eager for a taste of wartime glory could pursue insects to extermination, just as the Allies did the Nazis and the Japanese.” The gung-ho hysteria that accompanied the use of DDT spray was its own fuel to a fire that had more to do with communities trying to piece together the ramifications of the senseless amounts of destruction wrought by war, and political forces working from deep within mass fear and uncertainty to push forward nationalist and/or imperialist projects. Shah notes how the American political apparatus shifted into high gear:

After all, noted the Chief of the Chemical Warfare Service, ‘the fundamental principles of poisoning Japanese, insects, rats, bacteria, and cancer are essentially the same. […] Insects were ‘an evil force,’ a member of the House of Representatives said, one that made people dissatisfied. ‘I do not need to tell you,’ he added, ‘that dissatisfaction breeds communism.’ Exterminating commie pinko insects with DDT, in other words, became downright patriotic.

Shah’s attempt to outline these complex factors is exactly the kind of project taken on by Timothy Mitchell in his aforementioned Rule of Experts, the latter which I began reading as I was midway through Shah’s book. The chapter titled “Can the Mosquito Speak?” in Rule of Experts is a specific study of the spread of malaria in particular parts of Egypt, but Mitchell is keen to emphasise how the discourse of techno-politics traffics in binary thinking that eliminates and elides factors outside of human control, agency, and crucially, expertise, in pitting human beings against the world of nature. Dr. Fred Soper, mentioned in both Shah and Mitchell’s books, lead the American DDT eradication program after having succeeded in eradicating yellow fever in South America using methods based on “modern warfare” and the “physical elimination of the enemy species”, in Mitchell’s words.

The key factor of political will and its embodiment in techno-politics, for all nation-states carving out boundaries of power, is the ability to convey expertise in its methods. The DDT spray campaign and its “single-bullet solution”, as Shah calls it, is the equivalent of bombing the hell out of enemy territory.

Mitchell’s point about human agency (that, “like capital, [it] is a technical body, [it] is something made”) is amply demonstrated throughout The Fever, which packaged and distributed as popular science but is a cogent, elegant interrogation of forces of biology, politics, culture, capital, and history that undermine and underline human agency. If there are flaws with The Fever, they’re mainly to do with the inherent limitations of the popular nonfiction genre itself – too little space for too much information. But this is only a minor quibble, because Shah is an intelligent, assured writer who never underestimates her audience’s capacity for understanding and piecing together the complex, labyrinthine causes and factors behind malaria’s continued grip over humankind.

If, as Mitchell points out in Rule of Experts, “techno-science had to conceal its extrascientific origins” in an attempt to paint a rational, ordered world well under the control and authority of human “logic”, then Shah’s book is an important intervention in that reveals the scientific and extrascientific origins that make malaria an (as yet) unbeatable scourge. Shah is rarely polemical or shrill, but her searing comments on the “rescue industry” that feed into US-sanctioned antimalaria efforts that have a “bias toward political expediency as opposed to accuracy” shows the rigorous ways in which capital directs all efforts that are made to supposedly “improve” people’s lives. Shah zeroes in on Jeffrey Sachs’ attempt at framing antimalaria work as an economic investment, and lays bare the plain idiocy of certain celebrity do-gooders (Michael Crichton: “Banning DDT killed more people than Hitler”) as well as mainstream media like The New York Times which, in 1957, declared that the American DDT-based malaria-eradication program was “a Christmas gift directly to more than a billion people.” The gift that keeps on giving, as it turns out.

Shah’s book is a recommended read for readers interested on learning more about the spread and prevalence of malaria, certainly, but also for readers interested in knowing about the geo and techno-political factors of disease and its movement through communities and nations. In the end, as Shah quotes the malariologist Tom McCutchan as saying, “you have to got to give power to the people who are at risk.” And that, it would seem, is precisely what we are supremely uninterested in doing through our rescue efforts, philanthropy, and so-called humanitarian work.