The Trouble with Malaria in Africa

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Jim Webb, Colby professor and expert on historical epidemiology

 

By Timothy Gillis

PORTLAND, ME – The Center for Global Humanities hosted a seminar Monday at the University of New England, Portland Campus. James L. A. Webb, Jr. spoke on “The Trouble with Malaria in Africa.”

Beyond the obvious trouble with a deadly disease, Webb argued that one of the greatest challenges to health officials was a medical irony: concerted efforts of combining drugs for the affected population with insecticides aimed at malaria-carrying mosquitoes were extremely successful. But the disease has never been fully eradicated.

The Bill and Melinda Gates Foundation helped fund a malaria eradication program (later renamed a malaria “elimination” program, with “subtle distinctions” in the new word’s difference), Webb said.

The program made great strides against malaria, with dramatically improved statistics in each of the first few years. Drugs and insecticides combined to eradicate 50, 80, 90, 95 percent of transmissions. “But you could not fully eradicate it,” Webb said.

While he admired their efforts, Webb said the Gates Foundation “embarked on malaria elimination with an enthusiasm not tempered by knowledge of past campaigns,” adding that the foundation’s announcement of their goal was met with the science community’s collective jaw dropping.

“It’s not that hard to lower the percent of transmissions, but you can’t get to zero,” Webb said, the realization of which can be a deterrent to donors.

Webb said those getting into the malaria elimination business would do well to study historical epidemiology, which is not a political history or a social history. “It’s a history of infection and interventions… a study of the patterns of disease,” he said.

Malaria was, at one time, the World Health Organization’s #1 killer, the reason for its formation. By the 1960’s, there was little disease but it was never fully eradicated. Rebound malaria decimated West Africa in 1965 until it began to be controlled in the 1980’s.

“When you turn your back on it, it springs back,” he said, reminding the audience that malaria was wiped out in the United States as recently as the 1840’s.

“They used to have epidemics in Sebago,” he said.

Speaking at a university known for its strengths in the health sciences, Webb called for historical epidemiology to be added to the curriculum of med schools across the country. “The findings are cautionary… and the failure (of malaria control specialists) constitutes a significant public health risk,” he said.

Webb said the government wants a cure for malaria, to be able to put troops in Africa and not worry about disease, but that’s a “white perspective on malaria.”

Someone who had braved the evening’s falling snow to attend the lecture asked Webb to speak about vaccines for malaria. He said there have been some successes, but the challenge was that vaccines had to be “stage-specific” when targeting treatment, at several stages of the life cycle of the virus.

An official at the World Health Organization recently told Webb that “50 years from now, we’ll still be five years from a vaccine.”

Another questioner wondered about the role of poverty in the disease. Webb said there was no doubt that access to clean water, better housing, and electricity all made for a much-improved defense against disease.

“Having electricity, and a fan is far more effective than netting,” Webb said.

Someone asked why malaria seemed to be most apparent in Africa. Webb said 70 different mosquitoes transmitted the disease, but not all of them did it effectively.

“Many mosquitoes don’t care where they get their blood meal, from a cat, from a cow. But (African mosquitoes) are highly specialized, they have a preference for human blood.”

Webb was introduced as a pioneer in the field of historical epidemiology. His work integrates approaches from the biological sciences and the social sciences to produce perspectives that are useful to historians, practitioners, and planners in the field of global public health. He is the founding editor of two book series at the Ohio University Press: “Perspectives on Global Health” and the “Series in Ecology and History.”  He is currently writing a book on the history of malarial infections and interventions in tropical Africa.

He said one of the ironies of malaria control was the case of chloraquine, a drug that worked better than all the international interventions. It sold very cheap in local shops – for a penny or two a dose – and was an easy profit for the storeowners, he said.

But like other drugs, the effects were less impressive over time, once humans built up immunity to it.

The best way to understand the history of African pharmacopeia, he said, was to realize that their plant-based treatment reduces toxicity levels leading to general health. That method runs counter to the West’s use of drug-based treatment, focused on a specific ill.

A final question dealt with counterfeit drugs, with money being made off the sale of useless treatments for the disease.

Webb reaction was to say, “As a species, we’re pretty unethical.” What disturbed him about reports of counterfeit drug sales was that “the packaging is identical,” between fake and real drugs, “which suggests the factories have two shifts – one that makes real drugs, the other makes fake ones.”

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