Sonia Shah: 3 reasons we still haven’t gotten rid of malaria

Sonia Shah: 3 reasons we still haven’t gotten rid of malaria

So over the long course of human history, the infectious disease that’s killed more humans than any other is malaria. It’s carried in the bites of infected mosquitos, and it’s probably our oldest scourge. We may have had malaria since we evolved from the apes. And to this day, malaria takes a huge toll on our species. We’ve got 300 million cases a year and over half a million deaths. Now this really makes no sense. We’ve known how to cure malaria since the 1600s. That’s when Jesuit missionaries in Peru discovered the bark of the cinchona tree, and inside that bark was quinine, still an effective cure for malaria to this day. So we’ve known how to cure malaria for centuries. We’ve known how to prevent malaria since 1897. That’s when the British army surgeon Ronald Ross discovered that it was mosquitos that carried malaria, not bad air or miasmas, as was previously thought. So malaria should be a relatively simple disease to solve, and yet to this day, hundreds of thousands of people are going to die from the bite of a mosquito. Why is that? This is a question that’s personally intrigued me for a long time. I grew up as the daughter of Indian immigrants visiting my cousins in India every summer, and because I had no immunity to the local malarias, I was made to sleep under this hot, sweaty mosquito net every night while my cousins, they were allowed to sleep out on the terrace and have this nice, cool night breeze wafting over them. And I really hated the mosquitos for that. But at the same time, I come from a Jain family, and Jainism is a religion that espouses a very extreme form of nonviolence. So Jains are not supposed to eat meat. We’re not supposed to walk on grass, because you could, you know, inadvertently kill some insects when you walk on grass. We’re certainly not supposed to swat mosquitos. So the fearsome power of this little insect was apparent to me from a very young age, and it’s one reason why I spent five years as a journalist trying to understand, why has malaria been such a horrible scourge for all of us for so very long? And I think there’s three main reasons why. Those three reasons add up to the fourth reason, which is probably the biggest reason of all. The first reason is certainly scientific. This little parasite that causes malaria, it’s probably one of the most complex and wily pathogens known to humankind. It lives half its life inside the cold-blooded mosquito and half its life inside the warm-blooded human. These two environments are totally different, but not only that, they’re both utterly hostile. So the insect is continually trying to fight off the parasite, and so is the human body continually trying to fight it off. This little creature survives under siege like that, but not only does it survive, it has thrived. It has spread. It has more ways to evade attack than we know. It’s a shape-shifter, for one thing. Just as a caterpillar turns into a butterfly, the malaria parasite transforms itself like that seven times in its life cycle. And each of those life stages not only looks totally different from each other, they have totally different physiology. So say you came up with some great drug that worked against one stage of the parasite’s life cycle. It might do nothing at all to any of the other stages. It can hide in our bodies, undetected, unbeknownst to us, for days, for weeks, for months, for years, in some cases even decades. So the parasite is a very big scientific challenge to tackle, but so is the mosquito that carries the parasite. Only about 12 species of mosquitos carry most of the world’s malaria, and we know quite a bit about the kinds of watery habitats that they specialize in. So you might think, then, well, why don’t we just avoid the places where the killer mosquitos live? Right? We could avoid the places where the killer grizzly bears live and we avoid the places where the killer crocodiles live. But say you live in the tropics and you walk outside your hut one day and you leave some footprints in the soft dirt around your home. Or say your cow does, or say your pig does, and then, say, it rains, and that footprint fills up with a little bit of water. That’s it. You’ve created the perfect malarial mosquito habitat that’s right outside your door. So it’s not easy for us to extricate ourselves from these insects. We kind of create places that they love to live just by living our own lives. So there’s a huge scientific challenge, but there’s a huge economic challenge too. Malaria occurs in some of the poorest and most remote places on Earth, and there’s a reason for that. If you’re poor, you’re more likely to get malaria. If you’re poor, you’re more likely to live in rudimentary housing on marginal land that’s poorly drained. These are places where mosquitos breed. You’re less likely to have door screens or window screens. You’re less likely to have electricity and all the indoor activities that electricity makes possible, so you’re outside more. You’re getting bitten by mosquitos more. So poverty causes malaria, but what we also know now is that malaria itself causes poverty. For one thing, it strikes hardest during harvest season, so exactly when farmers need to be out in the fields collecting their crops, they’re home sick with a fever. But it also predisposes people to death from all other causes. So this has happened historically. We’ve been able to take malaria out of a society. Everything else stays the same, so we still have bad food, bad water, bad sanitation, all the things that make people sick. But just if you take malaria out, deaths from everything else go down. And the economist Jeff Sachs has actually quantified what this means for a society. What it means is, if you have malaria in your society, your economic growth is depressed by 1.3 percent every year, year after year after year, just this one disease alone. So this poses a huge economic challenge, because say you do come up with your great drug or your great vaccine — how do you deliver it in a place where there’s no roads, there’s no infrastructure, there’s no electricity for refrigeration to keep things cold, there’s no clinics, there’s no clinicians to deliver these things where they’re needed? So there’s a huge economic challenge in taming malaria. But along with the scientific challenge and the economic challenge, there’s also a cultural challenge, and this is probably the part about malaria that people don’t like to talk about. And it’s the paradox that the people who have the most malaria in the world tend to care about it the least. This has been the finding of medical anthropologists again and again. They ask people in malarious parts of the world, “What do you think about malaria?” And they don’t say, “It’s a killer disease. We’re scared of it.” They say, “Malaria is a normal problem of life.” And that was certainly my personal experience. When I told my relatives in India that I was writing a book about malaria, they kind of looked at me like I told them I was writing a book about warts or something. Like, why would you write about something so boring, so ordinary? You know? And it’s simple risk perception, really. A child in Malawi, for example, she might have 12 episodes of malaria before the age of two, but if she survives, she’ll continue to get malaria throughout her life, but she’s much less likely to die of it. And so in her lived experience, malaria is something that comes and goes. And that’s actually true for most of the world’s malaria. Most of the world’s malaria comes and goes on its own. It’s just, there’s so much malaria that this tiny fraction of cases that end in death add up to this big, huge number. So I think people in malarious parts of the world must think of malaria the way those of us who live in the temperate world think of cold and flu. Right? Cold and flu have a huge burden on our societies and on our own lives, but we don’t really even take the most rudimentary precautions against it because we consider it normal to get cold and flu during cold and flu season. And so this poses a huge cultural challenge in taming malaria, because if people think it’s normal to have malaria, then how do you get them to run to the doctor to get diagnosed, to pick up their prescription, to get it filled, to take the drugs, to put on the repellents, to tuck in the bed nets? This is a huge cultural challenge in taming this disease. So take all that together. We’ve got a disease. It’s scientifically complicated, it’s economically challenging to deal with, and it’s one for which the people who stand to benefit the most care about it the least. And that adds up to the biggest problem of all, which, of course, is the political problem. How do you get a political leader to do anything about a problem like this? And the answer is, historically, you don’t. Most malarious societies throughout history have simply lived with the disease. So the main attacks on malaria have come from outside of malarious societies, from people who aren’t constrained by these rather paralyzing politics. But this, I think, introduces a whole host of other kinds of difficulties. The first concerted attack against malaria started in the 1950s. It was the brainchild of the U.S. State Department. And this effort well understood the economic challenge. They knew they had to focus on cheap, easy-to-use tools, and they focused on DDT. They understood the cultural challenge. In fact, their rather patronizing view was that people at risk of malaria shouldn’t be asked to do anything at all. Everything should be done to them and for them. But they greatly underestimated the scientific challenge. They had so much faith in their tools that they stopped doing malaria research. And so when those tools started to fail, and public opinion started to turn against those tools, they had no scientific expertise to figure out what to do. The whole campaign crashed, malaria resurged back, but now it was even worse than before because it was corralled into the hardest-to-reach places in the most difficult-to-control forms. One WHO official at the time actually called that whole campaign “one of the greatest mistakes ever made in public health.” The latest effort to tame malaria started in the late 1990s. It’s similarly directed and financed primarily from outside of malarious societies. Now this effort well understands the scientific challenge. They are doing tons of malaria research. And they understand the economic challenge too. They’re focusing on very cheap, very easy-to-use tools. But now, I think, the dilemma is the cultural challenge. The centerpiece of the current effort is the bed net. It’s treated with insecticides. This thing has been distributed across the malarious world by the millions. And when you think about the bed net, it’s sort of a surgical intervention. You know, it doesn’t really have any value to a family with malaria except that it helps prevent malaria. And yet we’re asking people to use these nets every night. They have to sleep under them every night. That’s the only way they are effective. And they have to do that even if the net blocks the breeze, even if they might have to get up in the middle of the night and relieve themselves, even if they might have to move all their furnishings to put this thing up, even if, you know, they might live in a round hut in which it’s difficult to string up a square net. Now that’s no big deal if you’re fighting a killer disease. I mean, these are minor inconveniences. But that’s not how people with malaria think of malaria. So for them, the calculus must be quite different. Imagine, for example, if a bunch of well-meaning Kenyans came up to those of us in the temperate world and said, “You know, you people have a lot of cold and flu. We’ve designed this great, easy-to-use, cheap tool, we’re going to give it to you for free. It’s called a face mask, and all you need to do is wear it every day during cold and flu season when you go to school and when you go to work.” Would we do that? And I wonder if that’s how people in the malarious world thought of those nets when they first received them? Indeed, we know from studies that only 20 percent of the bed nets that were first distributed were actually used. And even that’s probably an overestimate, because the same people who distributed the nets went back and asked the recipients, “Oh, did you use that net I gave you?” Which is like your Aunt Jane asking you, “Oh, did you use that vase I gave you for Christmas?” So it’s probably an overestimate. But that’s not an insurmountable problem. We can do more education, we can try to convince these people to use the nets. And that’s what happening now. We’re throwing a lot more time and money into workshops and trainings and musicals and plays and school meetings, all these things to convince people to use the nets we gave you. And that might work. But it takes time. It takes money. It takes resources. It takes infrastructure. It takes all the things that that cheap, easy-to-use bed net was not supposed to be. So it’s difficult to attack malaria from inside malarious societies, but it’s equally tricky when we try to attack it from outside of those societies. We end up imposing our own priorities on the people of the malarious world. That’s exactly what we did in the 1950s, and that effort backfired. I would argue today, when we are distributing tools that we’ve designed and that don’t necessarily make sense in people’s lives, we run the risk of making the same mistake again. That’s not to say that malaria is unconquerable, because I think it is, but what if we attacked this disease according to the priorities of the people who lived with it? Take the example of England and the United States. We had malaria in those countries for hundreds of years, and we got rid of it completely, not because we attacked malaria. We didn’t. We attacked bad roads and bad houses and bad drainage and lack of electricity and rural poverty. We attacked the malarious way of life, and by doing that, we slowly built malaria out. Now attacking the malarious way of life, this is something — these are things people care about today. And attacking the malarious way of life, it’s not fast, it’s not cheap, it’s not easy, but I think it’s the only lasting way forward. Thank you so much. (Applause)

100 thoughts on “Sonia Shah: 3 reasons we still haven’t gotten rid of malaria

  1. woman I am not against your talk but the only reason the west beat malaria is a 3 letter drug DDT, without it the west would still experience malaria, and in southern europe some places like Greece are seeing its resurgence 50 years later

  2. It's not an argument, but I'm not exactly surprised you didn't get that. I bet you think that the post I replied to was an argument, as well, but it wasn't. It was a statement of opinion and an attempt to weasel out of having to make difficult moral decisions.

  3. Which says absolutely nothing about consumption, which is going to increase exponentially. About 15% of the world population already uses 80% of the resources and the remaining 85% are doing their absolute best to catch up. Do you see a problem with that? Any at all?

  4. consumption is contigent on many factors and is clearly not so simple. I'm not a defender of the status quo, but I am a rationalist. given humanities propensity for heirarchies I don't think an equitable distribution of resources can occur without poverty being the basline all humanity exist within. Would I like it to be less concentrated with exploitational assholes, yes.

  5. 1.2 milion deaths from malaria every year (which is an exagerated estimative), is 100,000 deaths per month NOT week and deffinately not day.
    Why the wrong sensationalist description and talk?

  6. Of course consumption isn't "that simple", but that's starting to sound like you're going for a Loki's Wager.
    Poverty is relative, but ignoring that for a moment, it's inevitably going to be the baseline. We can't keep doing what we're doing and just hope we'll avoid it.

  7. the war on poverty is like the war on drugs, the cure is worse than the diesease. the most effective option is a society where economic mobility (the ability to earn more and succeed) is a higher priority. if communists and socialists couldn't fix or cure poverty, what hope does anyone else have ? relative poverty exists because without differences in earning everyone earns the same, and progress is halted. extreme poverty can be tackled but what passes for poverty in the west is often a joke

  8. Ah, "projection". The adult way of just saying "No, you!".
    While you keep wasting resources trying to protect the one species that's least in need of protection, I'll do my best to take care of at least some of those that actually are in need. You have no sense of perspective.

  9. Food isn't the only resource we're using and the world doesn't, contrary to your beliefs, revolve around us. And you're still talking about how to optimally rape the natural world.
    Sure, humanity deserves to live, but try to get it through your skull that humanity's existence is not at stake. Bitching about humanity deserving to live because of a few people dying of malaria in the middle of a population explosion is completely absurd.

  10. Absurd is absolutely right, and my statement was both thought out and worded exactly like I wanted it.
    You are talking about land use in a manner that does imply rape of the natural world. Took you a surprisingly long time to start to backpedal.
    Humanity needs population control and since voluntary population control isn't happening, the need for disease *is* greater than ever. The only real downside with malaria is how inefficient it is.

  11. Homelessness shouldn't even exist. It's an incredibly nasty thing that it's around. I don't know why people don't understand the need to make sure your neihbor has basic necessities. How do you put a price on basic shelter and health? When you do, I'd label you a death merchant, and for me it's that simple.

  12. Poorer countries generally have higher population growth, so wiping out malaria by improving infrastructure and living standards would actually also help reduce population growth.

  13. When people recognize their greed perhaps they will have reincarnated and become conscious awareness of an unborn baby living a life in poverty because people failing to recognize, we are all sons and daughters of Almighty God who will make sure we either share world resources ad wealth or share a life of poverty because Almighty God represents equality for all his children.

  14. And by improving infrastructure and living standards you increase consumption, which completely negates whatever benefits you expected from the reduction in population growth. Case in point: The West.

  15. Tell that to the 3rd world dictators that deliberately keep their people in penury while raking in the western aid money with the help of corrupt agencies and charities..

  16. Please consider my words because we are Extra Terrestrial being from another dimension and our objective is to return to that dimension with our memory as our identity. If you believe in the existence of Almighty God you will understand, my words represent social develop, based on achieving true Democracy. Removing poverty from the world will be achieved by sharing world resources and wealth. Everyone on this planet is robot.

  17. She can choose to see herself as an ape's descendant if she wants but the evidence doesn't back her up, despite what the many parasitic cultural deconstructionists are pushing down gullible throats 24/7. I would have said "Since we're all made in the image of God" myself : )

  18. Exploited by wealthy nations? Rofl.
    North Koreans are poor because they are exploited by the US.
    The first step to removing poverty from the world is to grab the hammer of knowledge and beat ignorant trash that talk about exploitation.

  19. Why do we have cures and solutions available for nearly everything but very few are being implemented? Politics, false politically motivated economic ideologies of people believing debt spending and being at the mercy of banks.

    You have intellectual property monopolies, because that is all current IP laws are and totally unneeded for a successful society. Ignorance and scarcity increases when we spend more time bombing and war. Then you have idiots that want to control everything in society…

  20. Comparing malaria with cold/flu is fallacious. The former can be fatal.
    People agreed to wear masks when there was a chicken guinea outbreak.

  21. Buying iPhones and t-shirts from less developed countries may not be exploitation, but usurious loans (given to pay for contracts with Western corporations), when they obviously cannot be repaid (except with geopolitical favours and natural resources), most definitely is. Not to mention trade barriers and tariffs preventing competition, and making local agriculture economically impossible with food aid, etc. They need free trade, but that's not what they are getting.

  22. How about Sonia Shah talk about the 900 million yep million who have take a crap on the side of the road or the railway track's on beaches meaning the lack of toilets all over India which contribute to so many diseases also burning piles of cow sh*t all over the country can not be a healthy thing

  23. You proved nothing so you can tell me nothing.
    Talkless apes cannot become talking humans.
    …or did you forget about that little detail?
    Everything else about us is different too from head to toe.

  24. Yeah everything different : But 98% of our DNA matching the one of chimpanzees'
    Similar bone structure, brains, behavior in society prehensility etc.
    Yes, we aren't the same, but we are similar.
    Just as a domestic cat is the cousin of The King Of the Jungle, the lion.
    They aren't the same, but similar, same ancestors, same family.
    Both apes and humans are Homonidae.
    Oh btw, apes can learn sign language, they can't talk, indeed, but they understand, more than YOU do as I can see. <3

  25. i think that developed countries have also created a disruptive environment which highly not suitable for the growth of mozzies too.

  26. "How do you put a price on basic shelter and health? When you do, I'd label you a death merchant"
    This is capitalism, pal.

  27. Well I agree with the sentiment but basic shelter and health do require people to work on them and these people need to be payed and they are not death merchants , I think the whole world needs to give a lot more to charity and that could change things.

  28. Reason number 5 or, the elephant in the room: JAINISM. Smack that mosquito, use bug spray or mosquito coils. (And yes I understand that many people cannot afford these things, but I have to say her family would have had it coming to them.)

  29. Yes, she claims it is people not caring or seeing it as serious. But they are distracted by other crap they shouldn't kept down from it. Why is there such a stark difference from the US and western countries expectations and theirs? It's not that they love being with malaria and besides actually promises of developing these countries appropriately instead of backhand deals which basically steal more form then in turn for getting less.

    Hunger, for example shouldn't even be an issue for them.

  30. well, I am sorry to disappoint you but I happen to be from one of such areas and the first time I was in europe I was astonsihed as to why there was so much fear of malaria. To us it was REALLY like having the flu and we never took it serious. Infact complaning about malaria was like moaning about having a headache. So although the people in malaria countries may have other priorities, they have grown with it and feel it is just another normal way of life

  31. Malaria's way of life includes standing water, where it's vector breeds. India is a rice producing country. Rice production requires a lot of standing water.

  32. Enjoyed the talk, Very lucid presentation. Very true, the countries where the disease is endemic, rampant do nothing to control the breeding places of mosquitoes,Let us hope the vaccine that has been developed against malaria would help to control the scourge of malaria.

  33. I'd choose malaria over sleeping daily with some net. She gave a good example with us wearing face masks herself. So spend these resources more meaningfully.

  34. I agree. Education of children about malaria will promote future consciousness of prevention and cure of Malaria in local societies. Eradication of the insect is not viable since pesticides kill indiscriminately. Tourists use nets etc when they enter the region thanks to…wait for it…wait for it. Education . There is no poverty in the world. Only mental poverty. Study… learn.. educate..practice..self discipline.That is the answer.
    Aid and donations is as disruptive as malaria itself.

  35. @ Video 'About' Page: Malaria kills 100,000's of people every day??? According to WHO that should be revised down to about 1800. Maybe you meant to say infected?

  36. That is very convincing evidence of having the same Maker.
    You can almost see how our Maker went from making one living organism to making another since each set of directives are unique especially in the controlling directives that determine what the life form is.
    You need to see how different each life form is, not how similar everything is because it is the controlling directives that determine what things are.
    You need to see and understand that we look 95% like an uncle, not like any ape.

  37. Every bone is different.
    Every function and protein arrangement is different.
    Our immune system is different.
    Our mind and related functions is different.
    Our posture is very different.
    Our thoughts are very different.
    Our speech is very different.
    Everything about us is different because of the different directives that we have.

  38. Humans can talk reason and use logic. None of the apes can do any of that.
    It is a real dilemma, for you, that we are supposed to be so similar to apes and yet we are not.
    It is because our controlling directives are so different!

  39. lead by example! Built some "basic shelters" and give them away to homeless people. Put your money where your mouth is!

  40. this lady is amazing, but i feel need to point out the fact that if she frowns upon killing livign things, but arent parasites like Maleria living things as well??

  41. Her final solution… to build out malaria… has to be the most ridiculous proposal ever thought of. A main reason for environmental instability is building/deforestation/paving. Doing more of this in Africa will destabilise the last bits of secure environment in Africa. The simple fact of the matter is that, malaria, like the locals suggest, is simply normal, just like colds are normal for us northerners. 7 billion people, enough, too much.

  42. It's not development, it's weather. Malaria would never be endemic in the northern hemisphere without stronger climate change than we're experiencing. England has way more puddles of water than Africa. If the climate warms sufficiently, England would not be spared from Malaria. Tourists use nets and quinine cuz it's only for days/weeks/months, not a lifetime.

  43. the problem is the issue that if you cured malaria right now, youd have a massive population boom, existing societies balance the death rates by having larger families, no malaria means all those people growing up. without an economy capable of employing them, and education and healthcare infrastructure for the increasing population, and food production to feed them all….you just make it all worse than if they had malaria and you fixed the economy instead.

  44. But the only way to cure malaria is fixing the economy, so that scenario that you consider it's very unliklely to happen.

  45. … malaria isnt caused BY poverty, it causes poverty. you cure malaria with quinine and bed nets. and look at the west. we cured our diseases and our populations exploded, they only stabilized and declined after we reached a post industrialization era.

  46. When I went to Mozambique a few years ago I met a guy who had malaria about 10 times, and he was like 'meh'. So yeah, culture is a bit of a challenge. 

  47. Brilliant talk, I am currently doing my dissertation on malaria and found this topic to be very interesting and quite sobering. I shall be looking out for Sonia's book.

  48. Please donate to help stop malaria –

  49. Malaria got me sick one time in Africa, after that time, I became resistive to the disease. I don't get easily sick 

  50. I honestly didn't see her going in that direction. We all know that a great cause of the increase in malaria cases is due to climate change, which we have said time and time again is only getting worse do to our habits in the western world. Maybe she would have gone into more detail about how she feels we should move third world countries into the 21st century. But from what I am hearing her plan on eradicating malaria in the third world is more about what they need to and what needs to be changed over there than what needs to be changed over here. Discussion anyone?

  51. DDT won't solve the Malaria problem 4TIMESAYEAR since not only is it can wreak havoc on the environment there's also evidence that mosquitoes are being resistant to the pesticides such as DDT.  Yeah a very grim prospect.

  52. We didn't evolve from apes, but have a common ancestor…This is a very Intriguing subject concerning cultures and what they think about Malaria.

  53. Applause for the efforts the speaker has taken to study the problem from biological cultural and socio-economic perspectives.
    A point however is that malaria could be eradicated from european countries because of economic development and progressive urbanisation which made conditions unconducive for parasite survival. But Speaker has failed to notice that tropical climate differs drastically from european zone and that malaria has a much higher prevalence in the sub saharan africa since ages to an extent that malaria parasite has shaped evolution of human red blood cell properties and much more (sickle cell anaemia is naturally selected because it confers survival advantage in areas which are hyper-endemic for malaria).

    Moreover as she said that there is a strong correlation between malaria and poverty and economic development can not happen as long as malaria affects people how could then we only focus on economic empowerment without making an effort to eradicate or attenuate malaria endemic.

    Mansoor Siddiqui
    Malaria Biologist (PhD graduate student)

  54. Cure for malaria doesnt bring any profit for western pharmaceutical companies. As generic drugs are produced in India, patients in developing countries could afford HIV and cancer drugs. Supreme court of India blocked effort of western pharma companies to prolong their patents

  55. I​ am doing a project on ​plasmodium falciparum ​mosquito's
    In some of the districts in​ ​​Assam,orissa and Tripura ​ ​Plasmodium falciparum mosquito are found?

    can any one tell where exactly it is found

    I need to visit those area to gather data and other details

  56. Biggest reason why malaria is hard to get rid of is resistance or evolution of parasite and also of mosquito…i think this point is missing

  57. Why would you trust the Jesuits, the English man and the CIA. This lady is naive. How is it difficult to put up a square net in round hut. This women is very predjudice and don’t know it.

  58. for the quinine, can you just drink a whole bunch of tonic water?, also, why do tonic water bottle states "contains quinine."

  59. We did not evolve from apes. Research flat earth and stop believing the narrative being thought in school.

  60. So what should we do to help the ppl in those countries? If it's about culture and not lack of remedies…it's harder to treat , to change the way people there think that's a challenge.

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