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The past and future of malaria: A Q&A with Sonia Shah

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Sonia Shah shares a surprising reason why we still haven't ended malaria at TEDGlobal 2013 — that people in malarial countries have accepted it as an unfortunate fact of life. Photo: James Duncan Davidson

At TEDGlobal 2013, Sonia Shah shares a surprising reason why we still haven’t ended malaria — that people in areas where it still exists have accepted it as a normal part of life. Photo: James Duncan Davidson

Hundreds of thousands of people die from malaria every year. So why is it still around? In today’s talk, journalist Sonia Shah takes a look at the history of malaria and outlines some of the major challenges facing the end of one of the world’s deadliest diseases. Sonia Shah: 3 reasons we still haven’t gotten rid of malaria Sonia Shah: 3 reasons we still haven’t gotten rid of malaria It’s not simply that we need to improve our science, says Shah; we also face economic, cultural and political obstacles. One fascinating barrier: that people who live in the areas where malaria is a problem view the disease as a normal, though unfortunate, part of life — much like people in the developed world view the flu. Because they see it as a fact of life, they’re unlikely to go to great lengths to prevent it. Even sleeping with a bed net seems like overkill. Shah concludes her talk with a call to action to end “the malarious way of life” by fixing bad housing, drainage and roads, as England and the U.S. did when faced with malaria.

The TED Blog caught up with Shah to ask her a little more about her research and what comes next for malaria.

How did you research your book The Fever?

It was a combination of reportage — from Malawi, Cameroon, Panama, London and Alabama — and historical research. At the time I was doing my research, the Western world had pretty much forgotten its own history of malaria. Many of the critical books about malaria were long out of print, so tracking them down was a challenge. There was one really important book that I finally acquired by bidding on it on eBay. It had been discarded from a middle school library somewhere.

Was there anything in your research that genuinely surprised you about cultural attitudes toward malaria?

On my first trip to sub-Saharan Africa, I asked a local woman whether she’d ever had malaria. She looked at me like I had three eyes! It slowly dawned on me that that was like asking a New Yorker if she’d ever had a cold. I learned my lesson. After that, my question became, “When was the last time you had malaria?”

What you call for at the end of your talk — the destroying of the malarial way of life — is great, but a pretty tall order. It’s as big as getting rid of poverty itself. What are some concrete measures you’d like to see?

I don’t see myself as advocating a particular strategy in my work, actually. I’m trying to uncover the hidden history of the disease. But there are some lessons there. One is that once you start doing something to diminish malaria, you mustn’t stop until the parasite has been beaten into permanent submission. That will be hard now, with the current effort, as it relies on external financing, which is starting to dry up with the recession.

But it’s possible to fight malaria on a more grassroots level too, with environmental management and other methods. In Tanzania, for example, malaria’s been controlled by clearing garbage out of ditches, where mosquitos once bred; in Chinese rice fields, it’s been controlled by altering water levels in irrigation canals. Those are cheap, easy solutions! But they’re not one-size-fits-all. What’s needed is local expertise, which can create local solutions relevant to the local malarial ecology — and the local culture.

Is there anything ordinary citizens in non-malarious societies can do to help, or is this largely a problem for governments and aid organizations?

Don’t get me wrong: Supporting the current effort is important. As I mentioned above, once you start fighting this fire, you need to keep going. So go ahead and keep donating to the global program against malaria.

It seems to me that a lot more can be done to support African scientists, too. It’s great to have malaria experts at our universities in Cambridge and Seattle, but where they’re really needed is in Lagos and rural Malawi, for example. It’s African scientists and doctors and community health workers who will come up with lasting, local solutions. Let’s open the university doors and the virology labs and the drug development centers to them.

And below, see Shah’s answers to two questions that TED Curator Chris Anderson asked her on the TEDGlobal 2013 stage following her talk:

There’s a lot of people putting their heart and soul into bed net distribution. Is that work pointless? What would you say to that?

It’s a short-term goal. Those nets are only going to last, at best, three to five years. And then we have to do it again and again and again. If we start doing something against malaria now, we have to keep doing it. Malaria is like sitting on a spring. You have to keep sitting on that spring. If you get up — boing — it’s going to come right back up. Once we’ve started this bed net effort, we have to keep going to make a lasting gain against the disease.

Do any of the scientific initiatives we hear about — to engineer mosquitos to be sterile or create a non-infectious form of malaria — do any of those excite you?

Less than other people seem to be excited about it, because our problem with malaria is not technical. We’ve had good cures and tools to use against malaria for so long; the problem is not the technology. Also, with mosquitos, most people who live in malarious parts of the world, they already have enough mosquitos and I don’t think they’re going to be that interested in more mosquitos even if they are weird genetically engineered mosquitos. I think there are going to be ethical issues with that, too.