and to this day malaria takes a huge toll on our species we 've got three hundred million cases a year and over half a million deaths
now this really makes no sense
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
why i spent five years as a journalist trying to understand why has malaria been such a horriblescourge 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 continuallytrying to fight off the parasite and so is the human body continuallytrying to fight it off this little creature survives under siege like that but not only does it survive
it 's a shape shifter for one thing just as a caterpillar turns into a butterfly the malariaparasite 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 scientificchallenge to tackle but so is the mosquito that carries the parasite
only about twelve 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
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
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 scientificchallenge 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 one point three percent every year
year after year after year just this one disease alone
so there 's a huge economic challenge in taming malaria
but along with the scientificchallenge and the economic challenge there 's also a culturalchallenge 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
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 twelve episodes of malaria before the age of two
and so this poses a huge culturalchallenge 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 culturalchallenge in taming this disease
how do you get a political leader to do anything about a problem like this and the answer is historically you don 't
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 one thousand nine hundred and fifty s 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 culturalchallenge 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 scientificchallenge they had so much faith in their tools that they stopped doing malariaresearch 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
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
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
the calculus must be quite different
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
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
and that might work but it takes time
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
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
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