Until the middle of the seventeenth century, little was understood about malaria, the deadly disease that decimated populations and crippled armies. A legend, however, persisted about a beautiful Spanish countess who was cured during a stay in Peru by drinking a medicine made from the bark of a miraculous tree. And so began the search for the elusive cinchona tree by a trio of British explorers who sought to rid the world of malaria. Today, in laboratories and research facilities, the hunt continues—this time for a vaccine against the disease that eludes all efforts to contain it.
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Mark Honigsbaum is a former chief reporter of The Observer in London. He has written for The Guardian, The Sunday Times, GQ, and Vogue. He lives in London with his wife and two children.
Guadalcanal, November 1942. Another night of war. Aboveground, the air buzzed with mosquitoes and enemy ordnance. In foxholes, weary men in boots, fatigues and steel helmets sifted restlessly, counting the hours until dawn. If a soldier on Guadalcanal wanted to stay in one piece, a hole in the ground was the safest place to spend the night. But nocturnal refuge had its price: disease-bearing Anopheles mosquitoes. For proof, one need only to have visited the hospital field tent. There, by flickering electric lanterns, medics tended delirious patients whose blood swarmed with the delicate rings, crescents and clusters we know as malaria. During World War II, nearly half a million American servicemen came down with malaria. Atabrine, a drug that stained skin yellow and could also trigger psychosis, was the main defense. Why was real quinine, still the world's leading cure for malaria in the 1940s, so precious in the Pacific theater? Because 80 years earlier, cinchona--the natural source of quinine--was abducted from its native habitat in the Andean cloud forest. By the 20th century, virtually all the world's cinchona bark came from the island of Java. And by 1942, Java lay in Japanese hands. How the elusive cinchona, renowned for "febrifugal" powers since the 1600s, journeyed from South America to Dutch plantations in Java is a major thread of The Fever Trail. Lovingly researched and written by Mark Honigsbaum, former chief reporter for the Observer in London, this book is an adventure story cum historical account of dreams and schemes to steal the valuable tree with the crimson-lined leaf. In its closing chapters, The Fever Trail fast-forwards to malaria today: the stalled race to create a vaccine, the politics of new drug development and distribution, and, most troubling of all, the continued toll of Plasmodium falciparum. Falciparum is the malarial strain that killed in World War II and still kills one million to two million of the world's poor every year, especially in Africa. But first the back story, starring three leading cinchona hunters of the 19th century. Honigsbaum, who retraced their steps, lists them as "Richard Spruce, a hypochondriac Yorkshireman and moss collector who, despite his fear of disease, spent fifteen years wandering the Amazon and the Andes on behalf of the Royal Botanic Gardens at Kew; Charles Ledger, a cockney trader who came to Peru to make his fortune at the age of eighteen and left South America broken and penniless after a series of incredible expeditions through Bolivia and Chile; and Sir Clements Markham, the patron of Robert Scott's two expeditions to the Antarctic and the so-called father of polar exploration." The story of Ledger's loyal guide, Manuel Mamani, is one of The Fever Trail's poignant subplots. According to Honigsbaum, Mamani was the unsung hero who collected the seeds that later spawned Java's quinine-rich bark. At Ledger's behest, Mamani returned to the forest for more seeds, only to suffer a brutal imprisonment for threatening Bolivia's cinchona monopoly. Within days of his release, he was dead. Clements Markham was another idealist whose quest for cinchona ended on a melancholy note. Son of a canon to the royal court at Windsor, himself a noted historian and explorer of Peru, Markham was the most philanthropic of the Andean botanical explorers. Along with Florence Nightingale, he decried malaria's toll of death and disability on Britain's colonial subjects and shared her dream of saving them through better sanitation and treatment. Years later Markham's dream was dashed. Yes, the worldwide price of quinine had plummeted, thanks to Java's prolific Cinchona ledgeriana groves. But lives lost to human greed far outweighed lives saved by less costly malaria pills. One villain was Britain's East India Company, whose punitive taxes and neglect of public works fueled outbreaks of malaria, cholera and other infectious diseases. The other culprit? Cold commerce. In Honigsbaum's words, "There was a limit to philanthropy and in India the British had reached it. If any profits were to be made from the bark in the future, they would come from selling quinine to those who could afford it--in other words, 'rich' Europeans and Americans." This north-south disparity continues today. It's reflected in brisk sales of expensive new malaria drugs for safari-goers while an African child dies of malaria every 30 seconds following second-rate treatment or no treatment at all. To be sure, decades of worsening resistance by P. falciparum, skyrocketing pharmaceutical costs and changing patterns of transmission have upped the ante of conquering the ancient blood-borne parasite. But the sad truth is, we don't have to wait for a malaria vaccine. Were there the international will and infrastructure, currently available drugs could yet achieve Markham's dream. Meanwhile the U.S. military has recently beefed up its ongoing malaria research, both for the protection of troops and, perhaps, for a larger purpose Honigsbaum never mentions. Could it be, post- September 11, that global security might hinge not just on strategic accords but on more muscled control of the worldwide plagues of the poor? Read between the lines of The Fever Trail. An all-out commitment to curing malaria in this century is no longer foreign aid in the grand noblesse oblige tradition. It's an investment in humankind, global economic health and our own self-interest.
Claire Panosian Dunavan is professor of medicine at the University of California at Los Angeles School of Medicine, a specialist in infectious and tropical diseases, and a medical journalist. Her father served nine months on Guadalcanal in 1942-43, where he, like many others, suffered repeated attacks of malaria.
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