One of Taiwan's many extraordinary features is that it is entirely malaria-free, and has been since 1965. In view of the fact that the disease is prevalent in much of the rest of Asia, even 8,000 feet up in the Himalayas, Taiwan's eradication of the disease remains a considerable achievement.
Mosquito, a new and masterly overview of what the authors call "mankind's deadliest foe," is both fascinating and disturbing. It's a tribute to a valiant struggle over 100 years (the mosquito was only confirmed as a source of disease in 1897), and a reminder of what still remains to be done.
Ten percent of the world's population suffers from malaria every year, and mosquitoes can also carry dengue fever, yellow fever, filariasis, West Nile fever -- as found in New York City in 1999 -- and a host of deadly encephalitis viruses. (Six cases of Japanese encephalitis, for example, have been confirmed in Taiwan this summer).
It was the West Nile fever outbreak that really brought the threat from mosquito-borne diseases home to modern, urban humankind. To this day, no one knows for certain how it arrived in New York from Africa. The authors accept, however, that the disease is now established in the US and is destined to spread across the country in the years to come.
Time and again in this book, it is the action of a single individual that proves decisive. The 1999 New York outbreak, for instance, had originally been thought to be closely related to St Louis fever, but the fact that horses as well as birds were dying of it led to the eventual correct diagnosis. A single medical researcher donned a spaceman-like suit, walked across a field to were a dead horse lay, cut open its skull and extracted its brain. West Nile fever was confirmed.
Taiwan features for other reasons than because of its continuing malaria-free status. One crucial discovery was first made in Kaohsiung in the 1870s. A Dr Patrick Manson was researching the filariasis worm that, in its most extreme and terrible manifestation, causes the gigantic swelling of the lower leg and, in males, the scrotum, in what is known as elephantiasis. Though autopsies were then a crime, Manson secretly opened the bodies of several people who had died of this disease and discovered thread-like female worms, the length of a human arm, tightly coiled round their male counterparts in the victim's lymph nodes. The grotesque swellings were caused by the immune system's reaction to these copulating worms.
But how did these worms get into people? Manson acquired a microscope, and with this looked at the blood of his gardener. It proved to be teeming with tiny filarial parasites, and the hapless gardener agreed to sleep in a screened room in the company of mosquitoes. Manson subsequently dissected these insects and found that they had ingested the parasites, and that these then grew inside their systems before being introduced into other humans through later bites.
Throughout the post-World War II period DDT was central to the fight against malaria. The disease had, for instance, been endemic in Rome for centuries, causing some former popes to flee the city. Control had been achieved by draining the marshes, but the Germans had destroyed these defenses as they retreated at the end of World War II, and the malarial mosquitoes were quick to return.
In the late 1940s, the Americans financed a blanket spraying of virtually all accessible areas, in Italy and then world-wide, with exceptionally successful results. Islands in particular -- Sardinia, Sri Lanka, Jamaica, Taiwan -- became famous success stories. But the scientists soon learned that immunity to DDT would eventually develop. The aim was therefore to achieve a zero presence of the disease before the mosquitoes returned. In that way the pool of malaria infection in human blood would be removed and the mosquitoes, though remaining troublesome, would no longer be lethal, at least with that particular pathogen.
With Taiwan this has proved to be the case. In Sri Lanka, unfortunately, malaria has made a major comeback, as it has in many other places.
And DDT itself is now a source of controversy. Despite the very dramatic success immediately after its discovery in 1943, its dangerous spread through eco-systems became apparent, and was given huge publicity by Rachel Carson's 1962 book Silent Spring. Ten years later, on Dec. 31 1972, the US Environmental Protection Agency announced a ban on the use of the chemical throughout the country.
Now the battle between environmentalists and those who see its continuing use as central in the struggle against malaria has reached a new phase with the pending ratification by the UN of the Convention on Persistent Organic Pollutants, known as the POP Convention. This was signed by 10 countries in Stockholm on May 23 this year.
The two sides of the DDT issue argue over why countries in, Africa, for example, should be subjected to a hazardous chemical when it is banned in the affluent US. But Professor Spielman believes the real question is not so simple. In his view, in poor countries where malaria is still rampant, and indeed increasing, a cheap and very effective chemical like DDT has a place, at least for the time being. But it remains a bitterly contested matter.
This is an excellent book, technical enough to be authoritative, but accessible enough to grip the targeted lay reader. It is a popular work, in other words, that is genuinely educative.
The battle against yellow fever in the American Deep South in the 19th century, malaria in the same place in the 20th, the appalling fatality rate from yellow fever that almost stopped construction of the Panama Canal, the reasons the British found West Africa a "white man's grave" and the near-miracle of yellow fever never having moved into Asia when it is endemic in much of Africa and the Americas all make for an absorbing narrative.
So next time you see a cabin attendant spray around you before take-off, don't turn up your nose. There may be a mosquito lurking under your seat that, single-handedly, could bring yellow fever to Asia, with millions dying as a result.
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