[I]t takes so little effort and money to get rid of malaria, to bring in clean water, to give people a chance at an education. When you don't have hope, that's when people start to do weird, horrible, violent things. That's at the bottom of it. It's just a question of prioritizing. The funds are t
Random mutations much more easily debilitate genes than improve them, and that this is true even of the helpful mutations. Let me emphasize, our experience with malaria’s effects on humans (arguably our most highly studied genetic system) shows that most helpful mutations degrade genes. What’s more, as a group the mutations are incoherent, meaning that they are not adding up to some new system. They are just small changes - mostly degradative - in pre-existing, unrelated genes. The take-home lesson is that this is certainly not the kind of process we would expect to build the astonishingly elegant machinery of the cell. If random mutation plus selective pressure substantially trashes the human genome, why should we think that it would be a constructive force in the long term? There is no reason to think so.
Over a century now after Dr. William Gorgas wiped Yellow Fever out of Havana and Panama, and by that out of an entire continent, and more than half a century after Fred Lowe Soper led the eradication of Anopheles gambiae out of Northeast Brazil, their names are unknown, their carefully-detailed, boots-on-the-ground methods that they described in detail to leave expressly for generations to study and learn from to apply to malaria - and specifically they both had the desire for the destruction of malaria in Africa on their minds - is unread. The mistakes they warned about, the assumptions that they discovered to be useless and ineffectual in the field against disease-bearing mosquitoes are repeated today, while what Gorgas and Soper found to be effective and efficient in real-life conditions are routinely ignored or unknown, avoidable errors blithely doomed to be repeated thanks to modern ignorance of their incredibly important and transformative historical successes in public health. In the battles against malaria, to be ignorant of Gorgas’ and Soper's work in eradicating the mosquito that carries it is to be hobbled by the lack of hard-earned field knowledge, practical and effective discoveries that remain completely relevant and critical to success in eradicating malaria today.
Eradication represents a complete change of philosophy and a recognition of the equal rights of all citizens to protection from infection, no matter where they live. Eradication, by its very nature, is public health with a conscience. The public health control officer can sleep tranquilly, salving his conscience with the thought that most of his responsibility has been discharged – that he did not have enough money to do any more. The eradicator knows that his success is not measured by what has been accomplished but, rather, is the extent of his failure indicated by what remains to be done. He must stamp out the last embers of infection in his jurisdiction. His slogan must be: ANY IS TOO MANY.
Amateurs are fond of advising that all practical measures should be postponed pending carrying out detailed researches upon the habits of anophelines, the parasite rate of localities, the effect of minor works, and so on. In my opinion, this is a fundamental mistake. It implies the sacrifice of life and health on a large scale while researches which may have little real value and which may be continued indefinitely are being attempted… In practical life we observe that the best practical discoveries are obtained during the execution of practical work and that long academic discussions are apt to lead to nothing but academic profit. Action and investigation together do more than either of these alone.
But such is the nature of man that as soon as you begin to force him to do a thing, from that moment he begins to seek ways by which he can avoid doing the thing you are trying to force upon him. A man with malaria parasites in his blood is a danger to his companions. To kill all the parasites, he was then required to continue doses of quinine a week or ten days after his fever. When the convalescing men were given their daily dose of quinine they would manage to throw their tablets out of the dispensary window. The old turkey-gobbler pet of the hospital gobbled up all the tablets he could find. He became so dissipated he finally developed a species of blindness caused by too much quinine. I cannot vouch for this, but I was often twitted with this story as an illustration of how the men were treating prophylactic quinine.
When considering grand plans for effective communicable disease control in this time of Ebola peril, malaria continues to kill nearly a million people a year world-wide, and by far the single most reliable protection against malaria is to sleep under a mosquito net, but one of the major impediments to this basic and effective malaria control is that many people, regardless of education level or country of origin, in malaria endemic zones don't install and use one, not that they can't get one, but because they don't think the mosquito net 'looks nice.
If it is considered speaking knowledgeably about malaria by having spent a few weeks traveling into malaria endemic zones and fallen sick from being infected with it, then what is it considered by having lived in the very same malaria endemic zones for years without being infected by it?
She wasted and grew so thin that she no longer was a little girl, but the shadow of a little girl. The flame of her life flickered so faintly that it appeared sufficient to blow at it to extinguish it. Stas understood that death did not have to wait for a third attack to take her and he expected it any day or any hour.
If people's night fears of sorcery - which negatively influences their decision to use mosquito nets - fail to impress the outsider, the brute everyday reality remains; in a number of rural African villages it is still much too common for very real hyenas to snatch people, especially children, out of their own homes as they lie sleeping at night, because of the lack of a good front door.
Will Brazilian antigambiae measures succeed in Africa? As time goes by it will almost certainly be found that an increasing number of areas can be cleaned of gambiae and be freed of gambiae-transmitted malaria. In Africa, where the species is already widely disseminated, it would seem logical to attempt eradication by beginning in the center of the area to be cleaned and working always outward. It has been demonstrated in Brazil that species eradication of Aedes aegypti and Anopheles gambiae is feasible.
Malaria prevention and eradication should be inspired by General George Patton’s advice: “A good plan executed violently today is better than a perfect plan in a week.” In this war of attrition, millions of people will be lost while waiting on researchers to finally emerge triumphant from their labs with the perfect malaria cure; yet meanwhile, there are plenty of time-proven, practical actions that individuals, families and communities can do today with what is already in hand that can decisively defeat malaria transmission if applied with vigor and disciplined consistency.