Everything Everywhere Daily: History, Science, Geography & More - Malaria: The Disease That Shaped History

Episode Date: January 24, 2025

Malaria is one of the oldest known infectious diseases, with a history spanning thousands of years. It has shaped human civilization, influenced wars, and driven scientific advancements in medicine and public health. However, humanity has been making strides against this ancient disease over the last 250 years. We have learned what causes it and how it is transmitted, and we might be close to eradicating it completely. Learn more about malaria, how it has impacted humanity, and the quest to eliminate it in this episode of Everything Everywhere Daily. Sponsors Mint Mobile Cut your wireless bill to 15 bucks a month at mintmobile.com/eed MasterClass Get up to 50% off at MASTERCLASS.COM/EVERYWHERE Quince Go to quince.com/daily for 365-day returns, plus free shipping on your order! ButcherBox New users that sign up for ButcherBox will receive 2 lbs of grass-fed ground beef in every box for the lifetime of their subscription + $20 off your first box when you use code daily at checkout! Subscribe to the podcast!  https://everything-everywhere.com/everything-everywhere-daily-podcast/ -------------------------------- Executive Producer: Charles Daniel Associate Producers: Ben Long & Cameron Kieffer   Become a supporter on Patreon: https://www.patreon.com/everythingeverywhere Update your podcast app at newpodcastapps.com Discord Server: https://discord.gg/UkRUJFh Instagram: https://www.instagram.com/everythingeverywhere/ Facebook Group: https://www.facebook.com/groups/everythingeverywheredaily Twitter: https://twitter.com/everywheretrip Website: https://everything-everywhere.com/  Learn more about your ad choices. Visit megaphone.fm/adchoices

Malaria is one of the oldest known infectious diseases, with history spanning thousands of years. It shaped human civilization, influenced wars, and driven scientific advancements in medicine and public health. However, humanity has been making strides against this ancient disease over the last 250 years. We've learned what caused it, how it's transmitted, and we might be close to eradicating it completely. Learn more about malaria, how it's impacted humanity and the quest to eliminate it, this episode of Everything Everywhere Daily. What if your perceptions about the past were wrong? ThruLine is a podcast that takes you back in time to uncover the parts of the story that may

have gone unnoticed. It effectively turned day into night. And how it shaped the world now. Time travel with us every week on the ThruLine podcast from NPR. Malaria is one of a small handful of diseases that have majorly impacted. humanity throughout history. Some diseases like smallpox have been completely eradicated. Others, such as bubonic plague and cholera, still exist, but can easily be treated with modern medicine. Malaria, however, has a unique history. It's been around probably longer than any other disease

that has impacted humanity, and it's still around today. While we're making strides in eradicating the disease, it hasn't been totally tamed, and it still takes the lives of hundreds of thousands of people every year. For most of you listening to this, malaria isn't something you've probably suffered from and not something you probably worry too much about. Nonetheless, it does affect an enormous number of people all over the globe. Malaria is caused by parasites of the plasmodium genus of protis, which are transmitted to humans through the bite of an infected female Anopheles mosquitoes. Protis are single-cell eukaryotes, meaning that they have a nucleus in their cell, so they're not bacteria, but they're also not plants, animals, or fungi.

Malaria has a history that goes back further than any other disease that we know of. Fossilized mosquitoes trapped in amber, dating back around 100 million years, actually contain malaria-like parasites. DNA studies suggest that malaria-causing parasites have co-evolved with humans and primals, for at least 30 million years. Many of the worst diseases that have affected humanity have come from contact with domestic animals or were passed from person to person. Many of those diseases, like smallpox, were probably seldom seen or were not existent before the rise of agriculture. However, because mosquitoes transmit malaria, it's basically been around forever. It didn't require

a large population for it to spread. As soon as humans began recording information, there were reports of malaria. Ancient Sumerian and Egyptian texts describe periodic fevers and enlarged spleen, symptoms characteristic of malaria. Egyptian mummies from the New Kingdom about 3,500 years ago, have shown traces of plasmodium felciperum, the most deadly malaria parasite. The Athharva Veda, an ancient Hindu scripture, refers to fevers and diseases linked to mosquito-infested swamps.

In China, the Ni-Ching, aka the canter of medicine, from around 2,700 BC, describes federal illnesses similar to malaria. Malaria likely migrated from Egypt to Rome through trade, military campaigns, and human migration, facilitated by the extensive network of the Roman Republic and the Roman Empire. The Nile River Valley in Egypt was a known hotspot for malaria, particularly due to its warm climate and abundant mosquito breeding grounds. As Rome expanded its influence into North Africa, soldiers, merchants, and slaves carried the with them across the Mediterranean.

The disease found a suitable environment in the marshy areas of Italy, particularly around Rome, where stagnant water provided an ideal breeding ground for Anophilis mosquitoes. Over time, malaria spread northward into Europe aided by Roman roads, trade routes and urbanization, weakening populations and contributing to the decline of the Roman Empire. During the Middle Ages to the Renaissance, malaria remained endemic across Europe, the Middle East, and Asia. The disease was known as Roman fever due to its association with the marshy areas around Rome. The term malaria derives from the Italian phrase mal aria, which means bad air, based on the mistaken belief that the miasmas or foul air from swamps caused the disease.

When Europeans went to the Americas, they probably brought malaria with them. I say probably because some mummies found in the new world had, malaria antibodies. So it could be that there was a strain of malaria in the new world, and other more deadly strains came over in the Colombian exchange. Oddly enough, it was in the new world that one of the first major breakthroughs in treating malaria was made. In the 17th century, Jesuit missionaries in South America observed that indigenous people use Sinchona bark to treat fevers. An extraction made from the Sinchona tree became the first effective treatment for malaria. and the extraction was known as quinine.

Quineinine works by interfering with the plasmodium parasites' ability to digest hemoglobin inside red blood cells. The malaria parasite consumes hemoglobin as a food source, producing a toxic byproduct called heem, which it normally detoxifies by converting it into an insoluble form called hemozoan. quinine disrupts this detoxification process, causing toxic heem to accumulate within the parasite, ultimately leading to its death. Quineine is particularly effective against plasmodium felchiparum, the deadliest malaria strain, and it's been used since the 17th century. However,

it can cause side effects like tinnitus, nausea, and headaches, and most modern treatments have largely replaced quinine in most cases. Malaria was one of the biggest reasons why most of Africa wasn't colonized until the 19th century. Europeans who went into the interior of Africa, suffered high rates of malaria, which prevented colonization. Klineine was one of the things that made the colonization of Africa possible. The reason why Europeans had a unique disadvantage was that they didn't have the genetic adaptations to resist malaria. Over thousands of years, natural selections led to the development of several genetic

adaptations that provide resistance to malaria, particularly in regions where the disease has endemic, such as sub-Saharan Africa. These adaptations affect red blood cells, which the plasmodium parasite infects, making it harder for the parasite to survive and reproduce. One of the most common genetic resistances is the sickle cell trait. People with one copy of the sickle cell gene have partial protection against plasmodium falchiparum. Sickle-shaped red blood cells are less hospitable to the parasite, making it harder for malaria to thrive. However, inheriting two copies of the gene leads to sickle cell disease, a severe blood disorder. The late 19th century saw huge advancements in the understanding of malaria and its transition.

In 1880, Alphonse Leveron, a French army doctor, identified malaria parasites in the blood of infected patients. He won the Nobel Prize in medicine in 1907 for this discovery. In 1897, British physician Sir Ronald Ross demonstrated that Anophilis Mosquist, mosquitoes transmitted the malaria parasite. This discovery revolutionized malaria control efforts leading to mosquito eradication campaigns. In the 20th century, malaria was still a major problem in North America, Europe, Asia, South America, and Africa. The war on malaria was fought on two fronts. One was the development of treatments for malaria, and the other was the eradication of malaria carrying mosquitoes.

One of the biggest advances in the treatment of malaria was the, the discovery of chloroquine. Chloroquine was first synthesized in 1934 by German scientist Hans Andersog and his team while working for the Bayer Corporation. Initially, it was dismissed as too toxic and remained largely unutilized. However, during World War II, the search for anti-malarial drugs intensified due to quinine shortages, prompting researchers to re-examine chloroquine. By the 1940s, it was found to be both effective and safe for malaria treatment, leading to its widespread use as the primary anti-malarial drug for decades. Unfortunately, by the 1950s through the 1970s, plasmodium falchiparum developed resistances to chloroquine. Several other treatments were developed,

but they too suffered from resistance strains, which quickly developed. One of the biggest advances was artmissinin, which was discovered in the 1970s. Derived from the sweet wormwood plant, it was discovered by Chinese scientist Tu Yu Yu. She won the Nobel Prize in Medicine for her discoveries in 2015. This became the foundation for artemisinin-based combination therapies, which remained the gold standard for malaria treatment today. On the mosquito front, the biggest development was the creation of dichloral diphenyl trichloroethane, or DDT in 1939.

It became a revolutionary insecticide in the fight against malaria. During World War II, DDT was used to protect troops from malaria in the South Pacific. Post-war DDT spraying campaigns were launched globally to eliminate Anophilis mosquito populations. These efforts were largely disjointed and unorganized until 1955, when the World Health Organization launched the Global Malaria Eradication Program, or GMEP. The program's goal was nothing less than to eliminate malaria worldwide through massive mosquito control and anti-malarital. treatment efforts. The program relied heavily on indoor residual spraying with DDT, draining mosquito breeding sites, and widespread distribution of anti-malarial drugs like chloroquine. The GMEP saw significant success in North America, Europe, the Caribbean, and parts of Asian

Latin America, where malaria was largely eliminated. However, it failed in sub-Saharan Africa, where logistical, financial, and environmental challenges, DDT-resistant mosquitoes, and drug-resistant and drug-resistant parasites made eradication infeasible. Despite its successes, the program was ended in 1969 due to funding shortages. Starting in the 1970s, the overuse of DDT led to mosquito resistance. Also, environmental concerns about DDT's effect on wildlife led to DDT bans in many countries and a shift to alternate pesticides. Slowly but surely, more and more countries were able to eliminate malaria.

In the late 20th and 21st centuries, strategies started to change. The remaining countries where malaria was still prevalent were the ones where it was the hardest to eradicate. One of the biggest modern techniques to fight malaria has been the adoption of insecticide-treated bed nets. Bed nets seem like a rather low-tech solution, and it is in some ways, but it's also highly effective. Insecticide-treated bed nets are one of the most effective tools for malaria prevention, designed to protect people from mosquito bites while they're sleeping. These nets are impregnated with long-lasting insecticides, which not only act as a physical barrier, but also kill or repel mosquitoes that come into contact with them. Bed nets have shown to reduce malaria transmissions by over 50%, and lower child

morality rates in endemic regions. They are especially crucial in sub-Saharan Africa, where malaria transmission is the highest. Perhaps the most promising development in the war on malaria, however, has been the development of malaria vaccines. The development of malaria vaccines has been a long and challenging process due to the complex life cycle of the plasmodium parasite, which allows it to evade the human immune system. The Moskirix vaccine was developed over several decades with research beginning in the 1980s. It was created by Glaxo-Smith Klein in collaboration with the Path Malaria Vaccine Initiative. The first successful clinical trials were conducted in the early 2000s and large-scale,

scale phase three trials took place between 2009 and 2014, demonstrating partial efficacy against plasmodium-Felchiparum. After years of evaluation, the World Health Organization officially endorsed Muskewrex in October of 2021, making it the first malaria vaccine approved for widespread use. Muskerix has an efficacy of only 40%, which is good but not great. A more effective alternative emerged with the R21 Matrix M vaccine developed by Oxford University and the CIRM Institute of India. Approved by the WHO in October 2023, this vaccine demonstrated a higher efficacy of around 75% in clinical trials. Like muskirics, it targets the liver stage of the malaria parasite, but appears to provide

longer lasting protection. With the production capacity expected to reach 100 million doses per year, RR. R-21 is seen as a more scalable and cost-effective solution, and its roll-up began in early 2024 in Burkina Faso, Ghana, and Nigeria. Malaria is still a significant problem in the world. Currently, malaria causes approximately 600 to 620,000 deaths per year, with the vast majority occurring in sub-Saharan Africa, particularly among children under the age of five.

There is a belt around the equator where malaria still exists. This includes Southeast Asia, South America, India, the Middle East, and sub-Saharan Africa. However, progress is slowly being made. In 2024, two more countries, Cape Verdi and Egypt were declared malaria-free. And that means that there were three consecutive years of zero cases in each country. With those two additions, there are now 44 countries that have been declared malaria-free. Malaria has shaped human history for malaria-free. millennia, influencing civilizations, wars, and scientific advancements.

While major progress has been made, the battle against malaria is far from over. But new vaccines and global eradication programs finally offer a hope for a future that is malaria-free. The executive producer of Everything Everywhere Daily is Charles Daniel. The associate producers are Benji Long and Cameron Kiever. I want to give a big shout out to everyone who supports the show over on Patreon, including the show's producers. Your support helps me put out a show every single day.

And also, Patreon is currently the only place where Everything Everywhere Daily merchandise is available to the top tier of supporters. If you'd like to talk to other listeners of the show and members of the Completionist Club, you can join the Everything Everywhere Daily Facebook group or Discord server. Links to everything are in the show notes.