ISBN 0
9583418 3 4
This small
light blue paperback, unassuming in appearance, is a surprisingly
potent and captivating account of malaria history and programmes
aimed at malaria eradication or control. It is replete with tidbits
of information, whether for the historian, scientist, public health
specialist, or politician, and is a fine starting point for further
study of this field. Key players and stories are featured as Litsios
painstakingly brings forth the viewpoints and decisions that have
driven malaria programmes from one decade to the next. Meanwhile,
his underlying wish is that a greater understanding and appreciation
of the past will be realized and bring new hope for the people
of tomorrow.
This book
provides glimpses into the thinking of the times since the malaria
parasite was first discovered by Charles L. A. Laveran in 1880,
through landmark meetings including the League of Nation's Conference
on Rural Hygiene (Bandoeng, 1937) and a series of World Health
Organization (WHO) Expert Committee Meetings that convened between
1946 and 1986. This is a whirlwind tour of the malaria situation
and challenges faced by several generations. Litsios frequently
recaptures quotes from the past and cleverly employs irony to
bring attention to major decisions which seemed to have been
made with a disregard for available knowledge, with irrational
thinking, or with political motivations. This style makes for
amusing reading, but, importantly, it succeeds in bringing emphasis
to elements of the history of malaria that ought to be revisited,
and nudges current generations to critically assess the logic
behind important decisions today.
Strategic
plans for malaria control shifted dramatically from a broad
public health and social approach prior to World War II, where
malaria research in areas such as immunity and epidemiology
were also deemed relevant, to the WHO's militant-like eradication
campaign between 1955 and 1969, where DDT elimination of Anopheline
mosquitoes became the dominant goal. Now, with reference to
the changing politics of the post Cold War Era, Litsios conveys
the message that it is an opportune time to tackle malaria with
renewed recognition of knowledge and studies from the past,
and where "human development" is also a focus. With this in
mind, he carefully scrutinizes directions taken especially by
the WHO as the world's leader of malaria eradication and control
programmes for almost 50 years. His critical analysis points
to conflicting viewpoints that have existed with regards to
philosophical approaches, strategic planning, and methodologies.
Litsios points out examples where knowledge of the times was
overlooked as the WHO's global eradication campaign was designed
and implemented; in some cases a sense of urgency overruled
practicality; or, Cold War politics dictated its direction.
Later, Litsios discusses one of the WHO's current focuses as
a primary supporter and patent holder of the widely publicized
candidate malaria vaccine known as Spf66. Litsios notes that
once the results are available for the latest in a series of
large scale trials - conducted in Thailand - that the future
of this vaccine candidate "will be reviewed and decided upon."
The reader is thus brought up-to-date as the world currently
waits at another major crossroads to see in which direction
the WHO will decide to proceed.
Litsios'
critical accounts are meant to be instructive. He takes his
readers through periods of high hopes, confidence, despair,
and wonder, as history shows that massive efforts have helped
little to avenge malaria - the "King of Diseases," which, as
he notes, it was dubbed long ago in ancient Indian literature.
The Tomorrow of Malaria is very timely as the 100th anniversary
of the August 1897 discovery in Secunderabad, India of malaria
in mosquitoes approaches. The past 100 years of discovery, both
scientific and personal, are leading to a special period of
reflection. Socrates Litsios, who is currently a Senior Scientist
with the WHO Division of Control of Tropical Diseases, writes
with a sense of optimism as he refers to the WHO's current Global
Malaria Control Strategy, a product of the Ministerial Conference
on Malaria (Amsterdam, 1992), and the end of neglect noting
that this plan is "beginning to yield tangible results." He
has hope in "the tomorrow of malaria" as he beckons his readers
to be knowledgeable, logical, and responsible when deciding
upon the present and future of malaria.
I especially
recommend this penetrating little book to anyone working in
any area of malaria research or control. This literary work
may very well mark a reemergence of malaria scholars and help
these fields flourish with accomplished malariologists.
Mary Galinski,
PhD
Published
in Parasitology Today [PT 13 (2), 83-84, 1997]
