Malaria Foundation International
Global Networking Against Malaria

Book Review: The Tomorrow of Malaria
By Socrates Litsios, Pacific Press, 1996. (181 pages)

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]

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