MALARIA
The World's Oldest Emerging Infectious Disease
Springer:Malaria Volume

PREFACE    July 2005
         This book is dedicated to those who do not know about malaria but are eager to know, whether for personal, professional or other reasons. This is not a text book. We primarily want to introduce general audiences to the fact that the largest killer on earth is also the most forgotten, to share our concerns about this failure of modern society, collect a wide variety of viewpoints about the reasons why it could be so in a direct and critical manner, and what barriers could be lifted to reduce this major global health burden. We also aim to provide food for thought to the well-initiated, whether scientists, health professionals, policy makers, donors, philanthropists, historians or economists, etc.  New leaders are invited to rise up!
         Malaria is a persistent disease, one of the oldest companions of mankind. It is not decreasing, but is continually present in >90 countries, and is re-emerging in some areas with a greater vengeance due to drug resistant strains. The spirit of this book is to address the reasons why such a major killer has been, and is still, largely neglected. Why, may be part of the solution. This book looks at the present and into the future with the perspective of the last 100 years. We address how scientific knowledge and technologies have progressed, policies towards controlling the disease have evolved, how political will has waned or been revived, yet how malaria continues to spread with consistent increases in morbidity and mortality.
         With these intents, this book is divided into three sections. The first section provides a crude overview of the problem of malaria in past and present societies. This is followed by a synthetic reminder of the main features of the disease, of the malaria-causing parasite, of the available yet failing drugs, the incomplete immunity the parasite induces, or that which we hope to elicit by the ever elusive malaria vaccine. The third section is an open forum comprised of a wide variety of perspectives from scientists worldwide, public health specialists, heads of major research or control initiatives, policy makers and program managers. These contributors were asked to pin-point bottlenecks: provide personalized retrospective analyses and propose prospective strategies for malaria control in terms of scientific orientations, societal policies, programmatic strategies, health system’s needs, etc. In an attempt to develop a powerful debate that could potentially help shape future efforts, all authors were asked to be direct, outspoken, critical, and, if desired, anonymous.  We sought the views of many, whose voices tend not to be heard.
We do not aim to debate what the most appropriate intervention tools might be but, rather, why new ones have not been discovered when old ones were losing efficacy and close to half of humanity has been suffering from this disease. If the political and strategic bottlenecks were better defined and understood, the technological and public health advances could follow. The forum may help to identify possible answers to some of those “whys” from the authors’ diverse experiences. We did not want this to be simply another textbook on malaria, which in essence would be outdated as soon as it was issued.  We aimed for a book that would be valuable to readers and decisions-makers for years to come.
        
 
Malaria has played a major role in human history. Invaders from the North into tropical areas died from malaria in masses, and, without the acquisition of the recipe of the Indian’s famous remedy, the cinchona bark, there would have been no colonial empires and the world would be substantially different from how it is today. Progress in modern chemistry, the discovery of cheap insecticides and synthetic quinolines, led to the eradication crusade 50 years ago in the spirit of bringing to developing countries the benefits of modern technology. Its failure left policy makers in a state of disarray and a 30-year period with decreasing action addressing the ever growing malaria problem.  Calls from disease-endemic countries failed to be heard.
In an attempt to curb this disastrous trend and re-focus attention on the disease researchers launched the Malaria Foundation in 1992. Since, several other major global initiatives were also created to tackle malaria, and the last 10 years have witnessed an upsurge of attention on this disease, though often in a disjointed if not competitive manner. Increased funds for malaria research and control efforts, advanced research technologies, and advocacy efforts have once again heightened awareness of the malaria problem and may potentially bring new solutions to this field. It can be questioned how much this revival of interest in speaking of the problem is actually truly tackling the disease; ie. will ultimately translate into the development and application of new solutions for patients (and not only benefit researchers or agencies). From this standpoint, we trust that the contributions of the authors in these pages will bring some useful new insights to those who can make a difference in the coming decades.
 
 
Mary Galinski and Pierre Druilhe
Editors