Malaria kills about a million people every year. It's a guileful disease, not a brutish one like yellow fever or smallpox. Unlike those two illnesses, it doesn’t attack in big sweeps, killing some and leaving survivors with permanent immunity. It can hide out in cysts in the liver for years. It’s likely that much of the adult population of Zouérat was infected and that few if any of them knew or cared. Certainly, few of them knew the statistics that worry Western aid agencies: 90 percent of the people who die every year from the disease are Africans, most of them very young children, most of them undiagnosed.
A 2010 book by the journalist Sonia Shah helps explain how the disease could be so widespread but widely ignored by Africans. The Fever: How Malaria Has Ruled Humankind for 500,000 Years, is a history of the disease, but also an attempt to look at the dialectic between Africans—who have lived with the disease for years—and those Westerners who attempt to cure it. In the West, one of the fundamental assumptions of the axis of development economists, philanthropists, and NGOs involved in plotting a happy new future for Africa has been that malaria is a primary cause of misery on the continent, contributing to poverty and the AIDS epidemic. The ubiquitous Columbia economist Jeffrey Sachs has written that Malaria in Africa could be controlled with an investment of just three billion dollars a year. In one of the foundational papers of the Western aid movement, he argues that doing so “offers the potential to initiate a virtuous cycle in which improved health spurs economic growth and rising income further benefits human health.” In other words, Africa could be transformed by attacking a single mosquito-borne disease, and for the amount of money it takes to build a mid-market baseball stadium. What are we waiting for?
Shah complicates this picture. Might malaria be a symptom rather than a cause of poverty? Might the billions of dollars spent fighting malaria by Western organizations like the Bill and Melinda Gates Foundation be, at best, another example of misspent Western dollars and misplaced Western hopes, or, at worst, another example of neo-colonial meddling?