topic1a-history-malaria.qmd

# Brief History of Malaria

## Early References and Discoveries

Malaria is an ancient disease, with its presence documented as far back as 2700 BCE in Chinese medical writings. The term "malaria" itself originates from the Italian words "mala" "aria," meaning "bad air," a reflection of the ancient belief that the disease was caused by foul air emanating from marshes and swamps.

Throughout history, malaria has been a significant burden on many civilizations. Ancient Greeks, including Hippocrates, noted the periodic fevers associated with the disease. Roman scholars also wrote extensively about malaria, describing its symptoms and the environmental conditions conducive to its spread.

## Discovery of the parasite

The turning point in understanding malaria came in 1880 when Charles Louis Alphonse Laveran, a French army surgeon, discovered the malaria parasite, Plasmodium, while working in Algeria. This groundbreaking discovery earned Laveran the Nobel Prize in Physiology or Medicine in 1907[^topic1a-history-malaria-1].

[^topic1a-history-malaria-1]: Alphonse Laveran -- Facts. NobelPrize.org. Nobel Prize Outreach AB 2024. Mon. 5 Aug 2024. <https://www.nobelprize.org/prizes/medicine/1907/laveran/facts/>

Laveran's work laid the foundation for further research, leading to the identification of different Plasmodium species responsible for malaria in humans: *P. falciparum*, *P. vivax*, *P. malariae*, *P. ovale*, and later, *P. knowlesi*.

Ronald Ross in 1898 showed that malaria was transmitted from infected mosquitos when they bite humans, this discovery changed the perception of the disease from the previous thinking that it was spread from the foul air of decaying organic matter.

These two findings that describe the biological basis of the disease and its transmission were made just under 150 years ago. And at that time malaria was present in almost every country across the Globe (@fig-1). Researchers estimate that up to around 1900 human populations were at risk from malaria across about half of the world's land surface (53%)[^topic1a-history-malaria-2].

[^topic1a-history-malaria-2]: Hay SI, Guerra CA, Tatem AJ, Noor AM, Snow RW. The global distribution and population at risk of malaria: past, present, and future. Lancet Infect Dis. 2004 Jun;4(6):327-36. doi: [10.1016/S1473-3099(04)01043-6](https://doi.org/10.1016/S1473-3099(04)01043-6)

![Source: Our World in Data <https://ourworldindata.org/malaria-past-prevalence>](figures/Previous-prevalence-of-malaria-world-map_3105.png){#fig-1}

## Malaria and human populations

Since 1900 the malaria map has shrunk, confined to the tropics now, with much of Europe, North America, East Asia, Australia, parts of the Caribbean, South America and Africa having eliminated the disease.

The discovery of quinine in the bark of the cinchona tree in the 17th century became the first treatment against malaria and eventually led to the advent of the anti-malarial drug Chloroquine during World War II. In the 20th century, the advent of DDT spraying and the establishment of the World Health Organization's (WHO) Global Malaria Eradication Program in 1955 marked significant milestones, although the program was discontinued in 1969 due to various challenges and financial and political will for the cause diminishing. The initial aim of eradication was replaced with longer-term control strategies and improvements in disease management.

The late 20th and early 21st centuries have seen significant advances in malaria research and control. The development of artemisinin-based combination therapies (ACTs), the introduction of insecticide-treated nets (ITNs) and indoor residual spraying (IRS) have drastically reduced malaria transmission in many regions. In recent years, the focus has shifted towards innovative strategies, including the development of malaria vaccines. The RTS,S/AS01 vaccine, endorsed by the WHO in 2021, and the R21 vaccine endorsed this past year.

Despite these advances malaria still remains a significant burden on the worlds population and we shall explore this more in the coming topics.