THE FEVER TRAIL
In Search of the Cure for Malaria
By Mark Honigsbaum
Farrar Straus Giroux. 307 pp. $25
Imagine this: An epidemic of an infectious disease is sweeping through countries around the world, inflicting misery and death on millions. Effective treatment exists, but the countries that produce it have established stringent monopolies that they insist on enforcing in order to protect powerful domestic industries. World production falls far short of need, and high prices keep the medicine beyond the reach of many sufferers. Have-not governments clamor for relaxation of restrictions so that they, too, can produce the lifesaving drug for their countless citizens now perishing. But the producing nations refuse, prosecuting anyone they catch trying to bootleg the precious compounds.
Driven to desperation by their inability to get adequate supplies through regular channels, several consuming nations resort to irregular means, skirting international law and using stealth and indirection to procure the priceless remedies. And, in an ironic complication, as the clandestine struggle rages, certain opinion leaders in countries severely affected by the epidemic insist for ideological reasons that the treatment -- though universally accepted by medical experts -- is not needed and does not work.
No, this is not a recent account of the struggle between major pharmaceutical companies and underdeveloped countries ravaged by HIV over the expensive patented drugs that can extend the lives of infected people. This tale's desperate consumers are not poor nations of the Southern hemisphere denied anti-retrovirals by industrial giants of the developed world, but industrial, military and mercantile powerhouses of Northern Europe forced to cajole, connive and finally conspire to obtain the bark of the cinchona tree from the small republics of the Andes. The century is the 19th, the epidemic disease is malaria, and the cinchona bark, source of quinine and other potent anti-malarial compounds, is the cutting-edge miracle drug.
The temperate, developed world has largely forgotten malaria as a large-scale killer, but, as Mark Honigsbaum's intriguing and well-researched account in The Fever Trail reminds us, the "ague" of Shakespearean times and the "bad air" of Italy once wracked much of Europe and large parts of the Americas, too. The name of Washington's Foggy Bottom refers not to emanations from the State Department but to the malarial miasma that lay over the Potomac's marshy wetlands. Malaria figured importantly in the calculations of many governments. As European powers conquered colonies in the tropics, for example, the disease's shaking chills laid low the soldiers who enforced empire, as well as the workers who produced exportable wealth.
Historians do not know exactly who discovered that consuming the powdered bark of certain species of the cinchona, which grew in majestic stands on upper Andean slopes, could halt malaria. Honigsbaum plausibly argues that the local Indians first made the crucial observation. But it was Spanish Jesuits who received the credit for revealing the curative powers of "Peruvian bark" to the European world, incidentally inspiring some anti-Catholics to deny the obvious fact that the stuff worked against the disease. Numerous varieties of cinchona exist, however, producing barks with varying degrees of medicinal value. It took many years and many dangerous expeditions before botanists and physicians established which types produced the most effective medications.
Stripping the bark and shipping it abroad meanwhile became a highly lucrative trade that the South Americans monopolized until demand began to exceed supply to such an extent that the British and Dutch decided that they needed their own cinchona plantations. The Andean governments tried to protect their valuable monopolies, doing all they could to prevent Europeans from acquiring seeds and saplings. And so, with unshakable imperialist aplomb, the English, Dutch and French simply dispatched agents to steal them.
Honigsbaum's book centers on the exploits and misadventures of the assorted idealists, scoundrels and eccentrics who first identified and then absconded with the trees that produce the most effective anti-malarials. A series of intrepid Europeans braved jungles and mountains, rapids and bandits, disease and disappointment, not to mention the best efforts of the police of several nations, in the quest for cinchona. But it was ultimately a South American Indian who finally made possible the Dutch and British cinchona plantations in the Asian colonies of Java and India. As the South American governments had feared, these competitors ultimately destroyed their profitable trade, though they also provided relief to many, though far from all, sufferers around the world.
Honigsbaum also briskly covers more recent anti-malarial efforts. Those familiar with the struggle over AIDS drugs will find the passions and policies engendered by cinchona disturbingly familiar. Along the way, he also delves into the complex interactions of the disease-causing parasite with its human and insect hosts and into the frustrating economics of trying to provide costly pharmaceuticals to poor people in poor countries.
Many readers might prefer that a book about a major disease provide more detailed science and science policy along with the derring-do. But Honigsbaum's main interest obviously lies in what he calls "The Biggest Robbery in History" -- the remarkable campaign of "international skulduggery" that culminated in government-sanctioned theft of "perhaps the most valuable medicinal plant ever to be found anywhere." That's a story of intrigue and adventure, and he tells it as such. •
Beryl Lieff Benderly's most recent book is "Her Works Praise Her: A History of Jewish Women in America from Colonial Times to the Present" (with Hasia R. Diner).
